Self-sealing, large bore arterial punctures: a counterintuitive new phenomenon.
The human femoral artery can bleed dangerously following the removal of a catheter uring cardiac catheterization. In this study, a modified technique of needle insertion, simply inserting the needle bevel-down instead of the standard bevel-up approach, was tested as a means to reduce bleeding after catheter removal. Large bore needle punctures were made in surgically exposed arteries of anesthetized pigs using either a standard technique (45 degree approach, bevel up) or a modified technique (25 degree approach, bevel down). For half the punctures, topical phenylephrine solution (1 mg/ml) was applied to the adventitia of the artery to cause constriction. Median bleeding rates were reduced from 81 to less than 1 ml/min/100 mmHg intraluminal pressure by the modified technique with application of phenylephrine. In most cases zero bleeding, that is self-sealing, of the arteries occurred. It is postulated that a flap-valve of tissue created by the modified technique produced this self-sealing behavior. Sophisticated modeling studies are needed to fully understand this new phenomenon.
School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907-1288, USA.
Blayne A
BA
Roeder
Charles F
CF
Babbs
William E
WE
Schoenlein
Klad
K
Kokini
Farshid
F
Sadeghi
D000818:Animals; D001158:Arteries / Q000293:injuries; D002339:Carotid Arteries / Q000187:drug effects; D020212:Carotid Artery Injuries / Q000209:etiology* / Q000517:prevention & control; D003198:Computer Simulation; D004548:Elasticity; D020342:Finite Element Analysis; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006487:Hemostasis / Q000502:physiology; D008955:Models, Cardiovascular; D009339:Needles / Q000009:adverse effects*; D010656:Phenylephrine / Q000494:pharmacology; D011677:Punctures / Q000009:adverse effects* / Q000379:methods*; D013552:Swine; D014945:Wound Healing / Q000502:physiology; D014950:Wounds, Penetrating / Q000209:etiology* / Q000517:prevention & control
D010656:Phenylephrine