Safe implementation of an expedited radial hemostatic compression device removal protocol in the cardiac...

Hemostatic compression devices (HCDs) are routinely used following transradial catheterization to reduce bleeding risk. However, prolonged compression times can increase the likelihood of radial artery occlusion (RAO) and delay patient throughput in the cardiac catheterization laboratory (CCL).

At a single tertiary care center, we implemented an expedited HCD weaning protocol that halved the time to initial deflation for diagnostic procedures (from 120 to 60 min) and percutaneous coronary intervention (PCI) (from 240 to 120 min). This was a prospective, sequential pre-post implementation study in which patients were enrolled consecutively during each study phase. The protocol utilized expedited serial partial deflations to achieve faster hemostasis while maintaining safety. We recorded timestamps, HCD deflation details, and complications, defined as bleeding, severe hematomas, need for blood transfusion, surgical consultation, or unplanned admission. Rates of complications and times to HCD removal and CCL discharge were compared before and after protocol implementation.

A total of 397 patients were included (original protocol n = 200; expedited protocol n = 197). In the entire cohort, mean time to HCD removal decreased from 192 ± 60 to 150 ± 48 min (p < 0.001), and mean time to CCL discharge decreased from 198 ± 54 to 162 ± 60 min (p < 0.001) with the expedited protocol. Rates of serious complications (0.5% vs. 0.0%; p = 0.320) and overall bleeding or hematoma (16.5% vs. 18.3%; p = 0.692) were similar between groups. In the PCI subgroup (n = 58), time to HCD removal (270 ± 30 vs. 210 ± 42 min; p < 0.001) and time to discharge (288 ± 30 vs. 234 ± 60 min; p < 0.001) were also significantly shortened with no serious complications reported. While bleeding events in PCI patients trended higher in the expedited group (8.3% vs. 23.5%; p = 0.171), the difference was not statistically significant.

An expedited HCD weaning protocol safely reduced CCL length of stay in transradial catheterization without increasing bleeding or serious complications. This approach may improve procedural efficiency and patient throughput.