Radial artery catheterization: Difference between revisions
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# Loss of [[radial artery]] pulse in 4% of cases | # Loss of [[radial artery]] pulse in 4% of cases | ||
# Potential increase in the duration of the procedure and fluroscopy time | # Potential increase in the duration of the procedure and fluroscopy time | ||
==Radial Artery Anatomy== | |||
===In the Forearm=== | |||
* [[Radial recurrent artery]] - arises just after the radial artery comes off the brachial artery. It travels superiorly to anastomose with the [[radial collateral artery]]. | |||
* [[Palmar carpal branch of radial artery]] - a small vessel which arises near the lower border of the [[pronator quadratus muscle|pronator quadratus]] | |||
* [[Superficial palmar branch of the radial artery]] - arises from the radial artery, just where this vessel is about to wind around the lateral side of the wrist. | |||
===At the Wrist=== | |||
* [[Dorsal carpal branch of radial artery]] - a small vessel which arises beneath the extensor tendons of the thumb | |||
* '''First dorsal metacarpal artery''' - arises just before the radial artery passes between the two heads of the first dorsal interosseous muscle and divides almost immediately into two branches which supply the adjacent sides of the thumb and index finger; the lateral side of the thumb receives a branch directly from the radial artery. | |||
===In the Hand=== | |||
* [[Princeps pollicis artery]] - arises from the radial artery just as it turns medially to the deep part of the hand. | |||
* [[Radialis indicis]] - arises close to the princeps pollicis. The two arteries may arise from a common trunk, the first palmar metacarpal artery. | |||
* [[Deep palmar arch]] - terminal part of radial artery. | |||
==Additional images== | |||
<gallery> | |||
Image:Gray416.png|Tendons of forefinger and vincula tendina. | |||
Image:Gray417.png|Cross-section through the middle of the forearm. | |||
Image:Gray421.png|Transverse section across distal ends of radius and ulna. | |||
Image:Gray422.png|Transverse section across the wrist and digits. | |||
Image:Gray526.png|Diagram of the anastomosis around the elbow-joint. | |||
Image:Gray527.png|The radial and ulnar arteries. | |||
Image:Gray1235.png|Front of right upper extremity, showing surface markings for bones, arteries, and nerves. | |||
</gallery> | |||
==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) | ||
==Performance of the Allen Test Before the Procedure== | ==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. | 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. | ||
Revision as of 18:05, 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
- Reduced length of stay
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. 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).[1]
Potential Pitfalls of the Radial Approach to Cardiac Catheterization
- Spasm
- Vessel tortuosity
- Guide catheter support may be reduced
- Loss of radial artery pulse in 4% of cases
- Potential increase in the duration of the procedure and fluroscopy time
Radial Artery Anatomy
In the Forearm
- Radial recurrent artery - arises just after the radial artery comes off the brachial artery. It travels superiorly to anastomose with the radial collateral artery.
- Palmar carpal branch of radial artery - a small vessel which arises near the lower border of the pronator quadratus
- Superficial palmar branch of the radial artery - arises from the radial artery, just where this vessel is about to wind around the lateral side of the wrist.
At the Wrist
- Dorsal carpal branch of radial artery - a small vessel which arises beneath the extensor tendons of the thumb
- First dorsal metacarpal artery - arises just before the radial artery passes between the two heads of the first dorsal interosseous muscle and divides almost immediately into two branches which supply the adjacent sides of the thumb and index finger; the lateral side of the thumb receives a branch directly from the radial artery.
In the Hand
- Princeps pollicis artery - arises from the radial artery just as it turns medially to the deep part of the hand.
- Radialis indicis - arises close to the princeps pollicis. The two arteries may arise from a common trunk, the first palmar metacarpal artery.
- Deep palmar arch - terminal part of radial artery.
Additional images
-
Tendons of forefinger and vincula tendina. -
Cross-section through the middle of the forearm. -
Transverse section across distal ends of radius and ulna. -
Transverse section across the wrist and digits. -
Diagram of the anastomosis around the elbow-joint. -
The radial and ulnar arteries. -
Front of right upper extremity, showing surface markings for bones, arteries, and nerves.
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.
References:
- ↑ Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR (2009). "Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials". American Heart Journal. 157 (1): 132–40. doi:10.1016/j.ahj.2008.08.023. PMID 19081409. Retrieved 2010-02-23. Unknown parameter
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