How do you decide between manual pressure versus opting for a specific vascular closure device at the conclusion of a femoral access case?

Manual vs closure devices depend on the following:

1. cathlab turnover- if fast turnover needed, manual pressure with sheath pull in PACU speeds up stuff, as long as the “puller” is not the provider cath’ing
2. evidence for closure device vs manual pressure is only good for hospital LOS and early deambulation. If that's a concern for you, close. If not, manual.
3. large bore (>8 Fr), if possible, always close
4. heparinized patients: unless you wait for ACT within therapeutic ranges to pull and do manual p...