Once the procedure has finished, it is very important to obtain adequate hemostasis. If the anticoagulation has been adequately reversed, usually with the appropriate dosage of protamine and reference to the ACT ratios, manual pressure may be adequate. However, with the use of larger sheaths, 8 and 9 French, and with continued heparinization, the incidence of hematoma and post-procedure bleeding increases. Rarely, this can lead to emergency open surgical closure of the puncture site and/or marked hypotension, hypovolemia or even death. Devices such as the Fem-stop (Radi-Medical Systems), which is a mechanical pressure device kept at just below arterial pressure, and the Angio-Seal (Sherwood, Davis and Geck, Gosport, Hampshire) have much improved the management of hemostasis post-procedure. The Angio-Seal is easily deployable and consists of a delivery kit and three completely bio-resorbable components. Deployment of the device allows mobilization of the patient, if clinically appropriate, after 1-2 hours and obviates the need for prolonged observation of the groin puncture site.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.