Interventional Cardiology Unit, Cardiovascular Department, Santa Croce and Carle Hospital, Italy.
J Cardiovasc Med (Hagerstown). 2011 Feb;12(2):116-21. doi: 10.2459/JCM.0b013e328340392c.
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.
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).
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.
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.
桡动脉入路在冠状动脉造影和血管成形术中越来越受欢迎。然而，与股动脉入路相比，该技术要求更高，止血并非无忧。我们的护理人员实施了一项质量保证计划，对患者进行随访，以监测我们实验室中桡动脉入路的实施情况。
在 973 例连续患者中，均使用亲水鞘和充气止血带。通过随后的数据审核和方案变更（A = 175 例；B = 297 例；C = 501 例），减少了止血带充气量和时间。
患者桡动脉搏动无减弱且无任何大小血肿的百分比增加（A = 81.3%，B = 90.9%，C = 92.2%，P < 0.001），无任何不适（A = 44.2%，B = 75.1%，C = 89.3%，P < 0.001）。965 例患者（99%）可获得随访，956 例患者至少有一次可对入路部位进行复查。无血管并发症。总体而言，在最新随访时，桡动脉搏动消失的病例占 0.6%（95%置信区间 0.21-1.05%）。在 460 例接受方案 C 完全评估的连续患者中，止血后约 20 小时，有 5%的患者脉搏触诊无搏动。Barbeau 测试阳性的患者占 26.5%（95%置信区间 22.5-30.6%）。他们的体重明显较轻，止血时收缩压较低，止血带充气量较大；有任何大小的血肿和任何不适报告的情况也更频繁。Barbeau 测试在 30%的患者中在 3-60 天后恢复正常。
我们的护理人员主导的质量保证计划有助于减少桡动脉入路后的小血管后遗症并提高患者舒适度。通过脉搏血氧仪检测到的桡动脉早期闭塞较为常见，通常是可逆的，可能主要与止血时动脉的创伤/闭塞有关。
