Radial Artery Sheath Insertion Medication

Updated: Jul 27, 2016
  • Author: Matthew Tam, MBBCh; Chief Editor: Vincent Lopez Rowe, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Anticoagulants, Hematologic

Class Summary

Anticoagulants prevent recurrent or ongoing thromboembolic occlusion of the vertebrobasilar circulation. In patients with heparin-induced thrombocytopenia, LVAD implantation has been performed successfully, albeit with additional risk, by using alternative anticoagulants.

Heparin

Heparin may be used if thrombocytopenia is not present. Heparin augments the activity of antithrombin III and prevents the conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. Heparin prevents the recurrence of a clot after spontaneous fibrinolysis.

Heparin is routinely given to prevent thrombosis at the site of sheath insertion. The amount used ranges from 40-70 U/kg, depending on the duration and degree of vascular intervention required. Heparin may be administered either via the arterial sheath or intravenously (IV). When given intra-arterially, it is often diluted with the patient's own blood, which can be extracted from the sidearm.

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Vasodilators

Class Summary

Vasodilators dilate the mesenteric arterial system. Thereby, they reverse reactive arterial vasospasms. They may be administered during sheath advancement through the guide wire, after completion of the procedure but before removal of the radial sheath, or both.

Papaverine

Papaverine is a benzylisoquinoline derivative that exerts a direct nonspecific relaxant effect on vascular, cardiac, and other smooth muscle. In the absence of peritoneal signs, it is the drug of choice for acute myocardial infarction (AMI) of arterial origin if angiography indicates good distal perfusion. Papaverine is advocated for the treatment of the widespread vasoconstriction that follows therapy for superior mesenteric artery (SMA) emboli by other modalities.

Nitroglycerin (Nitro-Dur, Nitro-Bid, Nitrolingual, Nitrostat)

Nitroglycerin produces vasodilator effects on the peripheral veins and arteries.

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Cardiovascular, Other

Class Summary

Agents that prevent radial artery spasm may be used.

Adenosine (Adenoscan, Adenocard)

When used in myocardial perfusion, scintigraphy reveals areas of insufficient blood flow. Adenosine increases blood flow and causes coronary vasodilation in normal coronary arteries, while it causes little or no increase in stenotic coronary arteries. Adenosine is also a short-acting agent that alters potassium conductance into cells and results in hyperpolarization of nodal cells.

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Calcium Channel Blockers

Class Summary

Calcium channel blockers are used to prevent radial artery spasm.

Diltiazem (Cardizem, Dilacor XR, Diltzac, Matzim LA)

During depolarization, diltiazem inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.

Verapamil (Verelan, Calan)

Verapamil relaxes coronary vascular smooth muscle and produces coronary vasodilation.

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