Chito-seals

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.

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.

Tom

I too have seen the angioseal....I would try to google the chito seal and see what comed up.

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.

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..."

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.

CHITO-SEAL APPLICATION

1. Open Chito-Seal pouch into sterile field.
   
2. 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).
   
3. Pad may be placed over sheath hub prior to removal or placed directly over puncture site after sheath is removed.
   
4. Remove sheath following hospital protocol.
   
5. After sheath removal, maintain firm pressure.
   
6. Cover puncture site with moistened Chito-Seal pad, and apply firm pressure.
   
7. Pressure may be released at 2-3 minutes, to check for hemostasis.
   
8. Continue to apply pressure over puncture site until hemostasis is achieved, then slowly release, leaving the Chito-Seal pad in place.
   
9. Place dry gauze over Chito-Seal pad and cover with an appropriate dressing.
   
10. Within 24 hours, soak Chito-Seal pad with water and gently remove.

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!

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.