Saving Radial Access:  What Steps Should be Taken if You Fail to Access the Right Radial?

A Q&A column for cath labs with physicians performing radial access Failure to access the radial artery is the most common cause of failure for transradial catheterization. There are two general approaches to access: 1) The true Seldinger technique using an Angiocath needle; or 2) Anterior wall stick with a micropuncture needle. Regardless of the technique, it is vital to access the radial artery with the least amount of attempts possible to minimize risk of spasm. Once access is obtained, the wire should advance easily. If there is resistance, then one has encountered either a loop or a branch, or possibly gone subintimal. If the wire initially advances with ease, then a sheath can be advanced over the wire far enough to get it into the artery, but at this point, do not advance the sheath completely. Aspirate to confirm sheath placement in the artery, then inject diluted contrast and visualize the reason the wire did not advance. If there is a loop, often it can be negotiated with a coronary wire or hydrophilic wire in order to straighten the loop, and then a diagnostic or exchange guide wire can be advanced. A coronary or hydrophilic wire can often be advanced across the area of concern into the true lumen and the case completed, or it can be exchanged for a long sheath prior to completing the case. Either way, the presence of the catheter or sheath will seal the perforation or dissection by the end of the case (Figures 1-2; procedure performed by Dr. Zaheed Tai, DO, FACC). Once access has been obtained, the operator would like to maintain it. Repeated puncture increases the risk of spasm, thereby decreasing chances for success. Changing to the left radial is always an option; however, it often requires significant adduction of the arm to maintain routine laboratory set up. Also, the left radial is usually the preferred conduit if a radial artery is harvested for bypass. Email your question to Orlando Marrero at orlando.marrero@winterhavenhospital.com Find out more about transradial procedures at: https://www.transradialuniversity.com