Comparison between two protocols for deflation of the TR band following coronary procedures via the radial route

Abstract

Aim Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. Methods All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale. Results A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 ( n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 ( n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 ( p = 0.01). Conclusion A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.

Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

“…The right deflation timing of the hemostatic band is also of great importance, because it may result in repeated bleeding and re-inflation, factors that contribute to the initiation of the coagulation cascade, favoring RAO appearance. The removal of 3-5 mL of air every 15 min after 120 min of the placement of the device is supposed to be an effective method [53,54].…”

Effect of Radial Artery Compression with a Novel Automatic Pressure-Controlled Radial Compression Device: A Short-Term Prospective Interventional Pilot Study

“…In clinical practice, it is always recommended to compress the radial puncture site for at least 4 h after coronary intervention [19,20]. this study, the average compression time in the intervention group was 207 min.…”

Experiences of cardiac care nurses related to the management and delayed removal of trans-radial band of patients at a private tertiary care hospital, Islamabad

“…These findings are similar with previous studies. [15][16][17] Furthermore, the nurses reported the use of Allen's tests and bilateral oxygen saturation (Barbeau's test) to diagnose any problem with peripheral circulation of their patients. These assessment tests are consistently reported in the literature.…”