1. Vascular Closure Devices vs
Vascular Closure Devices vs. Manual Compression Vascular Closure Devices: The New Gold Standard
KENNETH A. GORSKI, RN, RCIS, RCSA, FSICP Cleveland Clinic Heart and Vascular Intstitute Cleveland, Ohio

2. Kenneth A. Gorski, RN, RCIS, RCSA, FSICP
I disclose the following:
Regina Deible CONNED me into this. I believe there are appropriate applications for both Manual Compression and Vascular Closure Devices. Square pegs will not fit into round holes without the aid of a hammer. Now, I have Seven Minutes to convince you otherwise.
On top of that, nobody told me upfront I would be debating my friend Michael Guiry. “Oh, by the way “
Over the years, I have done lectures and consulting for the Medicines Company, St. Jude, HemCon, Volcano, and a number of other companies willing to buy me a Starbucks coffee, dinner, or pay me a paltry fee compared to what they will pay physicans. So, I have no real or apparent conflicts of interest to report r/t this lecture
None of this reported above will impact my ability to present an unbiased presentation

3. Manual Compression Is it really “The Gold Standard” in Sheath Removal?
MC has a 60 year track record
Very little published information on proper technique
Technique varies from institution to institution, even person to person

4. Hematoma Post Manual Compression
picture gallery accessed 2/8/2010

5. Compression Vascular Closure Devices
Compression Devices
“C-Clamps” and “Manual Assists”
CompressAR – Advanced Vascular Dynamics
QuicKlamp – TZ Medical
EZ-Hold (TZ Medical)
Compass (Advanced Vascular Dynamics)
FemoStop (St. Jude)
SafeGuard (Datascope/Maquet)
Topical Hemostasis Accelerators
Syvek – Marine Polymers
ChitoSeal – Abbott Vascular
Clo-Sur P.A.D. – Scion CV/Medtronic
V+Pad – Angiotech
HemCon – HemCon/Cardinal Health
Many, many more

6. Pseudo-Mechanical Vascular Closure Device
Cardiva Boomerang/Catalyst products are designed to allow smooth muscle recoil around the puncture, “shrinking” the arteriotomy and reducing manual hold time (Catalyst III coated with Protamine to accelerate tract clotting)

7. Mechanical Vascular Closure Devices
Collagen / Gelfoam Plugs
AngioSeal (St. Jude Medical)
VasoSeal (St. Jude – Limited availability)
QuickSeal (SubQ; no longer available)
Tissue Tract “Sealers”
Duett (Vascular Solutions – viscous thrombin/collagen procoagulant)
Mynx (Access Closure)

8. Mechanical Vascular Closure Devices
Percutaneous Suture Devices
Perclose Products (Abbott Vascular)
Percutaneous Vascular Staples
StarClose (Abbott Vascular)

9. Why Vascular Closure???

10. Hemostasis Success Rates
Manual Compression
100% Successful All bleeding stops Eventually
Vascular Closure Devices
High Success Rates for both Diagnostic and PCI
* Success difficult to assess d/t No Standardized Definition for Hemostasis in VCD Trials and Registries

11. Time to Hemostasis Manual Compression Vascular Closure Devices
10-15 minutes dependant on sheath size
15+ minutes larger sheaths, obese patients, chronic renal insufficiency, and other associated risk factors
Interventional patient require 2 or more hours for anticoagulation to wear off prior to sheath removal
Vascular Closure Devices
Immediate Gratification
Hemostasis within a couple minutes of the end of the procedure

12. Bedrest and Time to Ambulation
Manual Compression
Bedrest dependent on sheath size and age of physician (some physicians still practice 1 hour bedrest per French size)
Interventional patient supine or head of bed < 30O for 2 or more hours until anticoagulation wears off for sheath removal
Post sheath removal additional bedrest, many cases overnight
Vascular Closure Devices
Bedrest 1-2 hours for diagnostic; some cases immediate ambulation after sedation worn off
Interventional patients supine or head of bed < 45O for 2-4 hours
Dependent on physician, may sit up on side of bed or ambulate after 4 hours (many will not allow to ambulate until next morning)

13. Patient Comfort Manual Compression Longer bedrest
Back pain in many patients
Improper/Poor technique – Fisting / “Gorilla Groin”
Obesity
High Sticks
Renal dysfunction
Large sheaths
All lead to prolonged manual compression and extreme patient discomfort

14. Gorilla Groin!

15. Patient Comfort Vascular Closure Devices
“Frequent Flyers” most often prefer VCD over Manual Compression
Some patients report tugging, pressure associated with device deployment as most painful part of procedure
Primary effect of conscious sedation generally worn off when device deployed

16. Very Operator Dependent
Manual Compression
Very Operator Dependent
Poor Technique = Poor Hemostasis
= Poor Outcome

17. Mechanical Closure Devices
Also Operator Dependent, however
Newer generation devices are easier to use, eliminated excess steps, and have less operator variability

18. Poor Technique = Poor Hemostasis
NO MATTER
WHAT METHOD IS USED
Poor Technique = Poor Hemostasis
= Poor Outcome

19. #1 Risk Factor for Femoral Access Site Complications
OBESITY
Do you want to hold THAT groin?

20. Bring in this guy for that hold . . .

21. Just say NO! GO RADIAL!

22. Please Support the Gorski Boy’s College Fund
Jonathan Gorski -
High School Freshman
Eats non-stop
Kenny Gorski –
High School Senior
Class of 2010
David Gorski – Malone University
Triple Major
Music Ed/Gen Ed/ Poli Sci

23. THE END !