A Chakraborty, B Bakamis, G Tan, H Fan, N Jain. Radiology Department, St George Hospital, Kogarah, NSW, Australia STANDARD: Most published ar2cles reported the incidence to be between 5–10% [1] [2] [4]. This was corroborated with the results from a meta-­‐analysis which included data from 2,373 cases [5]. INDICATOR: Development of groin haematoma during the procedure un2l the pa2ent le3 the radiology department. TARGET: Achieve an incidence rate on par with or beVer than published data [6] [3]. Pa2ent demographics, past history, observa2ons and biochemistry, access difficulty, pa2ent co-­‐opera2on, operator experience, use of ultrasound and dura2on of compression. Addi2onally, in a case of haematoma: 2ming of development, use of external compression device. ROUND ONE RESULTS What factors were found to be most associated with incidence of haematoma? Audit ques2on Prospec2ve audit of 100 cases was performed from June–
October 2013. Data 1sr Round Was interven2on and modifica2on of these factors possible? Usage of Ultrasound in Haematoma Pa2ents The overall incidence of groin haematoma was 17% at our centre. Non-­‐use of ultrasound (US) during access was associated with 81% cases of groin haematoma (33% of the study popula2on had no US used). Incorrect compression technique was found in 85% of the cases of groin haematoma. Only 18% of the study popula2on had their groin manually compressed incorrectly. How effec2ve was the interven2on and was it worthwhile? Re-­‐audit Groin haematoma is an established complica2on a3er percutaneous access of the common femoral artery (CFA). Several studies exist analyzing data to establish factors responsible for development of haematoma a3er needle puncture of the CFA. Most of these studies use coronary angiography data. This audit has been conducted in order to iden2fy factors associated with development of groin haematoma during and immediately a3er diagnos2c and interven2onal angiographic procedures at our centre. Once risk factors iden2fied, the aim was to modify our prac2ces to minimize the incidence of groin complica2ons. Interven2on BACKGROUND Manual Compression staDsDcs in cases where haematoma developed Ultrasound used 19% 14 12 Ultrasound not used 10 81% 8 6 4 2 0 Junior Trainee Senior trainee and consultant ROUND ONE ACTION PLAN Trainees were formally taught correct technique of manual compression. A reference sheet was developed. Ultrasound guidance while performing groin puncture was standardized for both consultants and trainees In 3 years Re-­‐audit Interven2on 2 Interven2on 1 Haematoma developed ROUND 2 RESULTS A prospec2ve re-­‐audit of 100 cases during November 2015–March 2016 showed that the incidence rate had reduced to 6%. Ultrasound guidance was used to access the Common Femoral Artery (CFA) in 96% cases. All trainees were formally trained in manual compression technique. The general demographics and case complexity was similar to previous audit as were other pa2ent and procedural parameters. Total cases Haematoma Ultrasound used 96 3 Ultrasound not used 4 3 3 2.5 2 1.5 1 0.5 0 100 Haematoma developed 96 Total cases Ultrasound used 4 Ultrasound not used Manual compression by senior trainees and consultants Total cases done Compression by Junior trainees Cases where haematoma developed 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% !! TAKE HOME POINT !! Use of ultrasound guidance significantly reduces incidence of groin haematoma in intervenDonal radiology. Manual compression technique should be formally taught to all new radiology trainees. References: 1. Wagner SC, Gonsalves CF, Eschelman DJ, Sullivan KL, Bonn J. Complications of a percutaneous suture-mediated closure device versus manual compression for arteriotomy closure: a case-controlled
study. J Vasc Intv Radiol 2003; 14(6): 735–741. 2. Lupi A, Rognoni A, Secco GG, et al. Different spectrum of vascular complications after angio-seal deployment or manual compression. J Invasive Cardiol 2012; 24(3): 90–96. 3. Sabo J, Chlan LL, Savik K. Relationships among patient characteristics, comorbidities, and vascular complications post- percutaneous coronary intervention. Heart Lung 2008: 37(3): 190–195. 4. Walker SB, Cleary S, Higgins M. Comparison of the FemoStop device and manual pressure in reducing groin puncture site complications following coronary angioplasty and coronary stent placement. Int J
Nurs Prac 2001; 7(6): 366–375. 5. Das R, Ahmed K, Athanasiou T, Morgan RA, Belli AM. Arterial closure devices versus manual compression for femoral haemostasis in interventional radiological procedures: a systematic review and metaanalysis. Cardiovasc Interv Radiol 2011; 34(4): 723–738. 6. Yeow KM, Toh CH, Wu CH, Lee RY, Hsieh HC, Liau CT, Li HJ. Sonographically guided antegrade common femoral artery access. J Ultrasund Med 2002; 21: 1413–1416.