Arterial Closure Device Insertion Periprocedural Care

Updated: Nov 29, 2016
  • Author: Venkat Rajaram, MD, MS; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Periprocedural Care

Patient Education and Consent

During the consent process, discuss with the patient the possibility of using a closure device, including both the merits and the downsides. In addition, explain what to expect (eg, a temporary knot at the access site, usually after Angio-Seal is used).

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Preprocedural Planning

Before obtaining access, make a clear track with a scalpel and the hemostat. This facilitates easy advancement of closure devices after the procedure. It also prevents accumulation of any blood in the soft tissue during the procedure.

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Equipment

Equipment used for arterial closure device insertion includes the following:

  • Local anesthetic with syringe and needle
  • Gauze (4 × 4, dry and wet)
  • Chlorhexidine preparation kit
  • New pair of sterile gloves
  • Short and long J-wires (for Perclose ProGlide; Angio-Seal comes with its own wire)
  • Tegaderm dressing
  • Perclose ProGlide or Angio-Seal kit, with contents

Angio-Seal packet contents (see the video below) include the following:

  • Insertion sheath
  • Arteriotomy locator
  • 6-French Angio-Seal: 70-cm, 0.035-in./0.89-mm J-tip guide wire
  • 8-French Angio-Seal: 70-cm, 0.038-in./0.96-mm J-tip guide wire
  • Angio-Seal device
Arterial closure device insertion. Angio-Seal equipment.

Perclose ProGlide packet contents (see the video below) include the following:

  • Perclose ProGlide 6-French suture-mediated closure (SMC) device
  • Snared knot pusher
  • Suture trimmer
Arterial closure device insertion. Perclose ProGlide Suture-Mediated Closure equipment.
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Patient Preparation

Clean the arteriotomy site and the sheath with chlorhexidine again before deploying the device.

Anesthesia

It is advisable to administer an additional dose of local anesthetic at the femoral access site before deploying a closure device in order to minimize discomfort. The local anesthetic administered before access is obtained may not be adequate.

Positioning

No specific position is required for access closure. As with any angiographic procedure performed from a femoral access site, the patient needs to stay in the supine position with lower limbs extended.

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Monitoring & Follow-up

Before moving the patient out of the catheterization laboratory recovery area, ensure that any oozing of blood after closure device deployment is just track ooze and not failure of the device.

As a rule, the patient can ambulate normally in 2 hours after Perclose ProGlide placement. However, factors such as use of anticoagulants, access issues, and overall patient status (both general and cardiac) must be considered in deciding on the length of bedrest before ambulation.

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