Targeting the safe zone: A quality improvement project to reduce vascular access complications

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Quality Improvement Science

Background:

• Vascular access complications during cardiac catheterization increase morbidity and mortality.
• A quality improvement (QI) program was implemented to mitigate these risks.
• The program focused on micropuncture techniques and "safe zone" femoral artery puncture.

Purpose of the Study:

• To evaluate the effectiveness of a QI program in reducing vascular complications post-cardiac catheterization.
• To assess the impact of specific procedural changes on complication rates.

Main Methods:

• Implementation of a protocol mandating micropuncture technique and "safe zone" targeting for femoral artery puncture.
• Encouragement of ultrasound guidance, radial artery approach, and vascular closure devices (VCDs).
• Analysis of data from 3120 patients (pre-QI) and 3222 patients (QI cohort).

Main Results:

• No significant difference in overall vascular complications (1.03% pre-QI vs. 0.96% post-QI).
• A trend towards reduction in hematomas (0.77% vs. 0.40%) and pseudoaneurysms (0.35% vs. 0.19%).
• Increased VCD use from 35% to 60% (P < 0.001).

Conclusions:

• Micropuncture technique and "safe zone" targeting did not significantly decrease overall vascular complications.
• A trend towards reduced hematomas and pseudoaneurysms was observed.
• Patient age and procedure type (PCI vs. diagnostic) are significant factors in complication occurrence.