The Side-Arm Technique on Perclose (STOP) Hemostasis Method to Prevent Bleeding With Indwelling Large Bore Catheters;...

Bleeding from large-bore mechanical circulatory support catheters like Impella CP® and arterial extracorporeal membrane oxygenation (ECMO) cannulas is a significant problem with clear adverse prognosis. This study evaluated a simple mechanical strategy-the Side-arm Technique On Perclose (STOP)-to reduce bleeding.

We performed a retrospective evaluation in a series of patients managed by one operator from a community hospital with large ECMO and shock programs. The STOP method complements pre-closure with Perclose sutures; it involves threading the longer "blue" string through a cut sheath side-arm, tightening the suture around the entry site, and using the side-arm stopcock for temporary wire locking and hemostasis. This pull-push action tightens the suture loop around the device entry site, achieving hemostasis. Main endpoints included bleeding after STOP, leg ischemia needing intervention, and successful hemostasis at removal.

Among 21 patients (24 devices), all underwent pre-closure with two Perclose devices. Most devices (81%) were placed in the femoral artery; five Impella CPs used the axillary approach. STOP was started post-insertion or, in two cases, at bedside. No patients presented bleeding or oozing after STOP; no limb ischemia occurred. Only two required extra Perclose at decannulation (median 2 [1-4] days later).

The STOP method effectively prevents or controls arterial bleeding around large-bore catheters, offering a straightforward, low-cost solution with good results in this small cohort.