Femoral Arterial Sheath Removal Research Articles

Effect of Direct Cold Compress for Femoral Arterial Sheath Removal on Reduction of Local Vascular Complications in Patients after Percutaneous Coronary Intervention: A Randomized Controlled Trial

Background: Percutaneous coronary intervention (PCI) is one of the cardiac catheterization procedures used to diagnose and treat coronary artery disease(CAD). It may lead to local vascular complications after the removal of the femoral arterial sheath, which may contribute to morbidity and mortality, and increase the patient's length of stay and hospital costs. Objectives: The present study aimed to determine the effect of direct cold compress for femoral arterial sheath removal on reduction of local vascular complications in patients after PCI. Methods: A randomized controlled trial, post-test only was conducted on patients in the present study. A non-probability (homogenous purposive sample) of (90) patients are involved after PCI (45 patients for the experimental group and 45 patients for the control group). The experimental group exposed to direct cold bag compression for removing the femoral arterial sheath removal. While, the control group exposed for usual nursing care provided for patients in CCU. The study was conducted at Al-Najaf AL Ashraf City/ AL-Najaf Center for Cardiac Surgery and Cardiac Catheterization. The local vascular complications involved in the present study for both groups are hematoma, bleeding and ecchymosis. Outcomes: The study results indicated that there is a reduction in local vascular complications (hematoma, bleeding, and ecchymosis) for patients after femoral arterial sheath removal in the experimental group compared with those patients in the control group. Conclusion: The present study has been concluded that the using of direct cold bag compress for removing the femoral arterial sheath in patients after PCI is an effective approach in reduction of local vascular complications compared with the control group. Recommends: Based on the results of the present study, the researcher suggests the direct cold bag compress for femoral arterial sheath removal as a nursing intervention to reduce local vascular complications (hematoma, bleeding, and ecchymosis) for patients after PCI.

Music-induced analgesia for adults and older adults during femoral arterial sheath removal after cardiac catheterization: a randomized clinical trial protocol

BackgroundCardiovascular diseases cause the death of 17.5 million people every year. Cardiac catheterization is an invasive diagnostic exam that allows treatment followed by the examination and can cause some complications such as pain. From this perspective, music has alleviated suffering and promoted pain relief for patients. This study aims to evaluate the effectiveness of music therapy to relieve pain in adults and older adults during femoral arterial sheath removal after cardiac catheterization.MethodsThis is a randomized controlled clinical trial, with two arms and a single-blind design to be carried out with 68 patients equally allocated into control and experimental groups. The intervention will be applied with the use of headphones without any musical transmission in the control group or with the patient’s musical preference in the experimental group with sound intensity of 60 dB. These patients will be evaluated in three moments: immediately before, during and 15 min after the painful procedure. The primary outcome includes reduction of pain intensity verified by the Visual Analogue Scale and the secondary outcome corresponds to improvement of vital signs and vocal and facial pain expressions.DiscussionThis study will allow by testing a non-pharmacological strategy to relieve pain during femoral sheath removal after cardiac catheterization, having its parameters evaluated at three moments: immediately before (30 min), during the procedure and 15 min after the painful procedure. It also enables the use of a low-cost, potentially effective resource that makes nursing care more humanized by improving user satisfaction with the service provided, in addition to reducing the need for post-procedure analgesics.Trial registrationThis study is registered on the Brazilian Clinical Trials Registry (REBEC) platform under number RBR-3t3qwp7 (05/04/2022) and was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte under CAAE 52,586,521.8.0000.5537 (11/11/2021).

Effects of Valsalva Maneuver on Pain and Vasovagal Reaction During the Removing of Femoral Arterial Sheath After Percutaneous Coronary Intervention: A Randomized Controlled Trial

PurposeThe objective of this study was to investigate the effects of the Valsalva maneuver on pain and vasovagal reactions during femoral arterial sheath removal in patients undergoing percutaneous coronary intervention. DesignThis study was a randomized controlled trial. MethodsIn this study, 60 patients undergoing elective coronary angioplasty were randomly assigned to the intervention and control groups. After angioplasty, the patients in the intervention group performed the Valsalva maneuver (20-30 mm Hg) for 10 seconds during the sheath removal. Conversely, in the control group, no inspiratory pressure was applied. Before and immediately after the sheath removal, the patients’ pain, vital signs, and vasovagal reactions were measured. FindingsThe primary characteristics of the patients were similar in the two groups. The patients in the intervention group had significantly lower pain scores during femoral sheath removal compared to the control group (2.33 ± 1.56 vs 5.56 ± 3.08, P < .001). The Valsalva maneuver during femoral sheath removal decreased the patients’ heart rate in the intervention group compared to the control group (78.26 ± 12.37 vs 85.46 ± 11.79, P < .001); however, blood pressure and vasovagal reactions were not significantly different. ConclusionsThis study showed that the Valsalva maneuver during femoral arterial sheath removal can reduce the pain severity score, without increasing the incidence of vasovagal reactions.

The prevention and management of approach-specific complications of abdominal aortic balloon occlusion in pelvic and sacral surgery

Objective: To investigate the causes,prevention and treatment of femoral artery puncture related complications caused by the application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in the resection of pelvic and sacral tumors. Methods: Clinical data of 23 patients with femoral artery puncture related complications who received REBOA in the resection of pelvic and sacral tumors from August 2010 to August 2018 at the Musculoskeletal Tumor Center,Peking University People's Hospital were retrospectively analyzed.There were 8 males and 15 females,with the an age of (37.0±16.2) years (range:15 to 65 years).Arterial access via the Seldinger technique for REBOA was obtained in the right common femoral artery of 18 cases,and in the left of 6 cases.An arterial sheath with a diameter of 11 to 12 F(1 F≈0.33 mm) was used for the patient.The occurrence and treatment of postoperative complications were analyzed. Results: Acute femoral arterial thrombosis occurred in 18 patients,which was managed by open repair 48 hours postoperatively.Among the 349 patients admitted before 2015 who received hemostasis by compression after femoral artery sheath removal,12 patients (3.4%) developed acute femoral artery thrombosis.While the 476 patients admitted after 2015 who used a vascular stapler to close the femoral artery wound,6 patients (1.3%) developed acute femoral artery thrombosis.One case of retroperitoneal hematoma and 1 case of femoral pseudoaneurysm were found and surgically fixed.Postoperative follow-up was (40±18) months (range:13 to 108 months).Three cases with chronic lower extremity ischemia were confirmed by Doppler ultrasonography during 1 to 5 years follow-up.Two of them had minimal symptoms and denied further treatment,while the other one received femoral-femoral artery bypass surgery to restore distal flow for pain and numbness relief. Conclusions: Acute femoral arterial thrombosis was the most common femoral artery puncture.Technique refinement of REBOA,the use of percutaneous suture device and close follow-up can reduce the approach-specific complications,and help to detect and treat the complications timely,which may popularize the clinical application of REBOA.

Randomized Controlled Trial Comparing Simple Light Dressing (Transparent Film Dressing) Versus Pressure Dressing (Elastoplast) After Femoral Arterial Sheath Removal

Pressure dressings were routinely used to prevent further bleeding after femoral artery sheath removal. Many patients often complained of discomfort during and after removal of the pressure dressing. This study aimed to evaluate the clinical effectiveness of a transparent film dressing and conventional pressure dressing in terms of incidences of hematomas, bleeding, skin loss, and level of comfort experienced. A randomized controlled trial study was conducted to compare the patients with pressure dressing and transparent film dressing in radiological-guided invasive procedures requiring retrograde femoral artery puncture. Outcome variables included incidences of bleeding, hematoma, skin integrity, and comfort level during and after the dressings were removed. A total of 260 patients were enrolled and most patients had undergone visceral intervention with size 5 Fr vascular sheaths inserted. There was no significant difference in bleeding and formation of hematoma (p > 0.7) and loss of skin integrity (p = 0.1). However, 39% of the patients in the pressure dressing group experienced discomfort compared with 5% of patients in the transparent film dressing group (p < 0.01). Results of this study supported the use of transparent film dressing after femoral artery sheath removal. The use of transparent film dressing did not lead to an increase in bleeding or hematoma formation and has provided greater comfort to patients.

Clinical Features of Acute Massive Pulmonary Embolism Complicated by Radiofrequency Ablation: An Observational Study.

Although pulmonary embolism (PE) complicated by radiofrequency catheter ablation (RFCA) is rare, it can be life-threatening. Our goal was to elucidate the clinical features of acute massive PE after RFCA.Of 2386 patients who underwent RFCA for supraventricular tachycardia or idiopathic ventricular arrhythmia, 4 patients (0.16%) whose cases were complicated by acute massive PE were examined.These 4 patients were female and middle-aged (range 43–52 years), and 2 of the 4 patients had iron-deficiency anemia and reactive thrombocytosis. Ablation in all patients was performed in the left heart via the right femoral arterial approach. All of the patients had a long-duration hemostasis procedure and bed rest following femoral arterial sheath removal after RFCA. All of the patients collapsed and lost consciousness during their first attempt at walking after RFCA. The emergent electrocardiogram in 2 of the 4 patients revealed an S1Q3T3 pattern, 1 patient demonstrated new onset of right bundle-branch block (RBBB) and S1Q3 pattern and Qr pattern in V1, and the remaining patient had negative T waves in leads V1, V2, and III. The emergent echocardiogram revealed right ventricular hypokinesis and pulmonary hypertension in the 4 patients with acute PE after ablation. Although all of the patients initially experienced sinus tachycardia when they recovered consciousness, 2 of the 4 patients suddenly developed intense bradycardia and lost consciousness again, and these patients finally died (50% fatality rate). All of the patients were identified by CT pulmonary angiography or pulmonary angiography.Our report suggests that although acute massive PE is highly rare, there is a real and fatal risk in patients who experienced acute massive PE after RFCA. Particular attention should be paid to the first ambulation after RFCA. Acute PE should be strongly suspected when sudden loss of consciousness occurs upon mobilization after RFCA. The new onset of S1Q3T3 pattern, RBBB or T wave inversion in the right precordial leads, and early detection of echocardiographic right ventricular dysfunction may be useful for making an early diagnosis of acute PE after RFCA. Early ambulation after left-sided RFCA might be helpful to prevent the formation of deep venous thrombosis and subsequent PE.

Early Removal of the Arterial Sheath After Percutaneous Coronary Intervention Using the Femoral Approach: Safety and Efficacy Study

Introducao: Avaliamos a seguranca e eficacia do uso de protamina, guiada pelo tempo de coagulacao ativado, para a remocao imediata do introdutor arterial femoral em pacientes submetidos a intervencao coronaria percutânea com heparina nao fracionada, com o objetivo de propor um algoritmo para a pratica clinica. Metodos: Estudo prospectivo, com pacientes consecutivos, com angina estavel ou com sindrome coronariana aguda de baixo ou moderado risco. Comparamos os pacientes com a retirada precoce do introdutor arterial aqueles nos quais o introdutor foi retirado de acordo com o protocolo convencional. A decisao pela remocao precoce ou convencional do introdutor foi deixada a criterio do operador. Resultados: O grupo de remocao precoce (n = 149) apresentou menor tempo de manuseio do sitio de puncao que o grupo de remocao convencional (58,3 ± 21,4 minutos vs. 355 ± 62,9 minutos; p < 0,01), principalmente devido a reducao do tempo ate a retirada do introdutor (42,3 ± 21,1 minutos vs. 338,6 ± 61,5 minutos; p < 0,01), sem impacto sobre a duracao da compressao femoral (16,0 ± 3,6 minutos vs. 16,4 ± 5,1 minutos; p = 0,49). Nao houve trombose hospitalar de stent e nem diferenca significativa na incidencia de eventos vasculares ou hemorragicos. A incidencia de outras hemorragias, que levaram a hospitalizacao prolongada, foi menor no grupo de remocao precoce (1,3% vs. 5,1%; p = 0,05). Conclusoes: O uso seletivo de uma abordagem, para a remocao imediata do introdutor femoral guiada pelo tempo de coagulacao ativado e a administracao de protamina, e seguro e eficaz em pacientes submetidos a intervencao coronaria percutânea pela via femoral.

Early Removal of the Arterial Sheath After Percutaneous Coronary Intervention Using the Femoral Approach: Safety and Efficacy Study

ABSTRACT Introduction We evaluated the safety and efficacy of protamine administration, guided by activated clotting time, for the immediate femoral arterial sheath removal in patients undergoing percutaneous coronary intervention with unfractionated heparin in order to propose an algorithm for clinical practice. Methods Prospective study with consecutive patients with stable angina or low-to-moderate risk acute coronary syndrome. We compared patients with an early removal of the arterial sheath to those whose sheath removal was based on a standard protocol. Results The early removal group (n = 149) had lower access manipulation time than the conventional group (58.3 ± 21.4 minutes vs. 355.0 ± 62.9 minutes; p p p = 0.49). There was no stent thrombosis during hospitalization and no significant differences in the incidence of major vascular or bleeding events. The incidence of other bleeding events leading to a prolonged in-hospital length of stay was lower in the early removal group (1.3% vs. 5.1%; p = 0.05). Conclusions: The selective use of an approach for immediate femoral sheath removal, based on activated clotting time guidance and protamine administration, is a safe and effective option in patients undergoing percutaneous coronary intervention by femoral access.

Femoral Arterial Sheath Removal – Aligning Practice with Evidence to Promote Patient Safety

Following percutaneous coronary intervention (PCI) via the femoral artery, lengthy sheath dwell times may compromise patient safety. Mandatory bed rest is uncomfortable for patients. Within the Heart Investigation Unit (HIU) at Hamilton Health Sciences (HHS), the current policy is not evidence based. Front line nurses questioning of the status quo led to rewriting the corporate femoral arterial sheath removal policy, aligning nursing practice with current evidence and optimizing patient safety.

The effectiveness of superficial subcutaneous lidocaine administration prior to femoral artery sheath removal.

The dynamic world of healthcare requires continuous review of practice to ensure that patient care aligns with current evidence and best practice. Superficial subcutaneous lidocaine injection has been an order option at London Health Sciences Centre-University Hospital (LHSC-UH) for use in post-percutaneous coronary intervention (PCI) prior to femoral artery sheath removal (FASR). The purpose of administering lidocaine is to reduce pain during FASR, subsequently enhancing the patient's experience. A critical appraisal was performed by the Continuous Quality Improvement-Cardiac Care Council (CQI-CCC) at LHSC-UH, evaluating the effectiveness of superficial subcutaneous lidocaine for use in patients undergoing FASR. This paper details the process followed to evaluate this practice and reports on the subsequent findings and recommendations. A literature review, a retrospective chart audit, a blinded online survey and peer hospital polling were compiled, and a summary of findings was shared with the cardiac interventionists, with subsequent polling. No significant evidence for pain reduction was identified when lidocaine injections were administered prior to FASR. As such, a unanimous decision was reached to remove lidocaine from the LHSC Coronary Angioplasty Clinical Pathway order form.

Effectiveness of femoral arterial closure devices compared to traditional compression methods following femoral sheath removal: A Systematic Review

Review Questions/Objectives The systematic review objective is to synthesise the best available research evidence related to the effectiveness of femoral arterial closure devices as compared to traditional compression methods post femoral sheath removal in the cardiovascular patient. The specific review question to be addressed is: • What effects do femoral arterial closure devices, as compared to traditional compression methods, have on outcomes post femoral sheath removal in the cardiovascular patient? Inclusion Criteria Types of participants This review will consider studies that included all types of cardiovascular adult patients (18+ years old) with post femoral sheath removal following endovascular procedures regardless of previous treatments. The femoral artery is preferable access site due to the larger diameter of the artery compared to the radial or brachial arteries. Due to the larger diameter of the femoral artery, time to hemostatis and complications are significantly different than that of the brachial or radial arteries.For accurate comparison, patients undergoing procedures using radial or brachial access will not be included. Types of interventions The interventions of interest are arterial closure devices and traditional compression methods used following femoral arterial sheath removal. Studies that compare arterial closure devices and compression methods post endovascular procedure will be included in this review. Similarly, studies that compare various compression methods post endovascular procedure will be included in this review. Studies that compare radial or brachial access to femoral access and hemostasis will not be included in this review to allow for accurate comparison. Femoral access has significantly differing times to hemostatis and complication rates than radial or brachial access. Types of outcome measures The primary outcome of interest is the difference in effectiveness of femoral arterial closure devices and traditional compression methods on patient outcomes. Studies meeting criteria for participants and intervention which include outcomes related to bleeding risks and vascular complications, such as hematoma, bleeding at the site, retroperitoneal bleeding, pseudoanuerysm, and AV-fistula creation will be considered for inclusion in this review. In addition, studies describing attainment of hemostasis following femoral sheath removal will be considered.

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

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. 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). 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. 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.

Comparison of Complications in Percutaneous Coronary Intervention Patients Mobilized at 3, 4, and 6 Hours After Femoral Arterial Sheath Removal

The purpose of this research study was to explore groin complication rates of patients mobilized at 3, 4, and 6 hours after femoral arterial sheath removal following a percutaneous coronary intervention procedure. Participants were recruited from those undergoing coronary angioplasty and coronary stent placement at a large public hospital in Brisbane, Queensland. Participants were randomly allocated to the 3, 4, or 6 hourly mobilization group. After removal of the femoral arterial sheath and again the next day, participants' groins were assessed for evidence of complications including hemorrhage, hematoma formation, and pseudoaneurysm. The results showed that the length of bed rest after arterial sheath removal had no significant effect on bleeding (F 304 = 5.39, P = 0.21) or hematoma formation (F 304 = 0.258, P = 0.612) at the groin puncture site for participants who mobilized at either 3, 4, or 6 hours after percutaneous coronary intervention arterial sheath removal.

Dexmedetomidine for endovascular neurosurgery

Perioperative managements for endovascular neurosurgery require some considerations such as minimizing hemodynamic changes and especially avoiding blood pressure elevation accompanying extubation, immobilizing the trunk and lower limbs until bleeding from the site of femoral artery sheath removal has stopped, and monitoring patients in the ICU for at least 12 hours to notice neurological deterioration promptly. The aim of this study was to assess the usefulness of dexmedetomidine as a postoperative sedative drug for endovascular neurosurgery.

Very Low Complication Rates with a Manual, Nurse-Led Protocol for Femoral Sheath Removal Following Coronary Angiography

We aimed to provide contemporary information on the complication rates after femoral artery sheath removal using a specific, nurse-led protocol, which is universally applicable and can be readily adopted by other units. Previous studies have reported a wide range of complication rates following femoral sheath removal after cardiac catheterisation. A variety of methods has been used for access site management and therefore it is difficult to compare complication rates between units. Data were collected prospectively on patients undergoing diagnostic coronary angiography via the transfemoral route in a single centre. Sheaths were removed by trained cardiac nurses with direct application of manual pressure over the femoral artery in accordance with a specific protocol. We also investigated the same endpoints in patients who received an arteriotomy closure device (ACD) during the study period. None of the 516 patients who had their femoral sheaths removed with manual compression developed a major haematoma or complication. A minor haematoma developed in 1.6% of patients. Similarly, none of the 484 patients who received an ACD developed a major haematoma and 0.8% developed a minor haematoma. Mean arterial blood pressures were higher in patients that developed a haematoma. Our study shows that a manual, nurse-led system of femoral sheath removal following diagnostic coronary angiography is very safe and effective and that this remains a viable method of access site management.

Vaso-vagal reactions during femoral arterial sheath removal after percutaneous coronary intervention and impact on cardiac events

We determined whether vaso-vagal syncope during sheath removal after percutaneous coronary intervention leads to a higher incidence of major adverse cardiac events including acute stent thrombosis, in 611 patients who participated in our previous trial assessing the impact of intravenous sedation and local anaesthesia at this time on patient comfort. A total of 35 (5.7%) patients experienced a vaso-vagal reaction. Major adverse cardiac events at day 30 occurred in 5.7% of patients experiencing vaso-vagal syncope and 7.1% of those who did not ( p = 1.00) with no case of stent thrombosis in the vaso-vagal group. Whilst unpleasant for patients, we conclude that vaso-vagal syncope during sheath removal after percutaneous coronary intervention is not associated with increased adverse cardiac events in the stent era.

Effect of local anesthesia and intravenous sedation on pain perception and vasovagal reactions during femoral arterial sheath removal after percutaneous coronary intervention

Background There is no consensus with respect to the use of analgesia during femoral arterial sheath removal after percutaneous coronary intervention (PCI). We performed a randomized controlled trial to assess the impact of intravenous sedation and local anesthesia during femoral sheath removal after PCI on patient comfort and the incidence of vasovagal reactions. Methods All patients undergoing PCI whose femoral sheaths were to be removed with assisted manual compression were eligible. Patients were randomized to receive either intravenous sedation (Fentanyl and Midazolam) or local anesthesia (1% lignocaine) infiltrated around the sheath site or both or neither. The primary endpoint of the study was the patients reported worst pain according to a Visual Analogue scale (VAS) after sheath removal. The incidence and predictors of vasovagal reactions during sheath removal and occurrence of vascular complications was also determined. Results A total of 611 patients were randomized into this study. The mean pain score was highest in the local anesthesia only arm as compared to the sedation only arm, the combined local and sedation arm and the neither sedation or local arm ( p = 0.001). vasovagal reactions were experienced by 35 patients (5.1%) with the highest percentage in the local anesthesia only group (9.8%). Multivariate logistic regression analysis identified a higher pain score (OR 1.18, 95% CI 1.12–1.24, p = 0.001), use of glyceryl trinitrate during sheath removal (OR 9.05, 95% CI 5.06–16.1, p < 0.001), a lower body mass index (OR 1.12, 95% CI 1.08–1.18, p = 0.009) and the left anterior descending artery as the treated vessel (OR 5.2, 95% CI 3.41–7.87, p < 0.001) as independent predictors of the occurrence of a vasovagal reaction. There was no significant difference in vascular complications between the 4 study groups. Conclusions The routine use of fentanyl and midazolam prior to sheath removal leads to a reduction in pain perception and vasovagal incidence, whilst the routine use of local infiltration during sheath removal should be discouraged as it leads to more pain and a trend to more vasovagal reactions.