A Novel Technique for Large Bore Venous Access Closure

Background
Large bore venous access sheaths are commonly used without a dedicated closure device system. We are describing a novel extravascular hemostasis technique requiring simple suture and stopcock mechanism to obtain hemostasis and to assess bleeding in real time. If adequate hemostasis is achieved, sutures are then removed.

Methods
10 consecutive patients who underwent 16 F percutaneous venous access were retrospectively analyzed. A subcutaneous figure of eight suture secured by a stopcock was used to close the femoral venous access site immediately after the procedure (Figure 1- 4).

Results
A total of 10 patients underwent large bore venous access (Mean age of 80.7 ± 9 , 40% male and Mean BMI was 28.9 ± 5.7). Other co-morbidities include diabetes mellitus (30%), hypertension (70%) and CKD stage III or more (70%). All patients had ACT >250 during procedure. Complete hemostasis was achieved in all patients immediately after 6 hours of bed rest without reversing anticoagulation. There were no hematoma , late bleeding, local skin changes or need for blood transfusions. Mean time to ambulation was 365 minutes. Mean length of stay was 2.3 days.

Conclusions
The use of simple sutures along with a stopcock as described in our study is a simple cost effective hemostasis technique with reproducible results and safe outcomes. It did not require any foreign material in vascular system as seen in some dedicated closure devices. It gives one the option of checking for hemostasis prior to removal of sutures.