Radial artery catheterization: Difference between revisions
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# Early patient ambulation | # Early patient ambulation | ||
# Greater patient satisfaction | # Greater patient satisfaction | ||
# Absence of retroperitoneal hematomas, femoral pseudo aneurysms, arterial / venous fistulas | |||
*Potential Pitfalls of the Radial Approach to Cardiac Catheterization | *Potential Pitfalls of the Radial Approach to Cardiac Catheterization | ||
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# Vessel tortuosity | # Vessel tortuosity | ||
# Guide catheter support | # Guide catheter support | ||
#Loss of [[radial artery]] pulse in 4% of cases | |||
*Contraindications to Utilization of the Radial Approach to Cardiac Catheterization | *Contraindications to Utilization of the Radial Approach to Cardiac Catheterization | ||
#Cellulitis or other infections over the radial artery | #[[Cellulitis]] or other infections over the [[radial artery]] | ||
#Absence of palpable radial artery pulse | #Absence of palpable [[radial artery]] pulse | ||
#Positive Allen test (see below), indicating that only one artery supplies the hand | #Positive Allen test (see below), indicating that only one artery supplies the hand | ||
#Coagulation defects (relative) | #Coagulation defects (relative) | ||
Revision as of 16:02, 23 February 2010
Editors-in-Chief: C. Michael Gibson, M.S., M.D.,
- Advantages of the Radial Approach to Cardiac Catheterization
- Reduced bleeding
- Early patient ambulation
- Greater patient satisfaction
- Absence of retroperitoneal hematomas, femoral pseudo aneurysms, arterial / venous fistulas
- Potential Pitfalls of the Radial Approach to Cardiac Catheterization
- Spasm
- Vessel tortuosity
- Guide catheter support
- Loss of radial artery pulse in 4% of cases
- Contraindications to Utilization of the Radial Approach to Cardiac Catheterization
- Cellulitis or other infections over the radial artery
- Absence of palpable radial artery pulse
- Positive Allen test (see below), indicating that only one artery supplies the hand
- Coagulation defects (relative)
- Performance of the Allen Test Before the Procedure
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.
- Choosing the Left or Right Side for the Radial Approach
If the internal mammary artery must be canulated, then the left radial artery should be used.
- Obtaining Radial Access
- Initial Insertion of the Catheters
To reduce spasm, 500 micrograms of diltiazem can be administered via the sidearm prior to insertion of the right and left sided catheters.
- Catheter selection
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.