• Coronary Clinical Interest Section

    An Easier Way to Obtain Access for Right Heart Catheterization during Transradial Left Heart Catheterization

    We love doing transradial coronary angiography, but it sometimes puts us in a bind if we need to do a concomitant RIGHT heart cath. You either need to get access in the neck, the subclavian, or … the GROIN! It's actually fairly easy to over wire an existing upper-arm IV1, but about half the time the IV blows before they get to the cath lab, or the IV is in a vein which is too small to use.

    Here's an easier way to get right heart access during transradial coronary angiography.

    The upper and lower arm is prepped and draped in sterile fashion, using brachial drapes over the wrist and antecubital fossa. Arterial access is next obtained via the radial artery and the sheath inserted. Swing the table over so that the antecubital fossa is positioned under the image and then inject 5-7 ml of a 50/50 contrast/saline mix into the radial artery under fluoroscopy via the side port of the sheath (the "arterial phase"). After approximately 5-10 seconds, the basilic vein of the upper arm should be visible (the "venous phase").

    This is a good time to numb up an area over the basilic vein.

    Obtain access with the same micropuncture needle used for the radial access, place a 5 Fr radial sheath in the basilic vein, and then perform the right heart catheterization through the sheath.

    Using this technique, we're able to access a sizeable / usable vein 100% of the time, and don't have to worry about whether or not the floor staff have been able to place a "good enough" IV.

    We typically remove the venous sheath in the lab (after removing the radial sheath), and hold pressure for 2-5 minutes.

     


     

    Cath Lab Hack Presented By:

    Chad M. Dugas, MD
    Interventional Fellow, Baylor University Medical Center / Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX
     

    Jeffrey M. Schussler, MD, FSCAI
    Interventional Cardiologist, Baylor University Medical Center / Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX;
    Medical Director of Cardiac Rehabilitation, CVICU Hamilton Heart and Vascular Hospital, Dallas, TX;
    Professor of Medicine, Texas A&M School of Medicine, Bryan, TX
    Twitter: @Updock

    Anthony D. Yoon, MD, FSCAI
    Interventional Cardiologist, Baylor University Medical Center / Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX

     

    SCAI.org Editorial Advisory Board Commentary

    "This is a very helpful trick but be careful about exposing your hands to radiation; that should be avoided. We have also found ultrasound helpful to gain venous access of arm veins that are not apparent superficially."

    Michael Ragosta, MD, FSCAI
    SCAI.org Editor-in-Chief

     


     

    References:

    • Kern MJ. Forearm Vein Access for Radial Procedures: An Easy Method for Right and Left Heart Catheterization. Cath Lab Digest. 2011 December;19(12).