The pulseless radial artery in transradial catheterization: challenges and solutions

Relationship between platelet/hemoglobin and radial thrombus in patients with coronary angiography via radial access

Aim: To predict the development of radial artery thrombus (RAT) in patients with radial approach coronary angiography of platelet-to-hemoglobin ratio (PHR). Materials & methods: This study was designed to evaluate the relationship between RAT and PHR. A total of 1156 patients who had coronary angiography via the transradial approach between 2021 and 2022 in the authors' center were included in the study. Results: Radial thrombus was detected in 52 (4.5%) patients. PHR was higher in the group with thrombus and was statistically significant. In the regression model, PHR was an independent predictor of the development of radial thrombus (p = 0.007). Conclusion: High PHR may be an independent predictor of the development of radial thrombus.

Efficacy Assessment of Phentolamine Accompanied by Lidocaine Subcutaneously under Ultrasound Guidance on Radial Artery Catheterization in Pediatric Patients

Objective

Pediatric patients are facing greater difficulties in radial catheterization for anatomic variation and smaller diameter. This study is to investigate the efficacy of phentolamine accompanied by lidocaine subcutaneously under ultrasound guidance on radial catheterization in pediatric patients.

Methods

66 pediatric patients were enrolled and randomly divided into saline group, phentolamine group, and phentolamine+lidocaine group. Baseline characteristics and surgical types were collected. Relevant solutions were subcutaneously injected, and catheterization was subsequently conducted under ultrasound guidance. Radial artery diameter and depth were measured, the success rate of catheterization and procedure time were calculated, and the complications were evaluated with ultrasonography.

Results

No significant differences were observed in age, sex, weight, American Society of Anesthesiologists' classification, systolic blood pressure, diastolic blood pressure, heart rate, hemoglobin, and surgical types among three groups. Subcutaneously, the diameter in phentolamine and phentolamine+lidocaine groups increased significantly compared with the saline group. Moreover, the diameter also increased significantly after injection compared with that before injection both in the phentolamine and phentolamine+lidocaine groups. The first-attempt success rates were significantly higher while the procedure times of cannulation were shorter in the phentolamine and phentolamine+lidocaine groups than that in the saline group. Kaplan–Meier analysis showed that the overall procedure time was shorter in the phentolamine and phentolamine+lidocaine groups than the saline group. Overall complications and vasospasm incidence were lower in the phentolamine and phentolamine+lidocaine groups than the saline group.

Conclusion

Phentolamine accompanied by lidocaine subcutaneous injection under ultrasound guidance improved the first-attempt success rate and reduced the complication of radial artery catheterization in pediatric patients.