The Side-Arm Technique on Perclose (STOP) Hemostasis Method to Prevent Bleeding With Indwelling Large Bore Catheters; Concept and Early Results.
Academic Article
Overview
abstract
OBJECTIVES: Bleeding from large-bore mechanical circulatory support catheters like Impella CP® and arterial extracorporeal membrane oxygenation (ECMO) cannulas is a significant problem with clear adverse prognosis. This study evaluated a simple mechanical strategy-the Side-arm Technique On Perclose (STOP)-to reduce bleeding. METHODS: We performed a retrospective evaluation in a series of patients managed by one operator from a community hospital with large ECMO and shock programs. The STOP method complements pre-closure with Perclose sutures; it involves threading the longer "blue" string through a cut sheath side-arm, tightening the suture around the entry site, and using the side-arm stopcock for temporary wire locking and hemostasis. This pull-push action tightens the suture loop around the device entry site, achieving hemostasis. Main endpoints included bleeding after STOP, leg ischemia needing intervention, and successful hemostasis at removal. MAIN RESULTS: Among 21 patients (24 devices), all underwent pre-closure with two Perclose devices. Most devices (81%) were placed in the femoral artery; five Impella CPs used the axillary approach. STOP was started post-insertion or, in two cases, at bedside. No patients presented bleeding or oozing after STOP; no limb ischemia occurred. Only two required extra Perclose at decannulation (median 2 [1-4] days later). CONCLUSION: The STOP method effectively prevents or controls arterial bleeding around large-bore catheters, offering a straightforward, low-cost solution with good results in this small cohort.
