TR Band protocol at Södersjukhuset, Stockholm, Sweden

At our cath-lab we use TR-band as the hemostasis device after coronary angiogram via radial access. The TR-band is uses both for right and left accesses. Initially a reversed Barbeau Test is performed before the radial access will be the access of choice. The test ensures adequate arterial circulation to the hand via the ulnar artery as the radial access may be impaired by the introducer placed in the radial artery. This test also establishes a baseline circulation of the radial artery. Ultrasound may be used to locate the radial artery for puncture.

The scrub nurse is responsible for applying the TR-band after the procedure is complete. The sterile drape is carefully removed and the site is cleaned and wiped dry. The introducer sheath is carefully pulled out a couple of cm. The green marker on the TR-band is placed 3-5 mm proximal of the puncture site and the band is wrapped around the wrist making sure it is not to lose nor to tight. The device cuff is inflated with 15 ml of air and the syringe is removed. With the pressure applied the introducer sheath is pulled out. To evaluate the amount of air needed in the cuff for hemostasis the syringe is attached and air is slowly removed until bleeding occurs. 2-3 ml of air is then added again to ensure hemostasis. With the amount necessary for hemostasis another Barbeau Test is performed to evaluate the radial circulation. The time, amount of air in the TR-band and the result of the Barbeau Test is recorded on the TR-band removal protocol. The protocol is used for documentation and monitoring the removal process and noting any potential complications or additional actions needed for effective TR band management.