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Releasing pressure and observation of puncture site

• Starting at no more than three minutes for complete occlusion and at no more than ten minutes for partial occlusion of distal blood flow, compression should be released in small increments.
• Compression must be released in small increments gradually by using the Arm Lever. Do not raise the StrongArm quickly or by large amounts since the sudden increased blood flow could cause bleeding.
• When releasing compression, the Arm Lock should be loosened, and the Arm Lever should be raised and lowered in small motions. This raises the Arm and releases compression on the artery in small increments. Moving the Arm Lever to a 45° angle is the recommended range of motion when gradually releasing pressure. Small movements in the Arm Lever result in significant increases in blood flow. Each time the Arm is raised, the Arm Lock should be re-tightened.
• The puncture site should be observed while compression is being released. If any oozing or bleeding starts, compression should be immediately increased by pushing gently down on the Arm until the bleeding or oozing stops. Any blood should be immediately wiped away from the area inside the V-notch.
• At five or ten-minute intervals, compression should be released in small increments, as long as there is no oozing or bleeding.The Arm Lock should be re-tightened each time compression is released.
• Patients undergoing only angiography who have not received blood-thinning or anti-platelet drugs typically will achieve hemostasis within 20-30 minutes from the time the sheath is removed. Patients undergoing angioplasty or stent or graft procedures who have received blood-thinning or anti-platelet drugs will take longer to achieve hemostasis, depending on catheter size and the type of medications administered. ACTs should be checked prior to pulling the sheath to ensure clotting times which enable a hold time of reasonable duration.
• The 3-Finger Jack Disc should be removed from the body surface by gently 'easing' it away from the skin using fingertips and gentle, small movements-- sometimes the Disc can stick to the body surface. Care should be used so that the clot is not disturbed.
• Pressure dressing should be applied to the puncture site as per institutional procedure. Transparent dressings, e.g. Tegaderm, are recommended, to enable visualization of the puncture site, post-hemostasis. This permits observation of a post-hemostasis re-bleed, which can sometimes occur if heparin or other anti-coagulants are administered after completion of the procedure.