Mechanical compression versus haemostatic wound dressing after femoral artery sheath removal: A prospective, randomized study

VASA ◽  
2009 ◽  
Vol 38 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Schwarz ◽  
Rastan ◽  
Pochert ◽  
Sixt ◽  
Schwarzwälder ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Calcium Ion ◽  
Wound Dressing ◽  
Patient Comfort ◽  
Bleeding Complications ◽  
Compression Bandage ◽  
Mechanical Compression ◽  
Manual Compression ◽  
Major Hemorrhage ◽  
Group 1

Background: Bleeding complications in the groin are one of the major disadvantages of femoral catheter procedures. The immobilisation of the patient and the compression bandages can jeopardize the patients’ comfort. Aim of the study was a randomized comparison of safety and patient comfort of mechanical pressure followed by pressure bandage overnight using two different haemostatic pads after femoral artery sheath removal. Patients and methods: Nine hundred and eight consecutive patients undergoing diagnostic or therapeutic procedures via a 5 or 6 F femoral sheath were randomly selected either for mechanical compression therapy followed by a compression bandage (302 patients, group 1), or manual compression with application of a calcium ion releasing device (compression bandage only after application of > 5000 IU of heparin; 303 patients; group 2), or manual compression with a thrombin covered PAD without compression bandage (303 patients, group 3). Results: No major hemorrhage or death occurred. A false aneurysm was found in 10 (3.3%), 13 (4.3%), and 10 patients (3.3%) of group 1, 2, and 3, respectively (p = 0.38). Three patients (0.3%) needed surgical treatment. 69 (22.7%) patients in thrombin covered PAD-group required a compression bandage overnight due to seeping hemorrhage after 15 minutes. In the calcium ion releasing PAD-group 124 (40.9%) patients had continued bandaging, 46 (15.2%) due to seeping hemorrhage after 15 min, and 78 (25.7%) due to application of heparin > 5000 IU. Conclusions: The use of mechanical compression combined with a pressure bandage, and the use of haemostatic wound dressing assisted sheath removal technique offer a comparable level of safety. Patient comfort is improved with the usage of PAD devices, however the technical failure rate of the PAD should be taken into account.

Manual versus mechanical compression for femoral artery hemostasis after cardiac catheterization

1998 ◽  
Vol 7 (4) ◽  
pp. 308-313 ◽  
Author(s):  
A Simon ◽  
B Bumgarner ◽  
K Clark ◽  
S Israel
Keyword(s):  
Cardiac Catheterization ◽  
Femoral Artery ◽  
Vascular Complications ◽  
Control Group ◽  
Mechanical Compression ◽  
Success Rates ◽  
Manual Compression ◽  
Diagnostic Cardiac Catheterization ◽  
Compression Time ◽  
Catheterization Procedure

BACKGROUND: Most cardiac catheterizations are performed via femoral artery access. Reported rates of both peripheral vascular complications and success rates for the use of manual and mechanical compression techniques to achieve femoral artery hemostasis after cardiac catheterization vary. OBJECTIVE: To determine is use of a mechanical clamp is as effective as standard manual pressure for femoral artery hemostasis after cardiac catheterization. METHODS: Subjects consisted of 720 patients from 2 community hospitals who had elective diagnostic cardiac catheterization via the femoral artery. The control group (n=343) received manual compression for hemostasis; the study group (n=377) received mechanical compression. Standard protocols were used for the 2 compression techniques. Pressure was applied for a minimum of 10 minutes for 5F and 6F sheaths and catheters and for a minimum of 15 minutes for 7F and 8F sheaths and catheters. Prospective data were collected and analyzed for each patients, including sheath or catheter size, blood pressure, height, weight, age, time from administration of local anesthetic to successful cannulation of the femoral artery, anticoagulation status, total compression time, physician performing the catheterization procedure, nurse or technician who obtained hemostasis, and complications. In follow-up, patients were asked site-specific and functional status questions 1 to 2 days after the catheterization procedure and again 3 days after the catheterization procedure. RESULTS: Data were analyzed by using frequency distributions, measures of central tendency, and measures of variability. Only 1 difference between the 2 groups was significant: manual compression time was 14.93 +/- minutes, whereas mechanical compression time was 17.13 +/- minutes. CONCLUSION: Mechanical compression is as effective as manual compression for femoral artery hemostasis after cardiac catheterization.

Time to hemostasis: a comparison of manual versus mechanical compression of the femoral artery

1995 ◽  
Vol 4 (2) ◽  
pp. 149-156 ◽  
Author(s):  
MA Bogart
Keyword(s):  
Femoral Artery ◽  
Demographic Data ◽  
Mechanical Compression ◽  
Manual Compression ◽  
Special Equipment ◽  
Group 2 ◽  
A Prospective Study ◽  
The Cost ◽  
Mean Time ◽  
Pressure Dressing

BACKGROUND: Compression of the femoral artery to achieve hemostasis is necessary following angiographic and interventional cardiovascular procedures. OBJECTIVES: To evaluate length of time to hemostasis with manual versus mechanical compression of the femoral artery. METHODS: In a prospective study of 503 patients randomized into one of three groups, manual compression with a pressure dressing or vascular stasis button was used on groups 1 and 3, respectively. Mechanical compression with a pressure dressing was used on group 2. The length of time to hemostasis was measured in minutes. Demographic data, current medications, risk factors, laboratory values, and procedural data were analyzed. RESULTS: Mean time to hemostasis was 22 minutes with manual compression and 31 minutes with mechanical compression. Crossover from mechanical to manual compression to achieve hemostasis occurred in 21 of 168 patients (13%). CONCLUSIONS: Results of this study show that advantages of manual compression include shorter time to hemostasis, no requirement for special equipment, and the ability to remove arterial and venous sheaths simultaneously. Disadvantages include upper extremity fatigue and human resource considerations. If the operator is a nurse, the cost of compression increases and the ability to meet patient needs may be restricted. Although mechanical compression is a "hands free" approach, arterial hemostasis is prolonged, special equipment is required, and the total cost per procedure is higher.

VIPER-2:A Prospective, Randomized Single-Center Comparison of 2 Different Closure Devices With a Hemostatic Wound Dressing for Closure of Femoral Artery Access Sites

2008 ◽  
Vol 15 (1) ◽  
pp. 83-90 ◽  
Author(s):  
Aljoscha Rastan ◽  
Sebastian Sixt ◽  
Uwe Schwarzwälder ◽  
Thomas Schwarz ◽  
Ulrich Frank ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Wound Dressing ◽  
Single Center ◽  
Viper 2

Abstract 15073: Best Anticoagulation Strategy for Stroke Prophylaxis in Atrial Fibrillation Patients With Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sanghamitra Mohanty ◽  
CHINTAN G TRIVEDI ◽  
Joseph Gallinghouse ◽  
Domenico G Della Rocca ◽  
Carola Gianni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Bleeding Complications ◽  
Considerable Proportion ◽  
Medical Procedure ◽  
Bleeding Events ◽  
Full Dose ◽  
Half Dose ◽  
Group 2 ◽  
Group 1

Background: A considerable proportion of elderly patients are known to have coexistent atrial fibrillation (AF) and amyloidosis. Both conditions increase stroke risk. Objective: We evaluated the best anticoagulation strategy in a series of AF patients with amyloidosis. Methods: Consecutive AF patients with coexistent amyloidosis undergoing catheter ablation at our center were included in the analysis. Based on the stroke-prophylaxis approach they were divided into 2 groups; group 1: left atrial appendage occlusion (LAAO) with Watchman and group 2: oral anticoagulation. Following LAAO, all patients remained on full dose non-vitamin K oral anticoagulants (NOAC) for 45 days. Transesophageal echocardiogram (TEE) was performed at 45 days to assess completeness of closure. If the occlusion was complete, patients were kept on aspirin, 81 mg/day for long-term. In case of leak or dense ‘smoke’ in the left atrium (LA) or enlarged LA, they were prescribed half-dose NOAC. NOACs included dabigatran, apixaban, endoxaban and rivaroxaban. Group 2 patients remained on full-dose NOAC during the whole study period (1 year). All patients were prospectively followed up for 1 year. Results: A total of 87 patients were included in the analysis; group 1: 56 and group 2: 31 . CHA 2 DS 2 -VASc score was comparable between the groups (gr. 1: 3.7±1.6 and gr. 2: 3.2±1.7, p=0.18). The most commonly used NOACs were apixaban (45, 51.7%) and rivaroxaban (34, 39%). After the 45-day TEE, 34 patients from group 1 remained on baby-aspirin and 22 on half-dose NOAC. Of the 22, 12 patients had leaks <5 mm, 6 had large LA (mean diameter 5.2±1.4 cm) and 4 patients had dense LA smoke. At 1-year follow-up, 3 stroke and 1 transient ischemic attack were reported in group 1 on baby-aspirin (4/34, 11.8%). No stroke or bleeding complications occurred in the 22 patients on half-dose NOAC. In group 2 patients on full-dose OAC, a total of 5 (5/31, 16.1%) bleeding events (1 subdural hematoma and 4 GI bleedings) were recorded. Additionally, a stroke was reported that happened during brief discontinuation of OAC for another medical procedure. Conclusion: In our series of patients with coexistent AF and amyloidosis, half-dose NOAC following LAA occlusion procedure was observed to be the safest stroke-prophylaxis strategy.

scholarly journals Efficacy of Manual Hemostasis for Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Rajiv Tayal ◽  
Michael DiVita ◽  
Christoph W. Sossou ◽  
Alexis K. Okoh ◽  
Kelly Stelling ◽  
...  
Keyword(s):  
Axillary Artery ◽  
Academic Research ◽  
Bleeding Complications ◽  
Manual Compression ◽  
Access Site ◽  
Suitable Alternative ◽  
Compression Time ◽  
Intravenous Heparin ◽  
Randomized Control ◽  
Research Consortium

Background. The prevalence of peripheral vascular disease has led to the re-emergence of percutaneous axillary vascular access as a suitable alternative access site to femoral artery. We sought to investigate the efficacy and safety of manual hemostasis in the axillary artery. Methods. Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) Mega 50 cc intra-aortic balloon pumps (IABP) placed in the axillary artery position. They were anticoagulated with weight-based intravenous heparin to maintain an activated partial thromboplastin time (aPTT) of 50–80 seconds. Anticoagulation was discontinued 2 hours prior to the device explantation. Manual compression was used to achieve the hemostasis of the axillary artery. Vascular and bleeding complications attributable to manual hemostasis were classified based on the Valve Academic Research Consortium-2 (VARC-2) and Bleeding Academic Research Consortium-2 (BARC-2) classifications, respectively. Results. 29 of 46 patients (63%) achieved axillary artery homeostasis via manual compression. The median duration of IABP implantation was 12 days (range 1–54 days). Median compression time was 20 minutes (range 5–60 minutes). There were no major vascular or bleeding complications as defined by the VARC-2 and BARC-2 criteria, respectively. Conclusion. Manual compression of the axillary artery appears to be an effective and safe method for achieving hemostasis. Large prospective randomized control trials may be needed to corroborate these findings.

scholarly journals A case of extensive burn injury with hypercalcemia caused by calcium ion absorption from the wound dressing

Burns Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 28-30 ◽  
Author(s):  
Hideki Asai ◽  
Naoki Maegawa ◽  
Yasuyuki Urisono ◽  
Yasuyuki Kawai ◽  
Akinori Okuda ◽  
...  
Keyword(s):  
Calcium Ion ◽  
Wound Dressing ◽  
Burn Injury ◽  
Ion Absorption ◽  
Extensive Burn

scholarly journals Propofol Sedation During Spinal Anaesthesia - A Dose Finding Study

2012 ◽  
Vol 9 (3) ◽  
pp. 170-173 ◽  
Author(s):  
A Ghimire ◽  
B Bhattarai ◽  
T R Rahman ◽  
S N Singh ◽  
S Koirala ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
Spinal Anaesthesia ◽  
Sedation Score ◽  
Nausea And Vomiting ◽  
Patient Comfort ◽  
Dependent Manner ◽  
Satisfaction Level ◽  
Hemodynamic Parameters ◽  
Randomized Clinical Study ◽  
Group 1

Background It is important to be able to measure and maintain a specific sedation level to compare outcomes of different levels of sedation during anesthesia and the aims include general patient comfort, freedom from specific discomfort, and some amnesia for both the block procedure and the surgical operation, in order to meet the patient’s preference and safety. In this prospective randomized clinical study, we compared the three different infusion doses of propofol. Objective To find out the appropriate infusion dose of propofol for optimal sedation without causing undue side effects in patients undergoing spinal anaesthesia. Method One hundred twenty patients ASA PS I-II were randomly allocated to three groups 1, 2 and 3 receiving propofol infusion at the rate of 25, 50 and 75 microgram/kg/min with concentration of (0.5%), (1%) and (1.5%) respectively. They were observed for sedation score, hemodynamic parameters and satisfaction level. The adverse effects like respiratory depression, nausea and vomiting score were assessed. Result Median sedation score increased in a dose dependent manner, with significantly higher scores in group 2 and 3 compared with group 1. Hemodynamic parameters were better in group 1 and 2 as judged by mephentermine requirement. The awakening time after stoppage of infusion was significantly delayed in group 3 (p < 0.001). Respiratory depression, nausea and vomiting were comparable clinically. Almost three fourth of the patients were satisfied with the techniques used. ConclusionPropofol infusion at the rate of 50mcg/kg/min for sedation in spinal anaesthesia provides optimal sedation, early awakening and excellent satisfaction level in the postoperative period.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6299 Kathmandu Univ Med J 2011;9(3):170-3

scholarly journals The efficacy of the figure-of-eight suture technique in the treatment of tunnel bleeding of the femoral artery route after percutaneous coronary intervention or angiography

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094730
Author(s):  
Ya Huang ◽  
Jing-Guo Nong ◽  
Qiao Xue ◽  
Quan-Zhou Feng ◽  
Cai-Yi Lu
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Femoral Artery ◽  
Treatment Time ◽  
Coronary Intervention ◽  
Suture Technique ◽  
Manual Compression ◽  
Performance Time ◽  
Total Treatment Time ◽  
Percutaneous Coronary ◽  
Total Treatment

Objective To evaluate the efficacy of the figure-of-eight (FOE) suture technique in the treatment of tunnel bleeding after femoral artery puncture compared with manual compression (MC). Methods This prospective, randomized, controlled study enrolled patients that had received transfemoral coronary artery angiography or percutaneous coronary intervention and then developed tunnel bleeding. They were randomly assigned into two groups: FOE suture group (ES group) and manual compression group (MC group). Total treatment time, performance frequency, performance time, rate of deep vein thrombosis (DVT) and in-hospital time after the procedure were compared. Results A total of 152 patients were enrolled in the study (ES group, n = 63; MC group, n = 89). Compared with the MC group, the total treatment time (mean ± SD: ES 22.3 ± 5.4 h versus MC 26.8 ± 6.8 h), performance frequency (mean ± SD: ES 2.1 ± 0.7 versus MC 2.6 ± 1.1), performance time (mean ± SD: ES 8.9 ± 2.5 min versus MC 12.3 ± 4.1 min), in-hospital time after the procedure (mean ± SD: ES 3.5 ± 1.2 days versus MC 4.8 ± 2.1 days) and DVT rate (ES 0.0% versus MC 6.7%) were significantly lower in the ES group. Conclusion The FOE suture technique effectively treated tunnel bleeding after femoral artery puncture.

Closure of Large Percutaneous Femoral Venous access using a Modified “Figure-of-Eight” Suture

2018 ◽  
Vol 13 (2) ◽  
pp. 147-151 ◽  
Author(s):  
Christophe A. Wyss ◽  
Oliver Anliker ◽  
Oliver Gämperli ◽  
Daniel Sürder ◽  
Patric Biaggi ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Low Cost ◽  
Academic Research ◽  
Early Mobilization ◽  
Bed Rest ◽  
Bleeding Risk ◽  
Venous Access ◽  
Suture Technique ◽  
Bleeding Complications ◽  
Compression Bandage

Recent advances in different percutaneous treatments made insertion of large-caliber sheaths in the femoral veins more common. Venous punctures are historically managed by initial manual compression with subsequent application of a compression bandage and bed rest. We describe a modified “figure-of-eight” suture technique for minimizing the risk of accidental puncture of the vein while grabbing the subcutaneous tissue. We examined the safety and feasibility of this technique combined with early mobilization in a real-world setting. We performed a retrospective analysis on 56 consecutive patients undergoing percutaneous mitral valve repair using large femoral venous access. The patient population was heterogeneous and bleeding risk characteristics were common. Bleeding Academic Research Consortium Consensus (BARC)-classifiable bleeding complications occurred in eight patients (14%), BARC of two events or more in five patients (8.9%), and BARC of three or more event in only one patient (1.8%), which is a comparable success rate to large venous access closure with suture-mediated closure devices. No BARC Type 3b or BARC Type 5 bleeding occurred. During routine clinical follow-up, no groin-related problems were reported in all patients. Closure of large femoral venous access using a modified temporary subcutaneous figure-of-eight suture in combination of a light compression bandage and bed rest for 2 to 4 hours provides a safe and low-cost alternative to closure devices for early mobilization.

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