MAINTENANCE OF HEMOSTASIS AFTER INVASIVE CARDIAC PROCEDURES - IMPLICATIONS FOR OUTPATIENT CATHETERIZATION

Objectives. This study investigated the efficacy of four different met hods of arterial puncture site management during recovery from invasiv e cardiac procedures, The primary goals were less patient discomfort a nd improved clinical outcome, Background The increasing use of outpati ent catheterization, large interventional devices and potent periproce dural anticoagulation regimens has made the reduction of groin complic ations a high priority, Despite these trends, there are no randomized trials comparing commonly used techniques in treating the catheter ent ry site for the first few hours after the procedure, Methods. Four-hun dred consecutive patients undergoing catheterization laboratory proced ures were randomly assigned to one of four dressing techniques applied after achieving hemostasis: a sandbag placed over the site; a pressur e dressing constructed from surgical gauze and elastic tape; a commerc ially available compression device; and no use of compressive dressing , Of these 400 patients, 171 would have been eligible for outpatient p rocedures in the absence of geographic constraints, The dressings were removed, and ambulation was encouraged 5 h after sheath removal. Unif orm initial compression times, patient instructions, nursing follow-up and a structured interview and physical examination at 24 h were used , Results. The level of patient discomfort before and after dressing r emoval, as well as site tenderness at 24-h follow-up, was statisticall y similar in all four groups, Hematomas (typically small) and areas of ecchymosis were observed in 58 and 122 patients, respectively, but bo th their frequency and size were equally represented in each group, Im portant adverse events were confined to bleeding, rated as mild in 5.8 %, moderate in 0.8% and severe in 0.6% of patients, Again, all four gr oups were statistically similar, Comparable findings were observed in the subgroup of patients eligible for outpatient procedures, Conclusio ns, Despite an increase in inconvenience and expense, none of the thre e compression techniques that were investigated improved patient satis faction or outcome, Therefore, the routine use of compression dressing s after invasive cardiac procedures cannot be recommended. (C) 1997 by the American College of Cardiology.