title: Evaluation of a structured training program for arterial femoral sheath removal after percutaneous arterial catheter procedures by assistant personnel.
abstract: After cardiac catheterization procedures, arterial closure can be achieved by manual compression (MC), using external mechanical compression devices, or by applying vascular closure devices (VCDs) with comparable vascular access site-related complication rates. The aim of the present study was to assess vascular access site-related complications during the implementation of structured sheath removal and MC by paramedics after catheterization procedures. After an observational phase of 3 months to assess the baseline complication rate, a structured 4-level training program was implemented to train assistant personnel, in this case paramedics, in the management of sheath removal by MC. Access site-related complication rates after sheath removal were assessed prospectively and MC by paramedics compared with MC by physicians and application of VCDs. To account for imbalances in procedure- and patient-related risk factors of access-site complications, propensity score-based matching analysis was performed (ClinicalTrials.gov identifier NCT00825331). All consecutive percutaneous transfemoral arterial cardiac catheterization procedures were prospectively assessed over a period of 8 months (n = 3,503). MC was performed in 2,315 cases, of which 180 were performed by paramedics and 2,135 by physicians; VCDs were applied in 1,188 procedures. Rates of access site-related complications were significantly lower for paramedics compared with physicians (p = 0.03) and similar between paramedics and VCDs (p = 0.77). In conclusion a structured program for paramedics to be trained in sheath removal after percutaneous cardiac catheterization procedures can be readily implemented during clinical routine with low in-hospital complication rates.
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany. Electronic address: emilia.stegemann@t-online.de.
authors: Emilia
authors: E
authors: Stegemann
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
authors: Lucas
authors: L
authors: Busch
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
authors: Berthold
authors: B
authors: Stegemann
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
authors: Thomas
authors: T
authors: Lauer
authors: Division of Cardiology and Angiology, St. Bonifatius Hospital, Lingen, Germany.
authors: Rainer
authors: R
authors: Hoffmann
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
authors: Christian
authors: C
authors: Heiss
authors: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
authors: Malte
authors: M
authors: Kelm
mesh_terms: D000368:Aged; D000488:Allied Health Personnel / Q000193:education*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D020878:Device Removal / Q000193:education*; D004517:Education, Professional / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010823:Physician Assistants / Q000193:education*; D015397:Program Evaluation; D011446:Prospective Studies; D015203:Reproducibility of Results