Thumbs UP to Radial Approach Caths

Angela Jones BSN RN January 2015

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Background Evidence and trend for cardiac angiograms is showing

that utilizing the Radial Artery access point for cardiac procedures will decrease: post-op complications mortality rates decreasing the patient’s length of stay

Reported cases of post-op bleeding complications from the femoral access site that have led to poor outcomes

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Purpose

to increase the Radial Artery Access procedures

to decrease post-op complications to improve patient outcomes and satisfaction

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Relevance/Significance

Will decrease post-op complications, mortality rates and patient’s length of stay

Symptomatic complications are seen only 3-6% of the time

Femoral access has a 10% risk of severe postop complications leading to mortality

Radial Artery access demonstrates reduced patient hospital cost and length of stay by 15% (Rao, et al., 2008)

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Radial artery circulation is very sophisticated

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Evidence Ischemic complication related to accessing the

arteries of the wrist are extremely rare, due to the intricate blood distribution of the hand perfusion, and most likely an outcome of the collateral circulation that develop following asymptomatic closure of the artery (De Andrade, Tebet, Andrade, Mattos, & Labrunie, 2008).

Using anticoagulation meds after sheath insertion, using small sheath sizes, and avoiding complete occlusion of the RA post procedure while establishing hemostasis (Abdelaal, Molin, Plourde, MacHaalany, Bataille, Brousseau-Provencher, Montminy, Larose, Roy, Gleeton, Barbeau, Nguyen, Noel, Costerousse, & Bertrand, 2013).

The incident of Radial Artery Occlusion (RAO) is 4.8% to 19%, which typically has no

symptoms, since the hand has a dynamic circulation system, by being able to obtain blood

from both the radial and ulnar arteries (Greenwood, Della-Siega, Fretz, Kinloch, Klinke, Mildenberger, Williams, & Hilton, 2005).

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Strategy and Implementation Initial implementation in Diagnostic Coronary outpatients

Nurses championed education on the “Thumbs Up” procedure for Radial Artery assessment utilizing the Modified Allen’s Test

Nursing education encompassed a knowledge of medications, equipment set up, procedural steps and patient education pieces

In 2013 the CCL department expanded Radial Artery Access to

include the Acute Coronary Catheterization clients

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Evaluation Currently 75% of all coronary procedures utilize Radial

Artery access

Outcomes of Radial Artery access demonstrates: patients ambulate earlier, experience less pain have fewer restrictions during recovery

Length of stay is shortened thereby reducing costs Nurses demonstrate expertise with this new process

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Cath PCI: Risk Adjusted Rate of Bleeding Events

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Proportion of PCI Procedures with Transfusion of Whole Blood or RBCs

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What Percentage of Eligible Patients Go Home Same Day?

14-Aug Sept Oct Nov Dec 15-Jan Feb Mar Apr May Jun July Aug Sept Oct 15-Nov0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

44%

74% 72% 70% 74%

86% 86%

72%

82%

79%

80%

90%

82%

75% 75%

87%% of Same Day Discharged Patients

Goal = 80%

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Implications For PracticeEnsures the best care practices are implemented.Providing: Earlier ambulation Less procedural site pain 1-2% fewer post-op blood transfusions 80% of patients are eligible for Same Day

D/C

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Implications For Practice To enhance quality patient care improve patient outcomes

Management of Radial Compression devices

Monitoring bleeding, hematomas, and pain

Assessing for hand Circulation

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Acknowledgements• CARDIOLOGIST: Dr. J Bradley Oldemeyer• EDUCATORS: Keith Volk BSN RN, &

Kristi Ramsey BSN RN• NURSE MANAGER:

Carol Mackes BSN RN• CLINICAL QUALITY SPECIALIST:

Jerre Johnson BSN RN• All CCL and Pre-Post Clinical Staff

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Questions

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References

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