Radial catheterization procedure

Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Choosing the Left or Right Side for the Radial Approach
Radial artery in right upper extremity is usually used for catheterization due to operator convenience with typical catheterization table set-up. And also surgeons who use radial artery conduits for CABG usually use artery from non-dominant extremity. If the internal mammary artery must be canulated, then the left radial artery should be used.

Catheter selection
Many operators choose to start with the right coronary artery as the right sided catheter may allow for directing the wire as you make your way up around the arch. Once the wire is around the arch, it should remain there for exchanges. A JL 3.5 catheter may be used to engage the left coronary artery when catheterization is performed from the right arm.

Procedure

 * 1) The wrist should be shaved (if necessary) and cleansed in the usual sterile fashion. In addition, the groin should be prepped in case of access failure or the need for urgent IABP or a temporary venous pacemaker
 * 2) Intravenous (IV) line should be started on the contralateral extremity. If an IV should be placed in the intervention extremity, it must be placed  proximal to wrist preferably at the level of elbow.
 * 3) Arm is abducted and the wrist hyperextended
 * 4) Local skin anesthesia is then administered
 * 5) Proximal to styloid process of the radius, a small incision is made over the skin
 * 6) Subcutaneous tissue is then tunneled using forceps
 * 7) At 45° angle, an 18-21 guage needle should be introduced and an exchange length 0.035-0.038 inch J-tip guidewire is inserted
 * 8) Radial sheath of 23cm long and 4-6Fr size should then be introduced
 * 9) Using a rotating arm board under the shoulder facilitates ease of movement and placement of radial sheath
 * 10) Through sidearm of the sheath, 5000U of heparin should be administered
 * 11) To reduce spasm, 500 micrograms of diltiazem can also be administered via the sidearm
 * 12) Coronary catheters are then advanced along the guidewire into aorta
 * 13) Left and right coronary arteries are then catheterized using Judkins, Amplatz or multipurpose catheter
 * 14) Hemostasis is achieved by direct pressure at the puncture site at the end of the procedure after removal of radial sheath
 * 15) Radial pulse should be monitored after the procedure for several hours regularly.

Radial sheath kits are now available which contain hydrophilic coated sheaths in sizes 4-6Fr equipped with graduated introducers, various micropuncture needles and guidewire. Below is a video demonstrating radial artery approach in cardiac catheterization followed by application of TR band 