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Review paper
Published online: 2022-06-20
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New approaches to achieving hemostasis after venous access in cardiovascular patients

Khalid Bin Waleed1, Lisa MW Leung1, Zaki Akhtar1, Manav Sohal1, Zia Zuberi1, Mark M Gallagher1
DOI: 10.33963/KP.a2022.0148
·
Pubmed: 35724337
Affiliations
  1. Department of Cardiology, St. George’s University Hospital NHS Foundation Trust, London, United Kingdom

open access

Online first
Review
Published online: 2022-06-20

Abstract

Recent decades have seen a series of advances in percutaneous transvenous procedures for cardiac arrhythmias, including the implantation of leadless pacemakers. Many of these procedures require the insertion of large caliber sheaths in large veins, usually the femoral vein. Securing hemostasis efficiently and reliably at the access site is a key step to improving a procedure’s safety profile. Traditionally, hemostasis was achieved by manual compression to venous access sites, but the trend toward larger sheaths and the increased use of uninterrupted anticoagulation has strained the limits of this method. Achieving hemostasis by compression alone in these circumstances requires more attention and a longer duration, leading to greater patient discomfort and prolonged immobility. In turn, manual compression may be more time-consuming for medical professionals and increase occupied hospital beds. New approaches have been developed to facilitate early ambulation, decrease patient discomfort, and address the risk of access site complications. These approaches include vascular closure devices and subcutaneous suture techniques including figure-of-eight and purse-string sutures. This article reviews the new approaches applied to achieve venous access site hemostasis in patients undergoing transvenous procedures for cardiac arrhythmias.

Abstract

Recent decades have seen a series of advances in percutaneous transvenous procedures for cardiac arrhythmias, including the implantation of leadless pacemakers. Many of these procedures require the insertion of large caliber sheaths in large veins, usually the femoral vein. Securing hemostasis efficiently and reliably at the access site is a key step to improving a procedure’s safety profile. Traditionally, hemostasis was achieved by manual compression to venous access sites, but the trend toward larger sheaths and the increased use of uninterrupted anticoagulation has strained the limits of this method. Achieving hemostasis by compression alone in these circumstances requires more attention and a longer duration, leading to greater patient discomfort and prolonged immobility. In turn, manual compression may be more time-consuming for medical professionals and increase occupied hospital beds. New approaches have been developed to facilitate early ambulation, decrease patient discomfort, and address the risk of access site complications. These approaches include vascular closure devices and subcutaneous suture techniques including figure-of-eight and purse-string sutures. This article reviews the new approaches applied to achieve venous access site hemostasis in patients undergoing transvenous procedures for cardiac arrhythmias.

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Keywords

catheter ablation, percutaneous cardiac catheterization procedures, leadless pacemaker, suture techniques, manual compression

About this article
Title

New approaches to achieving hemostasis after venous access in cardiovascular patients

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Review paper

Published online

2022-06-20

Page views

83

Article views/downloads

54

DOI

10.33963/KP.a2022.0148

Pubmed

35724337

Keywords

catheter ablation
percutaneous cardiac catheterization procedures
leadless pacemaker
suture techniques
manual compression

Authors

Khalid Bin Waleed
Lisa MW Leung
Zaki Akhtar
Manav Sohal
Zia Zuberi
Mark M Gallagher

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