Paper
Saturday, July 24, 2004
This presentation is part of : Building a Research Community
Research-Based Practice: Effectiveness of Pneumatic and Clamp Hemostasis Devices in the Prevention of Vascular Complications
Quana D. Bert, ARNP, MSN, RN-C, Clinical Effectiveness, Swedish Medical Center, Seattle, WA, USA and Joya D. Pickett, RN, MSN, CCRN, Nursing, Swedish Medical Center, Seattle, WA, USA.
Learning Objective #1: Describe three characteristics of the population at risk for femoral artery complications
Learning Objective #2: Discuss which of the presented methods for achieving hemostasis -- manual, pneumatic, or clamp -- have been shown to be effective in specific clinical situations
Background: The optimal vascular access site management remains controversial. Clinical practice varies and little agreement exists on which hemostasis strategy is most effective.

Purpose: 1) To analyze empirical evidence appraising femoral artery hemostasis devices; 2) To assist in making informed decisions and planning evidence-based practice interventions.

Method: A rigorous two-tiered literature search was conducted utilizing predetermined inclusion criteria. Three studies were selected for analysis of methodologies, strengths, limitations, findings, and conclusions.

Results: When comparing hemostasis methods bleeding (hematoma, ecchymosis) and vascular (thrombosis, echogenic hematoma, AV fistula, or pseudoaneurysm) complications were clamp vs. manual (n.s., p=0.041), pneumatic vs. manual (n.s., not analyzed), and pneumatic vs. clamp (p<0.05, p=0.09). Initial bleeding was controlled when substituting pneumatic for clamp compression (p<0.01). In percutaneous coronary interventions the pneumatic device is as effective as manual pressure. Manual compression was found to be effective with a blood pressure >170, compared to pneumatic. Age (>63), weight (<78kg), and height (<171 cm) were predictive of complications. Combined factors of advanced age and reduced weight contributed to complications. Clamp over manual hemostasis prevented ultrasound defined pathologies. Physical exam alone failed to detect serious vascular complications.

Clinical Implications/Conclusions: The results indicate mechanical compressive devices are as effective as manual compression. Factors that predict bleeding complications were identified. Research supports interchanging compressive techniques to achieve arteriotomy hemostasis. Controlling blood pressure and limiting dose of acetylsalicylic acid may reduce the risk of bleeding. Patient comfort levels were comparable utilizing pneumatic or manual pressure. Considerations for future research include standard research definitions for bleeding and vascular complications, optimal blood pressure for sheath removal, and identification of the patient population requiring routine ultrasonography.

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