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Comparison between two protocols for deflation of the TR band following coronary procedures via the radial route
Hassan Al Riyami1, Adil Al Riyami1, Sunil K Nadar1
1Department of Cardiology, Sultan Qaboos University Hospital, Alkhod, Muscat, Oman.
Insights
A new protocol for TR band deflation after transradial coronary procedures significantly reduces band removal time without increasing bleeding complications or affecting patient satisfaction. Staff, however, preferred the earlier deflation protocol.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transradial coronary interventions are preferred due to lower complication rates.
- TR bands are commonly used for hemostasis post-procedure.
- Optimal TR band deflation protocols are not well-established.
Purpose of the Study:
- To compare two TR band deflation protocols: early deflation with increased intervals versus late deflation with smaller intervals.
- To evaluate the impact on total time to band removal, complication rates, and patient/staff satisfaction.
Main Methods:
- 174 patients undergoing transradial coronary procedures were randomized into two TR band deflation protocols.
- Protocol 1: 2 ml air removal every 30 minutes, starting 1 hour post-sheath removal.
- Protocol 2: 4 ml air removal every 15 minutes, starting 2 hours post-sheath removal.
Main Results:
- Protocol 2 significantly reduced time to TR band removal (201 ± 43 min) compared to Protocol 1 (274 ± 54 min; p < 0.001).
- No significant differences in bleeding or hematoma complications were observed between groups.
- Patient satisfaction was similar, but staff showed a preference for Protocol 1 (p = 0.01).
Conclusions:
- Delayed initiation of TR band deflation with smaller, more frequent intervals (Protocol 2) effectively reduces removal time.
- This protocol does not increase bleeding complications or negatively impact patient satisfaction.
- Staff preference for longer deflation intervals suggests a need for further protocol optimization considering both efficiency and clinical experience.
Aim:
Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction.
Methods:
All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale.
Results:
A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 (n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 (n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 (p = 0.01).
Conclusion:
A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.
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