A comparative study of TR Band and a new hemostatic compression device after transradial coronary catheterization

Objective: Transradial coronary catheterization has proved to be safe and effective in clinical practice. Various hemostatic compressive devices have been used in subsequent procedures. The objective of this study was to compare the efficacy and safety of a new hemostatic compression device and the widely used TR Band. Methods: A total of 118 patients were divided randomly into two groups: TR Band and the new hemostatic compression device. Efficacy of hemostasis, patient comfort, local vascular dysfunction, and radial artery occlusion(RAO) were evaluated and compared between groups. Results: Occurrence of errhysis or hematoma did not significantly differ between groups(13.6% vs. 11.9%, P = 0.782). Fewer patients had moderate to severe pain or moderate to severe numbness in the new hemostatic compression device group(1.7% vs. 22.0%; 1.7% vs. 18.6%, respectively). Pulse loss between distal artery and device was lower in the new hemostatic compression device group(5.1% vs. 22.0%, P = 0.007), and fewer patients experienced obstruction of venous reflux compared with the TR Band group(6.8% vs. 25.4%, P = 0.006). Combined incidence of RAO at discharge was 7.6%, and was lower in the new hemostatic compression device group(1.7% vs. 13.6%, P = 0.015). In contrast to the TR Band, application of the new hemostatic compression device was independently associated with lower incidence of RAO at discharge(odds ratio: 0.062, 95% confidence interval: 0.006–0.675, P = 0.022). Conclusions: Both the new hemostatic compression device and the TR Band can efficiently achieve hemostasis following transradial coronary catheterization. However, fewer patients felt discomfort with application of the new hemostatic compression device. Pulse loss in the artery distal to the compression device, obstruction of venous reflux, and RAO occurred significantly less often with application of the new device.

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

BACKGROUND The traditional radial approach(RA)is recommended as the standard method for coronary angiography(CAG),while a distal RA(DRA)has been recently used for CAG.AIM To assess the efficacy and safety of the DRA vs RA during CAG.METHODS The following databases were searched through December 2020:MEDLINE,the Cochrane Central Register of Controlled Trials,EMBASE,the World Health Organization International Clinical Trials Platform Search Portal,and Clinical-Trials.gov.Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included.The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm(RAS)and radial artery occlusion(RAO).Study selection,data abstraction and quality assessment were independently performed using the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Three randomized control trials and 13 registered trials were identified.The two approaches showed similar successful cannulation rates[risk ratio(RR)0.90,95%confidence interval(CI):0.72-1.13].The DRA did not decrease RAS(RR 0.43,95%CI:0.08-2.49)and RAO(RR 0.48,95%CI:0.18-1.29).Patients with the DRA had a shorter hemostasis time in comparison to those with the RA(mean difference-6.64,95%CI:-10.37 to-2.90).The evidence of certainty was low.CONCLUSION For CAG,the DRA would be safer than the RA with comparable cannulation rates.Given the limited data,additional research,including studies with standard protocols,is necessary.

An Extremely Effective and Safe Approach of Guiding Catheter Crossing over Spasmodic Radial or (and) Brachial Artery in Patients Whose Percutaneous Coronary Intervention Was Undergone via Radial Artery Access

Objective: Percutaneous coronary intervention (PCI) via the radial artery access has more advantages than that of femoral artery access, while radial or (and) brachial artery have tendency to be spasmodic. We sought to investigate the effectiveness and safety of guiding catheter crossing over spasmodic radial or (and) brachial artery segments by the aid of PCI wire and balloon compared with traditional anti-spasmodic approach. Methods: The clinical data of 168 patients with coronary artery disease (CAD) (group A), whose PCI was performed via radial artery access with radial or (and) brachial artery spasm or (and) dissection and guiding catheter passing through spasmodic segments successfully by the aid of PCI guiding wire and balloon were analyzed retrospectively, simultaneously, the other 73 patients (group B) who used conventional approach to cross over the spasmodic radial or (and) brachial artery segments were treated as the control. The success rate, the time consumption and the complication were compared between the two groups. Findings: There was no significant difference in the spasmodic site between the two groups (all p value > 0.05). The success rate in group A was significantly higher than that in group B (168(100%) vs 28 (38.4%), p (4.2%) vs 14 (19.2%), p Conclusions: It is more effective and safer for guiding catheter crossing over spasmodic or (and) dissected radial or (and) brachial artery segments by the aid of PCI guiding wire and balloon than using the routine approach of administration of anti-spasm drugs for trans-radial PCI.

A Novel Technique to Maintain Radial Arterial Catheter Position: The Arterial Catheter Stabilizer

Despite widespread use of arterial catheters, there is remarkably little described about their stabilization in the literature. A brief review of arterial catheterization techniques is included. The fixation techniques described in the literature and in commercial product information are essentially to tape or suture the arterial catheter flat against the skin. Often the wrist is immobilized in the dorsiflexed position to prevent kinking or dislodging of the catheter. We describe a simple device made from a gauze pad and tape to elevate and protect the arterial line while minimizing its kinking during wrist flexion.

经dTRA、常规TRA穿刺置管在冠脉和脑血管“一站式”造影检查中的应用对比观察

目的对比观察经远端桡动脉入路(d TRA)、常规桡动脉入路(TRA)穿刺置管在冠脉和脑血管“一站式”造影检查中的应用效果。方法择期行冠脉和脑血管“一站式”造影检查的受检者49例,随机分为d TRA 24例、TRA组25例,d TRA受检者采用经d TRA穿刺置管进行冠脉和脑血管“一站式”造影检查,TRA组采用经TRA穿刺置管进行冠脉和脑血管“一站式”造影检查。观察并比较两组受检者穿刺置管成功率、穿刺置管时间、手术时间、X射线曝光时间、术中累计放射总量、造影剂用量、压迫止血时间、术后食指血氧饱和度、术后住院时间、术后第1天VAS评分、术后第3天VAS评分、住院患者满意度等手术相关资料,以及术后出现迷走神经反射、穿刺点出血、右手及前臂张力性血肿、桡神经损伤、桡动脉闭塞、桡动脉痉挛、皮肤溃烂等并发症发生情况。结果d TRA组受检者穿刺置管时间、住院患者满意度均高于TRA组,术后第1天VAS评分、术后第3天VAS评分、压迫止血时间均低于TRA组(P均<0.05)。两组受检者均未出现迷走神经反射、穿刺点出血、右手及前臂张力性血肿、桡神经损伤、桡动脉闭塞、桡动脉痉挛、皮肤溃烂等相关并发症。结论与经TRA穿刺置管进行冠脉和脑血管“一站式”造影检查相比,经d TRA穿刺置管进行冠脉和脑血管“一站式”造影检查术后疼痛减轻、压迫止血时间缩短,患者满意度更高,可作为冠脉和脑血管“一站式”造影检查的常规入路之一。

全程优化护理在超声引导下桡动脉穿刺置管术中的应用

目的针对开展超声引导下桡动脉穿刺置管术的ICU危重症患者,施行优化护理措施,评价其护理效果。方法方便选取2021年1月—2023年1月厦门市苏颂医院重症加强护理病房(Intensive Care Unit,ICU)危重症患者80例为研究对象。以盲选法为分组依据,对照组40例、观察组40例。所有患者均开展超声引导下桡动脉穿刺置管术,对照组接受常规护理措施,观察组接受优化护理措施。统计两组的穿刺成功次数情况、术后并发症发生情况、护理满意度情况、穿刺效果相关指标。结果观察组穿刺一次成功率为87.50%,高于对照组的50.00%,穿刺两次及以上成功率为12.50%,低于对照组的47.50%,差异有统计学意义(χ^(2)=13.091、11.667,P均<0.05)。与对照组相比,观察组穿刺时间更短,穿刺次数更少,护理后的生活质量评分、疾病知识掌握程度评分更高,差异有统计学意义(P均<0.05)。结论针对开展超声引导下桡动脉穿刺置管术的ICU危重症患者,施行优化护理措施,能够提升穿刺一次成功率,降低并发症发生率,提高知识掌握率,提高生活质量。

儿童连续性动脉血压监测中桡动脉置管相关因素研究进展

儿童桡动脉置管连续性动脉血压监测是儿童围手术期和危重症监护中不可或缺的一项监护技术,影响其置管成功的因素一直是临床上研究的重点。本研究从操作者因素、患者因素、操作设备与材料等方面出发,对影响儿童桡动脉置管成功的相关因素的研究进展进行综述。

超声引导下动态针尖定位法在桡动脉穿刺置管中的应用

目的探讨超声引导下动态针尖定位法(DNTP)在桡动脉穿刺置管中的应用。方法选取2022年3月至2023年10月在黔南布依族苖族自治州人民医院麻醉科行择期手术需行桡动脉穿刺的80例患者作为研究对象,采用随机数字表法将符合标准的患者分为超声引导直入法(UGDN)组(n=40)和DNTP组(n=40)。比较两组的桡动脉穿刺置管的无血肿首次置管成功例数、首次穿刺成功例数、穿刺次数、穿刺时间、动脉后壁损伤例数和血肿发生例数。结果DNTP组无血肿首次置管成功率高于UGDE组,差异有统计学意义(P<0.05);DNTP组穿刺次数少于UGDE组,差异有统计学意义(P<0.05);DNTP组穿刺时间长于UGDE组,差异有统计学意义(P<0.05);DNTP组动脉后壁损伤例数、血肿发生率低于UGDE组,差异有统计学意义(P<0.05);两组的首次穿刺成功率比较,差异无统计学意义(P>0.05)。结论超声引导下DNTP应用于桡动脉穿刺置管中,虽然延长了穿刺时间,但是提高了置管成功率,减少了穿刺次数,降低了穿刺并发症发生率,是一种安全有效的方法。

Randomized study comparing incidence of radial artery occlusion post-percutaneous coronary intervention between two conventional compression devices using a novel airinflation technique

AIM To compare post-percutaneous coronary intervention(PCI) radial artery occlusion(RAO) incidence between two conventional radial artery compression devices using a novel air-inflation technique.METHODS One hundred consecutive patients post-PCI were randomized 1:1 to Safeguard or TR band compression devices. Post-radial sheath removal, each compression device was inflated with additional 2 m L of air above index bleeding point during air-filled device application and gradually down-titrated accordingly. RAO was defined as absence of Doppler flow signal performed at 24 h and at 6 wk post-PCI. Patients with missing data were excluded. Statistical significance was defined as P < 0.05.RESULTS All patients had 6 F radial sheath inserted. No significant differences were observed between Safeguard Radial(n = 42) vs TR band(n = 42) in terms of age(63 ± 11 years vs 67 ± 11 years), clinical presentation(electives, n = 18 vs n = 16; acute coronary syndrome, n = 24 vs n = 26) and total procedural heparin(7778 ± 2704 IU vs 7825 ± 2450 IU). RAO incidence was not significantly different between groups at 24 h(2% vs 0%, P = 0.32) and 6 wk(0%, both).CONCLUSION Safeguard Radial and TR band did not demonstrate significant between-group differences in short-term RAO incidence. Lack of evidence of RAO in all postPCI patients at 6 wk follow-up, regardless of radial compression device indicate advantage of using the novel and pragmatic air-inflation technique. Further work is required to more accurately confirm these findings.

Left Radial Approach versus Right Radial Approach of Coronary Angiography in the Diagnosis of Coronary Heart Disease

Background: Transradial coronary angiography has established itself as safe alternative to transfemoral approach. Today, the artery of approach lies completely on the operator’s choice. The Right Radial Approach (RRA) has been a favorite for most of the interventional cardiologists due to the convenience in operating from the right side. The Left Radial Approach (LRA) has always been a neglected route. LRA does have many advantages over the right, the vascular anatomy being one of them. The aim of our study was to compare the right radial approach of diagnostic coronary angiography with left radial approach. Method: A total of 70 cases of Coronary Angiography (CAG) with normal Allen test and satisfying the inclusion criteria were prospectively observed and studied after randomly assigning them into two equal groups, LRA (Left Radial Approach) n = 35 and RRA (Right Radial Approach) n = 35. Multipurpose TIG (Tiger) catheter was used in both the approaches to catheterize the right as well as left coronary artery. Results: The access time, catheter manipulation time, procedure time, amount of contrast used, hospital stay, intensity of pain experienced, cost of the procedure and quality of coronary angiogram observed were statistically insignificant while the fluoroscopy time was slightly statistically significant which was independent to catheter manipulation time. Conclusions: The neglected Left Radial Approach to coronary angiography is as efficacious, safe and cost effective with reduction in arterial spasm complications when compared to the Right Radial Approach performed by multipurpose Tiger catheter.

Transradial Approach versus Anatomical Snuff Box Distal Radial Access for Coronary Procedures

Background: Radial artery catheterization is a fundamental approach that is used as a procedural access in the different catheterization laboratories so our study is a comparison between distal radial artery approach and convential traditional transradial approach to explore the fesibility and safety of coronary angiography and percutanous coronary. Aim of the Work: The purpose of our study is a comparison between the conventional transradial approach versus distal transradial approach for diagnostic and interventional coronary procedures. Materials and Methods: This is a prospective study that included 60 patients who presented to the Cardiology departments in Ahmed Maher Teaching Hospital from December 2018 until October 2019 to perform planned Transradial Coronary Angiography and/or coronary intervention. The study is divided into two groups, group (A) included 30 patients who undergone the procedure through the distal radial approach (The Anatomical Snuffbox)and group (B) included 30 patients who undergone the procedure through the traditional Transradial approach. Results: Thrombosis and hospital stay are higher significant in radial group than distal radial group and patient satisfaction is higher significant in distal radial group than traditional Transradial while there is no significant difference between both groups as regard Success and failure rate of cannulation, bleeding, infection and duration of the procedure. Conclusion: coronary procedures by distal radial approach have minor access complication versus the conventional Transradial approach.

动态针尖定位法在住培学员桡动脉穿刺置管培训中的应用

评价动态针尖定位法(DNTP)在住院医师规范化培训(全文简称住培)学员桡动脉穿刺置管培训中的应用效果。选择在黔南布依族苗族自治州人民医院麻醉科专业基地培训的22名住培学员为研究对象,根据桡动脉穿刺方法将其分为超声引导下动态针尖定位法组(DNTP组,n=11)和触摸法组(C组,n=11)。选择220例择期手术需行桡动脉穿刺置管的患者并将其随机分入C组和DNTP组,C组采用传统触摸定位法进行穿刺置管,DNTP组采用超声引导下动态针尖定位法穿刺置管。记录两组首次穿刺成功率、首次置管成功率、穿刺次数、穿刺时间、桡动脉后壁穿透率和穿刺部位血肿发生率。研究发现,在桡动脉穿刺置管的培训中采用动态针尖定位法,能提高住培学员首次穿刺成功率和首次置管成功率,能减少穿刺次数,缩短穿刺时间。

混合模拟训练在住院医师超声引导桡动脉穿刺培训中的应用

目的融合目前已经成熟的新信息技术,建立混合模拟培训超声引导桡动脉穿刺培训方法。即将标准化病人、自制血管模型、超声实时引导方法用于桡动脉穿刺培训中,有效提高桡动脉穿刺置管的成功率,提高临床麻醉与培训质量。方法选择在同济医院麻醉科住院医师70人,随机分为两组,每组35人。观察组采取混合模拟培训法,将标准化病人、自制血管模型和超声引导穿刺三种方式相结合进行培训;对照组采取理论培训后由指导医师指导住院医师在自制血管模型进行超声引导穿刺和培训。分别记录两组培训前后住院医师穿刺成功的时间,并在培训活动结束后做无记名满意度调查。结果采取混合模拟培训明显降低了血管穿刺用时间[(93.63±17.44)s比(181.23±25.51)s],穿刺成功率明显提高(88.57%比62.86%)。观察组培训效果和满意度明显优于对照组(P<0.01)。结论采取混合模拟培训可以明显提高对住院医师超声引导桡动脉穿刺培训效果,住院医师满意度高。

经桡动脉同时行冠状动脉和肾动脉造影的可行性探讨

近年来经桡动脉途径行冠状动脉造影和介入治疗普遍开展,尤其经右桡动脉途径,操作方便,易为患者接受,最为常用。但临床常用的TIG共用导管及Judkins造影导管,常因导管长度不够而不适宜经桡动脉途径行肾动脉造影。

压脉带阻断桡骨茎突远端对桡动脉穿刺置管成功率的影响

目的探讨使用压脉带阻断桡骨茎突远端后对桡动脉穿刺置管成功率的影响。方法选择择期全麻手术拟行桡动脉穿刺的患者140例,ASAⅠ-Ⅲ级,男78例,女62例,年龄22-88岁,采用随机数字法均分为两组,触摸组（A组）采用触摸脉搏搏动盲穿法穿刺置管,压脉带组（B组）使用压脉带在桡骨茎突远端环绕手腕进行阻断后用触摸脉搏搏动盲穿法穿刺置管。记录B组患者完成穿刺后松开压脉带1min（T1）、再使用压脉带阻断后1min（T2）、2 min（T3）、5 min（T4）及彻底松开压脉带后1min（T5）、5min（T6）和10min（T7）的ISBP、IDBP和HR;记录T1-T4时的桡动脉内径。记录首次穿刺成功率、总体成功率、穿刺次数、穿刺时间及并发症的发生情况。结果 B组患者阻断前后桡动脉内径的差异无统计学意义。T2T4时B组ISBP明显高于T1时（P〈0.05）。B组患者首次穿刺成功率和总体成功率明显高于A组,B组穿刺次数明显少于,穿刺时间明显短于A组（P〈0.05）。结论使用压脉带阻断桡骨茎突远端可使桡动脉穿刺置管术的成功率显著增高,且具有穿刺次数少和穿刺时间短等特点。

冠脉导丝联合球囊在处理冠脉介入桡动脉痉挛时的应用价值

目的探讨应用冠脉导丝联合球囊在处理冠脉介入桡动脉痉挛时的有效性及安全性。方法将经桡动脉入径行冠脉造影或冠脉介入治疗术发生桡动脉痉挛的患者,按照随机数字表法于两种不同处理策略中随机采用一种处理策略,共计60例。导丝联合球囊组(WAB组,n=28)采用冠脉导丝联合球囊的方法处理桡动脉痉挛,完成经桡动脉入径的冠脉造影或冠脉介入治疗;药物组(Drug组,n=32)采用沿鞘管侧或造影导管、指引导管中注入硝酸甘油200μg,等待5 min后再次行桡动脉入径行冠脉造影或冠脉介入治疗,观察两组经桡动脉入径行冠脉造影或冠脉介入治疗的成功率及并发症。结果 (1)WAB组重度痉挛占71.4%,弥散痉挛占42.9%;Drug组重度痉挛占68.8%,弥散痉挛占40.6%;两组痉挛严重及弥散程度比较,差异无统计学意义(P>0.05)。(2)WAB组在冠脉导丝联合球囊指引下操作5F造影导管或6F指引导管通过痉挛部位,完成冠脉造影或冠脉介入治疗的成功率达92.9%,Drug组完成冠脉造影或冠脉介入治疗成功率为68.5%,两组比较差异有统计学意义(P<0.05)。(3)WAB组出现血管并发症2例(7.1%);Drug组出现血管并发症3例(9.4%),两组比较差异无统计学意义(P>0.05)。结论冠脉造影或冠脉介入治疗发生桡动脉痉挛时,可尝试冠脉导丝联合球囊的方法辅助导管通过痉挛部位,以完成冠脉造影或冠脉介入治疗。该方法安全可行,尤其适合无其它血管路径可替代的患者。

新生儿有创血压监测使用胫后动脉置管的可行性

目的探讨危重新生儿有创血压监测使用胫后动脉置管的可行性及效果。方法将收治NICU行动态血压监测的62例新生儿随机分为两组。观察组32例采用胫后动脉置管,对照组30例采用桡动脉置管,比较两组置管一次性穿刺成功率、留置时间及并发症发生率。结果两组置管留置时间、穿刺点渗血发生率比较,差异有统计学意义(P<0.05,P<0.01),两组一次性穿刺成功率及血肿、堵管、栓塞发生率比较,差异无统计学意义(均P>0.05)。结论采用胫后动脉置管对新生儿进行持续有创血压监测,可延长置管留置时间,降低穿刺点渗血发生率,为动脉置管提供了新的途径。

超声引导全程可视化桡动脉穿刺置管方法在肥胖病人麻醉中的应用

目的:评价超声引导全程可视化桡动脉穿刺置管方法在肥胖病人麻醉中的临床应用效果。方法:选择体质量指数≥28 kg/m^(2)拟行手术,需要动脉穿刺置管病人100例,随机分为超声引导长轴平面内组(L组)和超声引导短轴平面外组(S组);比较穿刺一次成功率、穿刺时间、穿刺次数、穿刺并发症等。结果:L组穿刺一次成功率高于S组(P<0.05);S组4例出现穿刺部位血肿,均更换对侧桡动脉穿刺成功,L组未发生穿刺部位血肿,2组差异有统计学意义(P<0.05);2组病人穿刺时间、穿刺次数、穿刺针使用数量差异均无统计学意义(P>0.05)。结论:超声引导长轴全程可视化桡动脉穿刺置管操作成功率高于超声引导短轴平面外技术。

老年冠心病经桡动脉和经股动脉介入治疗Meta分析

目的全面客观评价老年人冠心病经桡动脉和经股动脉介入治疗的安全性和有效性,为临床指导实践提供可靠证据。方法计算机检索Pubmed、EMbase、Cochrane图书馆、维普、万方和中国期刊全文数据库自建库至2012年中关于老年冠心病患者经桡动脉和经股动脉途径介入治疗的随机对照试验(RCT),利用RevMan 5.0软件对符合纳入标准的RCT文献进行Meta分析。结果本研究纳入7篇RCT文献共1930例。Meta分析结果显示,7篇文献结果表明经桡动脉途径手术成功率显著低于股动脉途径(P<0.001);5篇文献结果显示桡动脉途径血管并发症发生率显著低于股动脉途径(P<0.001);4篇文献结果表明两种手术途径手术时间及X线曝光时间比较差异无统计学意义(P>0.05);3篇文献表明桡动脉途径住院时间显著缩短(P<0.001)。结论严格把握适应证的前提下,提高术者的手术技能及操作熟练度,老年冠心病患者经桡动脉途径介入治疗是安全可行的。

5F指引导管在冠心病经桡动脉介入治疗中的应用

目的:评价冠心病患者经桡动脉介入治疗中使用5F指引导管的可行性和安全性。方法:102例经桡动脉介入治疗的冠心病患者,按指引导管大小随机分为A组(6F指引导管,n=54)和B组(5F指引导管,n=48),比较两组的手术成功率、穿刺部位相关并发症及住院期间心血管不良事件发生率。结果:A组的穿刺部位并发症高于B组(P<0.01),手术成功率及住院期间不良事件发生率两组无明显差别(P>0.05)。结论:5F指引导管在冠心病经桡动脉介入治疗中减少穿刺部位相关并发症,是安全可行的。