TRB Hemostasis

The radial artery is palpated to check the puncture site, and Allen test is performed. In positive case a standard radial access is performed with a conventional 6F introducer or with a 6in5F Glidesheath Slender. In case the Allen test is negative, the first choice is to check the other radial artery. In case of another negative Allen test the physician decides if to check the puncture site with ultrasound or if to switch to the femoral artery.

a) Clean the puncture site with saline solution;
b) apply the TR-Band by positioning the green marker 1 cm from the insertion point of the introducer into the artery;
c) gently remove the introducer and at the same time, with the appropriate graduated syringe, inject 10 to 15 ml of air into the device without interruption until haemostasis is achieved. (increase the amount of air insufflated if necessary);
d) then gradually remove 1 ml of air from the TR Band at a time until the initial bleeding occurs;
e) when bleeding occurs, add 1 ml of air and ensure the effectiveness of the haemostasis;
f) if bleeding persists, add 1 ml of air at a time until the bleeding stops;
g) at the end of the maneuver, evaluate the limb and hand and record any symptoms in the nursing documentation: temperature and color of the skin, pain, discomfort, sensation of swelling, tingling, numbness of the limb;
h) record on the nursing documentation the time of removal of the introducer and the final volume of air insufflated into the TR Band;
i) to assess the presence of antegrade residual flow after positioning of the TR Band, perform the Inverse Barbeau Test (IBT) and record the result: positive (POS) plethysmographic wave present, negative (NEG) plethysmographic wave absent;
j) if the IBT NEG evaluates the possibility of proceeding with further removal of air from the haemostasis device (see point d));
k) preferably position the limb in a dependent position and provide the patient with the following information:
l) do not use the affected hand, avoid flexion-extension and rotation of the wrist until the haemostasis device is removed;
m) immediately communicate any symptoms to the hospital unit staff such as: pain, discomfort, sensation of swelling, tingling, numbness of the limb;
n) if complications arise during removal, also perform the Barbeau test to evaluate the arterial circulation of the hand through the ulnar artery and record the result in the Haemodynamic Nursing Dossier