Perclose angiograms

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Mar 6, 2001

Anyone know anything useful to tell me about perclose angiograms. I am familiar with angioseal and the standard angiogram seal, but not perclose. Heaven forbid that we may actually get inserviced on it before 9 out 10 heart caths get brought up to us with it. I am particularly interested in complications percentages and any tips to tell patients. Thanks

NCNocRN · Mar 6, 2001

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.

Going Home

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.

NCNocRN · Mar 6, 2001

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.

Going Home

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.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Mar 6, 2001

Thanks for the info. Acutally in the last two weeks I know for sure that we have already had 2 that failed and resulted in surgical intervention. Another patient came up with a four by four under the tegaderm at site. How are you supposed to assess a patient for hematoma or bruit? I heard "oh, you can still feel for a hematoma through the four by four". Un,hunh right? This practice done anywhere else?

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Mar 6, 2001

Thanks for the info. Acutally in the last two weeks I know for sure that we have already had 2 that failed and resulted in surgical intervention. Another patient came up with a four by four under the tegaderm at site. How are you supposed to assess a patient for hematoma or bruit? I heard "oh, you can still feel for a hematoma through the four by four". Un,hunh right? This practice done anywhere else?

sharann, BSN, RN · Mar 6, 2001

Hi Joy,

I thought your info on the perclose was great. Unfortunately, my prob is the opposite of moonshadeau's. Do you (or any readers) know where I can find info on the Angioseal care. Is this the same as "femstop"? Our CVU has more percloses coming up from Cath Lab now, but I am fairly new at this, and the other RN's I asked weren't sure if ther's actual written info out there about this.

Thanks,

sharann (Sharon)

sharann, BSN, RN · Mar 6, 2001

Hi Joy,

I thought your info on the perclose was great. Unfortunately, my prob is the opposite of moonshadeau's. Do you (or any readers) know where I can find info on the Angioseal care. Is this the same as "femstop"? Our CVU has more percloses coming up from Cath Lab now, but I am fairly new at this, and the other RN's I asked weren't sure if ther's actual written info out there about this.

Thanks,

sharann (Sharon)

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Mar 7, 2001

Angioseal care I know fairly well. Angioseal is the same procedure as the angiogram. The only difference is if the angioseal is used, most likely the arteries are clean and no other surgical intervention is required. Angioseal can only be used if the MD got in with one try, like an IV start. If they went through the fem artery at all this can't be used. The actual angioseal is a collagen plug that is inserted during closing. This plug works like a drain stop. The plug dissolves in about 6 weeks. It is important to flag the chart or tell the patient to carry the card that is given to them on discharge. If they go home and come back, a heart cath can't be done on that side. It won't go in because of the plug until it dissolves. The angioseal comes up to our floor still attached to a tension device, once they reach the room, the tension device is released and the collagen plug is deployed. Then the site is covered with a tegaderm. Of course monitoring for hematoma, bruising and bleeding with frequent vital sign checks are important. The angioseal can still fail and the person can develop a retroperitoneal bleed or pseudoanurysm. The advantage of an angioseal is that usually the bedrest is 2-4 hours. Then if there are no complications the patient is discharged. The same discharge instructions for the perclose above are for the angiogram. I hope that helps some.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Mar 7, 2001

Angioseal care I know fairly well. Angioseal is the same procedure as the angiogram. The only difference is if the angioseal is used, most likely the arteries are clean and no other surgical intervention is required. Angioseal can only be used if the MD got in with one try, like an IV start. If they went through the fem artery at all this can't be used. The actual angioseal is a collagen plug that is inserted during closing. This plug works like a drain stop. The plug dissolves in about 6 weeks. It is important to flag the chart or tell the patient to carry the card that is given to them on discharge. If they go home and come back, a heart cath can't be done on that side. It won't go in because of the plug until it dissolves. The angioseal comes up to our floor still attached to a tension device, once they reach the room, the tension device is released and the collagen plug is deployed. Then the site is covered with a tegaderm. Of course monitoring for hematoma, bruising and bleeding with frequent vital sign checks are important. The angioseal can still fail and the person can develop a retroperitoneal bleed or pseudoanurysm. The advantage of an angioseal is that usually the bedrest is 2-4 hours. Then if there are no complications the patient is discharged. The same discharge instructions for the perclose above are for the angiogram. I hope that helps some.

sharann, BSN, RN · Mar 7, 2001

OOOOHHHHHHH, I get it. Thanks Moonshadeau! That's why my orienting RN was pissed at the nurse from Same Day Surgery. The "spring"was clipped over ther, and then when he arrived on our unit,she cut the angioseal.My preceptor said that the spring should have remained on until time to cut.

I appreciate the thoughroghness of you answer. If I could just ask one more thing(?), is "femostop" different?

Thanks again!

sharann, BSN, RN · Mar 7, 2001

OOOOHHHHHHH, I get it. Thanks Moonshadeau! That's why my orienting RN was pissed at the nurse from Same Day Surgery. The "spring"was clipped over ther, and then when he arrived on our unit,she cut the angioseal.My preceptor said that the spring should have remained on until time to cut.

I appreciate the thoughroghness of you answer. If I could just ask one more thing(?), is "femostop" different?

Thanks again!