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Most hematomas are self-limiting and benign, but large, rapidly expanding hematomas can cause hemodynamic instability requiring resuscitation with fluids and blood. Hematomas are usually formed following poorly controlled hemostasis post sheath removal. These are among the most common complications seen after cardiac catheterization procedures. The complications can be minor as discomfort at the site of catheterization, to major ones like death. For any patient, the complication rate is dependent on multiple factors and is dependent on the demographics of the patient, vascular anatomy, co-morbid conditions, clinical presentation, the procedure being performed, and the experience of the operator.
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The risk of major complications during diagnostic cardiac catheterization procedure is usually less than 1%, and the risk and the risk of mortality of 0.05% for diagnostic procedures. Radial access procedures also enhance patient comfort, reduce post-procedure bed rest and eventually length of hospital stay. The findings have been reproduced in non-emergency diagnostic and percutaneous interventional procedures and as well as in urgent settings of ST-segment elevation myocardial infarction. Several randomized controlled trials and meta-analyses have demonstrated reduced mortality, decreased major bleeding, access site complications, reduced length of stay, and comparable stroke rates using a transradial approach. Since its first description in 1989, a transradial approach for coronary angiography has been increasing compared to the transfemoral approach. Transradial versus Transfemoral Approaches The test is considered normal if the pulse oximetry tracing returns to normal within 10 seconds of releasing the pressure on the ulnar artery.
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Similar to the Allen test, compression of both the arteries is performed until the pulse oximetry trace is blunted. Barbeau test removes the subjectivity of the Allen test, and a pulse oximeter is placed on the ipsilateral thumb. The blush response in the hand is noted, and if the color in the palm returns before 10 seconds, the blood supply to the hand via the ulnar artery and palmar arch is considered satisfactory. Allen test is performed by compressing both the radial and ulnar arteries until the palm blanches, and then the ulnar artery is released. Before accessing the radial artery, an Allen test or Barbeau test is performed to confirm adequate collateral circulation to the palm. The ideal place to access the radial artery is 2 cm proximal to the radial styloid. When using the hand/wrist, the common site of access is the radial artery, even though the ulnar artery and brachial artery are also used in some situations. Optimizing vascular access using fluoroscopy or ultrasound to visualize the anatomical landmarks and accessing the artery using lower profile catheters, including micropuncture sheaths, can minimize the risk of access site complications. Higher puncture sites will increase the risk of retroperitoneal bleed, and lower puncture sites will increase the risk of pseudoaneurysm formation.
#OPEARTION BONGO 2 MANUAL#
It is essential to access the femoral artery at the appropriate site as adequate hemostasis can be achieved by applying manual compression over the artery against the femoral head. This has been shown to decrease the risk of complications by 49% in one published series. Some centers routinely acquire femoral access under ultrasound guidance. Placing a metal clip at the proposed puncture site and performing a quick fluoro exam to confirm the relationship to the femoral head can improve the accuracy of the puncture site. The femoral artery crosses the inguinal ligament at its midpoint, and an imaginary line joining the bony landmarks of the iliac crest and pubic symphysis defines the path of the inguinal ligament. The target for femoral puncture is the midpoint of the common femoral artery between the origin of the inferior epigastric artery and the bifurcation of the superficial and profunda branches, which is usually at the center of the femoral head. For cardiac catheterization procedures that require arterial access, the 2 common sites used include the common femoral artery and radial artery.