[ustfhh]

Does anyone have experience in the use of EZ Hold manual assist device to achieve hemostasis post femoral sheath removal? Our doctors prefers manual pressure than the use of femstop, and since i have arthritis..I am looking for a way to decrease hand injury. Does use of EZ hold device in your facility requires doctor's order? Do you know where i could buy them? Thanks a Lot.

[TennRN2004]

Originally Posted by ustfhh

Does anyone have experience in the use of EZ Hold manual assist device to achieve hemostasis post femoral sheath removal? Our doctors prefers manual pressure than the use of femstop, and since i have arthritis..I am looking for a way to decrease hand injury. Does use of EZ hold device in your facility requires doctor's order? Do you know where i could buy them? Thanks a Lot.

We use the clo-sur pads, which I think is very similar to what you're talking about. As far as MD order for pulling sheaths, it depends on what unit/what MD. In the SICU, we use the clo-sur pad almost exclusively, don't need a MD order, they don't care as long as the line gets pulled and the site looks okay, or they are notified if there are problems. In our CCU, sometimes the docs write specifically to use manual pressure, sometimes femstop, sometimes they leave that line on the order set blank and it's the RN's choice what to use.

I can tell you I see much less hematoma formation with the clo-sur pad and it would be great for your arthritis. We usually hold about 15 minutes (requires a lot less pressure too), I have never had any site problems with it, pt is mobile much quicker. In CCU I floated first femstop I ever used was horrible, pt had huge amount of bruising, hematoma formation, I would have rather used manual pressure than the femstop, but MD wanted femstop.

[ustfhh]

Thanks TennRN2004, I found the manufacturer's website on Clo-Sur Pads, and will e-mail them to see if they can market and promote that product to our hospital. I sincerely appreciate your response.

[jre]

I allways use this device every time I pull a sheath. Never had a problem. It's an easy way to apply just enough pressure to achieve hemostasis while not hurting your patient. Most other nurses I have observed and even learned from at one time apply too much pressure. My patients allways thank me for being gentle. The ones that has caths before usually remark about how my method is much more comfortable than what they had the last time. Hope this helps

[cameraman007]

Originally Posted by TennRN2004

We use the clo-sur pads, which I think is very similar to what you're talking about. As far as MD order for pulling sheaths, it depends on what unit/what MD. In the SICU, we use the clo-sur pad almost exclusively, don't need a MD order, they don't care as long as the line gets pulled and the site looks okay, or they are notified if there are problems. In our CCU, sometimes the docs write specifically to use manual pressure, sometimes femstop, sometimes they leave that line on the order set blank and it's the RN's choice what to use.

I can tell you I see much less hematoma formation with the clo-sur pad and it would be great for your arthritis. We usually hold about 15 minutes (requires a lot less pressure too), I have never had any site problems with it, pt is mobile much quicker. In CCU I floated first femstop I ever used was horrible, pt had huge amount of bruising, hematoma formation, I would have rather used manual pressure than the femstop, but MD wanted femstop.

This link on the FDA web site seems to say that the clo-sur pad is not FDA aproved for use with arteral sheath removeal

"In addition, a September 9, 2002, press release found at http://www.scioncv.com/PressReleases.html, entitled “Scion Cardio-Vascular Announces Agreement With Medtronic For Distribution Of The Clo-Sur P.A.D., An Innovative Device Used For Rapid Bleeding Control After Catheterization,” states that the device is used for rapid control of bleeding associated with all vascular access sites. The press release
refers to use of the device

for the rapid control of bleeding associated with catheter removal following a catheterization procedure such as coronary stenting, as well as other minimally invasive procedures. For the more than 5.8 million Americans each year who undergo angioplasties, cardiac catheterizations, PTCA, stenting and other minimally invasive procedures, the Clo-Sur P.A.D. represents a dramatic step forward in the healing process.

These materials suggest that this topical device can be used following a catheterization lab procedure to achieve closure of the arterial puncture site. Such uses are not included within the cleared intended uses for hydrophilic wound dressings. We invite you submit a 510(k) to support the use of the Clo-Sur P.A.D.™ for closure of the femaral artery site; however, in the absence of 510(k) clearance fur this use, your promotion of the Clo-Sur P.A.D.™ for this use creates a new inEnded use for this device that is not cleared by the FDA."

http://www.fda.gov/foi/warning_letters/g4147d.htm

This was noted in Jul 2003. perhaps it is ok to use the device now for sheath removal.

[cvryder]

I worked on a cardiac floor for several years and am just completing a travel assignment on another. On the first unit, when I started we were using the standard gauze + stretchy tape. Later down the road we went to the Syvek patch (love it!) then to Clo-Sur "because it was cheaper." Rarely used a Femstop.

On this unit, I'm back to the old gauze + stretchy tape and routine femstop use. Hate it! They had never heard of either Syvek or Clo-Sur but the assistant manager was quite interested. We seem to have more re-bleeds and hematomas here.

Correct me if I'm wrong, but the teaching hospitals where I've worked as a traveler seem to be more behind the times equipment-wise and treatment-wise than non-teaching facilities where I've worked. Why?

[ertocathlabrn]

I also have been looking where to purchase an EZ Hold device. Our cath lab RN's pull lines occasionally if a closure device cannot be used and we are all dying with hand pain afterwards. So we heard about these devices and were hoping to try one out....any help out there?

[kdecarl]

I realize that this is an old post...but I have some questions about sheath pulling. My unit is a high volume cath lab.. and in the past 3 months, our nurses have Manually pulled 366 arterial sheaths, averaging 30 per RN during this time...Some of our nurses have stopped pulling r/t injuries ...hand and wrist pain, thumb numbmess, one nurse would vagal during pulls..
Our nurses are getting hurt. Has anyone else heard of this?
Our MDs DO NOT and WILL NOT use closure devices.