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Implementation of radial arterial access for cardiac interventions: a strong case for quality assurance protocols by
Giuseppe Steffenino1, Mauro De Benedetto Fabrizi, Giorgio Baralis
1Interventional Cardiology Unit, Cardiovascular Department, Santa Croce and Carle Hospital, Italy. steffenino.g@ospedale.cuneo.it
Insights
A nurse-led quality assurance program improved outcomes for radial artery access, reducing complications like pulse loss and hematoma. This approach enhances patient comfort and safety during coronary angiography and angioplasty procedures.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Quality Improvement in Healthcare
Background:
- Radial artery access is increasingly preferred for coronary angiography and angioplasty.
- This technique requires specialized skills for effective hemostasis compared to femoral access.
- A nursing-led quality assurance program was implemented to monitor and optimize radial access procedures.
Purpose of the Study:
- To evaluate the effectiveness of a quality assurance program in improving outcomes of radial artery access.
- To assess the impact of protocol modifications on patient safety and comfort.
- To identify factors influencing radial artery occlusion and patient discomfort.
Main Methods:
- A prospective study involving 973 patients undergoing radial arterial access.
- Utilized hydrophilic sheaths and inflatable bandages for hemostasis.
- Modified bandage inflation volume and duration based on data audits and protocol changes (Protocols A, B, C).
Main Results:
- Significant reduction in radial pulse loss and hematoma occurrence (81.3% to 92.2%).
- Marked improvement in patient comfort (44.2% to 89.3%).
- No major vascular complications reported; early radial artery occlusion was frequent but often reversible.
Conclusions:
- A nurse-led quality assurance program effectively reduced minor vascular complications and enhanced patient comfort post-radial access.
- Early radial artery occlusion, though common, is frequently reversible and linked to hemostasis techniques.
- Protocol optimization is key to improving safety and patient experience in radial arterial procedures.
Background:
Radial arterial access is becoming increasingly popular for coronary angiography and angioplasty. The technique is, however, more demanding than femoral arterial access, and hemostasis is not care-free. A quality assurance program was run by our nursing staff, with patient follow-up, to monitor radial arterial access implementation in our laboratory.
Method:
In 973 consecutive patients, both a hydrophilic sheath and an inflatable bandage for hemostasis were used. Bandage inflation volume and time were both reduced through subsequent data audit and protocol changes (A = 175 patients; B = 297; C = 501).
Results:
An increase was achieved in the percentage of patients with neither loss of radial pulse nor hematoma of any size (A = 81.3%, B = 90.9%, C = 92.2%, P < 0.001), and no discomfort at all (A = 44.2%, B = 75.1%, C = 89.3%, P < 0.001). Follow-up was available for 965 patients (99%), and in 956, the access site could be re-inspected at least once. There were no vascular complications. Overall, the radial artery pulse was absent at latest follow-up in 0.6% of cases (95% confidence interval 0.21-1.05%). In 460 consecutive patients with complete assessment in protocol C, a palpable arterial pulse was absent in 5% of cases at about 20 h after hemostasis. Barbeau's test was positive in 26.5% of patients (95% confidence interval 22.5-30.6%). They had a significantly lower body weight, a lower systolic blood pressure at hemostasis, and a higher bandage inflation volume; a hematoma of any size and the report of any discomfort were also more frequent. Barbeau's test returned to normal in 30% of them 3-60 days later.
Conclusion:
Our nurse-led quality assurance program helped us in reducing minor vascular sequelae and improving patient comfort after radial access. Early occlusion of the radial artery as detected by pulse oxymeter is frequent, often reversible, and may be mostly related to trauma/occlusion of the artery during hemostasis.
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