Learning Objective 1: The learner will be able to compare the effect of hemostasis between hemostatic wound dressing and manual compression.
Learning Objective 2: The learner will be able to describe the quality limitations of current hemostatic wound dressing research.
Methods: Meta-analyses were conducted to evaluate the hemostatic effect of various HWDs on the femoral puncture site of percutaneous cardiac catheterization. Eight English and two Chinese electronic databases were used to search literature published up to August, 2011. Search terms used were ‘hemostatic wound pad or bandage ’, ‘angiography’, ‘puncture’, ‘angioplasty’, ‘cardiac catheterization’, and ‘ manual compression’. Studies provided comparisons between HWDs and manual compressions (MC) were included. Data were extracted by two researchers independently. Disagreement on extracted data was resolved by complete consensus between researchers. Study quality was evaluated by the Johns Hopkins Nursing Evidence-based practice Quality Rating Scale.
Results: Eight randomized controlled trials (RCTs) that met the inclusion criteria were located from 1333 articles. The total subjects involved were 2402 patients. HWDs analyzed were Clo-Sur pad, D-Stat Dry pad, Neptune pad, quickClot pad, and Star-Clos pad. Meta-analyses showed Clo-Sur pad supported an earlier ambulation than MC (Std diff in Means = -2.659, p< .001). As for the effect of hemostasis time, only D-stat Dry pad presented a stable and positive effect on the prevention (Std diff in Means = -1.158, P <.001). However, all pads showed similar but non-significant effect on preventing hematoma (Pooled OR < 1, p > .05 ).
Conclusion: The inconsistent result and insufficient evidence of each HWD made the use of HWDs debatable. While hematoma outcome presented a homogeneous result across studies, it may be reasonable to infer that the inconsistent results of time to ambulation and hemostasis time across studies might be due to measurement errors of these two outcomes.