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OBJECTIVE: The aim of this study was to investigate (1) whether the learning curve of new catheterization laboratory operators increases the incidence of complications of transradial access during percutaneous coronary interventions and (2) whether manual compression with a two-step approach is safe and efficient for radial access hemostasis. METHODS: We performed a prospective study with all consecutive patients who underwent a coronary diagnostic or intervention procedure with radial access. The primary end point was a composite of pulseless radial artery of the wrist and hematoma evaluated after 24 hours. The secondary end point of efficacy was defined as the presence of bleeding or hematoma after 30 seconds. RESULTS: From March 2016 to June 2016, 150 consecutive patients, of whom 147 underwent coronary angiography and/or percutaneous coronary intervention through radial access, were included in the present study. The primary end point was present in 33%, but pulseless radial artery of the wrist was present only in 5.3%. We found that the incidence of primary end point was statistically different according to the number of puncture attempts, with a cutoff of two punctures with blood. The secondary end point of safety was present only in 4.7% of the cases. CONCLUSION: Radial access is feasible and safe even if performed by training physicians. Manual compression with early evaluation after 30 seconds is a safe technique for managing the radial access after sheath removal.
Subject(s)
Humans , Catheterization , Catheters , Coronary Angiography , Hematoma , Hemorrhage , Hemostasis , Incidence , Learning Curve , Percutaneous Coronary Intervention , Prospective Studies , Punctures , Radial Artery , WristABSTRACT
Objective To analyze the effect of mechanical press and manual press in cardiopulmonary resuscitation.Methods A prospective randomized controlled study was performed.A total of 95 cases who needed cardiopulmonary resuscitation were collected,according to the inclusion criteria,which including mechanical compression group (n =48),and the manual compression group (n =47).Demographic,clinical course of two groups were collected.Arterial and venous blood gas analysis in the recovery after the start of 5 minutes,15 minutes,30 minutes,the end of recovery were also collected and the pH value,partial pressure of oxygen,extracellular base remaining,actual bicarbonate,lactic acid,calcium and central venous oxygen saturation (ScvO2) and other data were mainly analyzed.All data collation and statistical analysis were used Microsoft excel,SAS 9.4.The enumeration data were expressed by the frequency and percentage,and chi square test was used.The measurement data were expressed by mean and standard deviation,and t test was used.Multiple Logistic regression analysis was performed to analysis of the effect of various factors.Results There were no statistically differences in age and pathogenic factors between the mechanical compression group and manual compression group (P ＞ 0.05).The press time,success rate of resuscitation and hospitalization days were respectively (22 ±14) minutes,81％,(37 ± 16) days in the mechanical compression group and (27 ± 19) minutes,54％,(41 ±20) days in the manual compression group,with no statistically significant differences (all P ＞ 0.05).Mechanical compression group and manual compression group were cured in 17 cases,10 cases,survived in 21 cases,9 cases,deaded in 10 cases,28 cases,with statistically significant differences between 2 groups (P ＜0.05).The troponin Ⅰ and creatine kinase MB were respectively (4.1 ± 2.0) ng/ml,(31 ± 15) U/L in the manual compression group and (5.6 ± 1.9) ng/ml,(43 ± 22) U/L in the mechanical compression group,with statistically significant differences between 2 groups (P ＜ 0.05).The defibrillation energy and defibrillation times in manual group were significantly higher than that of mechanical compression group (P ＜ 0.05).Multivariate logistic regression analysis showed that the central venous oxygen saturation at the first 5 minutes after the start of compression (x2 =65.0538,P ＜ 0.0001),the arterial blood pH at the end of compression (x2 =21.5779,P ＜ 0.0001),and the 5％ sodium bicarbonate was significantly correlated with the prognosis of survival after resuscitation,mechanical compression group was better than the manual compression group (x2 =3.1421,P =0.0463).Conclusions The effect of cardiopulmonary resuscitation machine is better than that of manual compression,which can effectively improve the clinical treatment effect.The result recommends the use of cardiopulmonary resuscitation machine for patients with cardiac arrest.
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A vascular closure device (VCD) is a medical apparatus which is used for stopping bleeding at the puncture point after percutaneous vascular puncturing management. According to its principles , these devices can be categorized into active closure device, compression-assisted device and local hemostatic plaster. The use of these devices can shorten the time of hemostasis, the time of limb immobilization, and the time of hospitalization; it can also reduce the damage to the patient, improve patient’s comfort, and reduce the work load of the medical staff as well. But each VCD has its own applicable scope and learning curve , thus it might cause serious complications when it is improperly used. Therefore , in using VCD the interventional physicians should be familiar with the characteristics of each special VCD and have enough knowledge concerning the treatment of the common complications. This paper aims to make a comprehensive review of the closure device manufacturer data and the relevant literatures recently published so as to make a brief introduction of the principle, characteristics, scope of application and practical tips of several common vascular closure devices.
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With rapidly increasing numbers of neuroendovascular procedures performed annually in recent years, use of arterial closure devices after femoral artery access has been exceedingly common secondary to reduced time to hemostasis, decreased patient discomfort, earlier mobilization, and shortened hospital stay. Although uncommon, use of these devices can lead to a different spectrum of complications, as compared to manual compression. Ischemic symptoms following the use of these devices can have unexpected clinical sequelae and can occur in a delayed fashion. Awareness and recognition of such complications is important with the dramatically increased use of these devices in recent years. We report on a case of delayed vascular complication manifesting as vascular claudication following use of the AngioSeal closure device.
Subject(s)
Humans , Cerebral Angiography , Femoral Artery , Hemostasis , Length of StayABSTRACT
Objetivo: Comparar la incidencia de falla en la hemostasia y frecuencia de eventos vasculares, durante y después de la compresión con dos maniobras diferentes. Métodos: Se realizó un ensayo clínico de asignación aleatoria a compresión mecánica o compresión manual, para el retiro de introductor en arteria femoral posterior a cateterismo diagnóstico o terapéutico. Resultados: Se incluyeron 100 pacientes en el grupo de compresión con compresor (grupo uno) y 112 de forma manual (grupo dos). La falla para lograr hemostasia se presentó en 48% del grupo uno vs 19.7% en el grupo dos (p<0.001). Existió una tendencia a presentar con más frecuencia hematomas >4 cm durante el seguimiento con ultrasonido, en el grupo con compresor 11.4% vs el grupo manual 4.6% (p=0.062). En el análisis de regresión logística sólo se encontró que los factores independientes para falla en la hemostasia fueron: uso de compresor con OR 4.34 (IC 95%, 2.24-8.43, p<0.001) y edad mayor a 61 años con OR 2.44 (IC 95%, 1.3-4.7, p=0.008), el índice de masa corporal < 26 disminuyó el riesgo con OR 0.86 (IC 95%, 0.78-0.94, p=0.001). Conclusiones: Para el retiro de introductores, la compresión manual es superior al empleo del compresor mecánico para evitar la falla de hemostasia en el sitio de punción. Una limitación es que no se puede asegurar cuál de los dos métodos es superior para disminuir complicaciones vasculares, dado que no se completó el tamaño de muestra calculado.
Objective: To compare the incidence of hemostatic failure and rate of vascular events during and after vascular compression using two different techniques. Methods: Patients were randomized to mechanical or manual compression after a therapeutic or diagnostic catheterization procedure. Results: One hundred patients were enrolled in the mechanical compression group (group one) and 112 patients in the manual compression group (group two). Failed hemostasis was observed in 48% of patients in group 1 and 19.7% in group two (p<0.001). A tendency towards a greater incidence for hematoma (>4cm) formation was found on ultrasound follow-up in group 1 (11.4% vs 4.6%, p=0.062). Logistic regression analysis found that the only independent factors for hemostatic failure were: use of mechanical compression device (OR 4.34, 95% CI 2.24-8.43, p<0.001) and age greater than 61 years (OR 2.44, 95% CI 1.3-4.7, p=0.008). A body mass index <26 was found to reduce the risk for hemostatic failure (OR 0.84, 95% CI 0.78-0.94, p=0.001). Conclusion: After introducer sheath removal, manual compression is superior to mechanically-assisted hemostasis in avoiding hemostatic failure at vascular access site. This study was not able, however, to show the superiority of either method to reduce the rate of vascular complications due to the small sample size of patients enrolled at the time of early study termination for safety reasons.
Subject(s)
Female , Humans , Male , Middle Aged , Catheterization/adverse effects , Hemostatic Techniques , Hemorrhage/etiology , Hemorrhage/prevention & control , Femoral Artery , Pressure , Treatment OutcomeABSTRACT
Pseudoaneurysm of the breast is rare. To date only a, few cases related to blunt trauma, core needle biopsy, vacuum-assisted biopsy, or surgery have been reported. The author reports on a case of pseudoaneurysm after 14-gauge core needle biopsy, which was treated successfully with manual compression.
Subject(s)
Aneurysm, False , Biopsy , Biopsy, Large-Core Needle , Breast , NeedlesABSTRACT
BACKGROUND: Although modern cardiopulmonary resuscitation (CPR) substantially decreases the mortality induced by cardiac arrest, cardiac arrest still accounts for over 50％ of deaths caused by cardiovascular diseases. In this article, we address the current use of mechanical devices during CPR, and also compare the CPR quality between manual and mechanical chest compression. METHODS: We compared the quality and survival rate between manual and mechanical CPR, and then reviewed the mechanical CPR in special circumstance, such as percutaneous coronary intervention, transportation, and other fields. RESULTS: Compared with manual compression, mechanical compression can often be done correctly, and thus can compromise survival; can provide high quality chest compressions in a moving ambulance; enhance the flow of blood back to the heart via a rhythmic constriction of the veins; allow ventilation and CPR to be per formed simultaneously. CONCLUSION: Mechanical devices will be widely used in clinical practice so as to improve the quality of CPR in patients with cardiac arrest.
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Objective To assess the safety and efficiency of Angioseal device in patients undergoing coronary percutaneous procedure.Methods A prospective trial was carried out in 260 patients undergoing angiograph and angioplasty during october 2002 to July 2003.All patients were divided into two groups: Angioseal closure device and manual compression.Results In angiography,the time to hemostasis was (1.8?0.9)min by Angioseal and (25.3?13.4)min by manual compression(P
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A patient with symptomatic dural fistula involving the cavernous sinus did intermittant external manual compression of the cervical carotid artery and jugular vein. We observed complete closure of fistula with improvement of symptoms either clinically or at angiography done 6 weeks later, and recommend this technique with clinical follow up and angiography in selected cases before more definitive therapy is employed.