Clinical Editor's Corner: Kern

The Armen Glove for Radial Access Prep – A Better Way

Morton Kern, MD

Morton Kern, MD

Labs beginning radial artery procedures want to know, “What is the best way to set up the arm, drape, position the biplane tubes, and after the case, apply the hemostatic band?” How does your lab drape the arm and wrist for a radial case? Conventional technique uses several small blue cotton towels wrapped around the hand and arm after applying a sterile solution to the hand, wrist and forearm. First, the wrist is hyperflexed by putting a rolled towel under the wrist. The hand is placed upward with the wrist flexed and may be secured with tape (Figure 1). More small blue towels are draped around the hand and secured with clips. The towel clips sometimes get in the way of the operator during needle entry. While this is a common and perfectly acceptable method, there is always a better way. After struggling with the towel arrangements and having a patient tell me a towel clip pinched his thumb, I was happy to learn of a better way to prep the hand for radial access. Mr. Armen Avetisyan, our new cardiovascular technologist at the Long Beach VA cath lab (Figure 2), had a brilliant idea for our radial access sterile draping. It’s simple and elegant. After prepping the arm (shaving and wiping with a sterile solution), put a sterile glove on the hand in a sterile fashion (Figure 3). The Armen glove draping procedure begins with washing the hand, fingers, and arm with 2% chlorhexidine/70% alcohol solution (ChloraPrep™ with Tint, CareFusion, Leawood, KS). A sterile towel is placed under the arm on the arm board. Next, a large sterile glove is put on the hand. A sterile top drape has a stretchable plastic section with a central hole. It is then placed over the gloved hand. The drape covers the arm to mid forearm, and the glove covers the wrist and fingers. Arterial access is then performed in a routine fashion for radial sheath placement. Femoral artery access draping can be performed before or after the Armen glove draping in case of a radial access problem. One additional method to secure the arterial sheath in place is the application of a sterile, clear plastic Tegederm film, with a hole cut into the center by slicing an X with a scalpel. This idea was identified last year in our lab at UCI by Mr. Kent McAllister. The Tegederm is laid over the sheath with the valve protruding through the slit (Figure 3i and Figure 4). The Tegederm secures the sheath and side arm to the glove and the wrist, avoiding any need for a stay suture. One under-appreciated benefit of the gloved hand is that after the sheath is removed and the pressure band in place, there is no need to wipe the blood or clean the hand, since any blood that leaked out or was flushed out of the sheath or catheters during the procedure landed on the glove. I think this is one of the best cath lab ideas in the last year. A great idea like this is likely to remain one of our standards for radial access for some time. If you have a great idea, I’d like to know and share it with everyone here. Dr. Morton Kern can be contacted at