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Determining best practice: comparison of three methods of femoral sheath removal after cardiac interventional
Linda McAlpine Benson1, Douglas Wunderly, Benjamin Perry
1Bronson Methodist Hospital, Kalamazoo, Michigan 49007, USA.
Insights
Manual sheath removal resulted in fewer complications compared to mechanical methods like Compressar and Femostop. Further research is recommended to confirm these findings for broader patient populations.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Management
Background:
- Sheath removal is a critical step after percutaneous procedures.
- Current methods include manual compression and mechanical devices.
- Optimizing sheath removal can improve patient outcomes and reduce costs.
Purpose of the Study:
- To compare the efficacy and complication rates of three sheath removal techniques: manual compression, Compressar, and Femostop.
- To determine if there is a significant difference in complications between these methods.
Main Methods:
- An experimental study design was employed with 90 patients.
- Patients were randomly assigned to one of three sheath removal groups.
- Data on patient demographics, procedural details, and complications were collected.
Main Results:
- No significant differences were observed in patient characteristics or medication use between groups.
- A statistically significant difference in complications was found, with manual sheath removal having fewer complications (P = .04).
- Post-procedure heparin infusion and activated clotting time (ACT) values were significant factors associated with complications.
Conclusions:
- Manual sheath removal appears to be associated with lower complication rates compared to mechanical devices.
- Further large-scale, multicenter randomized controlled trials are needed to validate these findings.
- Manual compression, potentially with closure devices, may offer cost savings and improved resource utilization.
Objective:
To test the null hypothesis that there is no significant difference between 3 methods of sheath removal: manual compression, mechanical compression with the Compressar, and mechanical compression with the Femostop.
Methods:
The research design was experimental. Ninety patients were randomly assigned using a random-numbers table to undergo one of 3 methods of sheath removal. The principal investigator (L.M.B.) requested the patients' consent to undergo randomization of the sheath removal. Post procedure, each patient was told which method of sheath removal he or she would undergo based on results of the random-numbers table assignment.
Results:
There were no significant differences between the groups with regard to age, body mass index, sheath size, heparin utilization, antiplatelet agents, or use of IIb-IIIa inhibitors. The complications between the methodologies for sheath removal were statistically significant. Patients who underwent manual sheath removal had fewer complications compared with those who underwent sheath removal using the Compressar or Femostop (chi2 P = .04). When complications were compared with the other parameters, only the presence of postprocedure heparin infusion (chi2 P = .014) and ACT values (Student t test P = .044) proved to be statistically significant.
Conclusions:
Based on the results of this study, staff in the study setting are currently exploring manual sheath removal as the preferred practice. Randomized controlled studies with larger sample populations at multicenter research sites are needed to ensure generalizability of results to larger populations. When using manual pressure application in conjunction with closure pad devices, hold times can be decreased, thus resulting in cost savings through decreased equipment use, earlier discharge times, and improved bed utilization.
