Radial Artery Access For Coronary Angiography

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Patient has indications for cardiac catheterization and arterial access.
  • Femoral artery disease (eg, atherosclerosis, aneurysm)
  • Prior femoral artery injury or disease
  • Indicators of poor femoral artery access (eg, morbid obesity)
  • Coagulopathy that increases the risk of bleeding with femoral artery catheterization (eg,. severe liver disease, hereditary bleeding disorder)
CONTRAINDICATIONS
  • Absent radial or ulnar artery
  • Abnormal Allen’s test result
  • Patient is a dialysis access candidate.
  • Known hypoplasia of radial or ulnar artery
  • History of previous injury or surgery of the radial or ulnar artery
  • Interventions requiring larger than 8F catheter
EQUIPMENT
  • Sterile mask, gown, gloves, drapes (including a special drape for radial artery access—either a separate drape in addition to the standard femoral artery drape or a drape specifically designed for arm and groin access).
  • Sterile prep (povidone-iodine, chlorhexidine, alcohol)
  • Standard cardiac catheterization laboratory x-ray and hemodynamic monitoring equipment
  • Lead protection for operators and as appropriate for patient (consider thyroid, pelvic shielding, if possible)
  • Wrist stabilizer and arm board
  • Micropuncture access kit
  • Appropriate-sized access sheath, preferably one that can be advanced over a micropuncture wire (typically 4F or 5F for diagnostic studies and 6F for coronary interventions)
  • Standard soft-tipped wire, preferably not standard J-curve.
  • Standard coronary artery diagnosis and interventional catheters may be used.
  • An exchange-length J-tip wire for catheter exchanges
  • Lidocaine for local anesthesia, small (3- or 5-cc syringe), and small (eg, 25- or 30-gauge) needle for subcutaneous infiltration
  • Saline flush syringe
  • Parenteral nitroglycerin, 200 mcg/cc concentration in a 5- or 10-cc syringe
  • Parenteral heparin, 1000 to 5000 Units in a syringe
  • Parenteral verapamil, 2.5 mg/cc concentration in a 5-cc syringe
  • Bandage designed for radial artery compression

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Compression bands should be kept on for 1 to 3 hours. The bands may loosen over time or can gradually be loosened manually.
  • The patient does not require bed rest.
COMPLICATIONS
  • Bleeding at the site
  • Hematoma
  • Forearm swelling, including compartment syndrome (may signal perforation or other trauma to the artery)
  • Paresthesias caused by swelling, compartment syndrome, direct nerve damage
  • Diminished function of the arm or hand
  • Ischemia to the hand
  • Pain caused by radial artery spasm or catheter/vessel mismatch
  • Asymptomatic radial artery occlusion (5% of cases)
  • Radial artery intimal proliferation after catheterization, which may affect the quality of graft if it is used later in coronary artery bypass grafting or for dialysis
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