During catheter removal, ensure that the balloon is fully deflated. If significant resistance is felt as the catheter is being removed, it is likely that the balloon cannot pass through the sheath. In this case, the balloon and the arterial sheath must be removed together. See below on sheath management and removal.
Sheath Management and Removal:
After placing a REBOA, careful management of the femoral sheath is imperative. The majority of complications associated with REBOA use are related to the sheath and access site complications. Reported femoral access complications include arterial disruption, dissection, pseudoaneurysms, hematoma, thromboembolic phenomenon, and extremity ischemia. These complications have resulted in limb loss.29,30
Due to the risk of sheath dislodgement or vessel wall damage, excessive patient movement should be avoided. Patients with indwelling sheaths should be positioned supine or reverse Trendelenburg only. If the patient must be moved or turned, they should be kept in a flat position and log rolled. Avoid flexing the hip.