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PCI & AimRadial 2018 | Right Heart Access by Radial - Ian C Gilchrist
1. Right Heart Access by Radial
Ian C Gilchrist, MD, FACC, FSCAI
Professor of Medicine
Penn State’s Hershey Medical Center
Heart & Vascular Institute
Hershey, PA
Dorsal Radial Artery/Vein Access
icg2017
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Arm Veins: Original Cardiac Access
Forssmann Klinische Wochenschrift 1929;8(45)2085-7.
Werner Forssmann
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Case & Point
Icg/HMC cath lab
Access:
Radial artery
RIJ vein
Complication:
Pneumothorax
There is room for a safer
way to the right heart &
central venous system
This is no longer paid for in the United States
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Venous System Access
Before entering the cath lab
Nurse Heparin LockIV Catheter (20 g)
+ +
Nurse places heparin lock in forearm for use in
the catheterization lab for venous sheath access.
• saves time
• improves cath lab efficiency
• fosters team building
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Heparin Locks, Needles & Wires
Heparin lock on angiocath
Micropuncture needle
Micropuncture needle impaled in Heparin Lock
(remove both in block off field for sterility)
Wire holder
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Try in cath lab ± tourniquet
Inspect arm carefully
Don’t forget the other arm
Floor nurses unable to get access?
°C
Christen, et al. J Cardiovasc Pharmacol. 2004;44:659–664
Trouble Shooting
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No Touch Technology
Use non-invasive (no touch) technology to
localize vein & its path for superficial vessels
Uses absorption of hemoglobin to localize
vessels
AccuVein Device
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V
Photo’s by Mauricio Cohn, MD Miami, Fl
Ultrasound for
deep vessels
Photo’s by Mauricio Cohn, MD Miami, Fl
Photo’s by Mauricio Cohn, MD Miami, Fl
Pressure
Everyone has veins!
Trouble Shooting- No Veins
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Venous System: Typical Patterns
Radial (lateral) veins lead
equally to either Cephalic
or Basilic veins
Ulnar (medial) veins
usually continue as Basilic
vein
Chun et al. Radiology. 2003;226:918-920.
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Upper Venous Junction
Cephalic vein joins the Axillary vein
at a T-Junction.
– Defines start of the subclavian &
central venous system
– Location most likely to cause
technical issues
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Summary
Finish with hemostasis just like removing an IV
Can replace sheath with large IV-cath if needed
It is simple & extends the potential arm access
Learning both arterial & venous
techniques will make you a
better cardiologist
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