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Original Article   

Minerva Cardiology and Angiology 2022 Mar 25

DOI: 10.23736/S2724-5683.22.05843-4

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Nurse-led distal radial access: efficacy, learning curve, and perspectives of an increasingly popular access

Alberto CEREDA 1 , Luca ALLIEVI 2, Lorenzo BUSETTI 3, Rita KOLECI 3, Vincenzo DE NORA 3, Augustin VECCHIA 3, Marco TOSELLI 4, Francesco GIANNINI 4, Gabriele TUMMINELLO 5, Giuseppe SANGIORGI 3, 6

1 Interventional Cath Lab, Cardiovascular Department, San Carlo Hospital, Milan, Italy; 2 Department of clinical sciences and community health, University of Milan, Milan, Italy; 3 Interventional Cath Lab, Cardiovascular Department, San Gaudenzio Clinic, Novara, Italy; 4 Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy; 5 Division of Cardiology, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; 6 Department of Systemic Medicine, Institute of Cardiology, University of Tor Vergata, Rome, Italy


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BACKGROUND: The distal radial represents an evolution of the standard radial approach. Distal radial arterial access (DRA) in the so-called "anatomical snuffbox" is technically more difficult but offers potential advantages for patients. Moreover, the use of the distal radial would preserve the proximal radial from the risk of arterial occlusion after interventional procedures performed through the radial artery.
METHODS: We enrolled 100 consecutive elective patients undergoing cardiac catheterization (diagnostic or procedural). Arterial access to the distal radial was entirely managed by nursing staff supervised by the interventional cardiologist. In this single-centre single-operator experienced study, the same nurse operator performed puncture, wiring, and sheath advancement.
RESULTS: The technical feasibility was 89% and the failure rate occurred in the first 50 cases as evidenced by the learning curve. There were no major complications and the rate of minor complications is in line with that of the radial literature. BMI (OR 1.19 CI 95% 1.03-1.38), non-radial dominance (OR 3.5 CI 95% 1.04-12.3) and operator’s experience (OR 0.59 CI 95% 0.35-0.99 for every 20 consecutive cases performed) were associated with DRA failures.
CONCLUSIONS: The experience is encouraging and beneficial for all staff and patients with a high percentage of technical success and few mild complications.


KEY WORDS: Distal radial access; Interventional cardiology; Nursing management

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