Femoral arterial closure using ProGlide® is more efficacious and cost-effective when ambulating early following cardiac catheterization

Abstract

ObjectiveThis was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30 min) following femoral artery closure with the ProGlide® suture-mediated vascular closure device (PD) in patients undergoing diagnostic cardiac catheterization compared with manual compression.BackgroundIt is unclear whether early ambulation with ProGlide is safe or is associated with patient satisfaction and cost savings as compared with manual compression (MC).Methods and resultsInclusion criteria were met in 170 patients (85 PD and 85 MC patients). Patients ambulated 20 ft. within 30 min (PD) or after the requisite 4 h recumbent time (MC) if feasible. Primary endpoint was time-to-ambulation (TTA) following device closure. We also directly compared the safety of closure, times-to-hemostasis (TTH), -ambulation (TTA) and -discharge (TTD) with MC and, using a fully allocated cost model, performed cost analysis for both strategies. Multivariate analysis was used to determine predictors of patient satisfaction. The primary endpoint of safe, early ambulation was achieved following closure (mean of 27.1 ± 14.9 min; 95% confidence interval [CI] 25.2–30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost savings in the PD group (1250.3 ± 146.4 vs. 2248.1 ± 910.2 dollars, respectively; P < 0.001) and incremental cost savings by strategy also favored closure over MC ($84,807).ConclusionsProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization; translating into improved patient satisfaction and substantial cost savings.

Elaboração e validação de um manual informativo sobre cateterismo cardíaco

“…Although the literature still shows no consensus regarding this issue, studies have investigated shorter bed rest and have shown no harms to the patient. (21)(22)(23) Regarding nurse characteristics, most nurses were female, corroborating the characteristics of the profession overall. All participants had, at the minimum, specialization that contributed to obtaining scientific knowledge added to clinical experience.…”

Femoral artery access site closure with perclose suture mediated device in coronary interventions

“…The safety of the PP device post diagnostic coronary catheterization has been established. 9 , 10 Use of multiple PPs in ‘preclose manner’ has been studied in femoral arteriotomies for TEVAR/EVAR/TAVR up to 24 F. 16 However, the safety of use of single PP device without heparin reversal has not been tested in CI which require relatively larger sheaths along with higher dose of anticoagulant and antiplatelet agents. In addition, it is not yet proven whether safety of SMVCD is a class effect or not.…”

“…Earlier studies have reported device failure rate of 3–7 percent. 9 , 10 , 12 , 19 , 20 , 21 , 22 An Indian study has reported a failure rate of 4% in 323 patients studied. 9 Device failure rates have reduced over time with evolving operator experience.…”

“…Traditionally femoral access site hemostasis is achieved by manual compression (MC) which is associated with various drawbacks such as patient discomfort during compression, vasovagal reaction, prolonged immobilization and bleeding. 9 , 10 …”

Accelerated ambulation after vascular access closure device

“…Early ambulation has been shown to be cost-effective with the use of other vascular closure devices, such as the ProGlide® (Abbott Vascular, CA) suture-mediated device. 7 A study evaluating early ambulation (within 20 min following hemostasis) following the use of the StarClose® (Abbott Vascular, CA) vascular closure device has proven efficacy and safety. 8 Our study, albeit small, has shown that this approach for early ambulation is safe, with potential significant reduction in healthcare expenditure and human resource utilization.…”