Name
SHARED-PCI (Standardized HAemostasis protocol for Radial artery procEDures – Percutaneous Coronary Intervention)
Virtual Session Link
Session Type
Interventional Procedure
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Protocol Name
SHARED-PCI (Standardized HAemostasis protocol for Radial artery procEDures – Percutaneous Coronary Intervention)
Team Name
Auxologico Cath-Lab Research Group
Country
Italy
Radial Access Protocol

The radial puncture is performed in a standard way from the left or right side. A standard 6F or 7-in-6F sheath is inserted. After the procedure, the TR Band is positioned with the green marker 1 cm above the puncture site. The TR Band is inflated with 15 cc (to IFU indications) and then, once the patient comes back to the ordinary ward, the nurse will apply the following steps: 1. In the first 1,5 hours, the TR Band is taken in place without air withdrawal 2. After 1,5 hours, 5 cc are removed from the TR Band 3. Every 30 minutes, 5 cc are removed until complete deflation (overall hemostasis time 2,5 hours) 4. After a complete hemostasis, a reverse Barbeau test will confirm arterial patency

TR Band Application Protocol

After the procedure, the TR Band is positioned with the green marker 1 cm above the puncture site (both for proximal or distal puncture). The TR Band is inflated with 15 cc of air (to IFU indications)

Initial volume of inflation
15
Tim e before first deflation
90
Time between other deflations
30
Time between other deflations - rebleeding
30
Average volume at deflation
5
Discharge Protocol

The patient will discharged the same day or the day after the procedure.

Tips and Tricks

In our experience, a standardized air volume withdrawal and removal time could ensure effective hemostasis without increasing clinically relevant bleeding (EASY scale <2). Furthermore, as widely demonstrated in current literature, a shorter hemostasis time is often associated with a high patency rate of radial artery and an uneventful post-procedural management. In case of bleeding (or oozing) during the deflation steps, the nurse will proceed as follows: - Increase the air volume of the TR Band until the bleeding stops; at the next step scheduled time, try to remove the remaining volume from the previous step and the volume expected for the current step (i.e. 5 cc expected volume, after 3 cc volume the oozing starts, reinflate 1 cc to stop the bleeding; after 30 minutes, remove 4cc (last step) + 5 cc (current step). In this way, the final removal time will not change.

Average number TR Band deflations
3.13
Average time to hemostasis - interventional
187.32
Average RAO following completion of hemostasis
3.00