Stitches after EP Study?

Question

Can they use stitches after they remove the catheter after an EP study? I had an EP Study last Thursday and spent several hours in recovery because one side kept oozing blood when they removed the catheter. Why couldn't they stitch it instead up applying pressure for so many hours? Then I had to lay still for 6 more hours after they got the bleeding stopped.

Midijane · Accepted Answer

Hi there. Remember the spot where the catheter went into the top of the leg was just a puncture site. That means no insicion was made that would need stitched up.

Time for a little anatomy 101 now, the spot where the catheter enters into the skin is just a puncture site but it is still a large puncture site. The catheter passes throught the skin and enters into a vein right? When that same catheter is removed at the end of the procedure, it is pulled out of the vein leafing a literal hole in the vein for a short time. Nurses need to hold pressure on the site to help the hole in the vein have time to form a clot so blood won't leak out into your leg. Really, the puncture site needs a clot to form rather than a few stitches to close it up. A clot forms a perfect seal. 

Hope that makes sense.

Midijane · Answer

So glad you made an appointment. No worries about worrying :). Sounds like you voiced a valid concern. Good for you.

tls585 · Answer

I was able to see my doctor. He says it is just a hematoma but he will check it again in a few days. If the redness is still there, I will get an antibiotic. Thanks for your advice, I didn't want to seem like a big baby but it did get larger and more painful. Sorry to hear about your fistula. I have heard those REALLY hurt!

Midijane · Answer

I would just ask to be seen for concern of a growing lump in the groin of your catheterization site. Your concerned there may be a blood leak inside and would like to have it evaluated. I would guess the office staff should get you in that same day or the next depending on how you describe the worsening of the lump. Just my opinion here. Or, maybe you'll decide to watch and wait. Keep us updated.

Midijane · Answer

Hi again, if I were looking at my own leg in your situation I would ask myself, is the area growing upward or outward in size or does it feel as though it is flattening out over time? How is the color? Does it hurt more or less. Does the leg of the affected groin feel any different (ie- does it drag)? I guess the point is, do you feel like there is enough of a change for the worse since you've been home, that someone at your physician's office should take a look at it? And if you're honestly not sure, call an ask to be seen in the office since it is a valid concern of yours. 

Does that help any?

oldtrout466 · Answer

I would suggest asking for an ultrasound scan - which must be a Doppler scan which shows the venous and arterial blood as different colours. It is possible for the artery to be damaged during the procedure and that would require sustained pressure to stop the bleeding. During a catheterisation I had 7 years ago the artery was lying across the vein and was therefore punctured in accessing the vein. Unfortunately it meant the holes in the artery and vein healed together causing a join between the venous and arterial blood supplies -a fistula. Normally these are detected pretty quickly post op as they cause swelling and pain at the site - an ultrasound will be able to see what is going on.

tls585 · Answer

It is now 5 days since my EP study and the lump in the right site has grown from small pea size to a large grape size. should I be concerned? It does hurt.

tom_h · Answer

I had an orange sized hematoma that drained into my thigh in the days following the procedure.  It was real nasty looking and tender.  If they worked on your left side, they probably administered Heparin to prevent clots from the transseptal puncture.  This could slow the closing time at the leg site.  I awoke to a large sand bag pressing on the entry site and the rest of my "man parts".  It was quite umcomfortable!

tls585 · Answer

My labs were normal, no problems with the clotting factor. The nurse had someone check that during the time they were holding. It is sore and the lump is getting a little larger. Thanks for the good wishes, I expect to return to work tomorrow.

Jerry_NJ · Answer

My immediate question was: what was you clotting (protime/INR) at the time of the procedure.  

As already well stated, clotting is the normal way of stopping the bleeding.  I have had a catheter exam twice in my life, and both times I was on an coagulation control regiment to keep my INR beween 2 and 3, normal is 1.  I don't recall, but from what I just read it must be that I was off of the Warfarin/coumiden medication (and aspirin too) for a few days before the procedure.  In any case, I had no bleeding problems.

There may have been an unusually large entry/exit wound in your case.  I do read that stitches were used to close the wound.  Will the stitches dissolve or do you have to have them removed after healing?

Midijane · Answer

Yes something was definately going on for her to need to hold pressure so long. But not to worry, it sounds like she was trying to control a small leak and did a good job of staying ontop of it. 

Maybe your clotting studies (bloodwork that shows how thin a persons blood is) were a little elevated, making the pressure holding time longer. Other things factor in as well. 

Anyway, not to worry. I imagine your leg must be tender. Hope you're getting back to feeling like yourself. Take care.

tls585 · Answer

Thanks for the info. I was just curious because the nurse was holding the site for literally almost 3 hours. I wonder if the artery was nicked and that is why it took so much longer to clot?

tom_h · Answer

Stitching would require opening the skin to access the vein.  It's much safer to allow the puncture wound to close up on its own.  Stitching is an option however.