title: The fellows stitch: large caliber venous hemostasis in pediatric practice.
abstract: OBJECTIVE
  To analyze safety and efficiency of a subcutaneous figure of eight suture for hemostasis after large caliber venous sheath access in children.
  
  
  BACKGROUND
  Vascular complications remain a significant cause of morbidity after pediatric cardiac catheterization. In an attempt to reduce such complications and yet improve lab efficiency and decrease length of stay, various techniques have been applied to improve time to hemostasis.
  
  
  METHODS
  Prospectively recorded were vascular complications and hemostasis times in children where hemostasis was attempted using a figure of eight subcutaneous suture following large caliber venous cannulation. These were compared to a matched group achieving hemostasis using standard manual pressure techniques. Vascular ultrasound assessments were performed within 24 hr of hemostasis in both groups.
  
  
  RESULTS
  Thirty-two subcutaneous sutures were placed in 26 children, mean weights 31.9 kg [median (range): 29.4 (8.4 to 96) kg], with a mean sheath French size of 9.2 [8; (6 to 22)], 11 >10 French, compared to 33 sheaths in 30 cases using manual compression, mean sheath French size 9.1 (9; (6 to 13), with 10 cases ≥10 French. The mean and median times to hemostasis were shorter in the suture group: 13.6 min (P < 0.05) and 10 min (P < 0.05), respectively. Vascular complication rate was also lower in the suture group (n = 0) compared with the control group (n = 2) but did not achieve statistical significance.
  
  
  CONCLUSIONS
  A subcutaneous figure of eight suture hemostasis strategy can provide a safe and efficient method for large caliber venous hemostasis in a pediatric practice with improved hemostasis times and no additional morbidity.
authors: Division of Cardiology, The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Canada.
authors: Gareth J
authors: GJ
authors: Morgan
authors: Tadashi
authors: T
authors: Waragai
authors: Lucas
authors: L
authors: Eastaugh
authors: Rajiv C
authors: RC
authors: Chaturvedi
authors: Kyong-Jin
authors: KJ
authors: Lee
authors: Lee
authors: L
authors: Benson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D057785:Catheters; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005268:Femoral Vein; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects; D006801:Humans; D007223:Infant; D009864:Ontario; D011312:Pressure; D011677:Punctures; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome