Brief History of Radial Access - Access Study | Comparison of Transradial vs. Transfemoral access for vascular interventional procedures
Brief History of Radial Access - Access Study | Comparison of Transradial vs. Transfemoral access for vascular interventional procedures
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So first starting out,

I think we've had a lot of information the past couple days about where we came from, how this started, a lot of what we wanted in medicine is also through access. But the history of some of the catheterizations, as we go around, this comes from the cardiology world.

Some of the history and research that led our department to decide that they wanted to investigate transradial, one of the first ones was in 1997, and what this study shows, the top one, it shows you that in six French sheaths to 900 patients,

there were zero complications due to radial access for cardiac catheterization. Where with brachial and femoral, there were some complications.

Now we go to our nursing considerations when power-injecting through peripheral IV. First, we have to properly select the peripheral IV site, so Maria mentioned already earlier

regarding the high-risk sites, we avoid the dorsum of the hand, the wrist, for the risk of nerve damage, so we choose first the veins in the antecubital fossa. The catheter gauge, when selecting the catheter gauge, it is dependent on the patient's condition.

Elderly patients who have small veins, of course, we have to put in a smaller gauge. But sometimes, also dependent on the protocol, or the type of study. If it calls for a faster injection rate, of course, you have to put in a larger catheter.

We also ask, or allow input from patients, regarding which site is the best, because from previous experience, especially our cancer patients, they will be able to tell us which one is the best site for IV.

Next nursing consideration is to secure properly the site with transparent dressing to avoid premature catheter removal during injection, as well as to prevent dislodgement of the catheter, or any movement during injection. And we test inject it with normal saline

to verify patency, so note, if the patient complains of pain, if there's any evidence of infiltration or any swelling, you have to take that IV out right away and insert a new line.

This is just a little history of CO2 as a contrast agent.

In 1895 x-rays were discovered. Not that long afterwards room air was used with radiographs to visualize abdominal contents. Again, fairly soon after that, CO2 was introduced as a contrast agent. It was initially introduced to insufflate

the retroperitoneaum and CV structures and evaluate for masses. Room air was eventually abandoned as a contrast media because it became problematic. People were suffering air emboli. But CO2 remained viable.

In the '50s and '60s CO2 was used to visualize the right atrium to diagnose pericardial effusion. During the same period of time, animal studies demonstrated that CO2 was safe for venous injections and was generally well tolerated.

In the late '60s, CO2 was reported safe for injection into the IVC. Fast forward to the '80s and the development of digital subtraction angiography, CO2 becomes useful as a contrast media for vascular procedures.

The next study is a rival study that was a pretty large study,

it was over 70,000 patients. Again, this has to do with the cardiac interventional role. And what this study showed was there was a reduced cardiac mortality due to bleeding complications post intervention. The next one is the matrix trial, the matrix trial

is when they started introducing a lot of the anticoagulants, the Plavix and the other integral ones that we use nowadays. And what this study showed, you can see the numbers would've decreased, what this study showed was the radial

to the femoral complications were decreased and that radial access reduced net adverse effects due to bleeding. Bleeding at the access site, more specifically.

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