Day 3: TR Band Flashcards
True or False: radial caths can be performed regardless of perfusion test results.
True
What is the Barbeau or Modified Allen’s Test and how is it performed?
A test that uses pulse oximetry and manual compression of the ulnar and radial arteries to assess flow to the palmar arches.
First, the finger pulse oximeter will be placed and reading is confirmed. Next, compress both the radial and ulnar arteries and visualize flatline on PO. Release pressure on ulnar and watch for return reading on PO.
What steps can you take to locate the radial artery without ultrasound?
First, locate the flexor crease and the styloid process. Access should be 2-3cm (or 2 finger widths) proximal to the crease. It should be about 1cm (or 1 finger width) proximal to the styloid process.
What could happen if too much lidocaine is administered subcutaneously for radial access?
The radial artery pulse can be obliterated.
What is the primary difference between single and double wall access?
Single wall is typically associated with Ultrasound guided access, non-coated wires (SS/Nitinol) and does not pierce through the back side of the vessel (aka anterior wall puncture only).
Double wall access does not use Ultrasound guided access, pierces through and through (aka back wall puncture), typically done by ICs, utilizes coated wires and can be easier for new operators learning access.
True or False: SCAI does not consider Ultrasound guided radial access for coronary procedures best practice.
False
Spasm is a physiologic response to stress, pain, and anxiety. What is happening during spasm?
Alpha receptors stimulated by the “fight or flight” response lead to contraction of the smooth muscle within the artery wall and cause vasoconstriction.
Walk through the mitigation steps of radial artery spasm.
1) STOP - time and patience (15 min intervals)
2) DO NOT push or pull if resistance is present
3) Relax the patient via room ambience (dim lights/ calm music) and gentle sedation (Valium, Versed, Fentanyl)
4) Consider patient’s clinical condition and then administer antispasmodic cocktail (Nitro, Verapamil and check Heparin)
5) Apply best practices in further attempts (decrease sheath:artery ratio, use hydrophilic sheath)
6) Apply warm compress
7) Perform Flow mediated dilation (BP Cuff)
8) Call for anesthesia bailout
What are the 3 primary drug classifications or categories involved in a radial cocktail?
- Vasodilators to relax and dilate the vessels
- Calcium Channel Blockers to block Calcium from entering muscle cells in the arterial walls
- Anticoagulants to prevent blood cells from clotting (aka blood thinners)
What is the most common Calcium Chanel Blocker given in a radial cocktail and what is the typical dosage given?
2.5 - 5.0mg (milligram) of Verapamil is given via the sheath side port (IA)
What is the most common Vasodilator given in a radial cocktail and what is the typical dosage?
200 - 400mcg (micrograms) of Nitroglycerin or Nitro is given directly through the sheath side port (IA).
What is the most common anticoagulant in a radial cocktail and what dosage is given?
50 u/kg (units/kilogram) of Heparin is given either via IV or IA.
What is the primary objective during radial access that significantly decreases the incidence of radial artery occlusion?
Patent Hemostasis - patent refers to keeping the artery open, while hemostasis refers to closing or clotting the access site. Therefore, PH can be defined as the minimum pressure to inhibit bleeding through the puncture site, but not so much as to cause failure of the vessel under pressure.
What are the 3 KEY FEATURES of the TR Band?
1) 2 balloons for targeted compression of radial artery
2) transparent band for visualization
3) rounded edges for patient comfort and protection of ulnar nerve/artery
What is the indication for use of the TR Band?
It’s indicated for use in managing closure and assisting in hemostasis of the RADIAL artery and enables the titration of air.
What are the components of the TR Band (this labeling a spec diagram)?
Adjustable fastener
Belt
1mm green puncture site marker
Pressure confirmation balloon
Air injection port w/ valve
Small pressure balloon
Large compression balloon
Support plate with logo
Why is the Slip Tip Air Inflation inlet on our syringe important?
It is the tip on our inflation syringe that connects to the TR Band air port. It is important because it is not a leurlock and therefore will not allow air to enter the vessel. If it is lost or misplaced, they are not sold separately and a regular syringe is not compatible, so a new TRB would need to be opened. Suggested to tape or fasten the syringe to the table, patient’s upper arm or to the wall.
Where do you line the green puncture site location marker and the Terumo logo on the TRB?
Align the green puncture site marker 2mm proximal from the insertion site.
Align the Terumo logo on the opposite side of the puncture site.
What is a clinical consideration to be aware of when considering administering Nitro to a patient?
It can decrease blood pressure so the patient will need to be able to tolerate it.
True or False: there is no significant difference between Intranet-arterial and systemic Heparin administration in regard to radial access.
True.
The radial artery is more prone to spasms which can lead to complications like RAO. What are the 2 biggest factors that differentiate radial sheaths from femoral?
Hydrophilic coating and smaller ODs
What are the differences between Glidesheath and Glidesheath Slender?
GS has a suture eye and is indicated for radial, brachial and ulnar.
GSS has slender technology for the smaller OD magic and only indicated for radial artery.
Industry standard has OD two French sizes larger than the ID. Glidesheath Slender utilizes ___________ technology to achieve an OD _______Fr smaller than the ID.
Thin wall technology
1Fr
What is the primary benefit of Slender technology?
Using a smaller French size reduces the risk of vessel trauma/spasm while still allowing the operator to use devices they’re accustomed to.
