Proposal for invasive monitoring after radial cardiac catheterization in patients with hemodynamic instability
Section: Artículos Científicos
Authors
Rubio Alcañiz2, Pablo Benítez Martín1, José Miguel Latorre Jiménez1, José Manuel Álvarez Vázquez1, Manuel Benito Mayoral1.
Position
1 Grado en Enfermería. Enfermeras de la Unidad de Hemodinámica del Servicio de Cardiología del Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria. 2 Grado en Enfermería. Supervisor de la Unidad de Hemodinámica del Servicio de Cardiología del Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria.
Contact address
Vicente Rubio Alcañiz. C/ Lomo La Plana, 33 2C. 35019 Las Palmas de Gran Canaria
Contact email: v.rubio@celp.es
Abstract
Introduction. After radial cardiac catheterization, the introducer is withdrawn and hemostasis is performed to avoid vascular complications. In the unstable patient, invasive monitoring may be vital after the procedure. We propose a way to maintain invasive arterial monitoring without losing radial arterial access for invasive monitoring after cardiac catheterization.
Method. Prospective descriptive study. All patients who required a continuous arterial line after cardiac catheterization were consecutively included. At the end of the procedure, the 6 French introducer was exchanged for a 20-gauge catheter with the help of an inflated pneumatic bracelet.
Results. Of the 37 patients included, 50% were in cardiogenic shock and had severe ventricular dysfunction; 70% of patients required norepinephrine perfusion. Pressure morphology was correct and blood draw was normal. Regarding vascular complications, bleeding occurred in 3%, and 5% of patients had mild hematoma.
Discussion. Although radial artery catheterization is not risk-free, exchanging a 6 french introducer for a 20-gauge cannula with the help of a pneumatic bracelet allows safe monitoring and access to blood samples, without increasing vascular complications. Therefore, it allows an improvement in the management of seriously ill patients following cardiac catheterization.
Keywords:
cardiac catheterization; radial artery; hemodynamic monitoring; hemostasis; vascular closure devices; nursing care
Versión en Español
Título:
Artículo completo no disponible en este idioma / Full article is not available in this language
Bibliography
1. Weiner R, Ryan E, Yohannes-Tomicich J. Arterial Line Monitoring and Placement. In: Oropello JM, Pastores SM, Kvetan V. Critical Care. McGraw Hill; 2021. Disponible en:
https://accessanesthesiology.mhmedical.com/content.aspx?bookid=1944§ionid=143522170
2. Chaparro-Mendoza K. Cateterismo de la arteria radial para monitorización invasiva: evitar las complicaciones, un reto en anestesia. Rev Colomb Anestesiol 2012;4:262-5.
3. Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial. Lancet 2011; 377:1409–20.
4. Ibáñez B, James J, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. Guía ESC 2017 sobre el tratamiento del infarto agudo de miocardio en pacientes con elevación del segmento ST. Rev Esp Cardiol. 2017;70(12):1082-1143.
5. Mason PJ, Shah B, Tamis-holland JE, Bittl JA, Cohen MG, Safirstein J et al. An update on radial artery access and intervention in acute coronary syndrome. A scientific statement from the American Heart Association. Circ Cardiovasc Interv 2018,11(9):e000035.
6. Bertrand OF. Acute forearm muscle swelling post transradial catheterization and compartment syndrome: prevention is better than treatement. Catheter Cardiovasc Interv. 2010;75(3):366-8.
7. Barbeau GR, Arsenault F, Dugas L, et al. Evaluation of the ulnopalmar arterial arches with pulse oxymetry and plethysmography: Comparison with the Allen’s test in 1010 patients. Am Heart J. 2004; 147:489–93.
8. Bertrand OF, de Palma R, Meerkin D. Vascular Acces Vol. 1. Percutaneous Interventional Cardiovascular Medicine (2014) (pp.1-16)
http://www.pcronline.com/eurointervention/textbook/pcr-textbook/chapter/3-24.php
9. Cohen MG, Rao SV. Radial Artery Approach. En: Grossman and Baimn‘s. Cardiac Catheterization, Angiography, and Intervention. 8th ed. Philadelphia. Lippincott, Williams and Wilkins;2014. p.170-190.
10. Rubio Martin M, Benítez Martin P, Rubio Alcañiz V. Manejo de la hemostasia radial tras cateterismo cardiaco. Revisión bibliográfica. Enferm Cardiol. 2020; 27(81): 38-46.
