Cath Lab Digest - October 2007 - (Page 35)

35 Boomerang while still delivering the same quality of care.” Nurse Technician Kelley Weakley agreed: “With the Boomerang we hold for less time, but we also have to exert less pressure.” In addition to decreasing the rates of patient complications and staff injuries, deployment of the Boomerang may improve cath lab staffing and financial operations. Shorter hold times and faster ambulation mean that patients spend less time in recovery. Sherry Day, Prairie Heart’s post-catheterization charge nurse, commented, “As team leader, I know that on a heavy volume day we’re all pulling lines. With the Boomerang, we have a shorter turnaround time for staff and physicians, which is definitely easier on the staff. But shorter turnaround also means the patients are less stressed because they spend a shorter time in recovery with less compression discomfort, their families can come in the room sooner, they’re up and walking earlier, which means they’re discharged more quickly.” Kelley Weakley noted: “We see less bleeding and fewer hematomas with the Boomerang than with compression alone.” Prairie Heart patient Roger A. Pierjok recalled his first catheterization procedure at another hospital 26 years ago when he was 31 years old: “When the doctor pulled out the sheath, he put direct pressure on the site and held it until he started getting muscle cramps. Because I’m in mining safety and have EMT training, I could see that he couldn’t hold this much longer, so I slipped my thumbs down there and held the pressure myself. They had to put a couple of stitches in to close the site because the incision was large to accommodate the larger device at that time. Then in the car coming home, the stitches broke open and I could see my leg was black. So when I got home I laid on the driveway and put pressure on that site myself for 30 minutes. I had lots of complications with that first procedure.” Pierjok then recounted his recent experience with his third catheterization procedure, performed by Dr. Goswami and the cath lab staff at Prairie Heart in early September of this year. “The procedure was three days ago and I had no discomfort,” he reported. “I’m walking around without even a twinge at that site. Compared with the old system of doing these procedures, this last one was less painful and I experienced less irritation. I’m 57 and the prospect of future procedures is a real one for me. That’s one less thing for me to worry about.” Dr. Mishkel summed up his experience: “Because this device relies on the body’s natural tendencies to heal itself, the Boomerang is clearly less invasive than other VCDs. Also, we are quite happy that we observe shorter times to achieve hemostasis and ambulation than with manual compression alone. Using the Boomerang results in less discomfort for patients and staff alike, but most important, it leaves nothing behind when the patient is discharged.” ■ The physicians and staff named in this article can be contacted at Sheryl.Friedrich@st-johns.org. 8. Jones T, McCutcheon H. Effectiveness of mechanical compression devices in attaining hemostasis after femoral sheath removal. Am J of Crit Care 2002 (March);11(2):155 ff. 9. Arora N, Matheny ME et al. A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. Am Heart J 2007(April); 153(4):606–611. 10.Casteneda F, Swischuk JL, Smouse B et al. Gelatin sponge closure devide versus manual compression after peripheral arterial catheterization procedures. J Vasc Interv Radiol 2003;14:1517–1523. 11.Walker SB, Cleary S, Higgins M. Comparison of the FemoStop device and manual pressure in reducing groin puncture site complications following coronary angioplasty and coronary stent placement. Intnl J of Nurs Prac 2001;7:366–375. 12.Amin FR, Yousufuddin M, et al. Femoral haemostasis after transcatheter therapeutic intervention: a prospective rendomised study of the angio-seal device vs. the femostop device. Intnl J Cardiol 2000;76:235–240. 13.Kunert M, Gremmler B, et al. Use of FemoStop system for arterial puncture site closure after coronary angioplasty. J Invas Cardiol 2004;16(5):240–242. 14.Katsouras CS, Michalis LK, et al. Treatment of acute lower limb ischemia following the use of the Duett sealing device: Report of three cases and review of the literature. Cardiovasc Interv Radiol 2004;27:268–270. 15.Funovics MA, Wolf F, et al. Feasibility study of NeoMend, a percutaneous arterial closure device that uses a nonthrombogenic bioadhesive. AJR 2003 Feb;180:533–538. 16.Tiesenhausen K, Tomka M, et al. Femoral Artery infection associated with a percutaneous arterial suture device. Vasa 2004 May; 33(2):83–85. 17.New Cardiovascular Horizons meeting, New Orleans, LA. “Vascular Access Management: Strategies to Preserve the ‘Precious’ CFA ‘Real Estate’.” September 8, 2007, presented by R. Smalling, MD Gregory J. Mishkel, MD Co-Director, Cardiac Cath Lab Prairie Heart Institute stimulates the intrinsic coagulation cascade. After a short dwell time, the Boomerang disc is collapsed and removed from the artery, leaving nothing behind in the tissue tract or artery exacerbating an inflammatory response or a hindrance to future arterial access. In recently reported interim clinical trial results from the prospective, randomized BOOMERANG II Trial Prairie Heart results17, the Catalyst System hold time was reduced by an average of 16 minutes in diagnostic patients compared to manual compression, and reduced by an average of 12 minutes in interventional patients. Average time to ambulation was also reduced by 121 minutes in diagnostic patients compared to manual compression, and reduced by an average of 157 minutes in interventional patients. On average, the total access management time in diagnostic patients was reduced more than 50% and in interventional patients by 40%, as shown in Figures C and D. On average, the Catalyst System same-day discharge patients went home 50 minutes earlier. The data subset analyzed for Prairie Heart as part of the BOOMERANG II trial currently includes 204 subjects — 166 Boomerang System and 38 manual compression subjects. Reportable complications that met criteria included one (0.5%) pseudoaneurysm that required thrombin injection are shown in Table 1. There were no bleeding complications at Prairie Heart. Cath lab manager Sheryl Friedrich commented, “We can get natural closure at the site earlier than with manual compression. Our standard order is for 20 to 30 minutes of hand hold after PCI, but we cut that time in half with the References 1. Lehmann KG, Heath-Lange SJ, Ferris ST. Randomized comparison of hemostasis techniques after invasive cardiovascular procedures. Am Heart J 1999;138(6):1118–1125. 2. Hoffer EK, Bloch RD. Percutaneous arterial closure devices. J Vasc Interv Radiol 2003;14:865–885. 3. Tavris D, Dey S, AlbrechtGallauresi B, et al. Risk of local adverse effects following cardiac catheterization by hemostasis device use – phase II. J Invas Cardiol 2005;17(12):644–650. 4. Denham C, Davies JF, Shahbazi R, Homer-Vanniasinkam S. Iatrogenic Limb Ischemia Caused by Angiography Closure Devices. Vasc Endovascular Surg 2007;40: 492–494. 5. Chew DP, Bhatt DL et al. Clinical end point definitions after percutaneous coronary intervention and their relationship to late mortality: an assessment by attributable risk. Heart 2006;92:945–950. 6. Simon A, Bumgarner B, Clark K, et al. Manual versus mechanical compression for femoral artery hemostasis after cardiac catheterization. Am J Crit Care 1998;7:308–313. 7. Streem, MD. Comparison of arterial puncture closure devices with standard manual compression after cardiac catheterization at Robinson Memorial Hospital. Cath Lab Digest 2004 (November);12(11):1,6–8.

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.