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| | __NOTOC__ |
| | {{Radial artery catheterization}} |
| {{SI}} | | {{SI}} |
| | {{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.; {{AO}} |
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| '''Editors-in-Chief:''' [[C. Michael Gibson, M.S., M.D.]],
| | Synonyms and Keywords: Radial first, Radialfirst, Radialfirst, Radial approach, Right radial, Left radial, Go radial |
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| * Advantages of the Radial Approach to Cardiac Catheterization
| | ==[[Radial artery cathetarization overview|Overview]]== |
| # Reduced bleeding
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| # Early patient ambulation
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| # Greater patient satisfaction
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| # Absence of retroperitoneal hematomas, femoral pseudo aneurysms, arterial / venous fistulas
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| # Reduced length of stay
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| In a meta-analysis of publications from 1980 to 2008, radial artery catheterization was associated with a 73% relative risk reduction in the risk of major bleeding (2.3% vs 0.05%, p<0.001) compared to femoral access.
| | ==[[Radial artery|Radial Artery Anatomy]]== |
| While the risk of the composite endpoint of death, [[myocardial infarction]] ([[MI]]) and [[stroke]] tended to be less frequent among patients undergoing radial artery catheterization (3.8% vs 2.5%, p = .058), there was no difference in mortality alone. Radial artery access also was associated with a 0.4% reduction in length of stay (p=0.001).
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| *Potential Pitfalls of the Radial Approach to Cardiac Catheterization
| | ==[[Radial Catheterization Advantages|Advantages]]== |
| # Spasm
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| # Vessel tortuosity
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| # Guide catheter support
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| #Loss of [[radial artery]] pulse in 4% of cases
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| *Contraindications to Utilization of the Radial Approach to Cardiac Catheterization
| | ==[[Radial catheterization pitfalls|Potential Pitfalls]]== |
| #[[Cellulitis]] or other infections over the [[radial artery]]
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| #Absence of palpable [[radial artery]] pulse
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| #Positive Allen test (see below), indicating that only one artery supplies the hand
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| #Coagulation defects (relative)
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| *Performance of the Allen Test Before the Procedure
| | ==[[Radial catheterization contraindication|Contraindications]]== |
| An Allen Test should be perforemd before the procedure to confirm that there is sufficient blood flow in the [[ulnar artery]] should there be a loss of patency in the [[radial artery]] due to either thrombosis or spasm which can result in gangrenous finger or had loss. The Allen Test is performed with the patient sitting with the hands turned in the supine position on the knees. Your fingers are then used to compress the tissue over both radial and ulnar arteries. Allow a few minutes for the blood to drain from the hand while the patient opens and closes her hands several times. Release the pressure on the ulnar artery while keeping the radial artery occluded. normal skin color should return to the ulnar side of the palm in 1-2 seconds, followed by quick restoration of normal color to the entire palm. A hand that remains white indicates either absence or occlusion of the ulnar artery, and radial artery puncture is contraindicated.
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| *Choosing the Left or Right Side for the Radial Approach
| | ==[[Radial catheterization allen's test|Pre-procedure Assessment]]== |
| If the internal mammary artery must be canulated, then the left radial artery should be used.
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| *Obtaining Radial Access
| | ==[[Radial catheterization procedure|Procedure]]== |
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| *Initial Insertion of the Catheters
| | ==[[Radial catheterization hemostasis|Achieving Hemostasis after Radial Artery Catheterization]]== |
| To reduce spasm, 500 micrograms of [[diltiazem]] can be administered via the sidearm prior to insertion of the right and left sided catheters.
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| *Catheter selection
| | ==[[Radial catheterization complications|Complications]]== |
| Many operators choose to start with the right coronary artery as the right sided catheter may allow for directing the wire as you make your way up around the arch. Once the wire is around the arch, it should remain there for exchanges. A JL 3.5 catheter may be used to engage the left coronary artery when catheterization is performed from the right arm.
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| | ==[[Best practices for transradial angiography and intervention|Best Practices for Transradial Angiography]]== |
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| {{WH}} | | {{Coronary Angiography}} |
| {{WS}} | | |
| | [[Category:Angiopedia]] |
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