Radial vs. femoral ambulation times to discharge

1. Radial vs. Femoral
Ambulation times to
Discharge
Bernadette Speiser MSN CCRN
Palo Alto Veteran’s Administration

3. Access Sites for RHC

4. Study:
 Literature was extremely limited
 RHC patients in a Veteran’s Hospital
 Reviewed 397 consecutive charts
 367 patients included in the study
 Discounted patients intubated, PA catheters
left in place, bedrest required

5. Patient Characteristics
Hospital status
Arm (basilic and
cephalic) Access Femoral Access Total
In-patient 73 (46.7%) 83 (53.3%) 156 (42.5%)
Out-patient 97 (45.9%) 114 (54.1%) 211 (57.5%)
Gender
Male 172 (48.1%) 186 (51.9%) 358 (97.5%)
Female 3 (33.3%) 6 (66.7%) 9 (2.5%)
Co-Mobidities
Diabetic 66 (26.4%) 184 (73.6%) 250 (68.1%)
Hypertension 147 (42.7%) 197 (57.3%) 344 (93.7%)
Hyperlipidemia 113 (39.0%) 177 (61.0%) 290 (79.0%)
Chronic renal insufficiency
(creatinine >1.4) 60 (37.5%) 100 (62.5%) 160 (43.1%)
Known CAD 55 (41.4%) 78 (58.6%) 133 (36.2%)
Tobacco use 129 (41.5%) 182 (58.5) 311 (81.2%)

6. Procedures Performed
Arm (basilic and
cephalic) Access Femoral Access Total
RHC 47 (61.8%) 29 (38.2%) 76 (20.7%)
RHC + LV Angiography 5 (41.7%) 7 (58.3%) 12 (3.3%)
RHC + Aortogram 0 (0.0%) 3 (100.0%) 3 (0.82%)
RLHC + Aortogram 1 (50.0%) 1 (50.0%) 2 (0.54%)
RLHC 97 (42.9%) 129 (57.1%) 226 (61.6%)
RLHC + grafts 12 (37.5%) 20 (62.5%) 32 (9.5%)
RLHC + grafts + FFR 1 (100.0%) 0 (0.0%) 1 (0.27%)
RLHC + FFR 8 (72.7%) 3 (27.3%) 11 (2.9%)
RLHC + FFR + PCI 1 (100.0%) 0 (0.0%) 1 (0.27%)
RLHC + PCI 1 (100.0%) 0 (0.0%) 1 (0.27%)
RLHC + grafts+ FFR 1 (100.0%) 0 (0.0% 1 (0.27%)
RLHC + InfraRedX 1 (100.0%) 0 (0.0%) 1 (0.27%)

7. Sheath Size
Sheath Size (venous)
Arm (basilic
and cephalic)
Access
Femoral
Access Total
4F 47 (62.7%) 28 (37.3%) 75 (20.4%)
5F 102 (77.9%) 29 (22.1%) 131 (35.6%)
6F 11 (47.8%) 12 (52.2%) 23 (6.2%)
7F 15 (11.3%) 118 (88.7%) 133 (36.2%)
8F 0 (0.0%) 5 (100.0%) 5 (2.1%)

8. Access Sites
Access site
Femoral Vein 192 52.3%
Cephalic Vein 22 6.0%
Brachial Vein 153 41.7%

9. Anticoagulation Dosage
Heparin Units IV Femoral Access
Arm (brachial and
cephalic) Access Total
No Heparin 124 (65.6%) 65 (34.4%) 189 (51.5%)
1200 Units 0 (0.0%) 1 (100%) 1 (0.3%)
1500 Units 6 (66.7%) 3 (33.3%) 9 (2.5%)
2000 Units 28 (51.9%) 26 (48.1%) 54 (14.7%)
2500 Units 3 (50.0%) 3 (50.0%) 6 (1.6%)
3000 Units 15 (33.3%) 30 (66.7%) 45 (12.3%)
4000 Units 3 (42.9%) 4 (57.1%) 7 (1.9%)
4500 Units 0 (0.0%) 1(100.0%) 1 (0.3%)
5000 Units 10 (20.0%) 40 (80.0%) 50 (13.6%)
6000 Units 0 (0.0%) 1 (100.0%) 1 (0.3%)
7000 Units 0 (0.0%) 1 (100.0%) 1 (0.3%)
8000 Units 1 (100.0%) 0 (0.0%) 1 (0.3%)
9000 Units 1 (100.0%) 0 (0.0%) 1 (0.3%)

10. Multivariate
Correlations
Variable
Age 0.1626
Gender 0.9555
Diabetes Mellitus 0.5496
Chronic Renal Insufficiency 0.2906
Hypertension 0.7330
Dyslipidemia 0.0089
CAD 0.1211
Tobacco Use 0.2372
Inpatient Status 0.0078
RHC Only 0.3064
RHC and LHC 0.0461
RHC and LHC and PCI 0.0263
Upper arm access (vs. femoral or combined upper arm/femoral) <0.0001
Heparin Dose 0.0318
Pulmonary Artery Catheter Size (> 5 French) 0.5863
Fluoroscopy time 0.0660
Radiation dose (Gy cm2) 0.4552

11. Discharge Impact in Minutes
Procedures Arm Access Femoral
Access
Patient time saved
in-hospital care
RHC only with manual
compression
140 minutes 181 minute 41 minutes/case
RHC + LHC with radial
hemostasis band
146 minutes 174 minutes 28 minutes/case
RHC + LHC with femoral
closure device
106 minutes 174 minutes 68 minutes/case
RHC + LHC manual
closure
205 minutes 327 minutes 122 minutes/case

13. THANK YOU