Materials and Methods
The V+Pad Non-Invasive Hemostasis Pad (InterV, Gainesville, FL; see Figure 1) was used as an adjunct with manual digital pressure to achieve rapid hemostasis in 100 patients leading to early ambulation post diagnostic angiography. The V+Pad has a durable 4 x 4 three-layer woven gauze design with a hydrophilic coating. The V+Pad works by accelerating platelet aggregation. The D-glucosamine-enriched fibers attract platelets to the pad™s absorbent gauze and exposed collagen at the vascular access site. This rapid platelet response leads to a platelet plug formation. The body™s natural thrombin converts fibrinogen to fibrin, which forms a mesh around the platelet plug. This mesh traps more platelets and red blood cells, thus the formation of a blood clot.

Procedure for manual digital pressure with the V+Pad:
1. V+Pad is applied over puncture site;
2. Sheath is removed, allowing small amount of blood to activate the pad;
3. Manual pressure is applied 4“6 minutes, depending on sheath size;
4. Hemostasis is achieved and a NexCare Tegaderm dressing is applied over the pad;
5. Patient™s head is elevated 30 degrees immediately post-hemostasis;
6. 60 minutes post-hemostasis, patient™s head of bed is raised to 90 degrees;
7. 90 minutes post-hemostasis, patient is ambulated and discharged from facility.

Inclusion/Exclusion Criteria
Post cardiac or peripheral diagnostic angiography patients receiving 4 Fr, 5 Fr, or 6 Fr sheath in the femoral artery were included.
Patients having a systolic blood pressure less than or equal to 150 mm of mercury were included.
Patients showing evidence of hematoma or active bleeding at access site prior to sheath removal were excluded.

Results
Manual compression with the V+Pad was compared to traditional manual compression protocols in achieving hemostasis and time to ambulation in 100 patients. Currently, our protocol for manual digital compression involves 15“20 minutes of pressure in diagnostic cases using 4 Fr to 5 Fr sheaths. Following hemostasis, patients remain in supine position for 60 minutes before head of bed elevation to 90 degrees is allowed. At this time, patients are able to eat while continuing bedrest for 2“3 hours. Using V+Pad as an adjunct to manual compression has resulted in decreased hold times, shorter length of bedrest and more position options to increase patient comfort and satisfaction (Table 1).
Ambulation at 90 minutes was consistently achieved with an end result of earlier discharge from facility. Puncture site assessment was performed per standard protocol, with special attention noted pre and post sheath removal, 60 minutes and 90 minutes post hemostasis. Follow-up phone calls were made 24 hours post procedure with a physician office visit within 1“2 weeks.
There were no complications noted involving hematomas. No adverse reactions were observed in relationship to the use of the V+Pad. No incidence of infection was reported by patients upon follow-up. Two patients did develop a rash related to Tegaderm sensitivity, which relieved itself and resulted in no puncture site compromise (Table 2).

Discussion
Using V+Pad as an adjunct to proper manual digital pressure can increase both patient and staff satisfaction. During interviews at specified follow-up intervals, patients reported being highly satisfied with the use of the V+Pad and the overall procedure. Reduced hold times, better positioning options, and faster time to ambulation are likely contributors to patient satisfaction. Patients sometimes complain about the amount of pressure and time needed to achieve hemostasis. Using the V+Pad, in conjunction with manual pressure, decreased our hold times to 4“6 minutes, depending on sheath size.
Shortened bed rest times from an estimated 3 hours to 1.5 hours, combined with allowing for elevation of the head of the patients bed to 30 degrees immediately post-hemostasis, drastically reduces back pain associated with prolonged immobility. Decreased pain associated with catheter procedures increases patient satisfaction, while reducing the need for pain medications.
Our facility consists of one procedure suite and recovery area for up to six patients. We perform as many as 10“14 diagnostic and/or interventional cases a day. Each staff member may be expected to remove 4“5 sheaths per day. Repetition and long hold times can take a toll on our fingers, hands and wrists. Using the V+Pad, we are able to reduce hold times, allowing more attention to be directed to patient care. Ambulating patients consistently at 1.5 hours facilitated flow in and out of our recovery area. Increased patient volume through improved hemostasis and ambulation efficiencies has positively impacted revenues without compromising patient care.

Conclusion
Outstanding patient care and patient satisfaction is a primary goal for caregivers. Allaying anxiety, and eliminating pain and discomfort is a high priority in the delivery of care we provide. Utilization of the V+Pad in our center helped to achieve goals we set for our patients. Our facility continues to employ the V+Pad without any evidence of post procedure complications. Patients continue to ambulate at 90 minutes, and satisfaction is at an all-time high.

Marcie Gruchevsky can be contacted at Mgruchevsky@cfl.rr.com