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Expert Perspective: Modified Figure-of-Eight Sutur ...
Expert Perspective: Sandeep A. Saha, MD, MS
Expert Perspective: Sandeep A. Saha, MD, MS
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Video Transcription
Hello, my name is Dr. Sandeep Saha, and I'm a cardiac electrophysiologist at the Oregon Heart Center in Salem, Oregon. In today's video, I'll describe a technique used for vascular hemostasis after complex procedures that require large-bore transfemoral venous access. This technique has become exceedingly popular among electrophysiologists, and I use this as my go-to method for achieving vascular hemostasis after complex left atrial or left ventricular ablation procedures, placement of left atrial appendage closure devices, as well as the placement of transvenous leadless pacemakers. Here is a snapshot of the things that I use. I will usually have 1% lidocaine, a 22 or a 25-gauge needle, a number 11 sterile blade, a vascular hemostat, non-absorbable suture, in this case, zero-ether bond, ultrasound jelly, and either a one-way or a three-way stopcock. This is the typical setup after a cryoablation procedure for atrial fibrillation. There is one 14-french long venous sheath in the right femoral vein, a long 10-french femoral sheath in the left femoral vein, and either a 6-french or a 7-french short sheath in the left femoral vein. The first step is injection of lidocaine into the subcutaneous tissues. This is done on both groins. The figure of 8 suture is delivered in two steps, a larger, broader, and deeper subcutaneous bite taken inferior to the venous access site, and a shallower superficial subcutaneous stitch, which is delivered cranial to or superior to the venous access site. So here we see the deployment of the first deeper subcutaneous bite, and then the more superficial superior subcutaneous bite. The ends of the suture are then cut, and then the next step that I do is the use of some ultrasound jelly to straighten the ends of the sutures, and this helps facilitate insertion of the ends of the suture into the central channel of the stopcock, in this case a one-way stopcock. The stopcock is held firmly against the skin with the left hand, while the suture ends are held taut with the right hand. The suture is then cinched after the sheath is removed, so as to maintain the pressure that was applied earlier. The same process is then repeated on the left side. I would usually have an assistant put gentle pressure on both stopcocks, especially during extubation from general anesthesia. The suture can also be deployed at the beginning of the case as shown in this clip before the insertion of the larger bore transfemoral venous sheath. In this case, the suture ends are introduced into the central channel of the stopcock but the stopcock is left to the side for later use. This is what the groin side looks like the following day. The tegaderm dressing is removed. The stopcock is turned to release the tension on the suture ends and then removed. The skin is then stretched and the suture is plucked out in one smooth motion. Thank you for your attention. Maybe this video will inspire you to try this technique the next time you have a procedure that requires large bore transfemoral venous access and maybe you will find this technique useful in your own lab. Feel free to let us know of your personal experience with this technique as well as other topics or videos that you would like to be seen featured in this series. Thank you.
Video Summary
Dr. Sandeep Saha, a cardiac electrophysiologist, discusses a technique for achieving vascular hemostasis after complex procedures requiring large-bore transfemoral venous access. The technique involves using a figure of 8 suture, lidocaine injections, and a stopcock to secure the site. Dr. Saha demonstrates the step-by-step process, including the deployment of the suture, removing the sheath, and releasing the tension on the suture for removal. He encourages viewers to try this technique for their own procedures and shares his interest in hearing about their experiences.
Keywords
vascular hemostasis
figure of 8 suture
lidocaine injections
stopcock
procedure
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