Cardiac Ablation Groin Access Assessment Form
Complete this assessment to evaluate groin access-site readiness prior to a cardiac ablation procedure.
Access Site Location
*
Right groin
Left groin
Bilateral
Skin Integrity at Access Site
*
Intact, no lesions
Bruising present
Hematoma
Open wound or ulcer
Other
Signs of Infection at Access Site
*
None
Redness
Swelling
Drainage
Pain/tenderness
Palpable Femoral Pulse at Access Site
*
Easily palpable
Difficult to palpate
Not palpable
Edema at Access Site
*
None
Mild
Moderate
Severe
Previous Groin Access Complications
*
None
Bleeding
Pseudoaneurysm
Arteriovenous fistula
Infection
Other
Assessment of Anticoagulation Status
*
Therapeutic
Subtherapeutic
Not anticoagulated
Unknown
Allergies to Prep Materials (e.g., chlorhexidine, iodine)
*
None
Chlorhexidine
Iodine
Latex
Other
Mobility and Positioning Concerns
*
No concerns
Limited hip mobility
Unable to lie flat
Other
Groin Access Readiness Assessment Table
*
Rows
Yes
No
Not Assessed
Site is free of infection
1
2
3
No active bleeding
4
5
6
Skin is intact
7
8
9
Pulse is palpable
10
11
12
No significant edema
13
14
15
Submit Assessment
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