BACKGROUND The cost-effectiveness of expensive suture mediation devices for the management of femoral access is currently under investigation, while the effectiveness of in-ward femoral access management by standard care has not yet been assessed. METHODS To determine whether a logistic model that includes management of femoral access by the cardiology ward staff is effective, 945 consecutive invasive procedures using > or = 8 Fr sheaths were prospectively screened over a 6-month study period. Vascular complications included: any need for surgical or endovascular repair, ultrasound-guided compression, any femoral or iliac bleeding requiring blood transfusion. RESULTS During the study period there were 581 diagnostic procedures, and 364 interventional procedures. Interventional procedures included 98 primary PTCA, 42 coronary atherectomies, and 39 intraaortic balloon pump supported PTCA. Vascular complication rate was 1.6% (surgical repair 0.2%, ultrasound-guided compression 1.1%, blood transfusion 0.3%). CONCLUSIONS The vascular access management by the cardiology ward staff was associated with a very low rate of vascular complications. This policy may play a role in reducing costs and improving logistics.