Ort M - AIMRADIAL 2013 - Nursing perspective


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Radial access: not just for cardiology anymore. A nursing perspective

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Ort M - AIMRADIAL 2013 - Nursing perspective

  1. 1. Margaret Ort, RN, MSN, BSN, CEN September 28, 2013
  2. 2.  Margaret Ort, RN has no relevant financial interests to disclose.
  3. 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. 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.
  5. 5.    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.
  6. 6.  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
  7. 7.     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?
  8. 8.    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.
  9. 9.   Pre-procedural set up required no additional resources. Patients required no more sedation as compared to femoral access.
  10. 10.  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
  11. 11.  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.
  12. 12.   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.
  13. 13.   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