Transradial Post-Procedure Protocols

Across the United States, the use of the radial artery to perform cardiac catheterization and percutaneous coronary intervention (PCI) has steadily risen within the past year. The interest among physicians, allied health professionals, and hospital administrators has also risen precipitously. This has been driven by evidence of profound reductions in bleeding complications, high rates of patient satisfaction, and in a subgroup analysis from the RIVAL study, a reduction in mortality among ST-elevation myocardial infarction (STEMI) patients. With this new wave of interest in an old access site, allied health professionals are in need of creating protocols to accommodate the physicians’ interest.

Recently, Tom Maloney was asked to remove a TR Band (Terumo, Somerset, New Jersey) from a patient who had been transferred to the critical care unit (CCU). When he asked for the protocol from the cath lab staff on how to bring the TR Band down, he received what he describes as anything from a blank stare to a couple variations. This made sense, because at his institution, it is the interventional care unit (IVCU) that receives the patients from the cath lab after cath lab staff applies the TR Band. However, cath lab staff does not remove the TR Band later in the day. Tom then went to the IVCU staff to ask for their guidance and received three variations from three different nurses. It was at this point that he realized the need for a standardized protocol.

Instead of “recreating the wheel,” he phoned several cath labs with high acceptance of radial procedures. When reaching out to two high-volume radial centers, he found out that they also did not have written protocols. Thus, he realized that he would have to write one from scratch. Ken Gorski shared with him a draft of the Cleveland Clinic’s transradial home instructions (still undergoing the approval process). In subsequent months, Tom gave several talks and let his audience know that if they wanted a copy of the protocols, they were welcome to have one. Much to our surprise, there was very high interest. Thus, the driver for this publication: to provide cath labs a template that they can customize to their needs and not have to start from scratch.

The disclaimer for this article is that it applies to the TR Band. We believe that other hemostasis bands are also valuable and efficacious. However, this has been the device that we have become comfortable with and has worked well for us. In addition, times can vary based on your comfort, so only use these as a guide. Our hope is that these protocols will save you some time in the future as you adopt your own “Radial First” program.

Thomas Maloney can be contacted at thomas.maloney@comcast.net.

Kenneth Gorski can be contacted at gorskik@ccf.org.

_________

*Thomas Maloney has subsequently accepted a position with Boston Scientific Corporation.
Disclosures: Thomas Maloney and Kenneth Gorski report no conflicts of interest regarding the content herein.