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Brachial drape over radial, then groin drape on top
VS
Groin drape with one opening on the radial and other on the right femoral
VS
Just groin drape and cut out holes for the radial
Ultrasound at the patients head
Linear probe, 9-15 range
Shallowest depth
Center-line on
Measure radial and ulnar artery beforehand
For diagnostic need vessel more than 1 mm
For intervention need >1.5 or >2.0 mm (I will communicate this)
Radial access kit wrapped in a towel:
1.US cover
2.5 ml 1% Lido
3.0.5” 25 g needle
4.Radial access kit (check size)
5.Dry 4x4s
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
DIAGNOSTIC RADIAL
2 lines at least, one to sheath and one to catheter
(HOT lines 5k U heparin/1L for Alkhatib)
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
Flush lines on top
Injections in-line
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
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 slowly 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
TR band Removal
Leave TR band on for 1 hour
Remove 2 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
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