Arm Veins: Original Cardiac AccessWerner Forssmann Forssmann Klinische Wochenschrift 1929;8(45)2085-7.
Provide a Safe Approach to the Central Venous SystemAccess:Radial artery RIJ vein There is room for a safer way to the right heart & central venous systemComplication: Pneumothorax Icg/HMC cath lab
A New Playground beyond the arterial tree Right Heart Catheterization Transvenous Pacemakers Right Ventricular Biopsy Venous FiltersPotentially any technology with the right length
Venous System: Typical Patterns Radial (lateral)veins lead equally to either Cephalic or Basilic veins Ulnar (medial) veins usually continue as Basilic vein Chun et al. Radiology. 2003;226:918-920.
Upper Venous Junction Cephalic vein joins the Axillary vein at a T-Junction. – Defines start of the subclavian & central venous system – Location most likely to cause technical issues
Venous System Access Before entering the cath lab + + Nurse IV Catheter (20 g) Heparin Lock Nurse places heparin lock in forearm for use inthe catheterization lab for venous sheath access. • saves time • improves cath lab efficiency • fosters team building
Nurses unable to get access?Try in cath lab ± tourniquet °C Inspect arm carefully Ultrasound? Levophase angiogram?Don’t forget the other arm
Heparin Locks, Needles & WiresMicropuncture needle impaled in Heparin Lock (remove both in block off field for sterility) Wire holder Micropuncture needle Heparin lock on angiocath
5F Right Heart Catheters (4 F also available) Edwards Lifescience TS105F5 Arrow Balloon Wedge AI-07124 105 cm 110 cmExamples from Penn State Hershey Medical Center Really need 125-cm , but industry not interested
Left/Right Heart Procedures Femoral vs Radial 250 Procedural Time Arterial Time 75±5.4 70±5.0 45±6.3 35±4.2 200 Time 150(minutes) Less radiation time p<.001 100 50 0 Femoral Radial Femoral Radial (n=175) (n=105) (n=175) (n=105) Gilchrist IC. Cathet Cardiovasc Intervent 2006;67:585-588.
Contraindications/Cautions Obstruction to drainage Radial breast surgery Trauma SVC disease Prior brachial cutdown EP devicesRef (July 2006): http://assets.families. com/Encyclopedias/gea2_02_img0132.jpg No visible veins
SummaryFinish with hemostasis just like removing an IVIts simple & extends the potential of transradial Learning both arterial and venous techniques will make you a better cardiologist