Implementation of radial arterial access for cardiac interventions: a strong case for quality assurance protocols by the nursing staff.
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.


METHODS
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.


CONCLUSIONS
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.
Interventional Cardiology Unit, Cardiovascular Department, Santa Croce and Carle Hospital, Italy. steffenino.g@ospedale.cuneo.it
Giuseppe
G
Steffenino
Mauro De Benedetto
Mde B
Fabrizi
Giorgio
G
Baralis
Marilena
M
Tomatis
Aldo
A
Mogna
Monica
M
Dutto
Maria Stefania
MS
Dutto
Laura
L
Conte
Giulietta
G
Lice
Simona
S
Cavallo
Brunella
B
Porcedda
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000517:prevention & control; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000451:nursing*; D016009:Chi-Square Distribution; D054869:Clinical Audit; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000451:nursing*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000592:standards*; D010092:Oximetry / Q000451:nursing; D011677:Punctures; D011785:Quality Assurance, Health Care / Q000592:standards*; D017534:Radial Artery; D018570:Risk Assessment; D012307:Risk Factors