Perclose Proglide® Tips and Techniques

Refer to Instructions for Use for additional information.

Cuff Miss

A cuff miss can occur when the tip(s) of the needle(s) do not lock with the cuff(s). The operator will notice no suture or link present after the Plunger is withdrawn.

Cuff and link present with no suture
No suture or link present

What Should the Operator do?

  • Park the Foot and retract device until Guide Wire Exit Port is visible
  • Insert guide wire and exchange for another device

How to Prevent?

  • Stabilize the Proximal Guide with left hand during Plunger deployment and retraction of suture
  • Maintain and stabilize the device at a 45° throughout deployment
  • Proper patient selection
Suture Break

If a suture break occurs, the suture may look thin and elongated, or the blue or white-tip suture limbs snap

What to do?

  • If the device is still in place insert a guide wire and exchange for another device
  • If device is removed, assess hemostasis and manual compression may be necessary

How to Prevent?

  • Use slow, constant, and increasing tension
  • Keep suture limbs coaxial at all times
Poor Flow
No flow

Venous: No flow is possible but acceptable with confirmation of position

Causes

  • Marker Port is against the vessel wall
  • Side wall stick
  • Low blood pressure
  • Clot or tissue plugging Marker Port
  • Device not in vessel lumen
Slow drip

Venous: Slow drip is adequate

Resolution for Poor Flow

  • If vessel is not 5 mm, do not deploy
  • Gently rotate device
  • Slow drip is acceptable
  • Retract device until Marker Port is above skin. Re-flush Marker Lumen and observe saline exit Marker Port
  • Continue inserting device until brisk pulsatile flow occurs in the artery and slow drip occurs in the vein
Lack of Hemostasis

A lack of hemostasis after multiple device deployment may be a result of incorrect order of knot advancement or tangled sutures.

Incorrect Order of Knot Advancement When Deploying Multiple Devices

  • Sutures must be advanced in order of deployment. First suture (10 o'clock) is closest to the vessel. If second suture is tightened first it may result in an unsuccessful close
  • Continue to tighten and lock each knot in the order placed (10 o'clock then 2 o'clock)

Tangled Sutures

  • After device deployment and a clamp is placed on the sutures, gentle retraction is placed on the clamp until the suture is taut. This removes suture slack
  • If the suture slack is not removed the suture limbs can become tangled or pushed into the arteriotomy during device exchanges
Foot Break

A Foot break can be caused by rotating and rocking the device or excessive force during Plunger deployment.

What Will the Operator See?

After the Plunger is withdrawn the operator will notice either:

  • No suture or link present
  • Just a link and no suture
  • Missing part of the Foot when the device is removed

How to Prevent?

  • Stabilize and position device at 45° throughout deployment
  • Do not change the angle, rotate, or rock the device
  • Do not aggressively deploy the device
  • Needles may deflect with certain anatomical conditions (heavily calcified arteries, scarred groins, etc.)
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