Embedded Files
Radial patient prep
BAIR hugger under patient
If no radial drape:
Just groin drape and cut out holes for the radial
VS
Brachial drape over radial, then groin drape on top
VS
Groin drape with one opening on the radial and other on the right femoral
ALWAYS PREP GROIN
Ultrasound Prep
Measure radial and ulnar artery beforehand
Ultrasound at the patients head
Linear probe, 9-15 range
Shallowest depth
Center-line on
For diagnostic need vessel more than 1 mm
For intervention need >1.5 (5 or 6 fr sheath) or >2.0 mm (8 fr guide)
I will communicate this
Radial access kit:
Wrapped in a towel:
US cover
5 ml 1% Lido
0.5” 25 g needle
Radial access kit (check size)
Dry 4x4s
I don't use ultrasound gel
No scalpel or clamp for radial.
Radial cocktail - in a 20 mL syringe:
•5 mg verapamil
•200 micro g nitroglycerine
•2000 U heparin
LEAVE the extra space in the syringe, will dilute/buffer with blood so it burns less
DIAGNOSTIC RADIAL
2 lines at least, one to sheath and one to catheter
(HOT lines 5k U heparin/1L)
5 fr radial sheath
5 fr SIM 2 gluide
“0.035 Glidewire 180 cm + Torque
1% buffered Lidocaine ~5 ml
2-5000 U heparin ready for IV (this will be in my clinic/consult note, and I will communicate it)
Flush lines on top
Radial intervention
I will communicate my system and usually have it in my clinic/consult notes at the end of the note
2-5 lines depending on intervention
Non-aneurysm embo/MMAE/ECA:
Replace 2-gang with 3 way stopcock to hanging contrast
Main: 5 fr sheath, 5 fr Sim glide, microsystem
Back up: 6 fr SIM Envoy, Vecta 46, microsystem
FD Stent/Intracranial embo:
Construct depends on radial size,
Radial 1.4-2.0 mm - 7 fr sheath, BMX 81, sim select, glidewire advantage is baseline access
if radial >2.0 mm and need larger bore - 7 fr sheath for cocktail, small nick. After cocktail glidewire advantage up to exchange sheath for Ballast vs BMX 92. Sim select
Connections bubble clearance:
Start from the flush line going back
1. Saline flush on 3 way top
2. Extension tube inline to 3-way
3. 2 gang
4. Contrast
5. Power injector
6. RHV Touhy
7. Catheter
I will check these in reverese order
End with test injections from the power injector x2-3
Goal of TR band is "Patent Hemostatsis"
Enough pressure to not bleed but not so much to stop flow
Pull sheath out 1-2 cm.
Press on the sheath to assess where the arteriotomy is - usually, a few mm higher up the arm than the skin puncture site
Place unfolded 4x4 gauze under the sheath to keep things clean.
Place the TR band so the green dot lines up with arteriotomy
Add 10 ml of air while steadily removing the sheath
Be ready to add another 2 ml air once the sheath comes out fully if there’s any bleeding (I start with 15 ml in syringe, some do 20 ml)
If no bleeding, slowly remove 1 cc of air, usually 9-11 ml needed.
Almost never less than 8 or more than 13 – Let MD know
Check for palpable pulse beyond the TR band/Good wave form on index pulse-ox
Distal TR band
Pull sheath out 1-2 cm
Place TR band so black dot over arteriotomy
Here the skin puncture and artery puncture are much closer to each other
Start with 10 mL air in the syringe
add 8 mL air while steadily removing the sheath
Look for any pulsation on the balloon, these tend not to bleed
Remove at most 2 mL (leaving 6 mL in the band) watching for pulsation
Add 1-2 mL from the point you see pulsation
THESE TEND NOT TO BLEED, LOOKING FOR PULSATION AT THE WINDOW
TR band Removal
Leave TR band on for 1 hour diagnostic, leave for 2 hours if on any antiplatelet or anticoagulant
Remove 2-3 ml of air, 1 ml at a time for 15-30 seconds assessing for any bleeding
If any bleeding add back the air 1ml at a time and wait 30 minutes
No bleeding, then leave TR band for 15 minutes before repeating
Normal to have venous stasis/discoloration of hand from TR band
Sensation should be intact, no tingling/pain, and capillary refill should be normal
Assess the arm above the TR band for any swelling or tenderness. A low TR band may not bleed out the skin puncture and bleed up along the radial artery compartment
Page updated
Google Sites
Report abuse