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Clinical Externship > Access Site Hemostasis > Flashcards

Access Site Hemostasis Flashcards

1
Q

Process that prevents or stops excessive bleeding.

A

Hemostasis

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2
Q

Prior to sheath removal, what should you assess?

A

-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

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3
Q

Why do some institutions remove the arterial sheath first?

A

To rapidly administrate IV fluids and medications in the venous sheath due to vasovagal response from removal

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4
Q

How to remove arterial sheath with manual compression

A

-Place three or four fingers over folded sterile gauze about 2 cm proximal and slightly medial to the skin incision and palpate the artery

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5
Q

How to remove the venous sheath with manual compression?

A

-Place three or four fingers over folded sterile gauze directly below the skin incision

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6
Q

How long do you need to maintain occlusive pressure for?

A

5-15 minutes depending on the size of the french size

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7
Q

If the puncture site is oozing, what should you do next?

A

Apply gentle pressure for an additional 5 minutes

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8
Q

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

A

C-Clamp

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9
Q

What device is this? Provides an alternative to hand compression. Weighted T-Shaped handle devices that combine manual and compression techniques

A

Handheld Compression Assists

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10
Q

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

A

FemoStop

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11
Q

How to use the Femostop:

A

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.

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12
Q

Once Femostop has been placed and dome is inflated (sheath removed) what is done next?

A

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.

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13
Q

What device is this? Tightly rolled sterile gauze or optimal dense foam dressing cores

A

Wedge Pressure Dressing

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14
Q

What device is this? Latex free sterile dressing, transparent window, and a built in pressure bulb to provide consistent pressure.

A

Safeguard Pressure Assisted Dressing

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15
Q

What device is this? Made from protein collagen that is either extravascular or some absorbable intravascular component

A

Vascular Plug and Sealer

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16
Q

What device is this? Bioabsorbable polymer anchor and a collagen sponge that covers the arterial surface within the skin tract. Used within insertion sheaths

A

Angio-Seal

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17
Q

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.

A

MANTA

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18
Q

What sizes are the MANTA available in and what is the make outer diameter?

A

14F: Max diameter 18F
18F: Max diameter 25F

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19
Q

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.

A

Mynx Vascular Closure Device

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20
Q

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.

A

Catalyst and Vascade

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21
Q

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

A

Perclose Products

22
Q

What Percutaneous suture is this? Extravascular clip that mechanically closes the arteriotomy above the blood vessel

A

StarClose

23
Q

What can you do with manual compression to hasten localized clotting at the puncture site?

A

Topical Hemostasis Accelerators

24
Q

What topical hemostasis accelerator is this? Woven pad composed of biopolymer with poly N acetyl glucosamine.

A

Syvek Products

25
Q

What topical hemostasis accelerator is this? Positive ionic charged porous pad that helps bind red blood cells

A

Clo-Sur P.A.D (Pressure-Applied Dressing)

26
Q

What topical hemostasis accelerator is this? Soft nonwoven hydrophilic pad that is impregnated with kaolin. A soft clay that is a good reagent.

A

QuickClot Interventional

27
Q

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

A

D-Stat Products

28
Q

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.

A

Neptune Products

29
Q

How do you perform brachial artery access closure?

A

-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.

30
Q

Why is radial and ulnar arteries easier to compress than femoral or brachial sites?

A

The vessels are not as deep and can be more effectively compressed.

31
Q

What is the compression time for radial and ulnar access

A

10-15 minutes

32
Q

Where do you place the oximeter for transradial access

A

Ring finger

33
Q

Where do you place the oximeter for transulnar access

A

Index finger

34
Q

How do you clean femoral access sites after hemostasis?

A

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

35
Q

What is the ambulation time for patient care following sheath removal and mechanical hemostasis devices?

A

30-120 minutes

36
Q

What is the most commonly encountered complications in sheath removal?

A

Vasovagal reaction
Hematoma formation
Access site bleeding

37
Q

How does the vasovagal reaction occur?

A

Vagus nerve is stimulated which results in hypotension, bradycardia, nausea, and diaphoresis

38
Q

What can be done to help vasovagal reaction?

A

-ECG monitoring
-IV fluids during sheath insertion and removal
-Place patient in -Trendelenburg position
-Atropine and antiemetic agents

39
Q

How to tell if a hematoma has occured?

A

Tissue becomes hard and painful for the patient. Distal pulses may become decreased

40
Q

What to do when a hematoma occurs?

A

Manual compression and a FemoStop can be used. If not resolved, surgical intervention may be necessary

41
Q

What is a Pseudoaneurysm?

A

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.

42
Q

How to diagnosis a psuedoaneurysm?

A

pulsatile mass with a systolic bruit
Using a color doppler ultrasound

43
Q

What is a retroperitoneal bleed?

A

Blood flowing from an arterial puncture into the body cavities. (Abdominal Cavity behind the peritoneum)

44
Q

What causes Retroperitoneal bleeds during procedures?

A

-Guide wire perforation
-Dissection from a sheath or catheter

45
Q

What are the symptoms of a Retroperitoneal bleed?

A

-Acute abdominal or back pain
-Abdominal distention
-Anxiety
-Decreased blood pressure
-Increased heart rate
-Diaphoretic
-Rectal pain

46
Q

How do you diagnosis a Retroperitoneal bleed?

A

CT scans

47
Q

How to treat a Retroperitoneal bleed?

A

-Discontinuing anticoagulation therapy
-Prolonged FemoStop compression
-Fluid replacement and blood transfusion
-Stent placement over the site

48
Q

What is a Vessel Thrombosis?

A

Formation of a blood clot in a blood vessel

49
Q

What can be done to reduce the risk of vessel thrombosis?

A

-Aspirating the sheath sidearm
-Occlusive pressure to be limited to 5 minutes.

50
Q

What should be told to the patient to prevent infection.

A

-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

51
Q

If infection occurs, what is the treatment?

A

Oral antibiotics, IV antibiotic treatment, surgical intervention.

Clinical Externship (4 decks)

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