Day 2: AngioSeal Flashcards
(42 cards)
What are the 4 main components of the AngioSeal VCD?
1) AngioSeal VCD
2) Arteriotomy/puncture locator
3) Sheath
4) 70cm J-wire
AngioSeal is indicated for use in:
Closing and reducing time to HEMOSTASIS at the FEMORAL ARTERIAL PUNCTURE SITE for diagnostic or interventional procedures using 6/8Fr procedural sheaths.
What are the primary differences between the 6 & 8Fr AngioSeal devices?
6Fr: Green, smaller sheath, 035 wire, less collagen
8Fr: blue, larger sheath, 038 wire, more collagen
What complication can occur if the puncture site is ABOVE the inguinal ligament and inferior epigastric artery and why?
RP BLEED if poor access was gained because there could be back wall injury or perforation. The artery dips behind the pelvic bone and therefore there is no bone to apply pressure against the artery for closure. Therefore the staff calls these “push and pray” closures since manual is also not an option.
What is SUTURE LOCK UP and how do you appropriately mitigate it?
This is when the suture spool gets stuck or tangled within the VCD like a fishing reel. It is not common but can happen via defect. To resolve or mitigate the issue, you will need to cut the suture in the small gap BETWEEN the VCD and Sheath cap. DO NOT cut below the sheath cap, as you could accidentally cut the tamper tube. Once suture is cut, proceed with removal of sheath and device and pushing compression tube etc.
What should you do to mitigate collagen exposure after AngioSeal deployment?
1) Maintain slight tension on suture.
2) Wet exposed collagen w/sterile gauze & saline.
2) Attempt to advance collagen under skin with compression tube or hemostat clamp.
3) Attempt to tent skin around site in N/W/E/S fashion.
4) Generate lidocaine wheel at puncture site.
What does NAVEL stand for?
N: femoral Nerve
A: femoral Artery
V: femoral Vein
E: Empty space
L: inguinal Ligament
Where is the External Iliac located?
Above the IEA and IL, and crossing over the pelvic girdle.
Where is the Inferior Epigastric Artery located?
Below the External Iliac, above the IL and in the empty space of the pelvic girdle.
Where is the CFA located?
Below the External Iliac and IEA, below the IL but above the bifurcation in SFA/DFA. It should be at the top 1/3 of the femoral head.
Where is the SFA and DFA located?
Both are below the CFA. The SFA is the continuation of the CFA down towards the foot and closest to the inside of the leg. The DFA or Deep Femoral Artery/Profunda juts out at the bifurcation with the SFA and is more visible on the outside of the leg.
What percentage of patients have a bifurcation that is proximal to the inguinal crease?
72 - 75% which leaves a hefty gap of patients that cannot rely on that landmark.
The maximal impulse is what percentage over the femoral head?
92.7% over the femoral head
How can you accurately gain access without using Ultrasound?
1) Physically find the hip bone and pelvic bone.
2) Visually find the halfway point between them and place a hemostat.
3) Under fluoro, locate the femoral head. Then line the CFA and hemostat.
What are the 3 main considerations for AngioSeal usage?
1) Puncture Location
2) Vessel Size
3) Deterrents
What is the indicated puncture location for AngioSeal?
CFA, proximal to the bifurcation of the SFA/Profunda and distal to the inguinal ligament and IEA
What is the indicated vessel size for AngioSeal usage?
4mm or greater, unless disease is present (then 5-5-40 rule)
What is the 5-5-40 Rule?
If disease is present at the puncture site, AngioSeal is safe to deploy if:
No disease within 5mm of access site
Vessel is 5mm or greater
Luminal narrowing is <40%
What are some of the deterrents for AngioSeal usage?
Significant, diffuse disease
Focal stenosis near the puncture site (within 2 mm)
Pre-existing VAC
Access through graft
Tortuous tissue tract or compromised sheath
What are the storage requirements for AngioSeal?
Keep AS away from ALL light sources (including Pyxis, sunlight, overhead lights etc,)
Maintain temperature between 59-77F and never over 100F.
What type of box is AngioSeal shipped in?
An insulated box with cold packs.
What requirements or restrictions are placed on AngioSeal shipments?
They are always shipped OVERNIGHT and only shipped MON-THURS.
What UOMs are associated with AngioSeal?
Each box contains 2 cartons of 5 devices each for a total of 10 devices.
What are the 5 main features and benefits of AngioSeal?
1) Lower complication rates
2) Higher deployment success rates
3) Shorter time to hemostasis
4) Faster time to ambulation
5) Provide cost savings via SDD and shorter LOS