Time to hemostasis: a comparison of manual versus mechanical compression of the femoral artery

Abstract

BACKGROUND: Compression of the femoral artery to achieve hemostasis is necessary following angiographic and interventional cardiovascular procedures. OBJECTIVES: To evaluate length of time to hemostasis with manual versus mechanical compression of the femoral artery. METHODS: In a prospective study of 503 patients randomized into one of three groups, manual compression with a pressure dressing or vascular stasis button was used on groups 1 and 3, respectively. Mechanical compression with a pressure dressing was used on group 2. The length of time to hemostasis was measured in minutes. Demographic data, current medications, risk factors, laboratory values, and procedural data were analyzed. RESULTS: Mean time to hemostasis was 22 minutes with manual compression and 31 minutes with mechanical compression. Crossover from mechanical to manual compression to achieve hemostasis occurred in 21 of 168 patients (13%). CONCLUSIONS: Results of this study show that advantages of manual compression include shorter time to hemostasis, no requirement for special equipment, and the ability to remove arterial and venous sheaths simultaneously. Disadvantages include upper extremity fatigue and human resource considerations. If the operator is a nurse, the cost of compression increases and the ability to meet patient needs may be restricted. Although mechanical compression is a "hands free" approach, arterial hemostasis is prolonged, special equipment is required, and the total cost per procedure is higher.

Comparison of the FemoStop device and manual pressure in reducing groin puncture site complications following coronary angioplasty and coronary stent placement

“…A mechanical technique, the C‐clamp compression device, was first introduced in 1974 and functions much like a C‐clamp used in carpentry 15–17 . It provides the application of constant pressure while maintaining limb perfusion, and frees up the operator to provide monitoring by only one nurse 17 .…”

“…However, it introduces the risk of malpositioning, which may result in failure to achieve haemostasis 15 . The C‐clamp was compared to manual compression in a number of studies, which generally reported no significant differences in femoral vascular complication rates 15–20 . However, disproportionate sampling designs and small sample sizes might make external validity and reliability questionable.…”

Usefulness and safety of the “God’s Hand” pneumatic compression device for hemostasis in femoral catheterization

“…After successful hemostasis by manual compression, 4-6 h of bed rest is required for complete hemostasis prior to ambulation, depending on the size of the sheath or catheter used, or the use of antiplatelets or anticoagulants during the procedure (5). Manual compression has dis- advantages such as being highly time consuming, causing fatigue of the hand and arm, and requiring nursing assistance to monitor the patient (12,13). To overcome the disadvantages of manual compression, other hemostatic methods, such as arterial closure devices (ACDs) and mechanical compression devices, have been developed (5,6,12,13).…”

Low‐Dose Protamine to Facilitate Earlier Sheath Removal from the Femoral Artery After Peripheral Endovascular Intervention

“…18 At the inception of PEI, the standard procedure for closure of the femoral catheterization site was manual pressure and several hours of bedrest. 19,20 The advent of vascular closure devices (VCD) decreased the time to hemostasis and ambulation, but has not decreased the incidence of vascular complications. 4,17 VCD are convenient because they allow for immediate removal of the arterial sheath, but our novel protamine-assisted sheath removal has a similar incidence of complications compared to other studies of access site complications.…”

“…During past 3 decades, PEI emerged as an alternative to peripheral bypass surgery for many patients with PAD 18 . At the inception of PEI, the standard procedure for closure of the femoral catheterization site was manual pressure and several hours of bedrest 19,20 . The advent of vascular closure devices (VCD) decreased the time to hemostasis and ambulation, but has not decreased the incidence of vascular complications 4,17 …”