Radial Access Flashcards
What is a key factor in determining the site and size of vascular access for interventional procedures?
a) The operator’s preference
b) Anatomic and clinicopathologic conditions
c) The anticipated duration of the procedure
d) The age of the patient
b) Anatomic and clinicopathologic conditions
Why is reviewing previous procedure notes and difficulties encountered during prior procedures important for vascular access?
a) To determine if a different operator should be chosen
b) To avoid known pitfalls and complications
c) To assess the risk of anesthesia
d) To choose the least invasive approach
b) To avoid known pitfalls and complications
What is the minimum assessment required before and after a vascular access procedure?
a) Blood pressure measurement
b) Arterial pulse assessment
c) Venous compression test
d) Echocardiogram
b) Arterial pulse assessment
Why has the use of ultrasound become routine for vascular access in interventional procedures?
a) To measure the length of the artery
b) To determine the exact location of the operator’s needle
c) To guide all access with greater accuracy
d) To assess for underlying cardiac conditions
c) To guide all access with greater accuracy
For procedures requiring “large-bore” access (≥10 F), what additional imaging technique has become essential in the planning phase?
a) Magnetic Resonance Imaging (MRI)
b) Preprocedure computed tomography (CT) scans
c) Electrocardiogram (ECG)
d) X-ray
b) Preprocedure computed tomography (CT) scans
Why has the radial artery approach become the new standard for coronary procedures in many labs?
a) It requires less training for the operators
b) It allows for quicker recovery
c) It has significantly fewer access-related complications
d) It is less expensive for the hospital
c) It has significantly fewer access-related complications
Which of the following is an advantage of using the radial approach over the femoral approach in coronary procedures?
a) It has a higher risk of bleeding
b) It is associated with better late outcomes, including lower mortality
c) It is easier to access for obese patients
d) It avoids the need for anticoagulation
b) It is associated with better late outcomes, including lower mortality
In which of the following conditions should radial artery access be particularly favored?
a) Presence of a large abdominal aortic aneurysm
b) Severe peripheral vascular disease
c) Need for emergency coronary artery bypass grafting
d) Active gastrointestinal bleeding
b) Severe peripheral vascular disease
Compared to the femoral approach, which of the following is typically more common with radial artery access?
a) Higher risk of stroke
b) Lower risk of infection
c) Higher rates of radial artery spasm
d) Increased need for sedation
c) Higher rates of radial artery spasm
What is a significant disadvantage of the femoral artery approach compared to the radial approach in coronary procedures?
a) It has fewer complications overall
b) It requires less operator expertise
c) It has a higher incidence of access-related complications
d) It is faster to perform
c) It has a higher incidence of access-related complications
Who pioneered the radial artery approach for coronary interventions in 1996 to reduce bleeding complications?
a) Kiemeneij
b) Gruntzig
c) Andreas
d) Williams
a) Kiemeneij
What is one major advantage of the transradial intervention (TRI) for coronary procedures compared to femoral access?
a) It requires less sedation
b) It significantly reduces bleeding complications
c) It is faster to perform
d) It is easier for older patients
b) It significantly reduces bleeding complications
In which of the following conditions is transradial intervention (TRI) generally avoided?
a) Severe left main coronary artery stenosis
b) Known upper extremity vascular disease
c) Hypertension
d) Uncontrolled diabetes
b) Known upper extremity vascular disease
Why is transradial intervention (TRI) a particularly good option for patients on systemic anticoagulation?
a) It allows for immediate mobilization
b) It reduces the need for contrast
c) It allows for angiography without interrupting anticoagulation
d) It reduces radiation exposure
c) It allows for angiography without interrupting anticoagulation
What is a key benefit of transradial intervention (TRI) for STEMI patients?
a) It allows for faster door-to-balloon times without increasing procedure duration
b) It is associated with higher contrast usage
c) It leads to longer recovery times
d) It requires less radiation exposure than femoral access
a) It allows for faster door-to-balloon times without increasing procedure duration
Which of the following is not a contraindication for radial access in coronary interventions?
a) Prior coronary artery bypass graft (CABG) surgery
b) Existing arteriovenous fistula (AVF)
c) Known carotid artery disease
d) Use of guide catheters larger than 7F
a) Prior coronary artery bypass graft (CABG) surgery
What is the impact of transradial intervention (TRI) on patient comfort?
a) It often leads to more pain during recovery
b) It significantly enhances patient comfort and satisfaction
c) It restricts patient movement post-procedure
d) It requires prolonged bed rest after the procedure
b) It significantly enhances patient comfort and satisfaction
In which type of patients does transradial intervention (TRI) reduce mortality, particularly when anticoagulation is required?
a) STEMI patients
b) Patients with atrial fibrillation
c) Hypertensive patients
d) Diabetic patients
a) STEMI patients
Why is it important for operators to familiarize themselves with the relevant anatomy of the arm and wrist when performing radial artery catheterization?
a) To avoid catheterization of the radial artery too distally
b) To assess the risk of clot formation
c) To select the appropriate guide catheter size
d) To ensure there is no risk of aortic dissection
a) To avoid catheterization of the radial artery too distally
What did the RADAR study show about the utility of the Allen test for assessing hand ischemia in radial catheterization?
a) It is essential to perform the Allen test before every procedure
b) The Allen test is not useful as 30% of patients with abnormal results had no signs of hand ischemia
c) The Allen test was shown to decrease the risk of radial artery spasm
d) It should always be performed in elderly patients
b) The Allen test is not useful as 30% of patients with abnormal results had no signs of hand ischemia
Which of the following tests can be used to assess the patency of the palmar arch before radial catheterization?
a) Doppler ultrasound
b) Allen test
c) Chest X-ray
d) Carotid ultrasound
b) Allen test
Which test is another option to assess palmar arch patency, besides the Allen test?
a) Barbeau test
b) MRI scan
c) Electrocardiogram
d) Pulse oximetry
a) Barbeau test
What is a potential challenge when moving through the radial artery to the ascending aorta during catheterization?
a) The catheter may become tangled in the wrist
b) Anatomic variants may make it difficult
c) The aortic valve may obstruct the catheter
d) The procedure may cause excessive bleeding
b) Anatomic variants may make it difficult
What is one reason the right arm is typically preferred for transradial coronary angiography?
a) It is more comfortable for the patient
b) Most catheterization labs are set up with the operator on the right side of the patient
c) The right arm is less prone to arterial spasms
d) The right radial artery is larger
b) Most catheterization labs are set up with the operator on the right side of the patient
What is a potential advantage of using the left radial artery for coronary angiography compared to the right radial artery?
a) It requires less sedation
b) It approximates femoral angiography more closely and may take less time and contrast
c) It is more comfortable for the patient
d) It provides better imaging resolution
b) It approximates femoral angiography more closely and may take less time and contrast
After accessing the left radial artery, how should the patient’s arm be positioned?
a) Fully extended above the head
b) Comfortably adducted over the patient’s belly toward the operator
c) Positioned at the side of the patient’s body
d) Supported by an armrest at a 45-degree angle
b) Comfortably adducted over the patient’s belly toward the operator
What is an optional device used to help secure the wrist in an optimal position during transradial catheterization?
a) A sterile drape
b) A cushioned arm board
c) A pulse oximeter
d) A blood pressure cuff
b) A cushioned arm board
What is one technique to keep the patient’s hand sterile and free of blood during the procedure?
a) Use of a sterile glove on the patient’s hand before draping
b) Applying a sterile bandage around the wrist
c) Wrapping the hand in a plastic sheet
d) Keeping the hand covered with a sterile dressing
a) Use of a sterile glove on the patient’s hand before draping
For elective transradial cases, what is generally preferred if access-site crossover is necessary?
a) Conversion to femoral access
b) Conversion to the contralateral radial site
c) Conversion to brachial artery access
d) Continuation with the initial radial site
b) Conversion to the contralateral radial site
What is the general access-site crossover rate in most studies for transradial coronary angiography?
a) 1% to 2%
b) 5% to 10%
c) 20% to 25%
d) 30% to 35%
b) 5% to 10%
What is one key benefit of using ultrasound guidance for transradial access?
a) It reduces the need for anticoagulation
b) It improves first-pass success rate and reduces time to access
c) It prevents radial artery occlusion
d) It decreases the need for sedation
b) It improves first-pass success rate and reduces time to access
Which of the following clinical events is not affected by the use of ultrasound guidance during transradial access?
a) Spasm
b) Bleeding
c) First-pass success rate
d) Time to access
a) Spasm
In which scenario should an operator consider using ultrasound guidance upfront or very early during transradial access?
a) The patient is young and healthy
b) The radial artery is large
c) There is significant hypotension or weak pulses
d) The procedure is elective and uncomplicated
c) There is significant hypotension or weak pulses
What can preprocedure ultrasound screening help detect that may make a transradial procedure difficult or unfeasible?
a) High blood pressure
b) Dual radial artery systems or radial artery loops
c) Presence of a pacemaker
d) Abnormal cardiac rhythms
b) Dual radial artery systems or radial artery loops
What is the gold standard for detecting radial artery occlusion?
a) Doppler ultrasound
b) Duplex ultrasonography
c) X-ray
d) CT angiography
b) Duplex ultrasonography
What is one potential outcome that preprocedure ultrasound may reveal about the radial artery that could affect procedural planning?
a) Presence of coronary artery disease
b) Calcified radial arteries
c) Elevated cholesterol levels
d) Elevated blood pressure in the upper extremities
b) Calcified radial arteries
Which of the following is a complication that can be easily detected with ultrasound during or after transradial access?
a) Aortic aneurysm
b) Pseudoaneurysm
c) Pulmonary embolism
d) Myocardial infarction
b) Pseudoaneurysm
What is the first step in the ultrasound-guided radial access technique?
a) Insert the access needle into the skin
b) Prepare the ultrasound probe with a sterile cover and gel
c) Inject lidocaine above the radial artery
d) Align the artery with the centerline guide on the display
b) Prepare the ultrasound probe with a sterile cover and gel
In Step 2 of the ultrasound-guided radial access process, how should the ultrasound probe be positioned?
a) Parallel to the artery
b) Perpendicular to the artery’s course
c) At a 45-degree angle to the skin
d) Parallel to the skin surface
b) Perpendicular to the artery’s course
What is the purpose of aligning the artery with the centerline guide on the display in Step 3?
a) To ensure the needle is directed at the optimal angle
b) To ensure the artery is directly beneath the center of the probe
c) To visualize the guidewire during insertion
d) To decrease the risk of arterial spasm
b) To ensure the artery is directly beneath the center of the probe
In Step 5, what is the correct angle for inserting the access needle under the center of the probe?
a) 30-degree angle
b) 45-degree angle
c) 60-degree angle
d) 90-degree angle
b) 45-degree angle
What technique is used to track the needle during insertion, according to Step 6?
a) Long, continuous movements
b) Short “strokes” (in-and-out movements of the needle)
c) Rotational movements of the needle
d) Circular motions of the probe
b) Short “strokes” (in-and-out movements of the needle)
What should the operator do if the tip of the needle is not visible during ultrasound-guided radial access?
a) Move the probe away from the needle
b) Adjust the probe position or angulation
c) Withdraw the needle completely
d) Use a different access site
b) Adjust the probe position or angulation
What is the final step in the ultrasound-guided radial access process?
a) Inject contrast to visualize the artery
b) Confirm appropriate intravascular placement with the guidewire
c) Secure the needle and remove the probe
d) Apply a compression bandage to the site
b) Confirm appropriate intravascular placement with the guidewire
Where is the ideal puncture site for transradial access located?
a) 2 cm distal to the radial styloid
b) At the radial styloid
c) Greater than 2 cm proximal to the radial styloid
d) In the middle of the forearm
c) Greater than 2 cm proximal to the radial styloid
What is a potential complication of performing a mid-forearm puncture for radial access?
a) Risk of arterial dissection
b) Difficulty in compressing the site and possible hematoma formation
c) Higher chance of radial artery spasm
d) Increased risk of bleeding from the brachial artery
b) Difficulty in compressing the site and possible hematoma formation
What is an important step when using the double-wall technique with a two-component needle?
a) Remove the cannula before advancing the needle
b) Only advance the needle through the front wall
c) Advance both the needle and its cannula beyond the back wall before removing the needle
d) Apply pressure to the needle after insertion
c) Advance both the needle and its cannula beyond the back wall before removing the needle
What should be done if resistance is encountered during wire advancement in radial access?
a) Withdraw the needle and start over
b) Use a larger needle
c) Use fluoroscopy to visualize the wire
d) Apply more pressure to advance the wire
c) Use fluoroscopy to visualize the wire
Which type of guidewires should be used with metal needles during radial access?
a) Hydrophilic-coated guidewires
b) Non-metallic guidewires
c) Only metal guidewires
d) Hydrophilic wires, regardless of the needle
c) Only metal guidewires
What can be used to reduce radial artery spasm and pain when withdrawing the sheath?
a) A larger sheath size
b) Hydrophilic-coated sheaths
c) A second skin incision
d) Increased sedation
b) Hydrophilic-coated sheaths
What is one method for securing the sheath without using sutures?
a) A small bandage placed over the puncture site
b) A Tegaderm with a slit cut into it
c) A pressure bandage around the arm
d) A sterile cotton ball placed under the sheath
b) A Tegaderm with a slit cut into it
What is the potential benefit of passing a 0.014-inch hydrophilic coronary wire through a radial arterial loop?
a) It helps to minimize contrast usage
b) It can straighten out tortuous loops, allowing smooth advancement of catheters
c) It reduces the risk of bleeding complications
d) It helps to reduce procedural time
b) It can straighten out tortuous loops, allowing smooth advancement of catheters
What should be considered when using a 7F or larger guide catheter during a transradial procedure?
a) Using a sheathless guide insertion or slender guide
b) Limiting the procedure to diagnostic angiography only
c) Avoiding the use of hydrophilic wires
d) Using only a 6F guide catheter for all interventions
a) Using a sheathless guide insertion or slender guide
Which size guide catheter is typically sufficient for most coronary interventions, including using 1.5-mm Rotablator burrs and bifurcation stenting?
a) 7F
b) 8F
c) 6F
d) 5F
c) 6F
What is the first step in the “through-and-through” technique for radial artery access?
a) Remove the needle after puncturing the artery
b) Advance the angiocath into the anterior wall, filling the proximal hub with blood
c) Use fluoroscopy to visualize the artery
d) Insert a 0.021-inch guidewire
b) Advance the angiocath into the anterior wall, filling the proximal hub with blood
What is one advantage of the through-and-through technique compared to the anterior wall puncture technique?
a) It causes fewer complications with radial artery spasm
b) It has a faster access time with fewer attempts for successful access
c) It requires less contrast during the procedure
d) It results in less bleeding after the sheath removal
b) It has a faster access time with fewer attempts for successful access
What is a common method for achieving hemostasis after radial artery catheterization?
a) Manual compression alone
b) Using a dedicated radial band to apply pressure
c) Applying a bandage and leaving the patient undisturbed
d) Using a pressure cuff on the upper arm
b) Using a dedicated radial band to apply pressure
What is the first step in using a dedicated radial band to achieve hemostasis?
a) Gradually decrease the pressure in the band
b) Remove the sheath from the artery
c) Apply the band on the wrist centered on the access site
d) Assess for antegrade flow
c) Apply the band on the wrist centered on the access site
How should pressure be adjusted in the radial band during hemostasis?
a) Start by completely removing the band after sheath removal
b) Initially increase pressure until hemostasis is achieved, then gradually decrease it
c) Keep the pressure constant throughout the procedure
d) Increase pressure only if bleeding persists after 30 minutes
b) Initially increase pressure until hemostasis is achieved, then gradually decrease it
What should be done if antegrade flow cannot be detected after initial hemostasis?
a) Maintain pressure on the band for 30 minutes
b) Attempt to decrease pressure in the band over 10 to 15 minutes to allow for objective antegrade flow
c) Increase the pressure on the band until the patient experiences pain
d) Use a second hemostatic band to secure the artery
b) Attempt to decrease pressure in the band over 10 to 15 minutes to allow for objective antegrade flow
What is the “reverse Barbeau” procedure used to assess?
a) The presence of collateral circulation in the hand
b) The presence of antegrade flow from the radial artery
c) The amount of contrast used during the procedure
d) The size of the radial artery
b) The presence of antegrade flow from the radial artery
What is the key factor for successful hemostasis with a radial band after sheath removal?
a) The application of strong manual pressure on the wrist
b) Achieving patent hemostasis, ensuring antegrade flow is maintained
c) Closing the puncture site with sutures
d) Immediate administration of anticoagulation therapy
b) Achieving patent hemostasis, ensuring antegrade flow is maintained
Which device is commonly used to achieve radial artery hemostasis due to its ease of use and ability to directly visualize the puncture site?
a) Radial artery compression band
b) Terumo TR Band
c) Manual compression bandage
d) Pneumatic pressure cuff
b) Terumo TR Band
What is one important reason why checking the activated clotting time is not necessary before sheath removal for radial artery access?
a) The radial artery is less prone to spasm
b) The radial artery is superficial and easily compressible
c) The procedure is typically performed under general anesthesia
d) The patient is usually under minimal sedation
b) The radial artery is superficial and easily compressible
What should be done to minimize radial artery spasm and patient discomfort during the radial procedure?
a) Increase the dose of sedatives
b) Administer another dose of an antispasmodic agent
c) Apply a cooling agent to the artery
d) Use a larger sheath size
b) Administer another dose of an antispasmodic agent
When removing the sheath, why should it be done slowly and smoothly while tightening the radial band?
a) To prevent air embolism
b) To minimize patient discomfort and avoid stripping the clot from the artery
c) To prevent the guidewire from dislodging
d) To avoid the need for additional anticoagulation
b) To minimize patient discomfort and avoid stripping the clot from the artery
What should be done when using a radial band to ensure proper hemostasis after sheath removal?
a) Inflate the band immediately after sheath removal
b) Pull the sheath out several centimeters so the band doesn’t cover the valve portion of the sheath
c) Remove the sheath before inflating the band
d) Use a smaller volume of air to inflate the band
b) Pull the sheath out several centimeters so the band doesn’t cover the valve portion of the sheath
What is the “patent hemostasis” technique, and how is it performed?
a) Tightening the band quickly after sheath removal to prevent bleeding
b) Slowly deflating the band until bleeding occurs and then reinflating the band with 1 to 2 mL of air
c) Applying manual pressure to the site for 30 minutes after removing the sheath
d) Using an anticoagulant before and after sheath removal
b) Slowly deflating the band until bleeding occurs and then reinflating the band with 1 to 2 mL of air
How long should the radial band be left undisturbed in the recovery area after achieving hemostasis for diagnostic procedures?
a) 4 to 6 hours
b) 1 to 2 hours
c) 30 minutes
d) 6 to 8 hours
b) 1 to 2 hours
What are the activity restrictions for patients after discharge following a radial procedure?
a) Avoid using the affected wrist for 12 hours
b) Avoid using the affected wrist for 24 hours
c) Avoid all physical activity for 48 hours
d) Avoid all exercise for 72 hours
b) Avoid using the affected wrist for 24 hours
What should patients do if they notice small hematoma formation after the procedure?
a) Apply a cold compress to the site
b) Elevate the arm and hold pressure on the site
c) Take an anticoagulant medication
d) Avoid moving their wrist for 48 hours
b) Elevate the arm and hold pressure on the site
What should patients report if they notice large hematomas or significant forearm or hand pain after the procedure?
a) They should immediately apply more pressure to the site
b) They should contact their healthcare provider or return to the hospital
c) They should avoid moving their arm for a few days
d) They should take an anti-inflammatory medication
b) They should contact their healthcare provider or return to the hospital
What is the most common cause of radial artery spasm during a procedure?
a) Use of large guidewires
b) Prolonged catheter manipulation
c) High levels of sedation
d) Use of hydrophilic sheaths
b) Prolonged catheter manipulation
Which of the following is not a risk factor for radial artery spasm?
a) Female gender
b) Small radial artery diameter
c) Large sheaths
d) Excessive use of anticoagulants
d) Excessive use of anticoagulants
What is the first-line strategy for preventing and treating radial artery spasm?
a) Apply cold compresses to the access site
b) Administer sedation, analgesia, and spasmolytic agents
c) Use larger sheaths for easier catheter movement
d) Administer heparin to reduce blood viscosity
b) Administer sedation, analgesia, and spasmolytic agents
How should the sheath be removed in the presence of severe radial artery spasm?
a) Apply strong force to withdraw the sheath quickly
b) Apply gentle but steady withdrawal of the sheath
c) Apply excessive pressure to prevent blood loss
d) Perform the procedure under fluoroscopy for better guidance
b) Apply gentle but steady withdrawal of the sheath
Which of the following is not a recommended treatment for severe radial artery spasm that hinders sheath removal?
a) Antispasmodic agents
b) Nerve blocks or anesthesia
c) Immediate use of larger sheaths
d) Sedation
c) Immediate use of larger sheaths
What should be done if a hematoma develops during the procedure?
a) Immediately stop the procedure and discontinue all anticoagulants
b) Check under the drapes for enlarging hematoma formation
c) Apply a pressure bandage and continue the procedure without interruption
d) Discontinue the procedure and refer the patient for emergency surgery
b) Check under the drapes for enlarging hematoma formation
How should a forearm hematoma be managed during the procedure?
a) Apply pressure to the site with a manual blood pressure cuff
b) Use a cold compress to reduce the swelling
c) Use large bandages to compress the arm immediately
d) Use an anti-inflammatory medication
a) Apply pressure to the site with a manual blood pressure cuff
What is the most serious complication of forearm bleeding and hematoma?
a) Reflex sympathetic dystrophy
b) Hemorrhagic stroke
c) Compartment syndrome with hand ischemia
d) Radial artery occlusion
c) Compartment syndrome with hand ischemia
Which of the following is a rare but debilitating complication of radial artery access?
a) Radial artery dissection
b) Reflex sympathetic dystrophy (chronic regional pain syndrome)
c) Aneurysm formation
d) Hemorrhagic shock
b) Reflex sympathetic dystrophy (chronic regional pain syndrome)
What is the management for compartment syndrome resulting from forearm hematoma?
a) Conservative management with analgesics
b) Surgical fasciotomy
c) Immediate anticoagulation therapy
d) High-dose corticosteroids
b) Surgical fasciotomy
What is the most frequent complication of transradial coronary intervention (TRI) aside from bleeding?
a) Radial artery occlusion
b) Retroperitoneal hemorrhage
c) Arterial dissection
d) Cardiac arrhythmia
a) Radial artery occlusion
Which of the following is not a risk factor for radial artery occlusion after a transradial procedure?
a) Duration of catheterization time
b) High sheath-to-artery diameter ratio
c) Use of hydrophilic-coated sheaths
d) Prolonged compression time
c) Use of hydrophilic-coated sheaths
What is the typical outcome for most cases of radial artery occlusion?
a) Immediate resolution with no treatment
b) Recannalization within 30 days in 50% of cases
c) Permanent occlusion requiring surgical intervention
d) Progressive limb ischemia
b) Recannalization within 30 days in 50% of cases
What is the most effective technique for preventing radial artery occlusion after a transradial procedure?
a) Use of smaller sheaths
b) Application of cold compresses
c) Patent hemostasis confirmed with oximetry or reverse Allen test
d) Immediate administration of thrombolytics
c) Patent hemostasis confirmed with oximetry or reverse Allen test
What is the recommended treatment for asymptomatic radial artery occlusion?
a) Surgical removal of the occlusion
b) Use of ulnar occlusion or catheter-directed techniques to encourage recanalization
c) Long-term anticoagulation therapy
d) Immediate placement of a stent
b) Use of ulnar occlusion or catheter-directed techniques to encourage recanalization
Which of the following is a rare complication associated with radial artery access?
a) Hematoma formation
b) Pseudoaneurysm
c) Arterial dissection
d) Retroperitoneal bleeding
b) Pseudoaneurysm
How is a pseudoaneurysm diagnosed?
a) Chest X-ray
b) Ultrasound
c) Computed tomography (CT) scan
d) Magnetic resonance angiography (MRA)
b) Ultrasound
What is the primary treatment for a pseudoaneurysm following radial artery access?
a) Surgical excision
b) Compression or thrombin injection
c) Immediate anticoagulation
d) Fibrinolytic therapy
b) Compression or thrombin injection
What is the treatment for radial artery dissections and perforations, which are rare complications?
a) Surgical repair of the artery
b) Balloon angioplasty
c) Guide catheter placement, as they typically seal internally
d) Placement of a stent
c) Guide catheter placement, as they typically seal internally
Which of the following is a rare but noted complication of hydrophilic sheaths used during transradial procedures?
a) Arterial embolism
b) Granuloma formation or sterile abscess
c) Retroperitoneal bleeding
d) Pseudoaneurysm
b) Granuloma formation or sterile abscess
Which of the following is a benefit of accessing the radial artery between the thumb and forefinger?
A) Reduced risk of bleeding
B) Increased risk of compartment syndrome
C) Reduced risk of subsequent radial artery occlusion
D) Increased risk of radial artery perforation
C) Reduced risk of subsequent radial artery occlusion
What is the preferred position for the patient during radial artery access between the thumb and forefinger?
A) Supine with arm fully extended
B) Arm in a neutral position with the snuffbox facing upwards
C) Arm in a fully pronated position
D) Arm hanging freely by the patient’s side
B) Arm in a neutral position with the snuffbox facing upwards
Which imaging technique is preferred for guiding radial artery access?
A) X-ray
B) CT scan
C) Ultrasound
D) MRI
C) Ultrasound
What is the recommended needle size for accessing the radial artery in this technique?
A) 25-gauge
B) 18-gauge
C) 21-gauge
D) 30-gauge
C) 21-gauge
What is the preferred angle for needle insertion during radial artery access?
A) 10 to 15 degrees
B) 30 to 45 degrees
C) 60 to 75 degrees
D) 90 degrees
B) 30 to 45 degrees
Why is a “through-and-through” puncture not recommended during this procedure?
A) It increases the risk of infection
B) It can damage surrounding tissues
C) It increases the likelihood of arterial spasm
D) It may cause artery perforation
B) It can damage surrounding tissues
What is the purpose of making a small skin nick during the procedure?
A) To facilitate easier insertion of the needle
B) To provide a channel for local anesthesia
C) To help pass the sheath without damaging the dilator tip
D) To allow for easier wire advancement
C) To help pass the sheath without damaging the dilator tip
What compression technique is often used after radial artery catheterization at the snuffbox location?
A) Radial artery bands
B) Standard bandage dressing
C) Manual compression with the thumb
D) Dedicated distal radial compression devices
D) Dedicated distal radial compression devices
What is the role of vasodilators and anticoagulation with heparin during radial artery catheterization?
A) To prevent arterial occlusion
B) To promote blood clotting
C) To facilitate easier catheter insertion
D) To reduce the risk of infection
A) To prevent arterial occlusion
Which of the following is TRUE regarding the setup of the snuffbox area for radial artery access?
A) The dorsal hand area should be kept compressed for easier access
B) The snuffbox should be positioned facing downward
C) A roll of 4x4 gauze or small towel may be used to keep the hand open
D) The patient should bend the wrist to increase access visibility
C) A roll of 4x4 gauze or small towel may be used to keep the hand open
When is ulnar artery access typically considered as an alternative?
A) When the femoral artery is unavailable
B) When the radial artery cannot be accessed successfully
C) Only in emergency situations
D) As the first choice over radial access
B) When the radial artery cannot be accessed successfully
How does ulnar artery access compare to radial artery access in terms of safety and efficacy?
A) Ulnar access is considered inferior to radial access
B) Ulnar access is noninferior to radial access
C) Ulnar access is less effective than femoral access
D) Ulnar access carries a higher risk of complications than radial access
B) Ulnar access is noninferior to radial access
What is a key anatomical difference between the ulnar and radial arteries?
A) The ulnar artery is located on the lateral aspect of the forearm
B) The ulnar artery has more tortuosity and loops than the radial artery
C) The ulnar artery courses along the medial aspect of the ulna with less tortuosity
D) The ulnar artery is more superficial than the radial artery
C) The ulnar artery courses along the medial aspect of the ulna with less tortuosity
What is a key consideration when accessing the ulnar artery to avoid complications?
A) Avoid puncturing the radial artery
B) Bias the needle path away from the ulnar nerve located just lateral to the artery
C) Increase the angle of the needle to minimize nerve injury
D) Ensure the needle enters at a more proximal location than the radial artery
B) Bias the needle path away from the ulnar nerve located just lateral to the artery
How does the point of access for the ulnar artery differ from that of the radial artery?
A) The ulnar artery is accessed more proximally
B) The ulnar artery is accessed more distally than the radial artery
C) The ulnar artery is accessed at the same point as the radial artery
D) The ulnar artery is accessed at the same location as the femoral artery
B) The ulnar artery is accessed more distally than the radial artery
What is a challenge associated with hemostasis in ulnar artery access compared to radial artery access?
A) Ulnar artery hemostasis is easier to achieve than radial artery hemostasis
B) Ulnar artery hemostasis is more difficult due to the artery’s deeper location
C) Ulnar artery hemostasis requires no special techniques
D) Radial artery hemostasis is more difficult due to deeper artery location
B) Ulnar artery hemostasis is more difficult due to the artery’s deeper location
What technique is sometimes used to achieve hemostasis after ulnar artery access?
A) Applying pressure with a tourniquet
B) Using a radial band placed “backward” to apply pressure over the ulnar site
C) Using a direct compression with the thumb on the ulnar artery
D) Applying a compression dressing to the radial artery
B) Using a radial band placed “backward” to apply pressure over the ulnar site
Why is it important to emphasize hemostasis after ulnar artery access, particularly compared to radial artery access?
A) The ulnar artery is more prone to dissection
B) Hemostasis is less critical for the ulnar artery
C) Hemostasis is more challenging due to the ulnar artery’s deeper location
D) The ulnar artery is located close to several critical nerves, making compression unnecessary
C) Hemostasis is more challenging due to the ulnar artery’s deeper location
Which of the following is a potential drawback of using the ulnar artery for access?
A) It has greater tortuosity than the radial artery
B) The ulnar artery is more difficult to cannulate than the radial artery
C) The ulnar artery is more likely to cause compartment syndrome
D) Hemostasis may be more difficult due to the deeper location of the ulnar artery
D) Hemostasis may be more difficult due to the deeper location of the ulnar artery
What is a primary advantage of using the ulnar artery for access when radial artery cannulation fails?
A) The ulnar artery is more superficial than the radial artery
B) It avoids the need for femoral artery access, which carries more risk
C) The ulnar artery provides easier access due to its larger size
D) Ulnar access can be done without ultrasound guidance
B) It avoids the need for femoral artery access, which carries more risk
What is a common antispasmodic medication used during radial artery catheterization to reduce spasm?
A) Lidocaine
B) Heparin
C) Verapamil
D) Fentanyl
C) Verapamil
What is the recommended dose range for intra-arterial verapamil during radial artery catheterization?
A) 1 to 2.5 mg
B) 2.5 to 5 mg
C) 10 to 20 mg
D) 100 to 200 mcg
B) 2.5 to 5 mg
Why is heparin used during radial artery catheterization?
A) To reduce radial artery spasm
B) To prevent radial artery occlusion
C) To sedate the patient
D) To enhance local anesthesia
B) To prevent radial artery occlusion
What is the typical dose of intravenous heparin used for diagnostic procedures during radial artery catheterization?
A) 500–1000 U
B) 2000 to 5000 U
C) 10,000 U
D) 70–100 U/kg
B) 2000 to 5000 U
When is the use of intravenous heparin recommended during radial artery catheterization?
A) Before the sheath insertion
B) After the sheath is inserted
C) Before catheter insertion
D) Before the procedure begins
B) After the sheath is inserted
What is the typical dose of nitroglycerin used as an intra-arterial spasmolytic during radial artery catheterization?
A) 100–200 mcg
B) 500–1000 mcg
C) 2.5–5 mg
D) 10–20 mcg
A) 100–200 mcg
What is the purpose of sedation and analgesia during radial artery catheterization?
A) To prevent arterial puncture
B) To increase sympathetic tone and reduce spasm
C) To minimize patient discomfort and reduce anxiety
D) To aid in vessel dilation
C) To minimize patient discomfort and reduce anxiety
What is the maximum amount of 1% lidocaine typically used as a local anesthetic during radial artery catheterization?
A) 2–3 mL
B) 0.5–1 mL
C) 5–10 mL
D) 1–2 mL
B) 0.5–1 mL
What dose of intravenous heparin is typically used during a percutaneous coronary intervention (PCI) procedure to prevent clotting?
A) 40 U/kg
B) 2000–5000 U
C) 70–100 U/kg
D) 10,000 U
C) 70–100 U/kg
Which medication may be used after sheath insertion to reduce radial artery spasm?
A) Nitroglycerin 100 to 200 mcg
B) Lidocaine 1%
C) Fentanyl 50 mcg
D) Verapamil 2.5 mg
A) Nitroglycerin 100 to 200 mcg
Why is it recommended to adopt a “standard” technique for femoral artery access?
A) To minimize costs associated with the procedure
B) To maximize the efficiency and reproducibility of good patient outcomes
C) To reduce the amount of anesthesia required
D) To make the procedure faster for the operator
B) To maximize the efficiency and reproducibility of good patient outcomes
Why is it recommended to adopt a “standard” technique for femoral artery access?
A) To minimize costs associated with the procedure
B) To maximize the efficiency and reproducibility of good patient outcomes
C) To reduce the amount of anesthesia required
D) To make the procedure faster for the operator
B) To maximize the efficiency and reproducibility of good patient outcomes
What anatomical landmark is used to define the common femoral artery (CFA) for access?
A) The iliac artery bifurcation
B) The femoral artery bifurcation
C) The inferior epigastric artery
D) The head of the femur
B) The femoral artery bifurcation
How is ultrasound used in femoral artery access?
A) To identify the depth of the femoral artery
B) To locate the common femoral artery and ensure access is above the bifurcation
C) To visualize the inferior epigastric artery
D) To assess the patient’s vascular health
B) To locate the common femoral artery and ensure access is above the bifurcation
What is the purpose of using a metal marker (e.g., hemostat) when preparing for femoral artery puncture?
A) To mark the location of the needle entry
B) To stabilize the femoral artery
C) To indicate the planned path of the needle on fluoroscopy
D) To highlight the bifurcation of the artery
C) To indicate the planned path of the needle on fluoroscopy
What view should be used when imaging the femoral artery with ultrasound?
A) Axial plane
B) Transverse plane
C) Sagittal plane
D) Coronal plane
A) Axial plane
What is the recommended angle for needle insertion during ultrasound-guided femoral artery access?
A) 0 to 15 degrees
B) 15 to 30 degrees
C) 45 to 60 degrees
D) 90 degrees
C) 45 to 60 degrees
What does the ultrasound image display when an artery is imaged during femoral artery access?
A) A pulsating echolucent circle
B) A solid echodense line
C) A large, compressible structure
D) A non-pulsating, dark area
A) A pulsating echolucent circle
How does ultrasound help in preventing complications during femoral artery puncture?
A) By identifying the location of the artery and avoiding vein puncture
B) By ensuring access is above the femoral artery bifurcation
C) By stabilizing the artery during the procedure
D) By confirming the correct placement of the catheter
B) By ensuring access is above the femoral artery bifurcation
What should the operator do when the needle tip is not seen on the ultrasound image?
A) Increase the needle’s insertion depth
B) Adjust the probe position or fanning to better visualize the needle tip
C) Change the needle size
D) Withdraw the needle and start the procedure again
B) Adjust the probe position or fanning to better visualize the needle tip
What is the next step after appropriate blood flashback is seen during femoral artery access?
A) Withdraw the needle and insert the catheter
B) Insert the guidewire through the needle into the vessel
C) Re-assess the ultrasound image for vessel location
D) Inject contrast to confirm vessel placement
B) Insert the guidewire through the needle into the vessel
What is the main purpose of using the micropuncture access technique in femoral access?
A. To increase the size of the arterial puncture
B. To improve safety and accuracy, especially for large-bore sheath placement
C. To avoid using guidewires altogether
D. To completely eliminate arterial trauma
B. To improve safety and accuracy, especially for large-bore sheath placement
What components are generally included in a micropuncture access kit?
A. Large-bore needle, 0.035-inch guidewire, and 8F sheath
B. Low-profile needle, 0.018-inch guidewire, and 4F/5F micropuncture sheath with dilator
C. Scissors, 0.014-inch guidewire, and a standard sheath
D. Only a small catheter and compression device
B. Low-profile needle, 0.018-inch guidewire, and 4F/5F micropuncture sheath with dilator
What is an advantage of micropuncture access compared to traditional techniques?
A. Larger arterial puncture for easier access
B. Smaller initial puncture with less arterial trauma
C. Avoiding ultrasound guidance
D. Eliminating the need for manual compression
B. Smaller initial puncture with less arterial trauma
How does the micropuncture technique confirm the optimal location of the arteriotomy?
A. Using contrast angiography through the micropuncture catheter or dilator
B. By relying solely on tactile feedback during puncture
C. Through blind access without imaging
D. By skipping angiography and directly placing the large sheath
A. Using contrast angiography through the micropuncture catheter or dilator
What is a notable benefit of using the micropuncture needle in calcified arteries?
A. Larger crossing profile for easier visualization
B. Lower crossing profile for improved access in resistant vessels
C. It avoids the need for any guidewire
D. It reduces the need for ultrasound guidance
B. Lower crossing profile for improved access in resistant vessels
What are common indications for femoral venous sheath placement in PCI?
A. Transseptal access, intracardiac imaging, temporary pacemaker, or pulmonary artery pressure monitoring
B. Placement of large arterial sheaths
C. Coronary artery bypass grafting
D. Avoiding transradial access
A. Transseptal access, intracardiac imaging, temporary pacemaker, or pulmonary artery pressure monitoring
Why is it recommended to avoid unnecessary or “routine” venous access during PCI?
A. Venous access is never required in PCI
B. Combined arterial–venous procedures increase bleeding complications
C. Venous access makes arterial access more difficult
D. Routine venous access increases the risk of infection
B. Combined arterial–venous procedures increase bleeding complications
What is the proper sequence for accessing the femoral vessels in PCI?
A. Access the artery first, then the vein
B. Access the vein first, then the artery
C. Simultaneous access of artery and vein
D. It does not matter which is accessed first
B. Access the vein first, then the artery
What is a safety precaution to avoid an inadvertent arterial puncture during femoral venous access?
A. Access the vessels blindly
B. Use an angle slightly more lateral than normal
C. Use ultrasound guidance for decompressed veins
D. Avoid ultrasound guidance for better tactile feedback
C. Use ultrasound guidance for decompressed veins
What is the most common cause of failed transradial catheterization?
A. Using ultrasound guidance
B. Unsuccessful arterial access
C. Lack of patient sedation
D. Starting with femoral access instead
B. Unsuccessful arterial access
How can vasospasm during transradial access be reduced?
A. Avoid local anesthesia entirely
B. Use general conscious sedation and limited local anesthesia
C. Perform multiple fast punctures
D. Avoid ultrasound guidance
B. Use general conscious sedation and limited local anesthesia
What is a key advantage of ultrasound-guided access in transradial procedures?
A. It reduces the need for anesthesia
B. It increases the likelihood of first-pass success
C. It eliminates the risk of vasospasm
D. It avoids the need for sedation
B. It increases the likelihood of first-pass success
Why is percutaneous brachial artery puncture generally discouraged?
A. It is technically impossible in most cases
B. It has the highest rate of bleeding complications compared to femoral and radial arteries
C. It requires longer equipment than other access sites
D. It is not suitable for any procedures
B. It has the highest rate of bleeding complications compared to femoral and radial arteries
In what situation might the brachial approach still be considered advantageous?
A. For coronary interventions
B. For lower extremity or renal procedures when equipment of sufficient length is unavailable
C. For routine vascular access
D. For patients with severe peripheral vascular disease
B. For lower extremity or renal procedures when equipment of sufficient length is unavailable
What is a common standby procedure for patients at high risk of complications during high-risk interventions?
A. Placing a small 4 to 5F sheath introducer in the opposite femoral artery or vein
B. Performing immediate coronary bypass surgery
C. Using brachial artery access instead of femoral or radial
D. Avoiding additional arterial or venous access
A. Placing a small 4 to 5F sheath introducer in the opposite femoral artery or vein
What should be performed before inserting mechanical circulatory support (MCS) or other large devices?
A. Venous angiography
B. Brachial artery puncture
C. Abdominal and iliac angiography to identify peripheral vascular disease
D. Immediate deployment of the device without imaging
C. Abdominal and iliac angiography to identify peripheral vascular disease
Why is additional arterial or venous access useful in high-risk interventions?
A. It eliminates the need for ultrasound guidance
B. It allows urgent placement of a pacemaker or mechanical circulatory support if needed
C. It reduces the risk of vascular complications
D. It replaces the need for imaging during the procedure
B. It allows urgent placement of a pacemaker or mechanical circulatory support if needed
What has increased the risk of vascular complications in percutaneous procedures?
A. Smaller sheath sizes
B. Increased use of larger-bore catheters for structural heart disease and mechanical support devices
C. Decreased use of ultrasound guidance
D. Routine use of brachial artery access
B. Increased use of larger-bore catheters for structural heart disease and mechanical support devices
What is the first step in successful management of vascular access for large-bore devices?
A. Immediate upsizing of the sheath
B. Proper location of the arteriotomy
C. Avoiding imaging or guidance
D. Bifurcation puncture for easy access
B. Proper location of the arteriotomy
Why is ultrasound-guided access recommended for large-bore device procedures?
A. To avoid the bifurcation and ensure anterior wall puncture
B. To perform vascular closure without sutures
C. To reduce the need for preclosure devices
D. To avoid using angiography for contralateral access
A. To avoid the bifurcation and ensure anterior wall puncture
What are the commonly used suture-mediated closure devices for large-bore arterial access?
A. Angio-Seal and StarClose
B. Perclose ProGlide and ProStar XL
C. Manual compression and Perclose ProGlide
D. ProStar XL and Angio-Seal
B. Perclose ProGlide and ProStar XL
What is the purpose of “preclosure” during large-bore vascular access?
A. To immediately seal the vessel before inserting the catheter
B. To set sutures aside for use after the procedure is completed
C. To avoid the need for sheath upsizing
D. To completely close the vessel before the procedure begins
B. To set sutures aside for use after the procedure is completed
When should sheath upsizing be performed during large-bore access management?
A. Immediately after the initial arterial puncture
B. After preclosure has been performed with a smaller sheath
C. Before confirming the location of the arteriotomy
D. After the procedure is completed
B. After preclosure has been performed with a smaller sheath
What is the final step in arterial access management after the procedure?
A. Immediate manual compression to close the vessel
B. Completion of vascular closure using the predelivered sutures
C. Removal of the sheath without any closure device
D. Performing a new arteriotomy for closure
B. Completion of vascular closure using the predelivered sutures
What is the purpose of crossover balloon hemostasis during large-bore arterial access procedures?
A. To occlude the contralateral artery for improved blood flow
B. To control bleeding by occluding the iliac artery during closure
C. To replace the need for closure devices
D. To avoid using angiographic confirmation
B. To control bleeding by occluding the iliac artery during closure
How is hemostasis confirmed after closure using the crossover balloon technique?
A. By performing manual compression
B. By using a Doppler ultrasound
C. By an angiogram from the contralateral catheter
D. By waiting for spontaneous cessation of bleeding
C. By an angiogram from the contralateral catheter
What is the role of the peripheral balloon in cases of incomplete closure or vessel rupture?
A. It is inflated for stabilization of the arteriotomy prior to placing a covered stent
B. It is removed immediately to avoid further complications
C. It is used to occlude the distal portion of the vessel permanently
D. It replaces the need for a covered stent
A. It is inflated for stabilization of the arteriotomy prior to placing a covered stent
What type of catheter and wire are commonly used for iliac crossover during the technique?
A. Internal mammary artery or Omniflush catheter with a 0.035-inch hydrophilic wire
B. Angio-Seal catheter with a 0.018-inch wire
C. Balloon-tipped catheter with a 0.014-inch wire
D. Straight catheter with a non-hydrophilic wire
A. Internal mammary artery or Omniflush catheter with a 0.035-inch hydrophilic wire
What is the recommended sequence for closing large-bore arterial access sites?
A. Withdraw the sheath immediately without closure devices
B. Place percutaneous vascular suture devices (e.g., Prostar XL or ProGlide) at the beginning of access and use them at the end of the procedure
C. Perform closure with manual compression only
D. Close the access site before removing the sheath
B. Place percutaneous vascular suture devices (e.g., Prostar XL or ProGlide) at the beginning of access and use them at the end of the procedure
How is bleeding control achieved during closure using a crossover balloon?
A. By inflating the balloon to high pressure
B. By inflating a modestly oversized balloon at low pressure to provide proximal hemostasis
C. By using a balloon only after the closure sutures are deployed
D. By inflating multiple balloons simultaneously
B. By inflating a modestly oversized balloon at low pressure to provide proximal hemostasis
What is done with the retrograde 0.035-inch wire after achieving adequate hemostasis?
A. It is left in place for potential re-access
B. It is removed once hemostasis is confirmed
C. It is replaced with a larger wire for added support
D. It is exchanged for a guide catheter
B. It is removed once hemostasis is confirmed
What is a common challenge in advancing guide catheters in elderly patients?
A. Large arterial diameter
B. Excessive vessel tortuosity
C. Vessel spasm
D. Fragile vessel walls
B. Excessive vessel tortuosity
What type of guidewire is most effective for negotiating tortuous vessels?
A. Straight 0.018-inch guidewire
B. Steerable 0.038-inch flexible guidewire (e.g., Wholey, Benson)
C. Non-hydrophilic stiff wire
D. Guidewire with a rigid, straight tip
B. Steerable 0.038-inch flexible guidewire (e.g., Wholey, Benson)
What tool may assist in directing a guidewire through extremely tortuous vessels?
A. Manual compression of the vessel
B. JR diagnostic catheter
C. Short arterial sheath
D. Non-steerable wire
B. JR diagnostic catheter
What is often effective in straightening tortuous segments of the vessel?
A. Standard-length guidewires
B. Long or braided vascular sheaths
C. Larger bore catheters
D. Hydrophilic wires alone
B. Long or braided vascular sheaths
Which imaging technique is recommended to delineate the arterial course in cases of vessel tortuosity?
A. Ultrasound imaging
B. Angiography
C. Doppler studies
D. Fluoroscopy without contrast
B. Angiography
What condition might weak femoral pulses indicate during vascular access?
A. Vasospasm
B. Atherosclerotic obstruction
C. Vessel rupture
D. High blood pressure
B. Atherosclerotic obstruction
If advancing a guidewire to the central aortic position is unsuccessful due to peripheral vascular disease (PVD), what should be performed?
A. Immediate placement of an iliac stent
B. Abdominal aortography and peripheral angiography
C. Blind advancement of the guidewire
D. Switching to brachial access
B. Abdominal aortography and peripheral angiography
What approach may be necessary for patients with lower extremity PVD that prevents femoral access?
A. Subclavian access
B. Radial approach
C. Brachial access
D. Transvenous access
B. Radial approach
What is a potential complication of arm access in patients with lower extremity PVD?
A. Vessel rupture in the radial artery
B. Coexistent subclavian atherosclerosis
C. Excessive tortuosity in the brachial artery
D. Inability to advance a guide catheter
B. Coexistent subclavian atherosclerosis
What is a common cause of inguinal scarring that complicates vascular access?
A. Recurrent infections
B. Prior interventional procedures or bypass surgery
C. Prolonged anticoagulant therapy
D. Chronic venous insufficiency
B. Prior interventional procedures or bypass surgery
If accessing a severely scarred or fibrotic groin, what technique is recommended for inserting a vascular sheath?
A. Direct insertion of the sheath without dilation
B. Use of progressively larger dilators (e.g., 5, 6, 7, and 8F)
C. Ultrasound-guided puncture without dilation
D. Placement of a sheath two sizes larger than the dilator
B. Use of progressively larger dilators (e.g., 5, 6, 7, and 8F)
Which vascular closure devices should be used cautiously in calcified or fibrotic arteries?
A. Perclose and StarClose
B. Angio-Seal and Mynx
C. ProGlide and Angio-Seal
D. ProStar and StarClose
A. Perclose and StarClose
What complication has been reported during StarClose device use in a scarred groin?
A. Device malfunction during deployment
B. Clip entrapment
C. Arterial rupture
D. Hematoma formation
B. Clip entrapment
When is reaccess through a site closed with a vascular closure device generally considered safe?
A. Immediately after closure
B. 2 to 4 weeks after closure
C. At least 8 weeks after closure
D. Only if the closure device has an internal artery fixation component
B. 2 to 4 weeks after closure
Which vascular closure device requires extra caution during reaccess, despite no reports of anchor dislodgement?
A. Perclose
B. StarClose
C. Angio-Seal
D. Mynx
C. Angio-Seal
What is a safer alternative to accessing a recently closed femoral site?
A. Ipsilateral femoral artery access
B. Contralateral femoral artery access
C. Radial artery access
D. Brachial artery access
B. Contralateral femoral artery access
Why are Perclose and StarClose devices difficult to use in calcified arteries?
A. Their mechanisms are too rigid for heavily calcified vessels
B. They are designed for venous applications only
C. They require the artery to be undilated for proper placement
D. They rely on anchor dislodgement for closure
A. Their mechanisms are too rigid for heavily calcified vessels
What is a common cause of inguinal scarring that complicates vascular access?
A. Recurrent infections
B. Prior interventional procedures or bypass surgery
C. Prolonged anticoagulant therapy
D. Chronic venous insufficiency
B. Prior interventional procedures or bypass surgery
If accessing a severely scarred or fibrotic groin, what technique is recommended for inserting a vascular sheath?
A. Direct insertion of the sheath without dilation
B. Use of progressively larger dilators (e.g., 5, 6, 7, and 8F)
C. Ultrasound-guided puncture without dilation
D. Placement of a sheath two sizes larger than the dilator
B. Use of progressively larger dilators (e.g., 5, 6, 7, and 8F)
Which vascular closure devices should be used cautiously in calcified or fibrotic arteries?
A. Perclose and StarClose
B. Angio-Seal and Mynx
C. ProGlide and Angio-Seal
D. ProStar and StarClose
A. Perclose and StarClose
What complication has been reported during StarClose device use in a scarred groin?
A. Device malfunction during deployment
B. Clip entrapment
C. Arterial rupture
D. Hematoma formation
B. Clip entrapment
When is reaccess through a site closed with a vascular closure device generally considered safe?
A. Immediately after closure
B. 2 to 4 weeks after closure
C. At least 8 weeks after closure
D. Only if the closure device has an internal artery fixation component
B. 2 to 4 weeks after closure
Which vascular closure device requires extra caution during reaccess, despite no reports of anchor dislodgement?
A. Perclose
B. StarClose
C. Angio-Seal
D. Mynx
C. Angio-Seal
What is a safer alternative to accessing a recently closed femoral site?
A. Ipsilateral femoral artery access
B. Contralateral femoral artery access
C. Radial artery access
D. Brachial artery access
B. Contralateral femoral artery access
Why are Perclose and StarClose devices difficult to use in calcified arteries?
A. Their mechanisms are too rigid for heavily calcified vessels
B. They are designed for venous applications only
C. They require the artery to be undilated for proper placement
D. They rely on anchor dislodgement for closure
A. Their mechanisms are too rigid for heavily calcified vessels
What is the primary goal of successful vascular access management after femoral PCI?
A. Prolonging hospitalization for monitoring
B. Timely and safe sheath removal with minimal discomfort
C. Using larger arterial sheaths to improve outcomes
D. Leaving the sheath in place for 24 hours
B. Timely and safe sheath removal with minimal discomfort
What factors have improved outcomes in vascular access management?
A. Using larger sheaths and prolonging anticoagulation
B. Discontinuing post-PCI heparin infusions and removing sheaths early
C. Leaving the arterial sheath in place overnight
D. Avoiding vascular closure devices
B. Discontinuing post-PCI heparin infusions and removing sheaths early
What is a potential complication of leaving a vascular sheath in place in a heavily anticoagulated patient?
A. Increased risk of arterial dissection
B. Retroperitoneal hematoma
C. Vascular spasm
D. Dehydration
B. Retroperitoneal hematoma
When are femoral arterial sheaths typically removed after PCI?
A. 24 hours after the procedure
B. Immediately in the laboratory or within a few hours
C. After the patient is fully ambulatory
D. Only after confirming complete hemostasis with ultrasound
B. Immediately in the laboratory or within a few hours
What resource is critically important for good outcomes in sheath care and hemostasis?
A. Antiplatelet medications
B. Staff and equipment for sheath management
C. Larger vascular sheaths
D. Delayed sheath removal techniques
B. Staff and equipment for sheath management
Why is immediate sheath removal preferred after PCI in most laboratories?
A. It minimizes the need for anticoagulation reversal
B. It reduces the risk of hemorrhage and retroperitoneal hematoma
C. It prevents infection at the access site
D. It improves patient comfort during the procedure
B. It reduces the risk of hemorrhage and retroperitoneal hematoma
What device is often used to facilitate immediate sheath removal in the catheterization laboratory?
A. Vascular closure devices
B. Long exchange-length guidewires
C. Peripheral balloon catheters
D. Angiographic catheters
A. Vascular closure devices
What practice is not routine following femoral PCI?
A. Leaving the arterial sheath in place overnight
B. Removing the sheath within a few hours
C. Using vascular closure devices for hemostasis
D. Minimizing anticoagulation post-procedure
A. Leaving the arterial sheath in place overnight
What is a key benefit of using smaller arterial sheaths in PCI?
A. Easier guidewire exchange
B. Reduced risk of vascular complications
C. Improved hemostasis without additional intervention
D. Faster procedure times
B. Reduced risk of vascular complications
What should be ensured before removing a femoral sheath after PCI?
A. The patient has eaten a meal.
B. Heparin is stopped, ACT is <150 seconds, and vital signs are stable.
C. The patient is sedated with general anesthesia.
D. A compression device is already applied.
B. Heparin is stopped, ACT is <150 seconds, and vital signs are stable.
Why is local anesthetic administered before manual sheath removal?
A. To prevent vasospasm
B. To reduce patient discomfort during the procedure
C. To prevent arterial thrombosis
D. To facilitate sheath removal
B. To reduce patient discomfort during the procedure
Which precaution is necessary when both arterial and venous sheaths were used during PCI?
A. Remove the venous sheath first.
B. Remove the arterial sheath first to preserve venous access.
C. Remove both sheaths simultaneously.
D. Prolong compression on both sheaths to prevent bleeding
B. Remove the arterial sheath first to preserve venous access.
What potential complication can prolonged pressure on the femoral vein cause?
A. Cyanosis of the opposite leg
B. Venous thrombosis
C. Retroperitoneal bleeding
D. Arterial dissection
B. Venous thrombosis
Where may sheath removal after PCI occur?
A. Only in the catheterization laboratory
B. In the lab, holding area, or at the patient’s bedside
C. Only in the holding area
D. Only at the patient’s bedside
B. In the lab, holding area, or at the patient’s bedside
What should be done before manually removing the sheath after PCI?
A. Ensure the patient has a full stomach
B. Ensure good intravenous access
C. Administer a sedative to the patient
D. Check the patient’s history for allergic reactions
B. Ensure good intravenous access
What is the recommended local anesthetic dose for skin around the sheath during removal?
A. 5–10 mL of 1% lidocaine
B. 10–20 mL of 1% lidocaine
C. 1–5 mL of 2% lidocaine
D. 10 mL of 0.5% bupivacaine
B. 10–20 mL of 1% lidocaine
Which of the following should be checked before removing the sheath after PCI?
A. Platelet count
B. The heparin is stopped and the ACT is less than 150 seconds
C. The patient is still under general anesthesia
D. The patient’s legs are elevated
B. The heparin is stopped and the ACT is less than 150 seconds
When both arterial and venous sheaths are used, which sheath should be removed first?
A. Either sheath can be removed first
B. The venous sheath
C. The arterial sheath
D. Both should be removed simultaneously
C. The arterial sheath
What should be avoided when applying pressure to the femoral vein during sheath removal?
A. Prolonged pressure to avoid venous thrombosis
B. Immediate release of pressure to avoid pain
C. Direct pressure to the artery
D. Using an external compression device
A. Prolonged pressure to avoid venous thrombosis
How long should pressure be held after sheath removal?
A. 5–10 minutes
B. 10–15 minutes
C. 15–20 minutes, depending on sheath size, ACT, and bleeding control
D. 30–45 minutes
C. 15–20 minutes, depending on sheath size, ACT, and bleeding control
What compression device is preferred for longer pressure application after sheath removal?
A. Manual pressure with a bandage
B. FemoStop or similar mechanical compression device
C. A large foam bandage
D. Compression socks
B. FemoStop or similar mechanical compression device
What is a key benefit of using compression devices like FemoStop after sheath removal?
A. They provide intermittent pressure for better hemostasis
B. They offer constant stable pressure and relative patient comfort
C. They apply pressure only when the patient is lying flat
D. They are intended for unsupervised use
B. They offer constant stable pressure and relative patient comfort
What potential complication should be minimized by limiting the duration of pressure application after sheath removal?
A. Nerve compression
B. Hemorrhagic shock
C. Thrombocytopenia
D. Skin necrosis, nerve compression, or venous thrombosis
D. Skin necrosis, nerve compression, or venous thrombosis
What is the FemoStop system used for?
A. Immediate surgical closure of the femoral artery
B. Prolonged compression when bleeding persists despite manual compression
C. Providing continuous access to the femoral artery
D. Lowering the pressure in the femoral artery during PCI
B. Prolonged compression when bleeding persists despite manual compression
How is the pressure in the FemoStop system controlled?
A. Manually with a pressure band
B. With an insufflator connected to a sphygmomanometer gauge
C. By adjusting the size of the compression dome
D. By monitoring the arterial pressure directly
B. With an insufflator connected to a sphygmomanometer gauge
What is one advantage of using the FemoStop system over manual compression?
A. It allows continuous access to the femoral artery
B. It provides more direct visualization of the puncture site
C. It can be left in place for longer periods and offers better control of pressure
D. It is cheaper and requires no special equipment
C. It can be left in place for longer periods and offers better control of pressure
In which patients should femoral compression systems like FemoStop not be used?
A. Patients with significant leg swelling
B. Patients with lower extremity bypass grafts at the access site
C. Patients who have undergone a femoral artery stenting procedure
D. Patients who are fully anticoagulated
B. Patients with lower extremity bypass grafts at the access site
What is one key feature of the FemoStop system?
A. It uses mechanical clamping to apply pressure
B. It is air-filled and molded to the skin contours
C. It is designed to stay in place for a minimum of 6 hours
D. It can only be used in the inpatient setting
B. It is air-filled and molded to the skin contours
How is hemostasis achieved in the catheterization suite after PCI?
A. By using manual pressure and observation only
B. By using vascular closure devices (VCDs)
C. By surgically closing the puncture site
D. By applying heat or laser therapy
B. By using vascular closure devices (VCDs)
What role does femoral angiography play in the use of vascular closure devices?
A. To identify the best location for catheter insertion
B. To confirm the suitability of device insertion
C. To assess the patient’s blood pressure
D. To determine if surgical intervention is required
B. To confirm the suitability of device insertion
Which femoral angiographic view is best for displaying the bifurcation of the profunda and superficial femoral branches?
A. Anterior-posterior (AP) view
B. Left anterior oblique (LAO) view
C. Ipsilateral oblique view (e.g., RAO for right femoral artery)
D. Lateral view
C. Ipsilateral oblique view (e.g., RAO for right femoral artery)
What is a primary goal of using vascular closure devices after PCI?
A. To reduce the amount of heparin administered
B. To increase the procedure time
C. To obtain quick and safe hemostasis and improve patient comfort
D. To improve the efficiency of the angiography
C. To obtain quick and safe hemostasis and improve patient comfort
What is a reported benefit of using vascular closure devices (VCDs) in PCI?
A. Higher rates of infection
B. Reduced patient comfort during the procedure
C. High success rates in fully anticoagulated patients
D. Longer hospital stays
C. High success rates in fully anticoagulated patients
What is the best approach to ensure successful vascular access and sheath management during a procedure?
A. Remove the sheath immediately after the procedure
B. Perform meticulous arterial puncture, proper sheath placement, and careful removal and hemostasis
C. Use a larger sheath size to minimize complications
D. Keep the sheath in place longer for better hemostasis
B. Perform meticulous arterial puncture, proper sheath placement, and careful removal and hemostasis
Why should an obturator be placed in the sheath during transport to the holding area?
A. To ensure that the sheath is properly sterilized
B. To prevent sheath kinking and potential bleeding
C. To ensure that the sheath stays in place
D. To make it easier to remove the sheath
B. To prevent sheath kinking and potential bleeding
What is the purpose of using a clear transparent dressing over the puncture site postprocedure?
A. To keep the puncture site sterile
B. To provide easy visualization of bleeding
C. To prevent swelling at the access site
D. To apply pressure to the site for better hemostasis
B. To provide easy visualization of bleeding
What is a key practice to prevent infections when dressing the puncture site after a procedure?
A. Use a wad of gauze under the dressing
B. Avoid using any dressing to allow the site to breathe
C. Ensure no blood or gauze combination is present under the dressing
D. Leave the site uncovered to facilitate drying
C. Ensure no blood or gauze combination is present under the dressing
What should be checked during each postprocedure check?
A. Only the blood pressure
B. Only the puncture site
C. The puncture site and distal pulses
D. Only the distal pulses
C. The puncture site and distal pulses
What are early warning signs of bleeding following a procedure?
A. Increased blood pressure and slow heart rate
B. Decreased blood pressure and increased heart rate
C. Decreased heart rate and increased blood pressure
D. Stable vital signs with no change
B. Decreased blood pressure and increased heart rate
What should be assumed as the cause of hypotension after PCI until another cause is identified?
A. An allergic reaction
B. Bleeding, such as retroperitoneal hematoma
C. A vasovagal response
D. Excessive sedation
B. Bleeding, such as retroperitoneal hematoma
If there is suspicion of a retroperitoneal hematoma (RPH) and the patient is stable, what imaging technique might be helpful?
A. Chest X-ray
B. Ultrasound
C. CT scan
D. MRI
C. CT scan
What should be monitored closely for signs of bleeding after a procedure?
A. The patient’s breathing rate
B. The patient’s heart rate and blood pressure trends
C. The amount of sedation used
D. The puncture site dressing only
B. The patient’s heart rate and blood pressure trends
Why is it important not to use gauze under the dressing over the puncture site?
A. It makes it difficult to adjust the dressing later
B. The combination of blood and gauze can be an excellent culture medium for bacteria
C. It may cause allergic reactions
D. It can lead to increased bleeding
B. The combination of blood and gauze can be an excellent culture medium for bacteria
What is the most common complication from femoral cardiac catheterization?
A. Pseudoaneurysm
B. Hemorrhage and local hematoma formation
C. Stroke
D. Cholesterol embolism
B. Hemorrhage and local hematoma formation
Which of the following factors increases the frequency of complications from femoral arterial access?
A. Smaller sheath size
B. Lack of anticoagulation
C. Obesity, anticoagulation, and large sheath size
D. Use of the radial approach
C. Obesity, anticoagulation, and large sheath size
Which complication is more frequent in patients undergoing repeat ipsilateral femoral punctures or prolonged sheath maintenance?
A. Pseudoaneurysm
B. Infection
C. Arterial thrombosis
D. Stroke
B. Infection
What are some common signs of a retroperitoneal hematoma (RPH)?
A. Abdominal pain and hypotension
B. Hematoma at the puncture site
C. Skin mottling and renal insufficiency
D. All of the above
D. All of the above
What clinical sign should raise suspicion of a retroperitoneal hematoma (RPH) after a femoral artery puncture?
A. Mild headache and dizziness
B. Tachycardia, hypotension, and falling hematocrit
C. Swelling at the puncture site
D. Abdominal cramping
B. Tachycardia, hypotension, and falling hematocrit
Which of the following can be a consequence of high-risk patients undergoing femoral artery puncture?
A. Increased risk of pseudoaneurysms
B. Skin mottling and “blue toes”
C. Chronic back pain
D. Decreased risk of arterial thrombosis
B. Skin mottling and “blue toes”
Which complication is most commonly associated with low femoral arterial puncture?
A. Retroperitoneal hematoma
B. Arterial thrombosis
C. Pseudoaneurysm
D. Stroke
C. Pseudoaneurysm
What is the typical treatment for a femoral pseudoaneurysm detected by ultrasound?
A. Immediate surgery
B. Manual compression with or without thrombin or collagen injection
C. Anticoagulation therapy
D. Use of a compression device
B. Manual compression with or without thrombin or collagen injection
What is the risk factor that may increase the likelihood of a stroke after femoral arterial access?
A. Overuse of anticoagulation
B. Radial artery access
C. Repeat femoral puncture at the same site
D. Prolonged post-procedure rest
A. Overuse of anticoagulation
Which complication is less likely to be a concern with radial artery PCI compared to femoral artery PCI?
A. Pseudoaneurysm
B. Retroperitoneal hematoma
C. Sepsis
D. Arterial thrombosis
B. Retroperitoneal hematoma
