Hemostasis

Abstract

Vascular access hemostasis is a real concern in interventional congenital cardiology. It serves to stop bleeding after sheath withdrawal at the end of the procedure without compromising the vascular integrity.

Several factors may influence the hemostasis; some of them are operator related and others depend on the patient’s condition. However, a combination of different factors may affect the hemostasis such as medications, the ratio of sheath size to vessel size, several attempts to obtain the vascular access, multiple cardiac surgery or repeated catheterization using the same vascular access site, bleeding disorders, polyglobulia, the complexity and length of exposure, and others.

Moreover, the technique used to reach the vessel may dictate the type of the hemostatic maneuver. While simple manual compression is usually sufficient after femoral access, hemostasis in the transhepatic catheterization is better achieved with coil embolization.

Manual compression represents the gold standard for hemostasis in the vast majority of cases. The pressure applied should be balanced to overcome intravascular pressure without compromising distal vascularization.

Some vascular closure devices are routinely used in femoral adult interventions. However, their use in pediatric patients is not largely widespread. We aim in this chapter to give a practical guide for different types of hemostatic maneuvers used in congenital cardiac catheterization.