In the CCU I work in, when we pull a sheath, we hold manual pressure x 25-30 min and apply wedge for 6-10 hrs depending on physician.
Recently, something called a Chito-Seal has been introduced to us. Supposedly, they get platalet aggregation to occur fairly quickly at the sheath site. Apparently the cath lab and regular floors that pull sheaths have been using them. Is anyone familiar with using the chito-seal? If so, what are the results like?
One nurse who uses them said she only has to hold pressure for about 8 min or so when using them. I have to admit, going from holding pressure for 30 min to only 8 min seems a bit scary...esp when I've already experienced a spurting episode in the past.
Nov 19, '07
I've heard of these seals being used in the ER for control of hemorrhaging, but never heard of its use in the Cath Lab. We use either the AngioSeal or PerClose device which requires NO manual pressure and the patient can be out of bed in 2 hours. However, the cardiologist is required to learn how to deploy the device and sometimes it fails. The nurse still needs to monitor the site for oozing and hematoma formation especially important if the patient is on IV GIIB/IIIA inhibitors post-cath.
Nov 20, '07
Sounds kind of iffy. I thought I had heard the Chito-Seal is more of a battlefield dressing used to contain severe bleeding in major trauma. I could be wrong though. Sounds like it provides surface hemostasis vs deep hemostasis. Would be curious to hear more about it.
Nov 20, '07
I too have seen the angioseal....I would try to google the chito seal and see what comed up.
Dec 12, '07
Chito seals are wonderful. I use them on every Art line (from Cath Lab not like radial art lines) on every pull. Our policy...One nurse holds the chitoseal at puncture site and hold moderate pressure 2-3min, while the other holds proximal (arterial) pressure for 5-10min while checking distal circulation and for the formation of a hematoma. I have had to hold pressure as long as 37min at which time we used a C-clamp. I have only had one experience when the chitoseal didnt work. IMHO.
Dec 24, '07
Apparently we're using the Chitoseals wrong, from reading this thread. You hold it over the puncture site immediately after pulling the sheath, along with the manual pressure? Do you wet it with saline first?
Our nurses hold pressure until bleeding stops completely (20-30 minutes in my short experience), THEN places the wet Chitoseal and dressing over the site. If that's completely wrong, no wonder we all say, "These don't seem to do anything, but we use them anyway..."
Dec 26, '07
We don't use it in the manner you've suggeseted. Our policy it to hold pressure over that artery (to slow blood to the puncture site). This is done by one RN finding the pulse above the site (either manually or using a doppler) while the other RN holds the puncture site with the Chito Seal. This RN is usually able to check distal circulation and for formation of a hematoma and other complications as the occlusive pressure held on the Chitoseal I feel can typically be done with usually one strong hand. The arterial pressure usually needs more. Do not completely occlude the artery. You will find the following instructions to be directly from the abbott site (the maker of Chitoseal). In one of the steps it notes that one can use a flash a blood to dampen the device. Personally this is what I do, I like it. Hope this helps/makes sense.
- Open Chito-Seal pouch into sterile field.
- Moisten Chito-Seal pad or puncture site with sterile saline (NOTE: A small flash of blood from the tissue tract may be used instead of sterile saline to moisten the pad. Use this method prior to step 6).
- Pad may be placed over sheath hub prior to removal or placed directly over puncture site after sheath is removed.
- Remove sheath following hospital protocol.
- After sheath removal, maintain firm pressure.
- Cover puncture site with moistened Chito-Seal pad, and apply firm pressure.
- Pressure may be released at 2-3 minutes, to check for hemostasis.
- Continue to apply pressure over puncture site until hemostasis is achieved, then slowly release, leaving the Chito-Seal pad in place.
- Place dry gauze over Chito-Seal pad and cover with an appropriate dressing.
- Within 24 hours, soak Chito-Seal pad with water and gently remove.
Dec 28, '07
That sounds like the Syvek patch we used at one hospital I worked at. I liked them a lot. We then switched to the Clo-sur patch which you wet with a small bit of arterial blood, then hold over the wound firmly while holding pressure on the artery above it. Generally one nurse did it by themselves because we never had enough staff for 2 to be in the room. If your hands are big enough it's possible to do a Clo-sur one-handed...mine are NOT!
Dec 28, '07
Is anyone familiar with star-closure??It is a devise that the doc places in the cath lab to prevent bleeding and hematoma. I have seen that the nurses no longer need to apply manual pressure with it, but not all the docs use it--I am not sure why. I have seen chito seal used often in my former facility.
Dec 28, '07
StarClose is a vascular closure device, a titanium "star" that squeezes together the edges of the hole in the artery (after a cath).
Vendor instructs the MDs to enlarge the hole made by the catheters and then deploy the StarClose.
Because the hole is enlarged, site oozing after deployment may occur, and should be controlled or corrected with moderate pressure to the site.
The vendor will tell you that pts may ambulate 20 min after deployment.
Indeed, we were instructed to have the pt give a healthy cough and then flex his leg in order to test the StarClose effectiveness!
We still order 2 hr bedrest for pts on whom StarClose was used.
There are a few instances NOT to use StarClose (or Angio-Seal, for that matter):
*if the artery access is at the bifurcation of the internal and exernal iliac arteries
*if the artery is a very small artery (the same size as the catheters used)
*if there is vascular disease in the vicinity of the arterial access
*if there is a placque near the arterial access.
The femoral artery ("stick site") is injected with a small amount of contrast sometime during the case (usually at the end), and the artery in question is imaged under fluoro, to check for any of the above conditions which might preclude deployment of a vascular closure device.
In our Lab, if we're not deploying a closure device, we resort to manual pressure with a Clo-Sur P.A.D.
It has to come in contact with blood, is a 10-min hold (gradually decreasing pressure, so the last two min are very light digital pressure) and a 3-hr bedrest (with affected leg still); pt may have his head elevated 30 degrees max (which is SO much better than FLAT in bed!).
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