Radial artery approach versus femoral artery approach in

Radial artery approach versus femoral artery approach in coronary angiography Analysis of the risks and complications and the effect on patient satisfaction. By: Angie Farris

Literature Search words �radial access �transradial access coronary angiography �femoral cardiac catheterization Search engines �Pub. Med �Health Reference Academic Search results: Variety of articles involving angiography and angioplasty. Studies focusing on specific groups of patients.

Research Articles Hsieh, V. , & Jolly, S. (2013, March). Comparing radial and femoral access for coronary angiography and interventions [Electronic version]. Journal of Comparative Effectiveness Research, 2(2), 151 -158. doi: 10. 2217/cer. 12. 79 Mullin, M. K. (2014, April). Transradial approach versus transfemoral approach for coronary angiography and coronary angioplasty. Critical Care Nursing Quarterly, 37(2), 159 -169. doi: 10. 1097/CNQ 000000014 Schussler, J. M. (2011, July). Effectiveness and safety of transradial artery access for cardiac catheterization [Electronic version]. Baylor University Medical Center, 24(3), 205 -209.

Rationale All three articles address the differences between radial artery and femoral artery approach coronary catheterization. They specifically evaluate the risks and complications of both methods and the effect on patient satisfaction. They also explain the challenges of the transradial artery approach and why in some cases the transfemoral artery approach is preferred as the standard of care.

Design study, methods and findings Study by Hsieh and Jolly Quantitative research Prospective study Analysis of randomized clinical trials Cross-sectional Population studied Randomized group of patient with acute coronary syndrome undergoing cardiac catheterization and/or intervention Variables Gender, age, comorbidities, body habitus, experience of operator, diameter and/or length of catheter, occurrence of artery spasm or occlusion. Findings Transradial approach reduces complications, cost, and length of stay in the hospital.

Design study, methods and findings Study by Mullin Quantitative research Prospective study Meta-analysis of randomized clinical trials Population studied Randomized group of patients undergoing coronary angiography and/or angioplasty. Population consisted of more males than females since more men than woman undergo coronary angiography. Variables Experience of operator, risk of complications, technique differences, comorbidities, gender, age, and body habitus. Findings Transradial angiography results in fewer risks and complications.

Design study, methods and findings Study by Schussler Quantitative Prospective study Analytical Cross-sectional study Population studied Patients undergoing coronary angiography and/or angioplasty who have not had an acute myocardial infarction. Variables Patient body habitus, and length and diameter of catheter. Findings Over 90% success rate with transradial approach. No access site complications.

Approval �Studies 1 & 2 were analyzing previous randomized studies so did not require either IRB approval or informed consent. �Study 3 was analyzing the standard of care used on all of their cardiac catheterization patients. Neither IRB approval or informed consent were required.

Quality and credibility Study 1 �Peer reviewed journal – Journal of Comparative Effectiveness Research �Level of evidence – A. Reviews of randomized clinical trials; RIVAL trial, RIFLE-STEACS study. �Rationale of study – analysis of clinical benefits of transradial approach and challenges. Also how to address these challenges. �Validity of results – Study takes into consideration internal and external factors.

Quality and credibility Study 2 �Peer reviewed journal – Critical Care Nursing Quarterly. �Level of evidence – A. Reviews of previous clinical trials; Examines several trials all focused on safety, efficiency, risks, and complications of radial versus femoral approach. �Rationale of study – to provide evidence of lower risks and complications associated with radial approach coronary angiography versus femoral approach. �Validity of results – Study takes into consideration internal and external factors.

Quality and credibility Study 3 �Peer reviewed journal – Baylor University Medical Center. �Level of evidence – A. Reviews of previous clinical trials as well as specific patients at Baylor University Medical Center. �Rationale of study – to provide information on the transradial approach and the history of the technique. �Validity of results – Study takes into consideration internal and external factors.

Relevancy �Individual – Findings are relevant to individual patients and clinical practitioners. �Policy – Findings have the potential to change current policy. �Standard of care – Possibility to change standard of care. Transradial approach may become the standard for performing cardiac catheterization instead of the transfemoral approach. �Professional – Utilizing the transradial approach may require training of operators, nurses, and other healthcare staff not currently familiar with this technique.

Implications Quality and safety Generalizability Barriers

Additional PICO Questions �In patients undergoing transradial artery approach coronary angiography, does utilizing the left versus the right radial artery result in fewer complications and increased success of procedure? �In patients undergoing transradial artery approach coronary angiography, does the administration of vasodilators alone versus the administration of vasodilators and calcium channel blockers, result in fewer incidence of radial artery spasm and radial artery occlussion?

Conclusion �The results of the articles chosen and the clinical studies which they reviewed, favor the transradial approach to coronary angiography over the transfemoral approach.