The Radial Approach Makes Its Way Into Interventional Oncology
In interventional radiology (IR), new devices and equipment are utilized every day for the goal of optimizing procedure techniques to improve outcomes. For transcatheter procedures, choosing the right vessel access site is critical for interventional radiologists to perform angiograms and embolizations. For the registered nurses caring for patients throughout the procedure and recovery, knowing how to properly manage these lines and accesses is also as important for continued care and overall patient safety.
For registered nurses caring for patients after having undergone an arterial access for IO procedure, the care and monitoring of the puncture site is important. Assessment of the access site, the pressure dressing, and signs of bleeding and hematoma are relevant and necessary components of post-procedure nursing care to minimize or prevent complications.
A radial access approach for IO procedures has several advantages. Much of the literature will inform you that radial access over femoral access minimizes the amount of time patients have to remain lying flat. Given that most oncology patients spend a good amount of time in the angiosuite laying in the supine position when undergoing an IR procedure, an additional 2-6 hours of bed rest post procedure due to a femoral approach adds hours of immobility and as healthcare professionals we all know too much bed rest following procedures is never a good thing!
We must also keep in mind that with most oncology patients, certain laboratory values may be abnormal, such as with existing primary liver cancer or liver metastases in which platelet count and/or coagulation parameters are affected. In these cases, a femoral access may have a higher risk of retroperitoneal bleeding, requiring blood transfusion, which leads to longer immobility or even unplanned hospital stay. Additionally, controlling a bleed with compression may be difficult. By comparison, a radial access is anatomically favorable due to the artery’s proximity to the skin surface, making it easier to locate the site, palpate, and manage the compression device and dressing to the site. Radial artery cannulation has lower risk of bleeding and eliminates the need for prolonged bedrest and immobility allowing patients to move around easier and ambulate sooner.
Nurses caring for patients in the post-procedure recovery phase after undergoing an IR procedure via radial approach should be familiar with the compression device and how to manage it. Nurses should also assess for clinical changes to the site such has color, sensation, or movement of upper extremity warranting further evaluation and intervention by the radiologist provider.
Radiology nurses working within IO practices in which radial access is being introduced benefit from participating in educational in-services along with other members of the IO team. Familiarity with patient selection (as not all patients may be candidates for this approach), access site criteria, site preparation, and access by the interventional radiologist will provide fundamental knowledge and improved care of the patient throughout the procedure. Furthermore, reading published literature and radial access device instructions provides information specific details. The radiology nurse’s understanding and knowledge of this technique throughout the pre-, intra-, and post-procedure phases will be better preparation to manage these patients.
