KC AGEL Pardubice
RADIAL ACCESS PROTOCOL
In our center is more than 90% of coronary cases done via radial approach. Most of our team prefer proximal right radial artery for sheath insertion. There are obviously some exceptions, eg. patient after CABG with LIMA-LAD graft, with known upper limb arterial disorder, need for use 7F guiding catheter etc. Left proximal radial approach and distal radial approach are in our center used in minority of cases. Site of puncture/insertion of sheath and size of sheaths is doctor decision in each cases. In coronary procedures we are used to use 5F tools in most of diagnostic and 6F tools in most of interventional procedures. TR bands are in our center used for hemostasis after sheath removal in more than 90% of transradial procedures. Due to long history of using TR bands in our center is our staff well experienced in work with this tool. Easy handling and perfect overview of puncture place are the main benefits of TR band in our opinion.
TR BANDTM APPLICATION PROTOCOL
Vital sings like blood pressure, pulse, ECG and oxygen saturation are checked in the end of each procedure. If normal, sheath removal and TR band deployment is done. This manipulation is always strictly aseptic. Size of TR band is choosed by experienced nurse. First TR band inflation is provided by nurse in cathlab, volume is between 12 to 15 ml air depending on size of TR band and hemostasis. Whole procedure including first inflated volume is described in patient documentation. For this purpose are in our center using special cards (see attachment).
TR BANDTM (TERUMO) IS USED AS STANDARD DEVICE |
INITIAL VOLUME OF INFLATION |
PATENT HEMOSTASIS CHECK AT APPLICATION? |
|
12-15 |
|
TR BANDTM (TERUMO) IS USED AS STANDARD DEVICE |
|
INITIAL VOLUME OF INFLATION |
12-15 |
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 |
15 |
15 |
25 |
2-3 |
TIME BEFORE FIRST DEFLATION |
15 |
TIME BETWEEN OTHER DEFLATION(S) |
15 |
TIME BETWEEN DEFLATION IF REBLEEDING |
25 |
AVERAGE VOLUME AT EACH DEFLATION |
2-3 |
DISCHARGE PROTOCOL
There are two different discharge protocols in our center.
First is applied on patients which staying after the procedure at hospital over the night. This group is observed by department stuff and usually discharge in the morning next day after procedure. This group contains patients undergoing complex procedures like PCI of CTO, complex PCIs with calcium modification etc.
Second group contains patients staying at day care facility. Patients from this group are usually discharged between 4 to 6 hours after procedures, depends of type of procedure. Diagnostic procedures after 4 hours, non complicated PCIs after 6 hours after procedure.
They can only leave the day care facility accompanied by a family member or carer. Each patient, no matter which group, is instructed before discharge about possible delayed complications of the procedure, as well as how to take care of the cover and what movement of the limb is possible after the procedure.
TIPS & TRICKS TO IMPROVE RADIAL ACCESS & DAILY WORKLOAD
Puncture of an artery wall on 12th hour. Gentle insertion of sheath, optimally Terumo glidesheath slender. After procedure sheath removement by experienced nurse. First TR band inflation with minimum air volume leading to hemostasis. Deflation of TR band as soon as possible. Rest the limb for next 24 hours.
|
5.87 |
||
Average time to hemostasis - Interventional Procedure |
89.9 mins |
||
Average RAO following completion of hemostasis |
0.00% |
