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Prospective Comparison of Palpation Versus Ultrasound-Guided Radial Access for Cardiac Catheterization.
MedLine Citation:
PMID:  24088429     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Radial access is increasingly used for both diagnostic and interventional cardiac procedures. Prospective data comparing ultrasound- versus palpation-guided radial catheterization are largely lacking.
METHODS: In this prospective, single-center study, a total of 183 consecutive patients scheduled for transradial cardiac catheterization by an experienced interventionalist were assigned 1:1 to either palpation- or ultrasound-guided radial access. Demographic and procedure parameters were prospectively recorded.
RESULTS: Baseline demographic and clinical parameters did not differ significantly between the ultrasound group (n = 92) and palpation group (n = 91). The initial radial catheterization success rate (87% vs 86.8%; P=.999) and time to access (47 seconds [interquartile range (IQR), 20-90 seconds] versus 31 seconds [IQR, 20-75 seconds]; P=.179) did not differ between the ultrasound and palpation groups, respectively. Pulse quality (absent, weak, strong) was independently associated with access failure in both groups (P<.001). Obesity was associated with access failure in the palpation group (P=.005), but not in the ultrasound group (P=.544). In 3/12 cases (25%) in the ultrasound group and 2/6 cases (33%) in the palpation group, the operator was able to establish radial access using the alternative method (P=.710). If palpation-guided radial access failed, an additional ultrasound-guided attempt before crossover to femoral access was associated with a shorter overall time to access (525 seconds [IQR, 462-567 seconds] versus 744 seconds [IQR, 722-788 seconds]; P=.016).
CONCLUSIONS: Ultrasound-guided radial access seems to provide no substantial additional benefit over palpation-guided access alone. Attempting the alternative guiding methods to establish radial access before crossover to femoral access seems to be a reasonable approach.
Authors:
Lynn Zaremski; Ramon Quesada; Margaret Kovacs; Melanie Schernthaner; Heiko Uthoff
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  25     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  538-542     Citation Subset:  -    
Affiliation:
Department of Angiology, University Hospital Basel Petersgraben 4, 4031 Basel, Switzerland. heiko.uthoff@usb.ch.
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