Manual compression hemostasis with novel hemostatic pad revolutionizes distal radial artery approach for diagnostic catheterization: Study

The study, published in Cardiovascular Revascularization Medicine, revealed the feasibility of manual compression hemostasis using calcium alginate pads for the distal radial artery approach with simple learning.

Traditionally, achieving hemostasis following radial artery access has relied on prolonged manual compression or the application of mechanical compression devices. While effective, these methods often entail prolonged immobilization, discomfort, and potential complications such as radial artery occlusion. The advent of the hemostatic pad offers a promising alternative, streamlining the hemostasis process and optimizing patient outcomes.

The hemostatic pad, composed of a unique blend of absorbent materials and hemostatic agents, is designed to accelerate the hemostasis process while ensuring optimal patient comfort. Upon completion of the catheterization procedure, the pad is applied directly over the puncture site, exerting controlled pressure to facilitate rapid sealing of the arterial puncture site.

The method of hemostasis for the distal radial approach has not been standardized, although this approach has gained immense popularity due to its advantages. In this study, Kenji Sadamatsu, Department of Cardiovascular Medicine, Omuta City Hospital, Omuta, Japan, and colleagues investigated the feasibility of manual compression hemostasis using a calcium alginate pad after coronary angiography via the distal radial approach.

For this purpose, the researchers retrospectively collected 150 consecutive patients (mean age, 74.9 ± 8.0 years; male, 75 %) who underwent coronary angiography via the distal radial artery with a predominantly 4 Fr sheath from 2021 to 2022 and were hemostatic according to the following methods.

After sheath removal, hemostasis was achieved by manual compression for 10 min using a hemostatic pad containing calcium alginate. After hemostasis confirmation, a small log-shaped gauze was placed over the pad and fixed using a self-adhesive elastic bandage for two hours. All procedures were conducted by four fellows just beginning the distal radial approach.

The study led to the following findings:

• The mean compression time was 12.4 ± 4.8 min, and hemostasis was successfully achieved in all patients, allowing the release of the elastic bandage after 2 h, with only one patient oozing the next morning.
• There were no major complications, while one patient had a >10 cm hematoma.
• Compared to that of the first 15 patients, for each fellow, the compression time of the subsequent patients was significantly shorter (14.5 ± 6.7 versus 11.1 ± 2.1 min).

"Our observational study revealed that manual compression hemostasis using a calcium alginate pad was effective and feasible for dRA in a senior population undergoing diagnostic catheterization with predominantly a 4F sheath with 3000 units of heparin," the researchers wrote. "With this method, even trainees could achieve hemostasis, and the hemostasis time was stable after the first 15 patients."

Reference:

Sadamatsu, K., Kugai, T., Eto, Y., Muta, M., Maeda, T., Ishimatsu, T., Shihara, M., & Fukumoto, Y. (2024). Manual compression hemostasis using a hemostatic pad for the distal radial artery approach. Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2024.05.028