Experience with the Chito-SealTM Topical Hemostasis Pad at Glendale Memorial Heart Center

The Glendale Memorial Heart Center was established in 1992 by a core group of cardiologists and cardiac surgeons, who believed in the need to provide exceptional cardiac care to the community. Today, the Heart Center is recognized for its dedication and commitment to the prevention and treatment of cardiac disease. Due in great part to our well-aligned group of cardiologists and cardiovascular surgeons, in 2000 and, again in 2002, Glendale Memorial was the area’s only nationally recognized Top 100 heart hospital. This designation represents exceptional quality in the treatment of AMI, CHF, CABG, and cardiac interventions. Glendale Memorial Heart Center has one of the highest volumes and successful outcomes in the nation. Over the past few years, utilization of Glendale Memorial’s three current cardiac catheterization laboratories exceeded normal capacity (per the American College of Cardiology standards, 800 diagnostic and interventional cases may be conducted in one cath lab per year), thus allowing us to construct a fourth cath lab, which was operational in late 2003. The Heart Center has, to date, has far exceeded volume standards. In FY 2003-2004, our cath labs conducted more than 4,200 procedures (diagnostic, interventional, peripheral and electrophysiology). Glendale Memorial’s cath labs are staffed by 14 full-time employees with the following credentials: 5 RNs (1 part-time) 1 CVT 7 RTs 1 Unit service coordinator (inventory control) 1 Administrator Secretary (scheduling procedures) Most of our staff is cross-trained to the extent of their licenses. Scrub persons include one RT and 1 CVT. Occasionally nurses do scrub. Nurses predominantly monitor and administer medications. RTs are required to be in the cath lab per state regulations and for radiation safety issues. RTs do pan the procedure table during most procedures. At times, some physicians pan the procedure table by themselves. All staff are required to be licensed for BCLS, ACLS, and a FLUORO License for x-ray techs. Nurses are all trained as critical care nurses. Glendale Memorial’s cath lab staff is responsible for pulling sheaths post procedures. Currently we use the Chito-Seal Patch (Abbott Vascular Devices, Redwood City, CA) for hemostasis on most of our diagnostic cases. With post intervention cases, the sheath is sutured in and the patient transferred to a critical care bed. Occasionally we use the Angio-Seal closure device (St. Jude Medical, Minnetonka, MN) post intervention (depending on the critical bed availability) where the patient may be transferred to a step-down unit. Glendale Memorial implemented the use of Chito-Seal approximately 18 months ago. John Johnson, RCIS Glendale Memorial Heart Center What percentage of your patients get Chito-Seal post-cath? At the Glendale Memorial Heart Center, we average between 35-40% usage of Chito-Seal per month. Are there certain patient subsets who benefit more from hemostatic pads/patches? No, we have not noticed any benefits to any particular subsets of patients. Are there certain types of patients who should not receive Chito-Seal pads? No. We have experienced favorable results on most of the patients we have used the patch on. Are there certain access sites (brachial, radial, etc.) when you would not use Chito-Seal? On the contrary, we have successfully used the patch on most of our brachial approach cases. Have you had negative patient outcomes attributed to the use of Chito-Seal? No, we have not experienced any negative outcomes attributed with the patch. Have you noticed decreased hold times using hemostatic patches compared with manual compression alone? Yes, usually we use the patch after most of our diagnostic cases (6Fr to 8Fr sheaths). We save five minutes of holding time per case. With many hemostatic pads/patches available on the market today, why have you chosen to use Chito-Seal? What were your selection criteria? We have tried different patches in the past and had some problems with hematomas. Chito-Seal was introduced to our cath labs and the hematoma problems were reduced drastically. Also, the pricing of the Chito-Seal patch works in its favor. What has been the response of patients to the use of Chito-Seal? The greatest responses are with those patients who have experienced multiple cath procedures for one reason or another. They are the ones who have experienced over time, the sandbags and the different compression devices on the market as well as the six hours bed restrictions. They are usually pleasantly surprised with the shortened bed restrictions and a simple gauze and tape post procedure. What has been the response of other staff member to the use of Chito-Seal? Our cath lab staff favors using Chito-Seal, especially since it saves on the compression duration. Are there applications other than post-cath hemostasis where you have considered using Chito-Seal? Yes, we perform many peripheral studies and interventions as well as opening AV dialysis shunts. The staff will frequently use the patch, post procedure, to achieve hemostasis. Sometimes these patients are heparinized with an ACT upwards around 230 sec.; the patch has made a difference in the holding times of approximately 1/2 hour instead of a full hour or more. Of course, as a precaution the patient is kept for the full 6 hours bed restriction. John Johnson is a cardiovascular technologist at Glendale Memorial Heart Center with 10 years of experience. He can be contacted at: jjohnson5@ chw.edu Michael Yeh, MD Glendale Memorial Heart Center What percentage of your patients get Chito-Seal post-cath? 20% What, in your opinion, is the clinical benefit of using Chito-Seal? Chito-Seal offers a quicker/earlier ambulating times. I have also noticed decreased time to hemostasis. So you ambulate patients faster with Chito-Seal? The usual time is between 3-4 hours for Chito-Seal; 6 hours for manual compression. Are there certain types of patients who should not receive a Chito-Seal Pad? Patients with groin erythema/fungal infection. Are there certain access sites (brachial, radial, etc.) when you would not recommend a patch be used? Currently not. Does Chito-Seal work on patients contra-indicated for closure devices (i.e. peripheral vascular disease, bifurcation sticks, etc)? Yes, I have actually combined closure devices and Chito-Seal on a few occasions. Are there certain co-morbid conditions (diabetes, peripheral vascular disease, etc.) where you would not recommend a pad to be used? Currently no, but I need to make sure to re-prep, especially in diabetic patients. Have you had any negative patient outcomes attributed to the use of Chito-Seal? So far, no. With many hemostatic patches available on the market today, why have you chosen to use Chito-Seal? Cost is a considerable issue. When will you use a pad versus a closure device (clinical or procedural considerations)? Bifurcation stick, small artery (less than 2 times the size of Perclose devices). Are there applications other than post-cath hemostasis where you have considered using Chito-Seal? Currently, no. Michael Yeh, MD, specializes in cardiology and internal medicine. He received his medical degree from St. George's University School of Medicine. Dr. Yeh served an internship and residency at Jacobi Medical Center, Albert Einstein College of Medicine in New York. He also served a fellowship, specializing in Cardiology at UCLA Medical Center in Los Angeles. Dr. Yeh can be contacted via the website www.ccsheartcare.com The authors have nothing to disclose.

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