Peri-Operative
When patient arrives, assess puncture site for bleeding or hematoma. There should be no bleeding.
If there is any bleeding, inject 2-3 mL of air into the port marked “air” and notify the fellow. Do not exceed a total of 18 mL of air.
Patient will remain in bed, but able to sit up and ambulate to the bathroom.
TR Band will remain in place for:
1 hour post-procedure for Non-Intervention procedures
2 hours post-procedure for Intervention procedures
TR Band Removal
Non-Intervention
Withdraw 2-3 mL of air after 1 hour
If bleeding occurs, re-inject 2-3 mL of air and wait 30 minutes and withdraw 2-3 ml of air again. Repeat removing 2-3 mL every 15 minutes until all air is removed.
Remove T.R. band and apply tegaderm and observe for 30 min. Hold pressure and call fellow if patient develops a bleed.
Intervention
Mandatory: (please check one box)
NO ACT needed
If 2BIIIA (Aggrastat or Integrilin) is infusing, begin removing air 2 hours after procedure is complete. No ACT is necessary.
If patient received Angiomax, begin removing air 2 hours after drip is discontinued. No ACT is necessary.
ACT Needed
If patient received heparin (specifically for intervention - not just for radial access), check ACT before removing air. If greater than 160 seconds, DO NOT
REMOVE and repeat ACT every hour until ACT is less than 160 seconds.
Withdraw 2-3 ml of air after 2 hours
If bleeding occurs, re-inject 2-3 mL of air and wait 30 minutes and withdraw 2-3 mL of air again Repeat removing 2-3 ml every 15 minutes until all air is removed.
Remove T.R. band and place tegaderm and observe for 30 min. Hold pressure and call fellow if patient develops a bleed.
Post TR Band Removal
Apply a 2x2 Tegaderm to the puncture site and secure with Kerlex wrap to arm board.
Instruct patient not to manipulate wrist for 24 hours. Arm board may be removed after 1 hour post a non-intervention and reassess the site for bleeding.
Instruct patient not to manipulate wrist for 24 hours. Arm board may be removed 6 hours after anticoagulation if a Percutaneous Coronary Intervention was performed then reassess the site for bleeding.
Educate patient on:
Leave puncture site open to air after 24 hours post-procedure. If minor oozing, patient may apply Band-Aid and remove after 12 hours.
No soaking wrist for 3 days
No driving for 24 hours
No lifting more than 3-5 pounds with affected wrist for 7 days.
Hold pressure with thumb against puncture site and finger against back of wrist for any frank bleeding and call 911 for immediate help.
Reportable Conditions:
Notify the doctor of any uncontrolled bleeding.
If wound is bleeding then elevate the arm and apply manual pressure to the area just above the wound by pressing the thumb above the wound and encircling the hand around the wrist for 20 minutes. After 20 minutes slowly remove pressure and assess if bleeding has stopped.
Notify the doctor if there is a loss of circulation in the hand or the hand has a sudden color change and appears cool and blanched accompanied by tingling and numbness
Source: Cardiology Services Date: 10/17/2022 Reference Text Version 5
