Shah Sunay, Gindi Ryan, Basir Mir B, Khandelwal Akshay, Alqarqaz Mohammad, Zaidan Mohammad, Voeltz Michele, Koenig Gerald, Kim Henry E, O'Neill William W, Alaswad Khaldoon
Henry Ford Hospital, United States.
Henry Ford Hospital, United States; Wayne State University, United States.
Cardiovasc Revasc Med. 2019 Feb;20(2):133-136. doi: 10.1016/j.carrev.2018.04.013. Epub 2018 Apr 14.
The purpose of the study is to develop an optimal TR-Band weaning strategy while minimizing vascular access site complications of hematoma or radial artery occlusion (RAO).
The trial was a randomized, prospective, single center study of 129 patients who underwent cardiac catheterization via the radial artery. Group A was an accelerated protocol in which weaning was initiated 20 min after sheath removal. Group B was an adjusted protocol, in which weaning was dependent on the amount of anti-platelet or anti-coagulation used. All patients underwent radial artery ultrasound to demonstrate arterial patency.
Baseline characteristics were similar in both groups, and PCI was performed in 36.7% of patients in Group A and 37.7% of patients in Group B. RAO occurred in 7.7% of patients overall, with no statistical difference between groups (Group A 5% versus Group B 10.1%, p-value = 0.337). Hematoma formation >5 cm in diameter occurred in 4.6% of patients in the overall cohort, without statistical difference between groups (Group A 5% versus Group B 4.3%, p-value = 1). The TR-Band duration was significantly shorter in Group A compared to Group B (112.9 ± 50.7 versus 130.7 ± 51.1 in minutes, respectively, p-value = 0.013).
We have demonstrated an accelerated weaning protocol is simple to utilize for nursing staff without increased vascular site complications of RAO or hematoma formation.
本研究的目的是制定一种最佳的TR-Band撤带策略,同时将血肿或桡动脉闭塞(RAO)等血管穿刺部位并发症降至最低。
该试验是一项针对129例经桡动脉行心脏导管插入术患者的随机、前瞻性、单中心研究。A组采用加速方案,在拔除鞘管后20分钟开始撤带。B组采用调整方案,撤带取决于抗血小板或抗凝药物的使用量。所有患者均接受桡动脉超声检查以证明动脉通畅情况。
两组的基线特征相似,A组36.7%的患者和B组37.7%的患者接受了经皮冠状动脉介入治疗(PCI)。总体患者中7.7%发生了RAO,两组之间无统计学差异(A组5% vs B组10.1%,p值 = 0.337)。整个队列中4.6%的患者出现直径>5 cm的血肿形成,两组之间无统计学差异(A组5% vs B组4.3%,p值 = 1)。与B组相比,A组的TR-Band使用时间明显更短(分别为112.9±50.7分钟和130.7±51.1分钟,p值 = 0.013)。
我们已经证明,加速撤带方案对护理人员来说易于使用,且不会增加RAO或血肿形成等血管穿刺部位并发症的发生。