Arterial access פרופ ' אריאל רוגין מנהל היחידה לקרדיולוגיה פולשנית מרכז רפואי רמב " ם, חיפה.

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Presentation transcript:

Arterial access פרופ ' אריאל רוגין מנהל היחידה לקרדיולוגיה פולשנית מרכז רפואי רמב " ם, חיפה

Arterial access

1. Basic principles

2. Selection of puncture site

3. Preparation of puncture materials

4. Patient installation and monitoring

5. Sedation if indicated

6. Palpation of the artery

7. Skin preparation

7. Skin preparation. Radial

Arterial Puncture (1)

Arterial Puncture (2)

Arterial Puncture (3)

Common Errors in Punctures

What if the wire won’t pass?

Advantages

Disadvantages

Major contra-indications

Allen test

Relative contra-indication

Radial puncture

What if the wire won’t pass?

From the radial puncture to the ascending aorta

Radial approach

Radial artery compression

Radial or femoral?

Why radial or femoral?

Vascular complications

The cardiac catheterization handbook. 4 th ed Moron J. Kern Indications for alternative routes to Trans Femoral approach

Anatomy of Radial vs Femoral Artery

Vascular access Site management (2003 estimate use)

Radial approach in western Europe

Description of studies included in the Meta-Analysis

Results - clinical conditions

Safety favors Radial

Entry site complications

TRA-Meta-analysis discussion

Secondary outcomes

Conclusions of this Meta-Analysis

Radial versus Femoral? Conclusions

Complications of femoral puncture

Bleeding

Hematoma

Pseudo-aneurysm

Pseudo-aneurysm - treatment

Distal Embolisation

Site/ Treatment of Embolisation

Preventing Puncture Site Thrombosis

Complications of radial puncture

Summary

Methods of Haemostasis

1. Manual compression

1. Manual compression: femoral artery

1. Manual compression: radial artery Sheath removal

1.Manual compression: radial artery Bandage

1.Manual compression: radial artery Patient care

1. Manual compression: brachial artery

2. Mechanical compression Femostop

2. Manual compression: Compression with C-clamp

3. Percutaneous closure devices

Angioseal

MYNX

Exco-seal

STARCLOSE