Transradial access by cardiology catheter lab nurses

Abstract

Introduction Nurse led radial arterial access (RAA) is emerging as an attractive alternative to traditional physician-led access.[1] Methods A multidisciplinary program was developed by the nursing and medical teams in a busy tertiary cardiac centre performing over 3000 interventional cardiology procedures of which 90% of cases are done radially. Phase 1 of the training programme consisted of 50 procedures per nurse performed under direct consultant operator supervision. Phase 2 consisted of routine nurse led radial artery cannulation on unselected patients. In addition 2 sub-studies were performed an audit of patient experience comparing the two nurse practitioners with cardiology trainees. An audit of the time to sheath insertion was carried out. Results Technical success was defined as access within two puncture attempts. In phase 1 of the training two nurses were successful in 84% of cases. In this case cohort there were no identified vascular complications. One patient needed an alternate access route. In Phase 2 311 cases were performed independently on unselected patients. The technical success rate was 86.5% for both nurses in total in this cohort. This included a mixture of both right radial (249 cases) and left radial (25 cases) access. 8 of these were also PPCI cases. No major vascular complications were identified. In cases where no access after two attempts was secured access was gained by a consultant. In 6 cases ultrasound guidance was used by the consultant. A patient discomfort score was recorded immediately via a questionnaire post access procedure. Results were compared with cardiology trainees performing RAA in parallel, demonstrating excellent outcomes. Similarly when comparing difference between patient on table to sheath insertion times between trainees and nurses performing the radial access, nurse radial access had competitive outcomes. Discussion Nurse led RAA procedure is an advanced practice skill which can be adopted by appropriately trained and experienced senior members of the nursing team. The advantages include facilitating flow through the catheter lab, greater advocacy of patients through their clinical pathway and high levels of patient satisfaction. Median Time Funding Acknowledgement Type of funding source: None