Basics of the Cath Lab: Resources for CVPs, Fellows, and the Cath Curious-Radial Sheath Hemostasis Demonstration

Video Transcription

Alright, so we started by flushing the sheath, making sure there's no clots in there. Then we are going to get our R-band prepped and ready.  I like to pull 20 milliliters of air up into the syringe, hook it up to our R-band, make sure the balloon inflates.  We'll then take our tegaderm off and take off our drape, making sure the radial sheath stays in place. We'll remove the stopcock, have you release your hand off of our holder.  Let's keep it as clean as possible, I like to take a 4x4 and fold it up underneath the sheath so when it gets pulled out you have something to soak up the blood.  Place the R-band over the hole 1-2 centimeters proximal to the exit of the skin, get it semi-tight, inflate the balloon halfway to 10 milliliters of air, check to make sure  that the sheath is going to slide out. Then increase up to 15 of air, slowly pull the sheath out, making sure there's hemostasis  and then let air out of the balloon until I see pulsation of the blood. Then I add in 2-3 milliliters of air back into the balloon, make sure the pulse stops,  keep pressure on my thumb and release the syringe from the balloon, I'll pull out my 4x4, make sure nothing's leaking, I'll check for a pulse with my finger, should have a  pulse and then we'll check with the oximeter, we'll have a waveform, hook the oximeter onto the thumb, we'll make sure we have a waveform up on our screen, we'll occlude the ulnar  artery until it flattens out, then we'll release it, make sure our waveform comes back, looks good, returns back to normal and then I just check to make sure there is no swelling  before or after the balloon and that is done, we'll secure it with an arm board so they can't lift or push or pull or move their wrist around.

Video Summary

In this video, the speaker demonstrates a procedure for removing a radial sheath. The process involves flushing the sheath, preparing the R-band, and ensuring the balloon inflates properly. The speaker emphasizes cleanliness and recommends using a folded 4x4 underneath the sheath to absorb any blood. The R-band is placed over the hole, tightened, and the balloon is inflated with air. The sheath is slowly removed, ensuring hemostasis. The speaker checks for pulsation and adds air to the balloon to stop the pulse, then releases the syringe. After checking for leaks and a pulse, the speaker occludes the ulnar artery to confirm a proper waveform. The speaker concludes by securing the site with an arm board. No credits were provided.

Asset Subtitle

Nathan Hall, MD, FSCAI

Keywords

radial sheath removal

procedure

R-band preparation

balloon inflation

hemostasis