Techniques to Reduce Bleeding with Large Bore Access Devices

Amir Kaki, MD, FACC, FSCAI, outlines the factors that have led to reductions in bleeding and complications with large-bore access devices, including the Impella® heart pump, over the past decade, and discusses techniques and best practices for access and closure. Dr. Kaki is the director of mechanical circulatory support and complex PCI at Ascension St. John Hospital.

Dr. Kaki notes that the PROTECT II randomized controlled trial demonstrated lower rates of vascular complications in patients treated with Impella compared to patients treated with intra-aortic balloon pump (IABP). He notes that in the years since, improvements in technique, training and technology have all been instrumental in consistent reductions in complications and bleeding.

Dr. Kaki also outlines best practices for access and closure, stressing that the “key to really successful closure is good access.” As a best practice, Dr. Kaki recommends using image-guided access, such as ultrasound or angiogram. At Ascension St. John Hospital, all large-bore access devices are explanted in the cath lab, and hemostasis must be achieved before patients leave the lab.