EARLY DEFLATE WITH RADIAL PRESERVATION

RADIAL ACCESS PROTOCOL

  1. Palpation of both radial arteries. Search for pulse.
  2. Select one of the arteries.
  3. Once the radial artery is selected, perform Allan test to confirm good blood flow of the hand. Allan test: Compress radial and ulnar arteries at the same time. With both arteries compressed, ask the patient to clench and unclech the hand 10 times. When the hand is then held open, ensure that the wrist and fingers are not hyperextended and splayed out. The palm is observed to be blanched. Release the ulnar artery. If the capillary refill time is less than 6 seconds, the test is considered positive.
  4. If Allan test is negative, repeat test on the opposite hand, if pulse is detected.
  5. If Allan test is negative in both radial arteries, consider other arterial access.

TR BANDTM APPLICATION PROTOCOL

  1. Upon completion of procedure withdraw introducer sheath 2-3cm.
  2. Apply the TR BAND Compression Device by aligning green marker, which is located on the center of the compression balloon (large) 1-2mm proximal to the puncture site, and fix the strap on the wrist with the adjustable fastener. The TR BAND Compression Device should be fixed tight enough to prohibit the band from spinning. This device must be positioned differently when used on the left or right wrist. When attaching the device.
  3. Inject 15mL and proceed to remove the sheath. Air should be fully inserted when sheath is completely removed. NOTE: The goal is for bleeding to cease when the sheath is completely removed.
  4. Begin titration of air using the patent hemostasis technique by removing 1mL per second while observing the access site for bleeding. When bleeding occurs or pulse is detected, inject 2ccs of air or until bleeding stops.
  5. Confirm radial pulse and evaluate radial artery patency by using the reverse Barbeau’s test: – Place the plethysmographic sensor on the thumb or index finger of the involved upper extremity with the observation of pulsatile waveforms. – Compress the ulnar artery at the level of the wrist, and observe the behavior of the waveform. – Absence of plethysmographic waveform is indicative of interruption of radial artery flow. If this occurs, the hemostatic compression pressure should be lowered to the point where plethysmographic waveform returns and hemostasis is maintained. This is evidence of antegrade radial artery flow.
  6. Note the air volume introduced Use of TR BAND on distal radial artery access:
    1. Remove the rounded support plate (rigid transparent plastic)
    2. adjust the TR BAND Compression Device to the puncture site, aligning the green marker 2mm proximal to the puncture site, and fix the strap to accommodate the device to the hand.
    3. Follow inflate and deflate of the device as per normal protocol

TR BANDTM DEFLATION & REMOVAL PROTOCOL

DISCHARGE PROTOCOL

Perform reverse Barbeau test to verify absence of radial artery occlusion.

TIPS & TRICKS TO IMPROVE RADIAL ACCESS & DAILY WORKLOAD

Use of TR BAND on distal radial artery access:

  1. Remove the rounded support plate (rigid transparent plastic)
  2. adjust the TR BAND Compression Device to the puncture site, aligning the green marker 1-2mm proximal to the puncture site, and fix the strap to accommodate the device to the hand.
  3. Follow inflate and deflate of the device as per normal protocol

Average number of TR BandTM Deflations

  

2.36

Average time to hemostasis - Interventional Procedure

149.7 mins

Average RAO following completion of hemostasis

14.00%

Team: ENFERMERÍA HEMODINÁMICA LA FE

Country: Spain

HAVE YOUR SAY

Want this protocol to win the peer vote award? Show your support by clicking the vote button below

SHARE WITH YOUR PEERS