Lisie heart protocol for TR Band
RADIAL ACCESS PROTOCOL
At our center, the right radial artery is the preferred access site for procedures. The following steps outline the standard protocol: - *Pre-Anesthetic Checkup*: During the pre-anesthetic evaluation, the radial artery is palpated to ensure it is of adequate size by assessing the pulse volume.
- Assessing Ulnar Artery Patency: A Modified Allen’s Test or Barbeau’s Test is performed to confirm the patency of the ulnar artery, ensuring adequate collateral circulation.
- Local Anesthesia and Access: The consultant or registrar infiltrates 3 mL of lidocaine at the radial site. Access is gained using an 18-gauge needle from the Radifocus Introducer Kit II.
- Sheath Introduction for Intervention: For interventional procedures, a 6F or 7F sheath is introduced.
TR BANDTM APPLICATION PROTOCOL
- TR Band Application Protocol – Post-PCI: Once the patient is transferred to the CCU and is clinically stable, the TR band application begins one hour after the procedure:
- Aspirating Blood: Aspirate 3-4 cc of blood to confirm no clots are present.
- Withdrawing the Sheath: Partially withdraw the sheath by 2-3 cm and clean the access site.
- Positioning the TR Band: Align the Terumo logo on the TR band with the little finger, and position the green marker 1-2 mm proximal to the puncture site.
- Inflation and Sheath Removal: Inflate the compression balloon with 7 cc of air using the TR band inflator. Then withdraw the sheath by approximately 50% of its length. Continue inflating a total of 13-15 cc of air and fully remove the sheath.
- Ensuring Patent Hemostasis: Remove 1 cc of air until a flash of blood appears, then immediately reinject 1 cc of air to maintain optimal pressure for patent hemostasis.
TR BANDTM (TERUMO) IS USED AS STANDARD DEVICE |
INITIAL VOLUME OF INFLATION |
PATENT HEMOSTASIS CHECK AT APPLICATION? |
|
15 |
|
TR BANDTM (TERUMO) IS USED AS STANDARD DEVICE |
|
INITIAL VOLUME OF INFLATION |
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 |
120 |
20 |
30-40 |
3-4 |
TIME BEFORE FIRST DEFLATION |
120 |
TIME BETWEEN OTHER DEFLATION(S) |
20 |
TIME BETWEEN DEFLATION IF REBLEEDING |
30-40 |
AVERAGE VOLUME AT EACH DEFLATION |
3-4 |
DISCHARGE PROTOCOL
Discharge Protocol - Post-Procedural Observation: After dressing the radial site, the patient is moved to a room for overnight observation, with a single companion allowed.
- Patient Instructions: Patients are instructed to notify the duty nurse immediately if any rebleeding or swelling occurs at the dressing site.
- Follow-Up: - The next day, during rounds, the registrar removes the dressing, inspects the puncture site, and applies a standard band-aid. - The patient is then discharged and advised to report any redness, swelling, or pain at the puncture site to the cardiology emergency contact number.
TIPS & TRICKS TO IMPROVE RADIAL ACCESS & DAILY WORKLOAD
- Ensure there is a little finger finger-width gap on the ulnar side when applying the TR band to prevent ulnar artery occlusion.
- If a proximal hematoma is noticed after TR band application, apply an additional TR band proximally.
- Place a gauze piece at the distal part of the TR band when removing the sheath to prevent blood spillage.
- For obese patients, use a large-size TR band (29 cm). This protocol ensures a smooth radial access procedure and the maintenance of hemostasis, contributing to patient safety and reduction in radial artery occlusion.
|
2.08 |
||
Average time to hemostasis - Interventional Procedure |
126.07 mins |
||
Average RAO following completion of hemostasis |
10.11% |
