Nursing

MANAGEMENT IN
RADIAL VASCULAR
COMPLICATION
Rini Tri Marwanti Skep
 Radial Approach
1989DrLucien Campeau (CANADA)
Entry point for diagnostic
catheterizations

1992 Dr. Ferdinand Kiemeneij

(AMSTERDAM)
Radial artery for interventional
procedures
Figure 2-3 Bleeding and vascular complications in radial and femoral PCI.(Adapted from RAO SV,Ou FS,Wang
TY,et al. Trends in the prevalence and outcomes of radial and femoral approaches to PCI: a report from the
National Cardivascular Data Registry.JACC CardiovascInter2008;1:379-386)
 Introduction
The Transradial Interventional (TRI)
approach has several distinct advantages
over femoral access.bleeding complications
from the radial artery approach are
negligible compared to those of femoral
access.

The superficial location makes for easy

access and control of bleeding.In patients
with a normal Allen test,no significant
clinical sequelae occur after radial artery
occlusion because collateral flow to hand
occurs through the ulnar artery.
 Advantages

1. Needle puncture simple and straight-forward

even in obese patients
2. Compression time shorter
3. Compression is easy
4. "nicking" a nerve during the procedure is very
low.
5. Complications are less common
 6. Patientsis that there is no longer any need to
lie flat and still for 4-6 hours
7. Patients may also be discharged home
without having to spend the night
8. Outpatient procedures possible
9. Patient convenience
10. Reduce discomfort, Hospital Stay and Cost
11. High patients turn-over rate
12. ODC Patients
13. Patients remain together in the pleasant
lounge, watcing TV or Videos, or reading news
paper until it is time to go home after PCI
Transradial Acces: The Preferred
Approach for Coronary Stentting

Elimination of access bleeding

Rapid ambulation

Reduced morbidity :patientn preference

Reduced morbidity : staff preference

Outpatient procedure option

Lower cost
Acces femoral&radial in
SHKJ(2016)
Use of the
Allens test

A. Normally the
palm is pink.
B. A fist is made
and the radial
and ulnar arteries
are compressed
C. The hand is
open and
blanched after
compression of
both ulnar and
radial artery
D. The palm is
pink after
release of ulnar
artery with
radial artery
occluded
 Oximetric
Allens test
A. Before radial or ulnar
artery compresion,pulse
oximeter waveform is
normal
B. Wafeform is flat when
both radial and ulnar
arteries are compressed.
C. Pulse waveform is normal
when only ulnar is
released.Radial artery is still
compressed.
This is a type A
response,type B is blunted
waveform,and type C is
flattened wave
 Transradial pitfalls
Elimination of access bleeding

Rapid ambulation

Reduced morbidity :patientn preference

Reduced morbidity : staff preference

Outpatient procedure option

Lower cost
 Complications
Radial Artery Spasm

Some spasm during sheath withdrawal is

common. The sheath should be removed quickly
but gently to procedure durasi of discomfort.
Despite all precautions,if radial artery spasm
occurs or persists,consider administering more
significant analgesics and sedation.
if spasm is severe and the sheath is immovable,the
following actions can be undertaken:

1. Calcium channel blockers

2. More analgesia and sedation

3. Warm compresses over the forearm to relax the

spastic artery

4. Nitroglycerin 200mcg intra arterial:repeated if

necessary
 Arm
Hematoma

Arm-wrappping
technique from the
elbow to the wrist.
Analgesia
Bracelet
Local ice
 Easy Hematoma Classification
After transradial/ulnar PCI
Figure 2-15 Diagram of forearm hematoma classification and its management modified from
bertrand et al .circulation 2006;114(24):2646-2653. Reprinted with permission from Kern
MJ.Transradial 101 handbbook.Malvern,PA:HMP cOMMUNICATIONS,2011
Radial artery
occlusion
Vascular
Ultrasound
Supportive
treatment with
Acetaminophen
Warm compresses
are all that is
needed
 Rare
complications

Ultrasound
Treated with compression or
thrombin injection if occure
complication
Pseudoaneurysm.
Incidence complication radial thn
2016 at SHKJ
Sheath Removal,Radial artery
hemostasis,and postprocedure care
Specifically
Simple plastic
designed
band
compression
A. Terumo band with
inflatable compression
pad.
B. Band applied around
wrist with green dot
over puncture
C. A thin gauze wick is
placed beneath band to
absorb blood when
pressure is released
toassess proper
compression pressure
in pad
D. Compression
pad inflated
E. Sheath
removed
F. Final result
 Perfect TRI

1. The first attempt puncture is the best:it has the best

chance of succes
2. The first wire should be nonhydrophylic
3. Never force a wire or catheter against resistance
4. Have a low threshold for fluroscopy.lookany time
having trouble.Look before you push
5. Keep an eye for prompt diagnosis of hematoma
6. Treatment of the problem at earliest stage will bring
the best result:quick compression of forearm and arm
in case of hematoma
 Key Points for Radial
Artery access
Always perform Allen test.proceed if type A or B
response.Consider if type C response

Use adequate patient sedation and access site

anasthesia

Use clues gained during diagnostic study for left or

right arm access and coronary cannulation

Work with the wrist close to the patients body.Bring

the left wrist onto the left hip for easier manipulations.

Use vasodilators and nitroglycerin during sheath

removal if vasospasm causes pain.
 THANK YOU