In the era of vascular closure devices, the skill of achieving hemostasis by manual compression is almost becoming a lost art. It concerns me to see cath lab personnel that do not have a good technique for manual compression. When those closure devices fail, we need to be confident in our ability to manage hemostasis. Most seem to go with the "brute force" or "monster mash" technique. While this can be effective, it presents some concerns.

First, a "brute force" or "monster mash" technique is more uncomfortable for the patient. Second, it tends to cause more bruising and displaces the skin is a way that makes it difficult to assess if a hematoma is developing. Third, this technique is often not effective in our "well nourished" patients (specifically those with a tight, round belly). Finally, it is physically more demanding on the staff and often leads to the excuse "I'm just not strong enough to hold pressure," requiring calling upon your second hand to assist.