Nursing Issues and Trends

in Trans-Radial Approach

 Introduction

What is the impact of Transradial Approach on Patient, Nurses, Physicians

and Hospital.
Major nursing issues in Transradial Cardiac Cath.

Summary & Conclusion.

References

Impact of Transradial Approach

Patient and Family

Nursing

Hospital

Physicians

Bed Rest

Quick Transfer

Early Discharge

More Patients ( quantity)

Elderly patient

Less nursing hours/patient

More beds

Less vascular events(

Quality)

Cachectic patient with

Pressure Ulce

Less Overtime

Heart Failure & SOB

Less Budget

Safety

Edematous Patient

Back Pain

Patient Comfort and

Satisfaction Impact

Nursing Management
Impact

Hospital Impact

Physician Impact

Very modern and equipped with advanced biomedical

technology
* Well staffed with expert cardiologists and nurses.
* Dynamic and active: adult and pediatrics, diagnostic
and interventional. Services provided for all
emergency cases, inpatients and day cases.
* Average monthly cases is 200 patients.

 Not great number of transradial cases

Concepts/ Factors
Suitability for emergency
procedures

AngioSeal

Radiation

Patient Conition/ Prefernce

Small Artery/Spasm

Nursing Preparation

Equipments/Supplies /
Troublshootings

Pain

Time Consuming

Operator Preference (Interest)

due to credentials and training

10

No of Narratives
15

20

Participants interviewed on May 2011 to assess the

factors of not having great Numbers of Transradial
Cases (n=20)

5
4
3
2
1

Both

Transradial

Transfemoral

No of Nurses

Nurses interviewed on May 2011 to assess their

preferences : Transradial vs. Transfemoral approach ( n=
10)

Preferable Cardiac catheterization

Approach

 Operator choice: does not prefer Radial

Could be because of

Worries of the spasm and canualtion

Worries of the supplies and equipment
Worries of the radiation hazards
Did not reach the learning curve and
credentials.

Is the operator convinced by this

results?(source: Jolly 2009)

And by this results (source: Jolly 2009)

More Results (source: Jolly 2009)

 Nurses Training:
Standard preparation of Transradial Patient
- shaving ( groin must be also shaved as
backup).
- IV canula site
- Allen Test
- Pre and post procedual care

 Spasm
.is there what is called Regional Radial Spasm .

 Standardize Cocktail medications

IA Verapamil
IA Nitroglycerin
IV Heparin
Based on experience, patient condition,
institutional guidelines.
Room for evidence base studiesmay be there is
no need for cocktail and administer Moderate
sedation only.

 Equipments and Supplies

Transradial approach requires the

continuous availability of the items needed
such as needles, sheaths, wires and catheters.
It is important to have adequate stock of
those items in different sizes ( for
troubleshooting) .

Patient Involvement

...Patient condition decides if (s)he suitable for

transradial access. But operators are strongly
advised to disclose the risk-benefit ratio of
transradial vs. Transfemoral approaches. ARE
WE REALLY DISCUSSING TRANSRADIAL
APPROACH WHILE SIGNING THE CONSENT
FORM

 Radiation dose in transradial approach is high,

it is true BUT we should apply all radiation
safety measures during the procedure.

 Documentation: nurse must have an accurate

documentation (Manual or Electronic) of the
procedural notes and the events could occur.

 Terumo Radial Band Guidelines:

Our cardiac cath lab had an approved official
evidence based guidelines of the application
of TR. Nurses still asking physician rather than
applying those guidelines.

Summary and conclusion

Transradial Cardiac cath is the approach
chosen based on patient condition, and
operator preferencewe need to consider the
patient choice.
It has many benefits on patient(family),
nurses, hospital and operator.
We need to maximize our cases and conduct
some evidence based studies to overcome
some of the issues.

AHA: Radial Best Femoral Access for Coronary Angio; Easy Switch for Cardiologist, Nov, 16, 2009
Brueck, M, Bandorski,D, Kramer, W, Wieczorek, M, Holtgen, R, Tillmanns, H: A Randomized Comparison of Transradial
Versus Transfemoral Approach for Coronary Angiography and Angioplasty, Journal of American College, Cardiology
Interventional, 2009,2,1047-1054

Cath Lab Digest, Transradial vs. Femoral Access: Facebook page , Jan, 21, 2010

Cappola, Ask the Expert: Benefits of Transradial Access, Terumo Medical Corporation, Retrieved from:
www. Terumomedical.com

Clifton, G, Ask the Expert: Benefits of Transradial Access, Terumo Medical Corporation, Retrieved from:
www. Terumomedical.com

Cohen, Interest in Transradial Angioplasty Growing Among U.S cardiologist is a Key Issue, Retrieved from:
www.ptca.org/news2008/0610.Radial .html

Jobe, Ask the Expert: Benefits of Transradial Access, Terumo Medical Corporation, Retrieved from:
www. Terumomedical.com

Jolly, S, Amlani, S, Hamon,M, Yusuf, S, Mehta, S,: Radial vs. Femoral Access for Coronary Angiography or Intervention and
the Impact on Major Bleeding and Ischemic Events: A systematic Review and Meta Analysis of Randomized Trials.
American Heart Journal, 2009, 157, 132-140.

Mario, D, C, Viceconte, N, Radial Angiolpasty: Worthy RIVAL, not undisupted winners, Lancet, 2001, 377:1381-1383

Saitu, S, Transradiial Approach: Angioplasty Org. Interview Series, Retrieved from:

www..ptca.org/radial/interview/saitu.html.

Tremmel, J, 2009, The Transradial Approach: Does Your Followship Training Program Teach It. Transradial World.

White, C, 2011, Radial Access Angioplasty Better than Femoral. Onmedica, Taking Medical Information Further, Apr 5th
2011.

Questions???

If I was a patient, I would be much comfortable with a

needle to my wrist than my groin, what about you!....

 Daddy, When I grow up

I would like to be a
cardiologist performing
only trans-radial Cath
Layan my lovely daughter