Protocol for TR band placement post trans radial artery procedures

 

  1. This device is placed on the hyper extended wrist and tightened via a Velcro band.
  2. A small green box indicates where the band should be placed proximal to the radial percutaneous site. Single wall stick; place the green dot on the TR Band about 3-4 mm proximal to the skin insertion site. Double wall stick; place the green dot just 1 mm or two proximal to the skin insertion site
  3. The TR Band inflator syringe is filled with 18 cc of air and slowly injected into the one-way side port which inflates the balloon overlying the radial artery.
  4. Concomitantly, the radial sheath is slowly pulled out completely, as the balloon is inflated to the maximum of 18 cc of air.
  5. Then slowly, withdraw air back out via the syringe, 1cc at a time, until the operator observes for blood leaking out from the puncture site, at which time, 1 cc of air is re-injected into the balloon and the syringe is disconnected.
  6. Keep the plunger in place with your thumb when inflating/deflating the TR band. Releasing the plunger will cause air to expel out of the band to quickly
  7. Remember to keep the syringe for later deflation

Application tips to remember:

  1. Make sure the radial artery insertion site is 3 or more cm proximal to the wrist crease. If the site and thus the band are too close to the wrist, it may slip if the wrist bends
  2. Make sure the site is cleaned with sterile saline and dried completely before the band is placed on the wrist
  3. Place the green box proximal to the sheath insertion site(Terumo logo closest to the patients little finger)
  4. Pulling the sheath slowly as you are simultaneously inflating the TR Band to 18 cc’s. You should be completely removing the sheath at about the same time you hit 18cc’s.
  5. Once all 18cc’s are in the band and the sheath is removed, you slowly about 1cc per second begin reducing the amount of air in the band while visualizing the access site for a blood flash
  6. Once you visualize a blood flash you immediately put 1 to 2cc’s back into the band and disconnect the syringe confirming that the blood has ceased.
  7. If the air is released slowly out of the band, there is no need for gauze to be positioned under the TR Band. If you are removing the air slowly and at first sight of a blood flash 1 to 2 cc’s is put back into the band you will have a dry field. You want to have complete visualization of the access site, you do not want a gauze pad to block your visualization of the arteriotomy.
  8. Also, there is no need to make a skin nick when introducing the sheath (unless completely necessary). The Glidesheath is hydrophilic coated and has a near seamless transition and will not require a nick for insertion. The TR Band is designed to provide the least amount of pressure to gain hemostasis while maintaining flow through both the radial and ulnar arteries. The TR Band is not designed to provide hemostasis for both the arteriotomy of the access site as well as a large skin nick. That is why with the design of both these products a skin nick is not needed and you should never experience a situation in which you would need more than 18cc’s of air, which is occlusive pressure.

 

 

 

 

TR Band Post Procedure Order Set

 

  1. All TR Band Post Procedure Monitoring:

 

  • No blood pressure readings, lab draws, or IV access in the procedure arm x 24 hours.
  • Instruct patient to keep wrist straight and refrain from lifting or pushing with the affected arm.
  • Monitor access site and extremity distal to puncture wound every 15 minutes until TR Band removed then follow diagnostic/interventional orders.
  • Assess for absence of ulnar pulse, capillary refill > 3 seconds, cyanosis, numbness and/or pain in affected extremity, if present notify MD.
  • If bleeding or hematoma occurs, immediately apply adequate pressure to achieve hemostasis and notify MD.
  • Limit movement in the affected arm for 6 hours post procedure.  If needed place wrist on arm board to restrict movement.
  • If sterile pressure dressing is used remove 6 hours after application.
  • Pt may ambulate 30 minutes after arrival in recovery area.

 

  1. Post Diagnostic Cath Procedure:

 

  • Forty-five minutes after TR Band is applied deflate 3cc of air from cuff.  If no bleeding occurs from the site deflate 3cc of air from the TR Band every 5 minutes until all air that was used to inflate the band has been removed.
  • If bleeding occurs when 3cc of air is removed re-inflate with 3cc of air.  Wait 15 minutes then restart releasing 3cc of air every 5 minutes until all air has been removed.
  • If site free of bleeding or hematoma after 5 minutes, remove TR Band and apply sterile dressing to site.
  • After TR Band removal evaluate access site for bleeding every 15 minutes x 4.
  • Limit movement in the affected arm for 6 hours post procedure.  If needed place wrist on arm board to restrict movement.
  • If sterile pressure dressing is used remove dressing 6 hours after application.

 

  1. Post Intervention Cath Procedure:

 

  • Two hours after TR Band is applied deflate 3cc of air from cuff.  If no bleeding occurs from the site deflate 3cc of air from the TR Band every 10 minutes until all air has been removed.  If site free of bleeding or hematoma after 10 minutes remove TR Band and apply sterile dressing to site.
  • If bleeding occurs when 3cc of air is removed re-inflate with 3cc of air.  Wait 30 minutes then restart releasing 3cc of air every 10 minutes until all air has been removed.
  • After TR Band removal evaluate access site for bleeding as follows: every 15 minutes x 4; every 30 minutes x 2and every hour x 2
  • Limit movement in the affected arm for 6 hours post procedure.  If needed place wrist on arm board to restrict movement.
  • If sterile pressure dressing is used remove 6 hours after application.

 

  1. Discharge Instructions:

 

  • Instruct patient to do no lifting with affected arm x 24 hours.
  • Instruct patient to apply manual pressure and call physician immediately if bleeding or hematoma occurs at the site.
  • Instruct patient to remove dressing the next day and keep site clean, dry and covered with a new band aid daily until healed.
  • Instruct patient to avoid submersion of site in water x 3 days.
  • Instruct patient to report any symptoms other than slight tenderness at the site or tingling of the fingers and hand for up to 3 days.