A randomized comparison of modified subcutaneous “Z”‐stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal
Objectives To compare subcutaneous “Z”‐stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency. Background Structural interventions increasingly require large caliber venous access, for which convenient, safe, and ef...
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| creator | Pracon, Radoslaw Bangalore, Sripal Henzel, Jan Cendrowska‐Demkow, Iwona Pregowska‐Chwala, Barbara Tarnowska, Agnieszka Dzielinska, Zofia Chmielak, Zbigniew Witkowski, Adam Demkow, Marcin |
| description | Objectives
To compare subcutaneous “Z”‐stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency.
Background
Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. “Z”‐stitch has been introduced for this purpose in some centers but systematic data on its performance is limited.
Methods
This single center study randomized consecutive patients with femoral venous access sites requiring ≥10F sheaths to the “Z”‐stitch or manual compression for hemostasis in a 2:1 fashion. There were three co‐primary endpoints: time to hemostasis, time to ambulation, and a composite safety endpoint comprising vascular access site complications. Groin Doppler‐Duplex was performed with the stitch in place and after its removal.
Results
86 consecutive patients with 90 access sites were randomized. Mean age was 61.7 ± 19.1 years, 33.3% were men. Median sheath size was 14 F (range 10–22 F). Patients randomized to “Z”‐stitch achieved hemostasis quicker [ |
| doi_str_mv | 10.1002/ccd.27003 |
| format | Article |
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To compare subcutaneous “Z”‐stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency.
Background
Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. “Z”‐stitch has been introduced for this purpose in some centers but systematic data on its performance is limited.
Methods
This single center study randomized consecutive patients with femoral venous access sites requiring ≥10F sheaths to the “Z”‐stitch or manual compression for hemostasis in a 2:1 fashion. There were three co‐primary endpoints: time to hemostasis, time to ambulation, and a composite safety endpoint comprising vascular access site complications. Groin Doppler‐Duplex was performed with the stitch in place and after its removal.
Results
86 consecutive patients with 90 access sites were randomized. Mean age was 61.7 ± 19.1 years, 33.3% were men. Median sheath size was 14 F (range 10–22 F). Patients randomized to “Z”‐stitch achieved hemostasis quicker [<1 min vs. 12.0 (IQR 10.0–15.0) min, P < 0.001] and ambulated sooner [7.0 (IQR 4.0–12.0) vs. 16.0 (IQR 11.8–20.3) hr post procedure, P < 0.001] when compared with manual compression alone. The “Z”‐stitch reduced rates of access site complications (OR = 0.27, 95%CI 0.09–0.76, P = 0.01). All imaged veins were patent before and after stitch removal.
Conclusions
The “Z”‐stitch is a safe and effective method of achieving hemostasis after large bore femoral venous sheath removal and results in faster hemostasis, early patient ambulation and less access site complications, without compromising vein patency when compared with manual compression alone. © 2017 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.27003</identifier><identifier>PMID: 28303670</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; bleeding ; Catheterization, Peripheral - adverse effects ; Catheterization, Peripheral - instrumentation ; Catheters ; Comparative Effectiveness Research ; Complications ; Compression ; Compression therapy ; Equipment Design ; Female ; Femoral Vein - diagnostic imaging ; Femoral Vein - physiopathology ; Femur ; Hemorrhage ; Hemorrhage - etiology ; Hemorrhage - prevention & control ; Hemostasis ; Hemostatic Techniques - adverse effects ; Hemostatics ; Humans ; Male ; Middle Aged ; Poland ; Pressure ; Prospective Studies ; Punctures ; Randomization ; Sheaths ; structural heart disease intervention ; Suture Techniques - adverse effects ; Time Factors ; Treatment Outcome ; vascular access ; Vascular Access Devices ; Vascular Patency</subject><ispartof>Catheterization and cardiovascular interventions, 2018-01, Vol.91 (1), p.105-112</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><rights>2018 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3533-150336c2fea192510e9d89e391bccdd35479f7e878c1feaf6ccc4d81941bf7733</citedby><cites>FETCH-LOGICAL-c3533-150336c2fea192510e9d89e391bccdd35479f7e878c1feaf6ccc4d81941bf7733</cites><orcidid>0000-0001-7519-0003</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.27003$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.27003$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28303670$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pracon, Radoslaw</creatorcontrib><creatorcontrib>Bangalore, Sripal</creatorcontrib><creatorcontrib>Henzel, Jan</creatorcontrib><creatorcontrib>Cendrowska‐Demkow, Iwona</creatorcontrib><creatorcontrib>Pregowska‐Chwala, Barbara</creatorcontrib><creatorcontrib>Tarnowska, Agnieszka</creatorcontrib><creatorcontrib>Dzielinska, Zofia</creatorcontrib><creatorcontrib>Chmielak, Zbigniew</creatorcontrib><creatorcontrib>Witkowski, Adam</creatorcontrib><creatorcontrib>Demkow, Marcin</creatorcontrib><title>A randomized comparison of modified subcutaneous “Z”‐stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal</title><title>Catheterization and cardiovascular interventions</title><addtitle>Catheter Cardiovasc Interv</addtitle><description>Objectives
To compare subcutaneous “Z”‐stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency.
Background
Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. “Z”‐stitch has been introduced for this purpose in some centers but systematic data on its performance is limited.
Methods
This single center study randomized consecutive patients with femoral venous access sites requiring ≥10F sheaths to the “Z”‐stitch or manual compression for hemostasis in a 2:1 fashion. There were three co‐primary endpoints: time to hemostasis, time to ambulation, and a composite safety endpoint comprising vascular access site complications. Groin Doppler‐Duplex was performed with the stitch in place and after its removal.
Results
86 consecutive patients with 90 access sites were randomized. Mean age was 61.7 ± 19.1 years, 33.3% were men. Median sheath size was 14 F (range 10–22 F). Patients randomized to “Z”‐stitch achieved hemostasis quicker [<1 min vs. 12.0 (IQR 10.0–15.0) min, P < 0.001] and ambulated sooner [7.0 (IQR 4.0–12.0) vs. 16.0 (IQR 11.8–20.3) hr post procedure, P < 0.001] when compared with manual compression alone. The “Z”‐stitch reduced rates of access site complications (OR = 0.27, 95%CI 0.09–0.76, P = 0.01). All imaged veins were patent before and after stitch removal.
Conclusions
The “Z”‐stitch is a safe and effective method of achieving hemostasis after large bore femoral venous sheath removal and results in faster hemostasis, early patient ambulation and less access site complications, without compromising vein patency when compared with manual compression alone. © 2017 Wiley Periodicals, Inc.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>bleeding</subject><subject>Catheterization, Peripheral - adverse effects</subject><subject>Catheterization, Peripheral - instrumentation</subject><subject>Catheters</subject><subject>Comparative Effectiveness Research</subject><subject>Complications</subject><subject>Compression</subject><subject>Compression therapy</subject><subject>Equipment Design</subject><subject>Female</subject><subject>Femoral Vein - diagnostic imaging</subject><subject>Femoral Vein - physiopathology</subject><subject>Femur</subject><subject>Hemorrhage</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - prevention & control</subject><subject>Hemostasis</subject><subject>Hemostatic Techniques - adverse effects</subject><subject>Hemostatics</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Poland</subject><subject>Pressure</subject><subject>Prospective Studies</subject><subject>Punctures</subject><subject>Randomization</subject><subject>Sheaths</subject><subject>structural heart disease intervention</subject><subject>Suture Techniques - adverse effects</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>vascular access</subject><subject>Vascular Access Devices</subject><subject>Vascular Patency</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1u1DAUhS0EoqWw4AWQJTZ0Ma1_JnG8rAZKkSqxKRJiYznONXGVxIOdDCqreQQeAFZ9s3kSbpuhCyRWto-_e3x9DyEvOTvhjIlT55oToRiTj8ghL4RYKFF-frzfc70sD8iznK8ZY7oU-ik5EJVkslTskNye0WSHJvbhBzTUxX5tU8hxoNHTPjbBB5TzVLtptAPEKdPd9teX3fb3bvszj2F0Ld1Ayqj3dphsd2-RIOeAHmOk1rUBNkBb6GMebQ6ZWj9Cop1NX4E624UaTx6vE1ZvYLh7I7dgx5YmVDe2e06eeNtleLFfj8in83dXq4vF5cf3H1ZnlwsnCykXvGBSlk54sFyLgjPQTaVBal7jgBpZLJX2CipVOY6ML51zy6bC-fDaKyXlEXkz-65T_DZBHk0fsoOum39uOJZWQiGP6Ot_0Os4pQG7M1xXRSVEuRRIHc-USzHnBN6sU-htujGcmbvkDDZm7pND9tXecap7aB7Iv1EhcDoD30MHN_93MqvV29nyDxoPqLk</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Pracon, Radoslaw</creator><creator>Bangalore, Sripal</creator><creator>Henzel, Jan</creator><creator>Cendrowska‐Demkow, Iwona</creator><creator>Pregowska‐Chwala, Barbara</creator><creator>Tarnowska, Agnieszka</creator><creator>Dzielinska, Zofia</creator><creator>Chmielak, Zbigniew</creator><creator>Witkowski, Adam</creator><creator>Demkow, Marcin</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7519-0003</orcidid></search><sort><creationdate>20180101</creationdate><title>A randomized comparison of modified subcutaneous “Z”‐stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal</title><author>Pracon, Radoslaw ; Bangalore, Sripal ; Henzel, Jan ; Cendrowska‐Demkow, Iwona ; Pregowska‐Chwala, Barbara ; Tarnowska, Agnieszka ; Dzielinska, Zofia ; Chmielak, Zbigniew ; Witkowski, Adam ; Demkow, Marcin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3533-150336c2fea192510e9d89e391bccdd35479f7e878c1feaf6ccc4d81941bf7733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>bleeding</topic><topic>Catheterization, Peripheral - adverse effects</topic><topic>Catheterization, Peripheral - instrumentation</topic><topic>Catheters</topic><topic>Comparative Effectiveness Research</topic><topic>Complications</topic><topic>Compression</topic><topic>Compression therapy</topic><topic>Equipment Design</topic><topic>Female</topic><topic>Femoral Vein - diagnostic imaging</topic><topic>Femoral Vein - physiopathology</topic><topic>Femur</topic><topic>Hemorrhage</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - prevention & control</topic><topic>Hemostasis</topic><topic>Hemostatic Techniques - adverse effects</topic><topic>Hemostatics</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Poland</topic><topic>Pressure</topic><topic>Prospective Studies</topic><topic>Punctures</topic><topic>Randomization</topic><topic>Sheaths</topic><topic>structural heart disease intervention</topic><topic>Suture Techniques - adverse effects</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>vascular access</topic><topic>Vascular Access Devices</topic><topic>Vascular Patency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pracon, Radoslaw</creatorcontrib><creatorcontrib>Bangalore, Sripal</creatorcontrib><creatorcontrib>Henzel, Jan</creatorcontrib><creatorcontrib>Cendrowska‐Demkow, Iwona</creatorcontrib><creatorcontrib>Pregowska‐Chwala, Barbara</creatorcontrib><creatorcontrib>Tarnowska, Agnieszka</creatorcontrib><creatorcontrib>Dzielinska, Zofia</creatorcontrib><creatorcontrib>Chmielak, Zbigniew</creatorcontrib><creatorcontrib>Witkowski, Adam</creatorcontrib><creatorcontrib>Demkow, Marcin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pracon, Radoslaw</au><au>Bangalore, Sripal</au><au>Henzel, Jan</au><au>Cendrowska‐Demkow, Iwona</au><au>Pregowska‐Chwala, Barbara</au><au>Tarnowska, Agnieszka</au><au>Dzielinska, Zofia</au><au>Chmielak, Zbigniew</au><au>Witkowski, Adam</au><au>Demkow, Marcin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A randomized comparison of modified subcutaneous “Z”‐stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Catheter Cardiovasc Interv</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>91</volume><issue>1</issue><spage>105</spage><epage>112</epage><pages>105-112</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><abstract>Objectives
To compare subcutaneous “Z”‐stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency.
Background
Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. “Z”‐stitch has been introduced for this purpose in some centers but systematic data on its performance is limited.
Methods
This single center study randomized consecutive patients with femoral venous access sites requiring ≥10F sheaths to the “Z”‐stitch or manual compression for hemostasis in a 2:1 fashion. There were three co‐primary endpoints: time to hemostasis, time to ambulation, and a composite safety endpoint comprising vascular access site complications. Groin Doppler‐Duplex was performed with the stitch in place and after its removal.
Results
86 consecutive patients with 90 access sites were randomized. Mean age was 61.7 ± 19.1 years, 33.3% were men. Median sheath size was 14 F (range 10–22 F). Patients randomized to “Z”‐stitch achieved hemostasis quicker [<1 min vs. 12.0 (IQR 10.0–15.0) min, P < 0.001] and ambulated sooner [7.0 (IQR 4.0–12.0) vs. 16.0 (IQR 11.8–20.3) hr post procedure, P < 0.001] when compared with manual compression alone. The “Z”‐stitch reduced rates of access site complications (OR = 0.27, 95%CI 0.09–0.76, P = 0.01). All imaged veins were patent before and after stitch removal.
Conclusions
The “Z”‐stitch is a safe and effective method of achieving hemostasis after large bore femoral venous sheath removal and results in faster hemostasis, early patient ambulation and less access site complications, without compromising vein patency when compared with manual compression alone. © 2017 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28303670</pmid><doi>10.1002/ccd.27003</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-7519-0003</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1522-1946 |
| ispartof | Catheterization and cardiovascular interventions, 2018-01, Vol.91 (1), p.105-112 |
| issn | 1522-1946 1522-726X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1878827941 |
| source | MEDLINE; Access via Wiley Online Library |
| subjects | Adult Aged Aged, 80 and over bleeding Catheterization, Peripheral - adverse effects Catheterization, Peripheral - instrumentation Catheters Comparative Effectiveness Research Complications Compression Compression therapy Equipment Design Female Femoral Vein - diagnostic imaging Femoral Vein - physiopathology Femur Hemorrhage Hemorrhage - etiology Hemorrhage - prevention & control Hemostasis Hemostatic Techniques - adverse effects Hemostatics Humans Male Middle Aged Poland Pressure Prospective Studies Punctures Randomization Sheaths structural heart disease intervention Suture Techniques - adverse effects Time Factors Treatment Outcome vascular access Vascular Access Devices Vascular Patency |
| title | A randomized comparison of modified subcutaneous “Z”‐stitch versus manual compression to achieve hemostasis after large caliber femoral venous sheath removal |
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