Читать книгу Interventional Cardiology - Группа авторов - Страница 89

Post‐procedure, hemostasis techniques aim to minimize bleeding and prevent RAO. Mechanical support bands that encircle the wrist aim to compress the radial artery allowing “patent hemostasis” with preservation of antegrade blood flow. Aggressive compression results in no‐flow states and predicts subsequent RAO [48]. We prefer a practical approach to patent hemostasis whereby the operator occludes using air into the compression device, removes air until the puncture begins to bleed before inserting 1–2cc more air into the compression device. Other patent hemostasis techniques that can minimize RAO include use of plethysmography (Barbeau test) or mean arterial pressure (via TR band attached to sphygmomanometer) to achieve hemostasis whilst sustaining antegrade flow [50].

The TR band (Terumo, Tokyo, Japan), PreludeSYNC (Merit, Utah, USA) and the Radistop (RADI, Uppsala, Sweden) are all commonly used compressive devices (Figure 3.5).

Figure 3.5 Distal radial access set up and hemostasis. (a) Hand into Starboard or sitting in anatomical position beside right groin. (b) Sterile aperture drape applied over snuffbox (note hand position with wrist slightly pronated in ulnar deviation to facilitate puncture. (c) Ultrasound guided puncture, note echo bright needle tip (red dotted arrow) entering anterior wall of distal radial artery (yellow dotted arrow). Bright carpal bone immediately under radial artery, (d) Sheath in situ. (e) Hemostasis using air filled compression bandage (Merit PreludeSYNC distal) (f) – TR band (with firm backing plastic removed) with green dot of maximum compression pressure appropriately 1–2 mm proximal to puncture site.