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    CREATED BY :

    PRINSHA SANTOKI

    05BM45(41)

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    INTRODUCTION

    Increasing rate of percutaneous coronary and

    non-coronary interventions.

    Millions of people worldwide undergo a femoral

    artery catheterization, and other interventional

    procedures, such as angiography, percutaneous

    transluminal coronary angioplasty (PTCA), stenting

    , atherectomy and catheter

    ablation.

    Due to this there is strong need to stop bleeding

    at the puncture site without clotting in vessels as

    quickly as possible.

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    HEMOSTASIS

    Physiologic process through which bleeding is

    halted, thusprotecting the vascular system

    integrity of the vascular system after tissue injury.

    It is responsible for minimizing blood loss.

    It is commonly referred to as stoppage of

    bleeding;

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    IMPORTANT FUNCTION OFHAEMOSTATIC

    MECHANISMS :

    Maintain blood in a fluid state while circulating.

    Stop bleeding at the site of injury by formation of

    haemostatic plug .

    Removal of the haemostatic plug when healing iscomplete.

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    Vasoconstriction :constricts the blood vessel,

    minimizing vessel diameter and slowing bleeding.

    Platelets adheration : Platelets bind to collagen

    in the exposed walls of the blood vessel to form a

    hemostatic plug .

    Clotting : A complex cascade of coagulation factors,

    resulting in the transformation of fibrinogen into fibrin

    making a clot.

    Fibrinolysis :The clot attracts and stimulates the

    growth of fibroblasts within the vessel wall, and begins

    the repair process which ultimately results in the

    fibrinolysi i.e dissolution of the clot

    STEPS OF ACHIEVING HEMOSTASIS :

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    CONVENTIONALMETHODS :

    In early days hand pressure, and/or sandbags wereused to stop bleeding following interventional cases.

    A nurse or technician holds direct manual pressure

    on the site until thrombus forms to seal the access

    site.

    DROWBACKS OF THESEMETHODS :

    During these procedures patient must remain

    immobilized .This is monotonous and tiresome task.

    Due to this patients have to stay long in

    hospital.

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    HEMOSTASIS DEVICES :

    TRICLIPS :

    Used for initial hemostasis.

    It is feasible in the initial control of peptic ulcer

    hemorrhage.

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    VASCULARHEMOSTASIS DEVICES :

    FEMOSTOP :

    Alternative to manual compression of the femoral

    artery.

    Inflatable transparent dome with connection tubing

    and stopcock provides more accurate placement of

    pressure.

    Accurate manometercontrolled

    pressure.

    Less contact with blood.

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    SUTUREMEDIATED CLOSUREDEVICE:

    Provides secure reliableVessel closure .

    Provides complete tissue

    apposition resulting in primaryhealing .

    Provides reduced time to Hemostasis,

    ambulation and discharge.

    No re-access restrictions if previous arteriotomy

    repairs were achieved w/ Perclose Suture-Mediated

    Closure devices

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    Automated knot tying .

    Reduced proceduretime.

    Easy deployment .

    Short sheath compatible

    with long and short

    wires.

    Hydrophilic coated

    straight tip sheath

    facilitates insertion

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    GUARDIAN HEMOSTASIS VALVE:

    It is designed to minimize blood loss

    during percutaneous procedures.

    providing a seal around guidewires and otherdevices.

    Its signature click-open, click-close design facilitates

    single-handed operation.

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    SAFEGUARD HEMOSTASIS DEVICE:

    It is a single use adhesive dressing with a transparent

    inflatable plastic bulb.When inflated the bulb is inelastic and provides

    consistent pressure over the wound site to maintain

    hemostasis.

    This device proved effective at maintainin hemostasisfollowing femorally accessed coronary catheterization

    procedures adhering to wound site reliably for hours

    and producing no complication.

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    RADIO-OPAQUEAGENT DELIVERY DEVICE:

    It promotes the clotting of blood at an internal woundsite it includes a catheter; a delivery instrument

    insertable through the catheter.

    A radioopaque blood clotting agent that deliverablethroug the delivery instrument; and a positive

    pressure apparatus that can dispense the blood

    clotting agent to the wound site through the

    delivery instrument.

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    EPICLOSEHEMOSTATEDEVICE:

    The EpiClose device is mostadvanced solution for femoral

    artery closure.

    The deployment methodology of the device relies onballoon inflation/deflation techniques that apply

    selective pressure precisely over the puncture site,

    with the addition of an energy application stage,

    which accelerates hemostasis.

    The Epiclose device can be introduced into the vessel

    through most of the existing interventional- cardiology

    introducer sheath

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    It consists of three resorbable

    components: an anchor,a collagen sponge and a

    suture along with a delivery

    system that closes the puncture.

    The anchor and suture act as a pulley to position the

    collagen into the puncture tract adjacent to the outside

    of the artery wall to seal and close .

    This easy to use device has been used to facilitate

    post-procedure care in over five million patients since

    its commercial launch in 1996.

    ANGIO-SEAL DEVICE

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    Following the catheterization

    procedure, the Angio-Seal device isinserted into the femoral artery .

    The Angio-Seal device is withdraw

    until the anchor is seated in theartery puncture

    PROCEDURE OF USING ANGIO-SEAL:

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    Complete withdrawal of the device compresses the

    collagen sponge in the puncture tract adjacent to the

    outside of the artery wall to stop blood flow through

    the puncture.

    The anchor, collagen and suture are resorbed within

    60-90 days after the procedure.

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    ACCESS CLOUSER DEVICE:

    This closure device immediately seals thearteriotomy using a conformable, water-soluble,

    extravascular sealant that rapidly expands in the

    tissue tract by absorbing blood and subcutaneous

    fluids.As blood collects inside the sealant's matrix it clots,

    producing a durable hemostasis.

    The sealant dissolves within 30 days, leaving

    nothing behind but a healed artery.

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    The device can be stored at room temperature and

    prepared in less than two minutes.

    The VascuSeal sealant technology is a patented

    synthetic,absorbable hydrogel delivered by a dual

    syringe applicator.

    VASCUSEAL :

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    VascuSeal sealant polymerizes within seconds when

    sprayed on the suture line and is blue in color which

    provides visualization of coverage and thickness of

    the material upon application.

    Postoperatively, VascuSeal sealant continues to seal

    the suture line as healing progresses under the gel.

    After several days, the hydrogel breaks down into

    water-solublemolecules that are absorbed and

    cleared through the kidneys.

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    It replace or augment manual compression following

    diagnostic catheterizations.

    Reduces time to hemostasis and facilitating more

    rapid recovery.

    External compression products, which include

    chemically-treated patches, also simplify the process

    of vascular closure for the clinician and staff.

    Reduce time in the recovery room, which contributes

    to better patient throughput and higher profits for

    catheterization labs.

    ADVANTAGES OFHEMOSTASIS DEVICES :

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    DISADVANTAGES :

    Complication related to infection and arterial thrombosis

    Another drawback is compatibility problem of thesedevices

    High coast.

    Limited knowledge of its use.

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    However VHD are improving, complication ratesassociated with their use may be decreasing, and

    their utilization may improve the process of care after

    femoral artery access.

    Better understanding of the occurrence of adverse

    events associated with the use of vascular hemostasis

    devices following cardiac catheterization & furtherresearch on the subject to develop more ideal closure

    devices will help to overcome these problems.

    HOW TO GET BETTER RESULT ?

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