Access Site Hemostasis Flashcards
Process that prevents or stops excessive bleeding.
Hemostasis
Prior to sheath removal, what should you assess?
-Assess distal pulses (dorsalis pedis and posterior tibial)
-Check for signs of existing hematoma
-Assess patient condition and ensure patient IV is running at appropriate rates
Why do some institutions remove the arterial sheath first?
To rapidly administrate IV fluids and medications in the venous sheath due to vasovagal response from removal
How to remove arterial sheath with manual compression
-Place three or four fingers over folded sterile gauze about 2 cm proximal and slightly medial to the skin incision and palpate the artery
How to remove the venous sheath with manual compression?
-Place three or four fingers over folded sterile gauze directly below the skin incision
How long do you need to maintain occlusive pressure for?
5-15 minutes depending on the size of the french size
If the puncture site is oozing, what should you do next?
Apply gentle pressure for an additional 5 minutes
What device is this? Flat, metal base with a pivoting metal shaft attached to the base. There is an adjustable arm lever and side to hold the desired level of pressure in place
C-Clamp
What device is this? Provides an alternative to hand compression. Weighted T-Shaped handle devices that combine manual and compression techniques
Handheld Compression Assists
What device is this? First device approved by the FDA as an alternative to manual compression. Composed of a plastic arch, inflatable transparent dome, tubing and manometer and a disposable belt
FemoStop
How to use the Femostop:
1: Note patients systolic blood pressure and assess distal pressures
2: Place belt under patients hips and in line with the puncture site. (Not twisted)
3:Thread belt through the clips located on the arms of the arch
4: Place center of dome 2 cm superior and slightly medial to to the skin puncture site
5: Once dome is positioned, retract sheath far enough to allow the hub to be free from the dome
6:Inflate dome to (30 mmHG venous) (60-80mmHg arterial) before sheath removal
7:When arterial sheath is removed, inflate to 20 mmHg above patients systolic blood pressure.
Once Femostop has been placed and dome is inflated (sheath removed) what is done next?
1: After 3-5 minutes, decrease dome pressure until a distal pulse can be found
2: Maintain this pressure for the next 10-15 minutes
3: Decrease pressure by 20 mm Hg every 2 minutes until the pressure has been completely released.
4: Some facilities will keep manometer at 30 mmHg until bed rest is complete.
5: Re inflate pressure to regain hemostasis if oozing or active bleeding occurs.
What device is this? Tightly rolled sterile gauze or optimal dense foam dressing cores
Wedge Pressure Dressing
What device is this? Latex free sterile dressing, transparent window, and a built in pressure bulb to provide consistent pressure.
Safeguard Pressure Assisted Dressing
What device is this? Made from protein collagen that is either extravascular or some absorbable intravascular component
Vascular Plug and Sealer
What device is this? Bioabsorbable polymer anchor and a collagen sponge that covers the arterial surface within the skin tract. Used within insertion sheaths
Angio-Seal
What device is this? Hemostasis device specified to close large bore arterial access. Similar to Angio-Seal, using bioabsorbable polymer anchor and collagen sponges to cover arterial surface.
MANTA
What sizes are the MANTA available in and what is the make outer diameter?
14F: Max diameter 18F
18F: Max diameter 25F
What device is this? Device that places a small balloon within the artery to create temporary hemostasis and sealant is delivered above the arteriotomy site. The balloon is withdrawn and light compression is applied while the sealant clots.
Mynx Vascular Closure Device
What device is this? A manual compression device that uses a guidewire and a nitinol disc to provide temporary hemostasis. Within the wire, heparin is eliminated to promote coagulation.
Catalyst and Vascade
What Percutaneous suture is this? Device that applies four nitrinol needles in and out of the vessel to deliver two braided polyester sutures that close the arteriotomy. Non absorbable
Perclose Products
What Percutaneous suture is this? Extravascular clip that mechanically closes the arteriotomy above the blood vessel
StarClose
What can you do with manual compression to hasten localized clotting at the puncture site?
Topical Hemostasis Accelerators
What topical hemostasis accelerator is this? Woven pad composed of biopolymer with poly N acetyl glucosamine.
Syvek Products
What topical hemostasis accelerator is this? Positive ionic charged porous pad that helps bind red blood cells
Clo-Sur P.A.D (Pressure-Applied Dressing)
What topical hemostasis accelerator is this? Soft nonwoven hydrophilic pad that is impregnated with kaolin. A soft clay that is a good reagent.
QuickClot Interventional
What topical hemostasis accelerator is this? A non woven gauze sponges impregnated with bovine thrombin and cellulose gum. Hemostasis is achieved with combination of manual compression and coagulation of the thrombin
D-Stat Products
What topical hemostasis accelerator is this? Topical dressing made from seaweed and calcium alginate in a pad applied to the undersurface of a compression disc.
Neptune Products
How do you perform brachial artery access closure?
-Prior to sheath removal, assess the radial pulse.
-Ensure patient has IV fluids running at a appropriate rate.
-Aspirate the sheaths sidearm.
-Place two or three fingers over folded sterile gauze proximal to incision site.
-Instruct patient to slowly exhale and remove sheath on exhale.
-Maintain occlusive pressure for 5 minutes and slowly decrease pressure until distal pulses can be palpated.
Why is radial and ulnar arteries easier to compress than femoral or brachial sites?
The vessels are not as deep and can be more effectively compressed.
What is the compression time for radial and ulnar access
10-15 minutes
Where do you place the oximeter for transradial access
Ring finger
Where do you place the oximeter for transulnar access
Index finger
How do you clean femoral access sites after hemostasis?
1: Site cleaned of any remaining blood and around skin tract
2: Clean site with chlorhexidine or another antimicrobial solution
3: Allow the solution to dry and swab the area with benzoin applicator. Allow that to dry
4: Bacitracin zinc or antibiotic oinment is applied to the puncture site and a sterile gauze pad placed over the site.
5: Cover it with a transparent dressing
What is the ambulation time for patient care following sheath removal and mechanical hemostasis devices?
30-120 minutes
What is the most commonly encountered complications in sheath removal?
Vasovagal reaction
Hematoma formation
Access site bleeding
How does the vasovagal reaction occur?
Vagus nerve is stimulated which results in hypotension, bradycardia, nausea, and diaphoresis
What can be done to help vasovagal reaction?
-ECG monitoring
-IV fluids during sheath insertion and removal
-Place patient in -Trendelenburg position
-Atropine and antiemetic agents
How to tell if a hematoma has occured?
Tissue becomes hard and painful for the patient. Distal pulses may become decreased
What to do when a hematoma occurs?
Manual compression and a FemoStop can be used. If not resolved, surgical intervention may be necessary
What is a Pseudoaneurysm?
Form of hematoma where the arterial puncture weakens the vessel wall and blood can flow between layers of the artery making a blood filled pouch.
How to diagnosis a psuedoaneurysm?
pulsatile mass with a systolic bruit
Using a color doppler ultrasound
What is a retroperitoneal bleed?
Blood flowing from an arterial puncture into the body cavities. (Abdominal Cavity behind the peritoneum)
What causes Retroperitoneal bleeds during procedures?
-Guide wire perforation
-Dissection from a sheath or catheter
What are the symptoms of a Retroperitoneal bleed?
-Acute abdominal or back pain
-Abdominal distention
-Anxiety
-Decreased blood pressure
-Increased heart rate
-Diaphoretic
-Rectal pain
How do you diagnosis a Retroperitoneal bleed?
CT scans
How to treat a Retroperitoneal bleed?
-Discontinuing anticoagulation therapy
-Prolonged FemoStop compression
-Fluid replacement and blood transfusion
-Stent placement over the site
What is a Vessel Thrombosis?
Formation of a blood clot in a blood vessel
What can be done to reduce the risk of vessel thrombosis?
-Aspirating the sheath sidearm
-Occlusive pressure to be limited to 5 minutes.
What should be told to the patient to prevent infection.
-Site dressing removed the following day
-Site cleaned with soap and water, dried and covered with a clean bandage
-Patients should not soak in a tub, hot tub or swimming pool for 7-10 days after
If infection occurs, what is the treatment?
Oral antibiotics, IV antibiotic treatment, surgical intervention.
