Novel method for radial sheath removal using manual pressure over hemostatic pad combined with ulnar compression.

OBJECTIVES: Study a novel method using manual pressure on a hemostatic pad and hemoband for ulnar compression as a potential alternative for radial sheath removal. BACKGROUND: The standard for transradial access site (TRA) sheath removal requires an inflatable pressure band over the radial artery and recently a band over the ulnar artery to reduce complications. We present a novel technique using a SoftSeal®-STF hemostatic pad over the radial artery combined with a hemoband over the ulnar artery after sheath removal. METHODS: All patients had activated clotting time (ACT); sheath removal was performed immediately upon transfer to the recovery room. A hemoband compressed the ulnar artery, radial artery flow was measured using plethysmography and pulse oximetry while direct pressure applied using SoftSeal-STF hemostatic pad for 15 min after radial sheath removed. Radial artery patency was measured using reverse Barbeau test. If radial artery occlusion (RAO) present, patient was asked to return in one month to repeat test. RESULTS: Fifty-nine patients were enrolled in the study, one-third with diabetes mellitus, one-third with prior coronary artery bypass surgery, and one-third with history of percutaneous coronary intervention. Mean ACT 261 ± 50 sec, all patients had 4 Fr sheaths and no PCI were performed. Three (6%) patients had minor bleeding requiring use of a pressure band and one (2%) had RAO, which re-canalized at one month. CONCLUSIONS: Manual pressure of SoftSeal-STF hemostatic pad combined with ulnar compression is a potential alternative to current practice with an inflatable pressure band.

Duke Scholars

Author Sunil Vadlakonda Rao Medicine, Cardiology