hemostasis, arterial acess, radial artery hemostasis

1. Hemostasis of vascular access site
Dr. Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI,
FAPSC, FAPSIC, FAHA, FCCP, FRCPG
Associate Professor of Cardiology
National Institute of Cardiovascular Diseases,
Sher-e-Bangla Nagar, Dhaka-1207
Consultant, Medinova, Malibagh branch
Honorary Consultant, Apollo Hospitals, Dhaka and
STS Life Care Centre, Dhanmondi
drtoufiq19711@yahoo.com

2. Access Site Hemostasis
After the catheterization procedure has been completed
and the catheters removed, the sheath is flushed.
If heparin has been given, an activated clotting time is
obtained; if this is >200 sec, protamine sulfate may be
given before sheath removal (25 to 50 mg protamine
IV reverses 10,000 U heparin).
Caution should be used in giving protamine to patients
receiving NPH insulin, who may have higher likelihood
of a protamine reaction .

3. Acees site hemostasis
• To remove the FA sheath, gentle pressure is
applied over the puncture site while the sheath is
removed, taking care not to crush the sheath and
strip clot into the distal artery.
• Firm downward pressure is applied for 15 to 30
minutes, periodically evaluating distal pulses.
• After manual hemostasis is achieved, an adhesive
bandage is used to cover the wound.
• Large pressure dressings are generally ineffective
to prevent bleeding and obscure the puncture
site.
• Additional methods to secure postprocedure
arterial hemostasis include mechanical pressure
clamps and vascular closure devices.

4. Acess site hemostasis
• A variety of vascular closure devices are currently
available.
• These devices reduce the time to obtain hemostasis
and early ambulation.
• These devices may be helpful in anticoagulated
patients and patients with back pain or an inability to
lie flat.
• All vascular closure devices should be used with
caution in patients with peripheral vascular disease or
low arterial puncture (at or below the femoral
bifurcation).

5. Acess site hemostasis
• Femoral angiography with an ipsilateral oblique angle
reveals the puncture site and any artery disease.
• Patients at high risk for groin hematoma and arterial
complications may need longer pressure application
or may benefit with a vascular closure device.

6. Characteristics and Treatment of a Protamine Reaction
Characteristics
Shaking
Flushing
Chills
Back, chest, or flank pain
Vasomotor collapse
Treatment
1. Morphine (2 mg IV) or meperidine (25 mg IV),
2. Diphenhydramine (25–50 mg IV)
3. Saline administration
4. Support of low blood pressure

7. Advantages and Limitations of closure Device

8. Appropriate Candidate for Closure Device

9. radial artery hemostasis
• sheath removal uses a plastic bracelet with
a pressure pad placed around the wrist.
• While pressing the pad over the puncture
site, the sheath is gently withdrawn and the
bracelet tightened.
• The bracelet should be tight enough to
ensure hemostasis but not occlude the flow
to the hand.

10. radial artery hemostasis
• Between 1 and 2 hours later, the patient is
checked and the bracelet is loosened.
• The patient can be discharged 2 hours later
and the bracelet removed at home.

11. Thank You All
drtoufiq19711@yahoo.com