SHARED-PCI (Standardized HAemostasis protocol for Radial artery procEDures – Percutaneous Coronary Intervention)
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 BANDTM 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)
TR BANDTM (TERUMO) IS USED AS STANDARD DEVICE |
INITIAL VOLUME OF INFLATION |
PATENT HEMOSTASIS CHECK AT APPLICATION? |
|
15 |
|
TR BANDTM (TERUMO) IS USED AS STANDARD DEVICE |
|
INITIAL VOLUME OF INFLATION |
15 |
PATENT HEMOSTASIS CHECK AT APPLICATION? |
|
TR BANDTM DEFLATION & REMOVAL PROTOCOL
TIME BEFORE FIRST DEFLATION |
TIME BETWEEN OTHER DEFLATION(S) |
TIME BETWEEN DEFLATION IF REBLEEDING |
AVERAGE VOLUME AT EACH DEFLATION |
90 |
30 |
30 |
5 |
TIME BEFORE FIRST DEFLATION |
90 |
TIME BETWEEN OTHER DEFLATION(S) |
30 |
TIME BETWEEN DEFLATION IF REBLEEDING |
30 |
AVERAGE VOLUME AT EACH DEFLATION |
5 |
DISCHARGE PROTOCOL
The patient will discharged the same day or the day after the procedure.
TIPS & TRICKS TO IMPROVE RADIAL ACCESS & DAILY WORKLOAD
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.
|
3.13 |
||
Average time to hemostasis - Interventional Procedure |
187.32 mins |
||
Average RAO following completion of hemostasis |
3.00% |
