Femstops

We leave it on until hemostasis has been achieved....inflate 10-20 mm Hg above the pt's SBP initally, remove the sheath (pressure is at 60-80 mm Hg at sheath removal), and maintain that pressure for 1-2 minutes (avoiding complete arterial flow stoppage for no more than 2-3 minutes). we then decrease the pressure q 5 minutes by 10 mm hg keeping a close eye on hemostasis, hematoma development, vs, and general tolerance of pt. we leave it on based upon those factors, etc as long as necessary to allow for good hemostasis. The manufacturer warns to not leave it on for inappropriately long periods to prevent tissue damage. They also advise during longer compressions that a brief interruption of at least every 3 hours is recommended.

we no longer use femostops after a sheath is pulled unless there is a growing hematoma and/or bleeding and we need to apply pressure longer than usual. its been months since we've gone back to applying manual pressure. there was a time that we had a rash of patients coming up with post intervention complications, nurses didn't agree but the cardiologists have rather unscientifically determined that it was the femostops and our techniques that were the culprit. ( we're still looking for studies out there that will prove or disprove this. does anyone know any?are you getting more complications with the femostops?). we then use the femostop for about 1 to 2 hours until we're sure that there is hemostasis, we then put on the 5lb. sandbag mainly to remind patients not to bend his knee or move his leg. i have read in one study that older people, females, emergent pcis ,underweights,lenght of time that the sheath is in place are some of the factors that determine whether or not the patient will have complications. i try and keep watch for these predictors.

Your cardiologists and the Femostop reps are telling you to DC the Femostops because of several very nasty lawsuits that happen every year and get talked about a lot at professional meetings.

Besides, manual pressure is still the safest and most cost-effective way to remove a sheath (personal opinion).

Over all we use manual pressure or clamps the most. If patients are leaving same day, uncomplicated, or movers/obese we will use some other device of the month. Femo stops are only used if the is a porblem with bleeding and manual pressure or other device has failed. I have seen nasty groin sites when the femostop has been on too long, or too tight. We don't routinely use sandbags any more. They kept disappearing and were hard to come by.

I've worked in hospitals that use femstops, clamps, and manual hand hold. I agree that it is Cardilogist preference. But I haven't seen any studies showing the benefits of one over the other.

We only use femstops with a growing hematoma or some other complication. We typically use manual or the clamp. However, the clamp is slowly being made out of practice and we are doing primarily manual. Some will do manual with a syvek. I don't use syveks because they are soooo expensive and you still are holding manual just for a shorter amount of time. After about 20 minutes of manual pressue if there is hemostasis we apply a pressure dressing and keep the leg straight, no bending etc for 6 hrs post hemostasis.

robred wrote

We leave it on until hemostasis has been achieved....inflate 10-20 mm Hg above the pt's SBP initally, remove the sheath (pressure is at 60-80 mm Hg at sheath removal), and maintain that pressure for 1-2 minutes (avoiding complete arterial flow stoppage for no more than 2-3 minutes). we then decrease the pressure q 5 minutes by 10 mm hg keeping a close eye on hemostasis, hematoma development, vs, and general tolerance of pt. we leave it on based upon those factors, etc as long as necessary to allow for good hemostasis. The manufacturer warns to not leave it on for inappropriately long periods to prevent tissue damage. They also advise during longer compressions that a brief interruption of at least every 3 hours is recommended.

I agree wholeheartedly. This is the sme way we use them

Oooo! Takin' me back! I hated to use the Fem Stops. Like a torture device for the pt! We only used it on a growing hematoma or non stop ooze.

Wondering, are there people that still sandbag?

I've had extensive use with Femostops and I love them. I've seen no complications from their proper use and I am able to chart right after their use... (versus digital pressure). The protocol we use in our institution calls for applying the pressure dressing 30 minutes after the sheath pull, if no oozing occurs when the Femostop is removed...if oozing occurs, then apply the Femstop at around 60mmHg for 1-2 hours longer.

We just went to the "new" femstops and I really like them...I seem to be able to use less pressure, have gotten fast hemostasis, and am able to take them off fairly quickly and switch to a sandbag...I usually only use manual pressure if I have a rebleed with a hematoma, thankfully I haven't had to do this alot. Mister dawg, this seems to be what we have been doing lately and it works well.

At my previous job we used femstops and as far as I am concerned they are torture devices. Some of the docs ordered four hr. fem stops and naturally the pts developed back pain from lying flat and urinary problems from not being able to void lying flat. Sometimes when we went to take them off the suction of the femstop being released would cause bleeding. Recovery time was much longer.

Where I work now we never use them, the docs either seal after heart caths or we use Destat dry while holding pressure. Far fewer complications and the pts are up much sooner.

Hmmm....sounds like improper usage of a great device to me. As far as a torture device, I think the Femostop is much more comfortable to the patient than my fingers being thrust into their groin because it has more surface area and thus the pressure is more distributed. Some of the doctors here also use Perclose, etc. in the cath lab but that is not true for all the doctors or patients. And for those patients that do rebleed, it's hard to say whether they would have rebled or not, whether pressure was held digitally or with the Femostop. A small amount of antibiotic ointment (a VERY small amount) should be applied to the center of the Femostop before it is applied to prevent it sticking to the patient when it is time to be removed, usually 30 minutes later. If too much ointment is applied, the Femostop will not remain in proper placement during the procedure, again this points to improper usage. Also, the Femostop allows for more control because it frees my hands up to do other things for my patients....And as for back pain, offer your patients something for pain, because they will be flat for awhile....basic nursing care.