Table 2

A list of possible problems and solutions with TRA

Problems related to cannulation
With arterial puncture	Locate course with more fingers
With arterial puncture	Puncture more proximally
With wire advancement	Good back flow—use hydrophilic wire
With wire advancement	Poor back flow—re-puncture
With sheath insertion	Incise skin
With sheath insertion	Use smaller diameter (5F)
Problems in the forearm/elbow	Angiography of the forearm
Problems in the forearm/elbow	Use hydrophilic wire under fluoroscopy
Problems with access to aorta	Deep breathe
	Hydrophilic wire
	Begin with JR, then exchange “over the wire”
Poor catheter support	Deep seating
	Multiple guidewires
	Change to dedicated curve
Radial spasm	Nitroglycerin and verapamil through the sheath
	Nifedipine sublingual
	Smaller catheter
Forearm haematoma	Bandage forearm
Forearm haematoma	Pressure cuff elbow