Protocols - Interventional UK 3 - Non-Logged In: TRI-HERO Challenge

Protocol Descriptions
Outcomes / Measures of Success

Every patient whilst attending pre-assessment, pre-procedure is assessed by our cardiology pre-assessment nurses to establish whether the preferred method of access - right radial artery - is appropriate. This is established by manual palpation, if this is deemed to be weak or non-palpable this is escalated to the consultant who is undertaking the procedure who will evaluate which access is most appropriate (this may result in access being gained via left radial or femoral). If radial access is to be used, the cardiology consultant or registrar who is performing the procedure will use approximately 3mls of lidocaine before gaining access using a 5fr sheath (for diagnostic) or at least a 6fr sheath for CAD +/- PCI

After catheterisation, clean the wound site with sterile saline and assess which size TR band is most suitable for the patient. Withdraw the sheath by approximately 2-3cms ensuring before applying the TR band the wrist is dry. Position the TR band with the green dot approximately 5mm distal to the puncture site. Inject 14mls of air into the TR band. Remove the sheath and observe the site for bleeding. If bleeding is observed more air may need to be injected into the TR band (do not exceed a total of 18mls, if haemostasis is not achieved at 18mls repositioning of the TR band may need to be considered). To check the progress of haemostasis, reduce the amount of air within the TR band slowly (1ml at a time) until arterial bleeding is seen. Once bleeding is seen reintroduce the minimum amount of air required (1ml at a time) until haemostasis is achieved.

TIME BEFORE FIRST DEFLATION	60
TIME BETWEEN OTHER DEFLATION(S)	15
TIME BETWEEN DEFLATION IF REBLEEDING	15
AVERAGE VOLUME AT EACH DEFLATION	2-4

Post procedure the patient is transferred from the cath lab to our day ward for monitoring post procedure. An ECG is undertaken (if intervention has taken place) and observations and wound checks are completed as per our local policy. The patient is discharged 4hours post PCI (TR band to have been removed at least 1hour prior to discharge). The patient must have someone at home for 24hours post procedure who is aware of post discharge information. The patient will receive discharge paperwork appropriate for their access site and procedure undertaken. This would include:
•   Monitoring for signs of bleeding or swelling (and how to act on this at home such as applying pressure, alerting the adult who is caring for you for the first 24hours and calling 999).
•   Expectations of local pain and bruising at wound site – advised to take regular analgesia if required
•   Monitoring for signs of infection (redness, hot, swelling)
•   Our contact number so patients can ask any further questions or arrange a wound review as a day case (contactable during our opening hours of Monday-Friday 08.00-18.00 outside of these hours patients are advice to contact NHS 111 or visit A&E if require urgent advice).
Patients are advised to remain hydrated to aid the removal of contrast from the body and to remove the dressing over the wound site after 24hours.

TR BAND^TM (TERUMO) IS USED AS STANDARD DEVICE	INITIAL VOLUME OF INFLATION	PATENT HEMOSTASIS CHECK AT APPLICATION?
	14

TR BAND^TM (TERUMO) IS USED AS STANDARD DEVICE
INITIAL VOLUME OF INFLATION	14
PATENT HEMOSTASIS CHECK AT APPLICATION?

DCHFT TR Band Protocol

RADIAL ACCESS PROTOCOL

TR BAND^TM APPLICATION PROTOCOL

TR BAND^TM DEFLATION & REMOVAL PROTOCOL

DISCHARGE PROTOCOL

TIPS & TRICKS TO IMPROVE RADIAL ACCESS & DAILY WORKLOAD

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