Clinical Experience

How Do You Secure Your Radial Sheath?

​Morton J. Kern, MD

​Morton J. Kern, MD

Small innovations can make a big difference. It’s a recurrent theme in interventional cardiology. Small changes or new application of a common piece or equipment, supply, or method can make a difference in your lab.1,2 
 
Last week, Roya Lisboa (Figure 1), one of our super cath lab nurses, handed me an IV bandage to secure the radial sheath. I’d been complaining, as many of my colleagues have reported, that the usual Tegederm clear plastic bandage (Figure 2) with a slit, holds the sheath in place for most routine cases but fails for longer procedures, especially when blood gets under the plastic. 
 
The SorbaView bandage (Centurion Medical Products) (Figure 3) has a clear window and fabric adhesive border with a locking piece of adhesive added after the bandage is placed. It is usually used to protect IV needles and catheters. The fabric border prevents blood from leaking into the puncture area. To secure the radial sheath, we made sure to attach the fabric adhesive to the hub of the sheath with the side arm passing under the adhesive and the locking patch over the side arm (Figure 4).  
 
I asked my expert colleagues what they used for securing their radial sheaths and the answers were interesting:
  1. Most respondents used Tegederm, but complained that its securing function is short-lived and if blood gets under it, it is a mess and stops working. This usually occurs involving a long case with multiple catheter exchanges.
  2. Several operators use long sheaths with no securing technique needed.
  3. Several operators use a suture if the sheath needs to be secured for long case.
  4. One European operator doesn’t use sheaths and goes sheathless for his procedures.
Several other devices available in our lab were investigated but none seemed suitable (Figure 5). While only a small change in our radial technique, the use of a new securing method may be a big advance for the procedure. It’s always a good idea to keep your eyes open in the cath lab.
 
References
  1. Kern MJ. New ideas from cardiac cath lab staff. Cath Lab Digest. 2008 Mar; 16(4). Available online at https://www.cathlabdigest.com/articles/New-Ideas-Cardiac-Cath-Lab-Staff. Accessed Dec 12, 2017.
  2. Kern MJ. Small innovations can make a big difference: the role of staff initiatives to drive efficiency in the cath lab. Cath Lab Digest. 2017 Feb; 25(2). Available online at https://www.cathlabdigest.com/article/Small-Innovations-Can-Make-Big-Difference-Role-Staff-Initiatives-Drive-Efficiency-Cath-Lab. Accessed December 12, 2017.
  3. Kern MJ. The Armen glove for radial access prep — a better way. Cath Lab Digest. 2010 May; 18(5). Available online at https://www.cathlabdigest.com/articles/The-Armen-Glove-Radial-Access-Prep-%E2%80%93-A-Better-Way. Accessed December 12, 2017.