This document discusses hepatocellular carcinoma and its treatment options. It then summarizes a study comparing transradial versus transfemoral access for transarterial chemoembolization. 201 radial cases were performed with few complications. Nurses surveyed preferred radial access as patients had less pain, could ambulate sooner, and required fewer nursing hours. Radial access also resulted in cost savings of $100 per case. The conclusion is that radial access improves patient safety, comfort, and privacy while reducing costs.

1. Margaret Ort, RN, MSN, BSN, CEN
September 28, 2013

2. 
Margaret Ort, RN has no relevant financial
interests to disclose.

3. 
Hepatocellular carcinoma effects
approximately 100,000 persons in the United
States annually. It is the third leading cause of
cancer mortality worldwide
(Alterkruse, McGlynn, B. Reichman, 2009).
Modalities for HCC treatment include partial
hepatic resection, liver
transplantation, systemic
chemotherapy, percutaneous ethanol
injections, radio-frequency ablation and
transarterial chemoembolization.

4. 
Traditionally, transarterial chemoembolization
has been performed exclusively by femoral
access. Transradial access is an innovation in
hepatic intervention. In an ongoing effort to
advance practice while congruously improving
patient outcomes and conserving resources we
explore alternatives to treatment.

6. 


Monitoring the number of post-procedural
complications associated with radial access
Surveying the interventional nurses, who are
direct caregivers pre-, intra-, and postprocedurally as to their observation of patient
responses to radial access versus femoral access
Monitoring the number of nursing hours
required to adequately recover a patient postprocedurally.

8. 
201 radial cases done: 167 male, 34 female –
patients ranging in age from 39 to 89 years

Complications:
4 patients developed radial artery thrombosis
12 patients developed grade 1 hematomas
1 patient developed a pseudoaneurysm
NO patient required surgical intervention
secondary to a complication

9. 



Twelve of sixteen interventional nurses were
surveyed and were asked:
What is your perception of the patient’s
experience with radial access?
Does radial access require greater procedural
preparation?
Do patients require increased sedation during
radial procedures?

10. 


100% of the nurses agreed that patients
experiences both intra- and post- procedurally
were improved.
Patients had significantly less pain at the
insertion site as compared to femoral access, as
less discomfort post-procedurally due to the
ability to position more freely and ambulate
markedly sooner.
Additionally, the unit was able to conserve
from 1 to 3 nursing hours per patient in the
recovery period.

11. 

Pre-procedural set up required no additional
resources.
Patients required no more sedation as
compared to femoral access.

12. 
Femoral
5 fr sheath - $11
19G needle - $3
5 fr SOS 80cm - $15
Mynx closure - $200

We realize a cost saving of $100/case




Radial
5 fr glide sheath - $37
micropuncture - $6
5 fr glide Cobra - $49
TR band - $43

13. 
Patient safety and comfort are always
paramount, hence the most significant reason
for transradial access. Radial access
significantly reduces the odds of major
bleeding as compared to femoral access.
Patients are able to sit up and ambulate post
procedurally improving overall comfort and
decreasing possibilities of back pain and
urinary complaints.

14. 

Patient privacy is significantly improved as
neurovascular checks are less invasive.
Stasis is generally safely achieved more
expeditiously hence there is a cost saving in
nursing recovery hours.

16. 

The Attending Physician Body of the
Department of Interventional Radiology at
Mount Sinai Medical Center : Dr. Robert
Lookstein, Dr Aaron Fischman, Dr. Scott
Nowakowski, Dr. Edward Kim and Dr. Rahul
Patel
Ms Nancy Lamberson, RN, ADN Dept of
Interventional Radiology MSMC