Randomized comparison of hemostasis techniques after invasive cardiovascular procedures.

BACKGROUND: The arterial access required during most invasive vascular procedures provides a common source of complications and morbidity. This problem has been made worse by recent trends in earlier ambulation and more aggressive antihemostatic drug regimens. Despite these trends, no randomized trials have been reported comparing the 3 most commonly used techniques in achieving hemostasis at the arterial puncture site. METHODS: A cohort of 400 patients undergoing catheterization laboratory procedures were randomly assigned to 1 of 3 groups of arterial compression: manual compression, mechanical clamp, and pneumatic compression device. Standard requirements of the trial included uniformity in initial compression times, patient instructions, nursing follow-up, and timing of ambulation as well as a structured interview and physical examination at 24 hours. RESULTS: Prolonged compression was required in 13% of the manual group, 20% of the clamp group, and 35% of the pneumatic group (P <.0001). In-lab bleeding was more common in the pneumatic group (3%, 4%, and 16%, respectively, P <.0001), as was the need for an alternate compression technique (1%, 1%, and 27%, P <.0001). The groups also differed in respect to mean hematoma size (3.9 cm(2), 7.8 cm(2), and 19.8 cm(2), P =.036) and level of discomfort during compression (1.9, 2.2, and 3.1 on a 1- to 10-point scale, P <.0001). Comparable findings were observed in the subgroup of patients eligible for outpatient procedures. CONCLUSIONS: Use of the pneumatic compression device leads to longer compression times, greater discomfort, more bleeding, and larger hematomas. Differences between manual compression and the mechanical clamp were more subtle but tend to favor use of the manual technique.

Behavioral measurement of temperament in male nursery-raised infant macaques and baboons.

We define temperament as an individual's set of characteristic behavioral responses to novel or challenging stimuli. This study adapted a temperament scale used with rhesus macaques by Schneider and colleagues [American Journal of Primatology 25:137-155, 1991] for use with male pigtailed macaque (Macaca nemestrina, n = 7), longtailed macaque (M. fascicularis, n = 3), and baboon infants (Papio cynocephalus anubis, n = 4). Subjects were evaluated twice weekly for the first 5 months of age during routine removal from their cages for weighing. Behavioral measures were based on the subject's interactions with a familiar human caretaker and included predominant state before capture, response to capture, contact latency, resistance to tester's hold, degree of clinging, attention to environment, defecation/urination, consolability, facial expression, vocalizations, and irritability. Species differences indicated that baboons were more active than macaques in establishing or terminating contact with the tester. Temperament scores decreased over time for the variables Response to Capture and Contact Latency, indicating that as they grew older, subjects became less reactive and more bold in their interactions with the tester. Temperament scores changed slowly with age, with greater change occurring at younger ages. The retention of variability in reactivity between and within species may be advantageous for primates, reflecting the flexibility necessary to survive in a changing environment.

Maintenance of hemostasis after invasive cardiac procedures: implications for outpatient catheterization.

OBJECTIVES: This study investigated the efficacy of four different methods of arterial puncture site management during recovery from invasive cardiac procedures. The primary goals were less patient discomfort and improved clinical outcome. BACKGROUND: The increasing use of outpatient catheterization, large interventional devices and potent periprocedural anticoagulation regimens has made the reduction of groin complications a high priority. Despite these trends, there are no randomized trials comparing commonly used techniques in treating the catheter entry site for the first few hours after the procedure. METHODS: Four-hundred consecutive patients undergoing catheterization laboratory procedures were randomly assigned to one of four dressing techniques applied after achieving hemostasis: a sandbag placed over the site; a pressure dressing constructed from surgical gauze and elastic tape; a commercially available compression device; and no use of compressive dressing. Of these 400 patients, 171 would have been eligible for outpatient procedures in the absence of geographic constraints. The dressings were removed, and ambulation was encouraged 5 h after sheath removal. Uniform initial compression times, patient instructions, nursing follow-up and a structured interview and physical examination at 24 h were used. RESULTS: The level of patient discomfort before and after dressing removal, as well as site tenderness at 24-h follow-up, was statistically similar in all four groups. Hematomas (typically small) and areas of ecchymosis were observed in 58 and 122 patients, respectively, but both their frequency and size were equally represented in each group. Important adverse events were confined to bleeding, rated as mild in 5.8%, moderate in 0.8% and severe in 0.6% of patients. Again, all four groups were statistically similar. Comparable findings were observed in the subgroup of patients eligible for outpatient procedures. CONCLUSIONS: Despite an increase in inconvenience and expense, none of the three compression techniques that were investigated improved patient satisfaction or outcome. Therefore, the routine use of compression dressings after invasive cardiac procedures cannot be recommended.