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Implementation of a diagnostic and interventional transradial programme: resource and organisational implications
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  1. S C Eccleshall,
  2. M Banks,
  3. R Carroll,
  4. R Jaumdally,
  5. D Fraser,
  6. J Nolan
  1. Cardiothoracic Centre, North Staffordshire Hospital NHS Trust, City General Hospital, Stoke on Trent, UK
  1. Correspondence to:
    Dr J Nolan, Cardiothoracic Centre, North Staffordshire Hospital NHS Trust, City General Hospital, Newcastle Road, Stoke on Trent ST4 6QG, UK;
    nolanjim{at}hotmail.com

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There is now convincing evidence that the radial artery is a very safe access site for cardiac procedures.1 Additional benefits include improved patient comfort, reduced procedural costs, and rapid mobilisation.2 Despite these advantages, many cardiologists continue to use the femoral artery for the majority of their procedures. This is because of a commonly held view that transradial procedures are technically challenging (and therefore often fail), time consuming, and involve excessive radiation exposure.

METHODS

A diagnostic and therapeutic transradial programme was instituted at the North Staffordshire Hospital in September 1998. The programme was initiated and supervised by an experienced transradial operator (JN). The workload consists of patients under the direct care of the supervising consultant, along with patients referred for transradial procedures because of arterial access problems. The radial artery was the access site of choice for all procedures performed or supervised by JN (including graft cases, where the left radial artery was employed when access to the left internal mammary artery was required). To minimise the risk of vascular complications in patients who had received thrombolytic treatment, the radial artery was employed for rescue angioplasty procedures. If arterial cannulation could not be supervised, the femoral access site was employed by trainees. All operators were fully trained in transfemoral procedures. The technique employed for transradial procedures has previously been described in detail3 and utilises a specific transradial introducer (Arrow International, UK) and 6 French sheath system (Cook Cardiology, Letchworth, Hertfordshire, UK). Standard Judkins and pigtail catheters …

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