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Transradial Cardiac Catheterization Periprocedural Care

  • Author: David H Adler, MD, FACC; Chief Editor: Eric H Yang, MD  more...
 
Updated: Jan 24, 2014
 

Equipment

Standard cardiac catheterization laboratory equipment and fluoroscopy are generally used. Specialized arterial sheaths and catheters can be used to facilitate transradial cardiac catheterization.

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Patient Preparation

The patient is brought to the catheterization laboratory in a fasting state after informed consent is obtained. A “time out” is performed, and the patient’s identity is confirmed and medical history reviewed. All team members are allowed an opportunity to voice any particular concerns regarding the case. The patient is then prepared and draped under sterile conditions.

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Anesthesia

In most cases, conscious sedation is performed. General anesthesia is rarely needed for routine cardiac catheterization and coronary intervention but may be used in some special circumstances. Local anesthesia (usually with lidocaine) is performed prior to arterial access.

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Positioning

The patient is placed in the supine position with the upper extremity extended and palm in a supine position. Frequently, an armboard is used to support the upper extremity, and a wrist support is used to stabilize and extend the wrist.

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Monitoring & Follow-up

The patient is monitored continuously during the procedure by the physician and staff. Continuous electrocardiographic monitoring, pulse oximetry, and blood pressure monitoring are performed.

The patient’s state of consciousness and pain level are also continuously assessed. A brief outpatient follow-up appointment is generally scheduled for 1-2 weeks to assess for any postprocedural problems, to review the findings of the procedure with the patient, and to evaluate the patient’s response to therapy.

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Contributor Information and Disclosures
Author

David H Adler, MD, FACC Assistant Professor of Medicine, Eastern Virginia Medical School; Cardiologist, Cardiovascular Associates, Ltd

David H Adler, MD, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association

Disclosure: Nothing to disclose.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic Arizona

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

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Radial Artery Loop: Radial loops are a common arterial anomaly. Most radial loops can be traversed with a guidewire and an sheath advanced beyond the loop in order to proceed with angiography. The radial loop pictured is an extreme example. A decision was made to use a different arterial access site in this case.
Radial Artery Spasm (1 of 3): Contrast injection shows severe spasm in the radial artery.
Radial Artery Spasm (2 of 3): After intra-arterial injection of nitroglycerin and verapamil, the radial artery spasm is relieved.
Radial Artery Spasm (3 of 3): After relief of spasm with vasodilators, an introducer sheath has been easily advanced into the radial artery.
Tortuous Subclavian Artery (1 of 2): Tortuosity of the subclavian artery can make catheter manipulation difficult.
Tortuous Subclavian Artery (2 of 2): Successful coronary angiography was performed in this case despite the severe tortuosity of the subclavian artery.
Radial Loop (1 of 3): This radial artery loop was encountered after placement of an an access sheath in the radial artery at the wrist. This common arterial anamoly presents a challenge to performing transradial catheterization, but can usually be traversed using a guidewire.
Radial Loop (2 of 3): A 0.014 inch guidewire has been advanced across the radial loop. This will allow advancement of a catheter above the loop.
Radial Loop (3 of 3): A catheter has been advanced beyond the radial loop to the ascending aorta. Successful coronary angiography was performed.
 
 
 
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