Immediate sheath removal after PCI using a Femostop is feasible and safe. Results of a registry.
BACKGROUND
Due to antithrombotic therapy before, during, and after percutaneous coronary intervention (PCI), and due sometimes to the need for an urgent reintervention, the arterial femoral sheath is generally not removed immediately after PCI, unless a vascular closing device is used. This strategy causes discomfort to the patient, increases the workload for the nursing staff, and bears a risk of local complications.


OBJECTIVE
The purpose of this registry is to demonstrate that immediate sheath removal after PCI is safe and feasible with the ultimate goal of enhancing patient care and hospital efficiency.


METHODS
In patients undergoing PCI, the femoral arterial sheath was removed immediately after PCI in the cath lab, using a Femostop, without manual compression. The patient's discomfort and the complication rate were measured. The overall time given to haemostasis was assessed.


RESULTS
A total of 339 patients were included. Patient discomfort during Femostop placement was assessed as follows: 85% suffered none, 2% slight, 3% moderate, and 10% severe discomfort. Complication rates were: 36% ecchimosis, 10% haematoma < 6 cm, 5% haematoma > or = 6 cm (literature data of manual compression--LDMC--5.1% to 9%), 1% pseudoaneurysm (LDMC 1% to 1.8%), 0.6% need for transfusion (LDMC 2.5%), 0.3% need for vascular repair (LDMC 1.5% to 2.7%). The patient's immobilisation time after PCI was reduced from at least 10 hours to 6 hours. The time given to haemostasis was also reduced.


CONCLUSIONS
Immediate sheath removal using a Femostop is feasible, safe, and improves the patient's comfort. The complication rate is equal or even lower to that reported after classical manual compression. Early ambulation improves the patient's comfort, and reduced time given to haemostasis causes organisational benefit. If a vascular closing device is not routinely used after PCI (for example, for economical reasons), immediate sheath removal after PCI could be the routine strategy.
Jaspers
Luc
L
Catheterisation Laboratories, Hasselt Heart Centre, Virga Jesse Hospital, Belgium. Luc.jaspers@virgajesse.be
Benit
Edouard
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary; D001803:Blood Transfusion; D003327:Coronary Disease / Q000628:therapy*; D020878:Device Removal; D004867:Equipment Design; D004869:Equipment Safety; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D012042:Registries; D012086:Reoperation; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex