Cath Lab Digest

Late in 2010, the Ross Heart Hospital interventional cardiology group at The Ohio State University Wexner Medical Center took the leap and became a radial-first catheterization practice.

“We’re a unified group of interventional cardiologists with similar practice patterns,” says Vincent Pompili, MD, Director, Interventional Cardiovascular Medicine and Cardiac Catheterization Laboratories. “We reviewed data from across the country and our own institution, agreed this change was best for patients, then committed to the new direction, with transradial catheterization as our first choice for patients having cardiac catheterization or intervention at Ohio State’s Heart and Vascular Center.”

The data is related primarily to bleeding rates and access site complications. Since introducing transradial catheterization, the practice has recorded a steady decrease in bleeding rates and access-site complications from catheterization. Today, with approximately 60 percent of the practice’s catheterization patients undergoing a transradial approach, these complications are significantly lower than the national average.

“Patient safety is a key driver of practice modification,” says Pompili. “The first quarter after the switch to a radial-first practice, bleeding complications and access-site complications decreased by 60 percent.”

Another important aspect of the data relates to cardiac outcomes. According to Quinn Capers IV, MD, Director of Peripheral Vascular Interventions, patients who have major bleeding from the femoral artery and require transfusion after catheterization are at increased risk for adverse cardiac events, including death for up to 12 months afterward.

“Transradial catheterization has reduced complications (access site and bleeding) at our institution, so it was an obvious and unanimous decision to change the practice,” says Capers.

While some patients are not candidates for transradial catheterization due to their anatomy, the practice anticipates the percentage of patients catheterized transradially could reach 75 percent.

“We look at all options for patients, consider their unique situations and identify any reasons to exclude transradial,” says interventional cardiologist Charlie Bush, MD, associate medical director of the Ross Heart Hospital. “The advantages are that significant. Pompili anticipates transradial catheterization will be gradually adopted as the norm around the country.

“We do not take advantage of all of the benefits of transradial catheterization if we do not also modify the recovery process,” says Pompili.

Patients undergoing transradial catheterization present a unique opportunity to optimize the recovery experience. Toward that end, The Ohio State University Wexner Medical Center opened a new Radial Lounge in September 2012.

Previously at Ohio State, all catheterization patients recovered in the same 23-bed invasive prep and recovery unit. Now, during catheterization procedures, the charge nurse is alerted when patients do not need stenting and are good candidates for recovery in the Radial Lounge.

These patients are transported via wheelchair to the Radial Lounge, where their IVs are removed. They can change into their clothes and spend the next two hours recovering comfortably in a recliner. The lounge has seven recliners for patients, couches for family members, and iPads. Patients wear an inflatable wristband that applies light pressure to the area of access and are monitored with wireless telemetry, allowing them freedom to walk around, eat and visit. Dedicated nurses, experienced in the care and recovery of post-transradial catheterization/PCI population, observe patients until they are ready to go home.

The Radial Lounge was designed with an adjacent consultation room for patients and their family members to discuss the procedure and view images with the physicians.

“Patients get one-on-one time with the cardiologist in a comfortable, private setting, which helps to increase the personalized feeling,” says Amanda Parkinson, Amanda Parkinson, RN, BSN, Nurse Manager of Invasive Prep and Recovery. “This wasn’t possible for transradial patients in our invasive prep and recovery unit because they have to lie down and are connected to monitoring equipment. The set-up in the Radial Lounge promotes mobility and supports positive changes in post-procedure protocols.”

“A significant benefit of transradial catheterization is faster, more comfortable recovery,” says Ernest Mazzaferri Jr, MD, interventional cardiologist and medical director of Ohio State’s Richard M. Ross Heart Hospital. He says the Radial Lounge improves the patient experience, eases the transition to discharge and provides the appropriate level of care to each patient.

Not having to lie down for hours after catheterization is especially good news for patients who have chronic pain, such as degenerative disk disease; who have had back or knee surgery; or who have a respiratory complication, such as congestive heart failure, COPD or emphysema.