Cardiovascular Journal of Africa: Vol 27 No 3 (May/June 2016)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 3, May/June 2016

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Overcoming the radial learning curve in the cath lab:

the African journey

In addition to its sessions tailored to the needs of specialists,

AfricaPCR also includes workshops specifically designed

for allied health professionals. One of the highlights of this

year’s programme was a lively interactive debate around the

pros, cons, challenges and benefits of introducing a radial

programme in African cath labs. The meeting was facilitated

by registered nurse Sr Diane Kerrigan, radiographer Kerry

Moir, and cardiologists Dr Mark Abelson (South Africa) and

Dr Jacques Monsegu (France).

Accessing the coronary arteries via the radial artery has

been increasing in popularity over the past approximately

two decades, as an alternative to the femoral and brachial

routes. The first radial interventional programme in South

Africa commenced more than 10 years ago. While the left

radial artery is usually used for bypass grafting procedures,

the right radial is the preferred route for angiography and

percutaneous coronary intervention.

Patient selection is highly dependent on operator

experience, so repetition of the procedure is key. ‘The more

you practise, the better you get’, said Sr Kerrigan.

There are many good reasons for going the radial route.

The procedure is more comfortable for the patient. The

artery is close to the surface and has a dual blood supply.

It’s associated with fewer renal, and nerve and vascular

complications. Transfusion requirements are less. Reduced

staff utilisation translates into reduced hospital-related costs,

as does a shorter hospital stay. Patients can be mobilised

earlier. Radial access is also associated with lower mortality

rates than with the femoral access.

However, for radial access to be undertaken successfully,

it is important for the cath lab team to be ready. It requires

trained allied professionals, lots of experience, a supportive,

quiet and relaxed environment, and good communication. It

is also imperative that all the correct equipment be available.

Sr Kerrigan highlighted the four key areas/learning steps

necessary to ensure a successful radial programme:

•

preparation and comfort of the patient, including sedation

•

accessing the radial artery

•

management of complications

•

haemostasis.

As previously noted, using the right radial artery is the

default practice in South Africa, but there might be a case

for using the left radial as it is a more direct route to the

coronary arteries. Also, left radial access is more similar to

femoral access, something that may be an advantage in the

earlier stages of the radial learning curve. Offsetting this,

however, is that using the right radial is more comfortable

for the cardiologist and exposes the patient to less radiation.

Summing up, Sr Kerrigan underscored these take-home

messages. ‘Be aware of the learning curve. Make sure the

patient has a good pulse and is comfortable. Use the

appropriate cocktail of medications. Choose the catheter

carefully and ensure good haemostasis.’

Source:

AfricaPCR 2016.