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Femoral vascular access is a common route for catheter-based procedures such as coronary angiography, angioplasty, valvuloplasty, and structural heart interventions. Following these procedures, achieving hemostasis at the arteriotomy site is essential to prevent complications such as bleeding, pseudoaneurysm, infection, or distal limb ischemia. Traditionally, manual compression has been used to achieve hemostasis, but this approach can be prolonged, uncomfortable, and less effective in patients with obesity, anticoagulation, or large-bore access requirements. Femoral vascular closure devices offer an alternative method for faster hemostasis, earlier ambulation, and increased patient comfort. These devices are broadly classified as passive or active. Passive devices aid external compression but do not shorten the time needed for hemostasis. Active devices, such as collagen plugs, sutures, and clips, directly close the arteriotomy site and are often preferred in complex or high-risk cases. The appropriate device selection depends on the patient's anatomy, arterial calcification, procedural complexity, and anticoagulation status. The course equips clinicians with the knowledge and technical proficiency to select and deploy femoral vascular closure devices safely and effectively. Participants gain a thorough understanding of device-specific techniques, evidence-based selection criteria, and the identification and management of complications. Emphasis on interprofessional collaboration enhances care by incorporating the expertise of nurses, radiology technicians, and clinicians in vascular access management. This team-based approach improves procedural efficiency, promotes patient safety, and reduces complication rates by ensuring appropriate device use and vigilant postprocedure monitoring. By addressing common challenges in device selection and deployment, the course contributes to improved hemostasis outcomes and supports high-quality patient care following femoral catheterization procedures. Objectives: Differentiate between the 2 types of femoral vascular closure devices (passive and active) and understand their respective indications. Identify the contraindications of femoral vascular closure devices, and evaluate when mechanical compression could be used as a safe alternative.

The course equips clinicians with the knowledge and technical proficiency to select and deploy femoral vascular closure devices safely and effectively. Participants gain a thorough understanding of device-specific techniques, evidence-based selection criteria, and the identification and management of complications. Emphasis on interprofessional collaboration enhances care by incorporating the expertise of nurses, radiology technicians, and clinicians in vascular access management. This team-based approach improves procedural efficiency, promotes patient safety, and reduces complication rates by ensuring appropriate device use and vigilant postprocedure monitoring. By addressing common challenges in device selection and deployment, the course contributes to improved hemostasis outcomes and supports high-quality patient care following femoral catheterization procedures. Objectives: Differentiate between the 2 types of femoral vascular closure devices (passive and active) and understand their respective indications. Identify the contraindications of femoral vascular closure devices, and evaluate when mechanical compression could be used as a safe alternative. Screen patients undergoing femoral access for catheterization to determine eligibility for closure devices and minimize the risk of vascular complications. Collaborate with interprofessional team members, including clinicians, nurses, and radiologic technologists, to enhance procedural safety and optimize patient recovery. Access free multiple choice questions on this topic.

Cardiac catheterization is often required for various procedures, including angiography, angioplasty, valve replacement, valvuloplasty, ablation, and congenital heart repair. This procedure is necessary to assess and care for many patients presenting with myocardial infarction, heart disease, valvular disease, or congenital heart disease—with a common site of catheterization entry being the femoral artery. Catheterization is a procedure that is heavily performed in the field of interventional cardiology. After catheterization procedures, appropriate mechanisms are necessary to close the port of entry of the catheter into the femoral artery. As a result, the need for devices to assist in closing the femoral artery is continually evolving. Initially, the only mechanism to assist in hemostasis at the catheter insertion site would be mechanical compression of the femoral artery. Although mechanical compression is sufficient in patients without certain comorbidities, it can be challenging in patients who are obese and on anticoagulation therapy. Additionally, patients treated through femoral access require a longer hospital stay than those who receive radial access. Manual compression would take longer to achieve hemostasis, increasing the strain on the healthcare system. Certain procedures, such as inserting left ventricular assist devices and mitral/aortic valve replacement procedures, require larger femoral vascular access sites, making mechanical compression cumbersome or a less effective method to achieve hemostasis.[1][2] Femoral vascular closure devices can be divided into 2 broad categories: passive and active. Passive closure devices help achieve mechanical compression and reduce thrombosis to achieve effective hemostasis. However, passive devices do not hasten the time it takes to reach hemostasis. Active closure devices include suture devices, collagen plugs, and clips.

One of the most common complications associated with femoral vascular closure devices is groin infection, underscoring the importance of adhering to strict sterile technique, including wearing proper attire, thorough skin preparation, and meticulous draping during device placement. Infections are reported more frequently with closure devices than with manual compression techniques.[11] Distal limb ischemia is another potential complication, typically resulting from thrombosis or distal embolization at or beyond the arteriotomy site. This risk is heightened in the presence of heavily calcified vessels, making such conditions a relative contraindication to device use. Compared to manual compression, closure devices have a higher incidence of ischemic complications.[11] Other potential adverse events include bleeding, hemorrhage, and pseudoaneurysm formation. However, manual compression generally makes these complications more frequent than vascular closure devices.[12] In severe cases, especially when ischemia or vascular injury occurs, surgical intervention—including possible bypass grafting—may be required to restore distal perfusion and manage complications effectively.

Effective use of femoral vascular closure devices after catheterization requires a coordinated, multidisciplinary approach to ensure optimal patient outcomes and procedural safety. Clinicians must possess the technical skills to select the appropriate closure device based on individual patient anatomy, bleeding risk, and procedural complexity. Accurate device deployment and recognition of early signs of complications, such as hematoma or limb ischemia, are critical. Interventionalists must communicate clearly with nursing staff to ensure proper post-procedural monitoring and documentation, especially during transitions from the cath lab to recovery settings. Nurses play a vital role in patient-centered care by providing real-time assessments of the access site, managing postprocedure positioning, and educating patients on activity restrictions and signs of delayed complications. Pharmacists contribute by managing anticoagulant and antiplatelet regimens before and after the procedure to balance the risks of bleeding and thrombosis. Radiologic technologists assist with imaging guidance during device deployment, while all team members benefit from structured communication protocols, such as time-outs and handoff tools. High-functioning interprofessional collaboration enhances team performance, improves patient satisfaction, reduces complications, and promotes a safe and efficient recovery following vascular access closure.