SWBH TR Band Protocol
RADIAL ACCESS PROTOCOL
Right radial is the preferred access method unless clinically indicated otherwise. Cath Lab or Cardiology Day Case Nurses will initially assess the radial by manually feeling the pulse and informing the cardiologist if this is strong, weak or not palpable. Radial access is gained in the Cath Lab by the Cardiology consultant or registrar using 1-2ml of lidocaine and a 6F radial sheath, unless clinically indicated otherwise. Once successful access, the sheath is secured using a tegaderm or mepore dressing.
TR BANDTM APPLICATION PROTOCOL
The 2nd operator is responsible for TR band application so this could be the Cardiology registrar or a Cath lab scrub nurse. The tegaderm or mepore dressing securing the site is carefully removed and the sterile drape pulled back. The site is cleaned of bodily fluids and dried with sterile gauze. The sheath is pulled back 2-3cm. A TR band is applied to the site aiming for the green dot to be placed slightly distal to the skin puncture. 15mls of air is injected to inflate the band; as the band inflates, the sheath is removed. 1ml of air is removed at a time, assessing for bleeding, aiming for the least amount of air to remain in the band as possible. When bleeding occurs, 2mls of air is reinjected. A reverse barbeau's test is carried out by the Cath Lab nurse whilst the patient is still on the Cath lab table to assess for radial patency.
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 |
60-90 |
10-15 |
10-15 |
3-5 |
TIME BEFORE FIRST DEFLATION |
60-90 |
TIME BETWEEN OTHER DEFLATION(S) |
10-15 |
TIME BETWEEN DEFLATION IF REBLEEDING |
10-15 |
AVERAGE VOLUME AT EACH DEFLATION |
3-5 |
DISCHARGE PROTOCOL
The patient is kept for monitoring post procedure between 2-6 hours depending what procedure was carried out. The patient receives discharge paperwork specific to their radial access site which explains to monitor for bleeding or swelling, to apply pressure if this occurs and contact the hospital for advice or to attend A&E outside of working hours. It explains to look out for signs of infection. It explains there may be some bruising and mild pain and the patient can take over the counter analgesia for this. The patient should keep the mepore dressing on for 3 days and try to keep the site dry during this time. The patient should avoid any heavy lifting on their access site side for 1 week. Contact numbers are provided to the patient should they have any further concerns once they are discharged.
TIPS & TRICKS TO IMPROVE RADIAL ACCESS & DAILY WORKLOAD
The patient is warned prior to the procedure that the initial administration of lidocaine may sting for sheath insertion. The patient is also warned that it may feel slightly uncomfortable during sheath removal once the TR Band is applied. If there are multiple puncture sites, we may apply a second TR band distal to the first, without any air injected to apply minimal pressure. Alternatively, we may apply a pressure bandage distal to the TR band for additional pressure. We aim to fully deflate the TR band in 2 deflations, if no bleeding occurs, as this relieves workload pressure for the nurses and means we are not disturbing the patient more than necessary during their recovery. Any hematomas are generally managed by the nurse, making contact for the Cardiology registrar to review if they are concerned.
|
2.5 |
||
Average time to hemostasis - Interventional Procedure |
124.24 mins |
||
Average RAO following completion of hemostasis |
0.00% |
