G-Sleeve Policy

PROCEDURE

PURPOSE:

To outline a process, which clearly identifies patients whom have had a procedure or will have a procedure, that limits the access of one of their extremities for diagnostic testing.

KEY POINT:

Measuring blood pressure, drawing blood, or initiating intravenous therapy on the affected extremity may cause tissue damage or potentiate the clotting/effectiveness of a hemodialysis graft. Examples of procedures include: axillary lymph node biopsy or dissection, hemodialysis graft or impending placement of hemodialysis graft, and post PICC line placement.

RESPONSIBLE PARTY:

All Registered Nurses

Procedure:

1. The Registered Nurse who initiates an initial patient assessment (inpatient and outpatient) will ask of past or future procedures that inhibit an extremity to be used for drawing blood or taking a blood pressure.

2. The Registered Nurse will document these findings in the proper assessment form.

3. The Registered Nurse will obtain the appropriate size sleeve (that designates “No Blood Pressure, No Blood Draws” and place the sleeve on the affected extremity.

4. The G-Sleeve should not be used to hold intravenous lines in place or to distract patients from pulling out intravenous lines.

5. The G-Sleeve is to remain on throughout the patients entire hospital stay until discharge so the patients affected extremity is protected in all departments.

6. The G-Sleeve should be replaced promptly if it gets soiled with a clean one.

REFERENCES:

Clancy, C.M., Farquuhar, M.B., & Collins Sharp, B.A. (2005). Patient Safety in Nursing Practice, Journal of Nursing Care Quality, 20(3). Pp.193-197.

Dirken, S.R., & Lewis, S.M. (2000) Nursing Management – Breast Disorders, Medical Surgical Nursing, Assessment and Management of Clinical Problems. (5th ed.). Mosby: St. Louis, MO

Brunier, G. & Bartucci, M. (2000) Nursing Management – Acute and Chronic Renal Failure, Medical Surgical Nursing, Assessment and Management of Clinical Problems. (5th ed.). Mosby: St. Louis, MO