hemostasis for arterial acecss site for cardiac catheterization

Information about hemostasis for arterial acecss site for cardiac catheterization

Published on July 20, 2014

Author: toufiqurrahman52

Source: authorstream.com

Content

Hemostasis of vascular access site: 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 [email protected] Access Site Hemostasis: 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 . Acees site hemostasis: 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. Acess site hemostasis: 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). Acess site hemostasis: 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. Characteristics and Treatment of a Protamine Reaction: Characteristics and Treatment of a Protamine Reaction Characteristics Shaking Flushing Chills Back, chest, or flank pain Vasomotor collapse Treatment Morphine (2 mg IV) or meperidine (25 mg IV), Diphenhydramine (25–50 mg IV) Saline administration Support of low blood pressure PowerPoint Presentation: Advantages and Limitations of closure Device Appropriate Candidate for Closure Device: Appropriate Candidate for Closure Device radial artery hemostasis: 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. radial artery hemostasis: 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. Thank You All : Thank You All [email protected]

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