Cardiac Cath Closure Devices....What Is the Difference?

[Michifura]

Can you please explain the difference between the closure devices used after cardiac cath.

I often get report from cath lab saying: perclose, starclose, or angioseal in place. What is the difference, why use one over the other?

I also notice pts come back with different bedrest times: 2 hrs, 4 hrs, 6 hrs, etc; why does that vary? does it have to do with the closure device that was used?

Yesterday, during report the cath lab nurse mentioned "the perclose did not take, pt will probably be going back with a femstop". The pt did not return with a femstop, only pressure dressing which two hours later I ended up changing, holding pressure, applying chitoseal and a sandbag.

I have not had a pt with a femstop. If the pt had returned with a femstop in place what would I have to do?

Thanks!!!!

[dianah, ASN]

Below are two sites I found in a web search.

One is an RN's posted list of vascular closure devices and how they work (minus starclose).

The other is a suggested sheet of MD orders post-FemStop.

http://rnbob.tripod.com/vascularclosuredevices.htm

http://www.resourcenurse.com/Referencemtls/policiesandprocedures/Critcare/FemoStop_MD_orders.doc

StarClose is presented in the following link, by Abbott:

http://www.abbottvascular.com/content/en_US/10.10.395:395/product/Abtdiv_Product_Profile_0080.htm

We do only diagnostic caths (no stents), and most of our MDs prefer AngioSeal as a vascular closure device.

* Bedrest X2 hr post-deployment.

If AngioSeal may not be used (there were multiple arterial sticks trying to gain access, the artery was too small or too diseased for deployment, or the arterial stick was too low), we use a Clo-Sur P.A.D. (like a chitoseal) followed by 3-4 hr of bedrest (4 if the MD is concerned about post-cath bleeding, i.e., s/he had to hold pressure for longer than 10-15 min postcath).

We used Starclose for awhile, had some problems with its deployment and no one has used it in about a year. When we used it, bedrest was still 2 hr (vendor's rep said it could be 1 hr, but we're conservative).

Same with Perclose (as I recall, its deployment was very painful for the pt): bedrest X 2hr post-deployment.

Our protocol allows for the pts to have HOB elevated slowly to (up to) 30 degrees during the 2 hr of bedrest (the AngioSeal and StarClose vendors told us the seal works better if HOB is elevated that 30 degrees).

Hope this helps. :)

[nerdtonurse?, BSN, RN]

All I can add is that the folks I've seen with starclosures seem to report more pain after the cath, but that may just be our docs, not the closure....

[Smarta13]

All I can add is that the folks I've seen with starclosures seem to report more pain after the cath, but that may just be our docs, not the closure....

No I don't think its your docs. Patients here who are starclosed report more groin pain verses angioseal or even manual pressure.