Authors (including presenting author) :
Mow HC(1)(2), Chan CM(1), Lau MC(2), Poon CH(1), Tsui WH(1), Wong KW(2), Yuen WT(2)
Affiliation :
(1) Cardiac Care Unit, Tuen Mun Hospital, (2) Cardiac Care Unit, Pok Oi Hospital, Medical and Geriatric Department, NTWC.
Introduction :
TR band (a kind of transradial hemostasis device) has been widely deployed for achieving hemostasis after trans-radial sheath removal after coronary angioplasty (PCI). Weaning maneuver is of paramount importance to striking a balance between hemostasis and complications but no standardized safe deflation of the band protocol available but two mainly strategies were evolved in this decade. An evidence-based accelerated & intermittent weaning protocol was developed in NTWC Cardiac Care Units (CCU) in 2022.
Objectives :
To compare the efficacy and safety of the accelerated & intermittent weaning protocol: 1). a shorter time to achieve hemostasis; 2). reduction the frequency of re-inflation of the TR band airbladder and hence nursing time; 3). minimize vascular complications.
Methodology :
A total of 100 patients with the TR band were recruited from TMH and POH CCU respectively. They were applied with conventional weaning strategy (NO intermittent air-bladder deflation interval after 1st de-air of the device bladder) and the accelerated and intermittent weaning strategy (Deflate balloon intervaly after 1st de-air of the device bladder until hemostasis achieved). Optimal hemostasis time, lesser nursing time in terms of reduction in the frequency of re-inflation of the airbladder and local vascular dysfunction, were evaluated and compared between groups.
Result & Outcome :
The accelerated protocol showed shorter hemostasis time (p=0.44917, t-test) and reduction in the frequency of re-inflation of the TR band air-bladder (p=0.00228, Chi-square test). However, there was no significantly increased incidence of the hematoma (p=0.31718, Chi-square test).
This accelerated and intermittent weaning protocol has been proven to be the most suitable and safe weaning strategy. Its’ viability and sustainability have been also evidenced by our project outcomes measures which this new weaning protocol can significantly reduce the risk of rebleeding and the nursing time to re-inflate the air-bladder while not increasing bleeding risk or hematoma that may facilitate the same-day discharge/bed management in our cluster.
