A Q&A for Cath Labs with Physicians Performing Radial Access

I have a question about sheath exchanges. We did a radial access case with Terumo Glidesheaths for the first time. We started with a 5 Fr Glidesheath. Then, when we determined that we wanted to do the intervention radially, we realized that the 6 Fr sheath dilator was a .021” hole and we had a .035” long wire in the distal end of the aortic arch. We had to get another 6 Fr Glidesheath with an .035” dilator. What 6 Fr sheath do you utilize? What do you do when you start with a 5 Fr sheath and have to upsize? Or do you upsize the sheath over the wire provided in the Glidesheath kit? We have some concern with exchanging over a shorter wire, and look forward to your insight. — B. Williams Traditionally, in our program, we start with a 5 French (Fr) Glidesheath by Terumo. We have found this sheath to answer our needs here in our program. There are many others, but we prefer the Glidesheath for its lubricious coating and ease of use when entering the body via the radial approach. If you start with a 5 Fr sheath, and are going into percutaneous coronary intervention (PCI) and need to upsize for a 6 Fr system, the safest way is to utilize the 260cm .035” wire. Never give up your purchase with the 260cm J wire. In my experience in our program, we do not recommend that you exchange a five for a six over an .021” wire. There is an increased risk of spasm and difficulty removal of the non-hydrophilic femoral sheath (unless you have the .035” Glidesheath). What you and your team may need to do, if applicable, is to select when to start with a 5 versus a 6. We typically start with a 5 for 90 percent of our patients. For all acute coronary syndrome patients, we use 6, for large patients we use a 6, and if there is a strong indication we are going into PCI, we start with a 6 Glidesheath by Terumo. Another option is that Terumo does have a .035” Glidesheath, and that will solve all your issues. The order number is RM*BF6M10MA, 10 cm length, .035” wire diameter with a .082 Tip inner diameter. Contact your Terumo representative for more specific information and cost. Ask your transradial program question to Orlando Marrero, RCIS, MBA, at Orlando.Marrero@WinterHavenHospital.org

NULL