ACCESS

CLOSURE DEVICES

Introduction

Last updated: apr 5, 2023

Vascular access closure devices can be divided into the following categories: suture-mediated closure devices, mechanical non-suture closure devices, intra-vascular sealant devices, extra-vascular sealant devices and manual compression assistance devices. Perclose (Abbott Vascular) is an example of a suture-mediated closure device that provides a pre-tied knot for the closure of the arteriotomy site while allowing maintenance of wire access. StarClose (Abbott Vascular) is an example of a mechanical non-suture closure device. The mechanism of this device is based on a nitinol clip which approximates the adventitia of the artery. Mynx device (CardinalHealth/Cordis) provides an extravascular sealant (polyethylene glycol) while Angioseal (St. Jude Medical) provides an intravascular sealant (bioabsorbable anchor with a collagen plug). The Catalyst II and III devices (Cardiva Medical) provide adjunctive hemostasis with manual compression. Many other devices are also available.

 

Material

5 - 8 F
5 - 9 F
8,8 - 10 F
8,8 - 10 F
5 - 21 F
12 - 25 F
 

Complications

Ischemic

Lower extremity ischemia from vascular access closure devices can be related to the stenosis/occlusion of the access artery or distal embolization. Device selection according to the characteristics of the access artery is important in minimizing this complication. These complications are usually managed with open surgical exploration. Endovascular approaches have also been employed in select cases.

Hemorrhagic

The risk of hemorrhagic complications is higher if the device is deployed in a vessel with unfavorable characteristics such as dense calcifications or at an inappropriate anatomic location (above inguinal ligament). Other factors can increase the risk of bleeding including increased age, interventional procedure, and end-stage renal disease. On-going hemorrhage from device failure can lead to blood loss anemia and hemodynamic instability requiring conversion to open surgical femoral exploration particularly if wire access is no longer in place. Alternatively, if the sheath size used was small and patient is hemodynamically stable, manual compression may be applied while either allowing heparin to wear off or administering protamine to reverse the heparin that was given during the procedure. Incomplete closure can also lead to the development of pseudoaneurysm from the access site. Depending on the clinical situation and imaging characteristics, this pseudoaneurysm can be managed either with ultrasound-guided thrombin injection or open surgical exploration.

Infectious

Vascular access closure devices introduce foreign material in the body (such as braided suture, nitinol, polyethylene glycol) and this can rarely serve as a nidus for infection. Particular attention should be paid to sterile technique throughout the procedure to minimize infectious complications from closure devices.

 

Post-op

  • Depending on the size, but up to 8F 4 h bedrest.
  • Tension and rhythm control every hour for 4 h
  • 3 d no showering
  • 3 d no heavy exersize

 

Report

Radialis

Radialisband, TR band geplaatst: . De radialisband moet minimaal 2 uur om de pols blijven zitten.

1 uur na plaatsen: Verwijder 2 ml lucht met behulp van de speciale blauwe spuit uit de radialisband.

1,5 uur na plaatsen: Indien geen nabloeding, verwijder 2 ml lucht met behulp van de blauwe spuit uit de radialisband.

2 uur na plaatsen: Laat de radialisband in 1 minuut langzaam leeg lopen met behulp van de speciale blauwe spui uit de radialisbandt.

Bij een nabloeding: - Injecteer (minimaal 2ml) lucht in de radialisband tot dat de bloeding is gestopt. - wacht half uur. - verwijder daarna 2 ml lucht uit de radialisband

Bij de 3e nabloeding - overleg met de arts over vervolg beleid.

Wanneer de radialisband geheel leeg is, deze nog een half uur om laten. Wanneer er toch een nabloeding zou ontstaan kan men gemakkelijk het ballonnetje weer opblazen. Als er na een half uur geen nabloeding is ontstaan kan de radialisband worden verwijderd. De radialisband langzaam verwijderen. De radialisband NIET WEGGOOIEN!

Als de radialisband verwijderd is moet de patiënt nog 1 uur op de afdeling blijven

Voor protocol zie Zenya; https://kwaliteit.mz.local/Portal/#/document/768e4472-365c-4e85-81c1-851ef075f675

 

Literature

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