Perclose was introduced at our facility a few months back, and we frequently have cases on our floor for us to monitor overnight as the patients also frequently receive IV anti-platelet inhibitors (such as Reapro, Integrilin, or Aggrastat) for 12-18 hours post-procedure. I have not personally seen or heard of any complications with Perclose. One nurse stated from her prior experience with Perclose that there is an increased risk for retroperitoneal bleeds. I am cautious, but so far I have not seen this. On the positive side, patients are up faster (bedrest up after only 2 or 3 hours!). With this procedure, as with all post-caths, carefully and frequently monitor pt hemodynamics and groin site (auscultate site for bruits), pulses, perfusion and over all skin appearance (skin pink, warm, dry). If a pt complains of pain in the lower back, keep in mind the possibility of a retroperitoneal bleed--this may be more than just discomfort from laying flat.
Here's some pt info:
Understanding Perclose Suture Mediated Closure
A Patient Guide
Suture Mediated Closure (SMC)
Suture Mediated Closure (SMC) is a new procedure which allows your doctor to close the femoral artery access site (opening in femoral artery) following your diagnostic or interventional catheterization procedure.
Your doctor will perform the catheterization procedure through the skin (percutaneously) using vascular catheters (small flexible tubes) designed to open the blockage. The vascular catheters are introduced and advanced to the blockage in your coronary or peripheral artery through a small access site in either your right or left femoral artery. At the end of the catheterization procedure your physician will use the SMC Device to perform another procedure which closes the small opening in the femoral artery with one or two stitches.
How Does SMC Compare with Conventional Treatment?
Before the SMC Device was available, the femoral artery was closed by applying direct pressure to the access site (compression) anywhere from fifteen minutes up to one hour. Applying direct pressure to the access site compressed the femoral artery allowing a blood clot to form in the opening of the femoral artery which closes the site. Any movement could dislodge the blood clot resulting in bleeding from the femoral artery, so it was necessary to remain immobile for 4 to 8 hours after compression was removed. Another method for closure of the access site involves plugging the site with collagen.
The SMC Device does not rely on blood clot formation to close the opening in the femoral artery. Instead, the stitch placed around the femoral artery closes the access site. Since blood clot formation is not required to close the opening, patients who receive SMC may sit up in bed soon after the procedure rather than having to lie flat in bed for 4 to 8 hours. Depending on the results of the catheterization and the SMC procedure, patients usually may get out of bed sooner than when compression is used to close the femoral artery.
The SMC Procedure
The SMC procedure is performed by introducing the SMC Device through the opening in the femoral artery. The SMC Device allows the physician to put one or two stitches in the femoral artery to close the opening.
The stitches delivered by the SMC Device are the same as those used over several years in blood vessels and other surgical procedures. Therefore the stitches are safe for both short and long term use.
What to Expect During the SMC Procedure
The time of the SMC procedure may depend on the amount of scar tissue you may have from previous catheterization procedures. It may take longer to place the SMC Device if there is significant scar tissue from previous procedures.
Prior to the SMC procedure, your physician will administer a local pain medication to ensure that any discomfort is minimal. During the introduction of the SMC Device you will feel some pressure as your physician exchanges the introducer sheath used for your catheterization with the SMC Device. This pressure generally is not uncomfortable and lasts for just a few seconds. Most patients do not experience any discomfort during the SMC procedure. A few patients will feel some momentary discomfort when needles and stitches pass through the artery wall or when the surgical knots close the opening in the femoral artery.
Saline (sterile water) is used to saturate the stitches prior to advancing them to the artery and you may feel the cold water on your leg when the saline is applied.
At the end of the SMC procedure a small dressing will be applied to the opening in the skin.
After the SMC Procedure
After the SMC procedure you will be moved to a post procedure care area or a standard hospital room depending on your catheterization procedure and whether you will be sent home later in the day or remain in the hospital overnight. Your heart rate, blood pressure and pulses will be monitored and the access site will be checked regularly for any bleeding.
In most cases you will be able to sit up in bed soon after the SMC procedure and your doctor may allow you to get up to use the bathroom. This will be dependent on the results of your catheterization, the use of a venous sheath (vascular catheter in the femoral vein), the medications administered during the procedures, and any oozing from the opening in the skin. Some oozing from tissue may occur if you have received blood thinners and other medications which prevent blood clotting. Light compression may be applied to control oozing.
Your physician will tell you about any limitations in activities and how to take care of the groin access site. In general, you should limit any heavy lifting (greater than 10 lb.) for one week to allow for complete healing of the opening in the skin. Clean the access site by washing with soap and water to minimize any risk of infection. Keep the site clean and dry.
Any bleeding from the groin should be reported to your physician immediately. Any increased oozing or oozing which persists should also be reported to your physician immediately.