Radial Artery Occlusion after Coronary Angiography with Trans Radial Access A nurse led study employing duplex ultrasonography and the reverse Barbeau test

Ulrika Johansson; Kjetil Isaksen; Ingvild Dalen; Alf Inge Larsen

doi:10.1093/eurjcn/zvad090

Radial Artery Occlusion after Coronary Angiography with Trans Radial Access A nurse led study employing duplex ultrasonography and the reverse Barbeau test

Eur J Cardiovasc Nurs. 2023 Aug 31:zvad090. doi: 10.1093/eurjcn/zvad090. Online ahead of print.

Authors

Ulrika Johansson¹, Kjetil Isaksen^{1

2}, Ingvild Dalen³, Alf Inge Larsen^{1

2}

Affiliations

¹ Department of Cardiology, Section of heart intervention, Stavanger University Hospital, Norway.
² Clinical institute 2, University of Bergen, Norway.
³ Department of Research, Section of biostatic, Stavanger University Hospital, Norway.

PMID: 37648677
DOI: 10.1093/eurjcn/zvad090

Abstract

Aims: Trans-radial access (TRA) is the recommended approach for coronary angiography and percutaneous coronary intervention (PCI). Radial artery occlusion (RAO) is the most common complication. We examined the incidence of RAO by means of duplex ultrasonography (DUSG) and the reverse Barbeau test (RBT), after TRA in a clinical setting using conventional compression dressings to achieve haemostasis. All radial artery patency examinations were performed by one dedicated nurse after a brief training course, we assessed the feasibility and quality of this routine in regular clinical practice.

Methods and results: In total 97 patients undergoing first time coronary angiograph and in some cases PCI via TRA completed the study. Conventional pressure dressing as means of haemostasis was used. Radial artery patency was examined by DUSG and by RBT, before and at follow-up one month after the procedure. An inter- and intra-observer validation of the ultrasound measurements was performed prior to inclusion. Two cases of RAO (2.1%) were discovered following TRA. All RAO cases were detected by both DUSG and the RBT. Results from the inter-observer validation showed no statistically significant discrepancy between an experienced physician and a newly trained nurse operator (p = 0.403). An intraclass correlation coefficient (ICC) was calculated at 0.89 indicating excellent reproducibility.

Conclusion: In a high-volume TRA centre, we detected an overall low incidence of RAO using conventional pressure dressing as means of haemostasis. The easy-to-use RBT detected all cases of RAO. Following a short course of training, a nurse from the cardiac catheterisation laboratory was able to perform high quality DUSG examinations of the radial artery to assess patency.

Keywords: Radial artery occlusion; compression methods; coronary artery catheterization; duplex ultrasonography; patent haemostasis; reverse Barbeau test; trans-radial access.