A new dedicated space at MedStar Union Memorial Hospital is helping to transform the experience of patients who need interventional cardiac catheterizations. The Radial Lounge is an innovative setting for a procedure that is at the forefront of cardiac care—plus it’s the only facility of its kind in the Baltimore area.
“The landscape of cardiac care is changing,” says George Ruiz, MD, chief of cardiology at MedStar Union Memorial. “Growing numbers of physicians are becoming enthusiastic practitioners of the radial method of cardiac catheterization, and more patients are asking for it.
And MedStar cardiac interventionalists are helping to lead that change.”
There are good reasons for the popularity of the procedure, explains John Wang, MD, chief of the cardiac catheterization lab at MedStar Union Memorial. “There are clear and compelling benefits including increased patient safety and comfort, as well as cost savings,” he says.
Physicians performing the radial procedure access a patient’s coronary arteries via the radial artery in the wrist, instead of using the femoral artery in the groin. That means patients can sit upright after their catheterizations and move around during recovery.
“In the past, patients needed to lie flat for hours to reduce the risk of bleeding, which many of them said was the worst part of the catheterization," says Dr. Wang. "With the radial approach, there is virtually no post-proce- dure bleeding, and immediately after, patients can sit up, move around, get a drink or go to the bathroom. Patients leave within a few hours of their procedure.”
Releasing patients the same day also makes the procedure more cost-effective. "Instead of us monitoring people overnight for possible complications, they are able to return home,” says Dr. Wang. “That’s not only preferable for them, but we have more beds available for patients with emergent or severe health conditions. And because the risk of major vascular complications is almost zero, there is also very little need for prolonged monitoring of these patients.”
The new lounge, used exclusively for radial procedures, resembles a high-end waiting area with a large open space outfitted with recliners and amenities such as a wide screen TV, computer station and refreshments.
“It’s a welcoming space, and there’s a sense of familiar- ity because everyone is having the same procedure,” says Cheryl Lunnen, vice-president of MedStar’s Heart & Vascular Institute for the Baltimore region. “Instead of a clinical look with individual bays, this arrangement is more relaxing for patients, and easier to navigate for caregivers.” Because each caregiver can monitor several patients post-procedure, staffing needs are lower than after traditional femoral catheterization—another cost-saving measure.
PERFORMING A RADIAL PROCEDURE
The physician inserts a small hydrophilically-coated sheath that slides easily into the radial artery. Then a guidewire is advanced from the radial artery to the ascending aorta, and a tiny catheter is advanced over the wire. Checking
for arterial blockages takes just a few minutes, and if the patient's condition indicates a need for a stent, that can be done through the wrist as well. (About a third of diagnostic radial catheterizations progress to stent procedures.)
One major innovation of the last decade has been the radial TR Band®, a wristband that resembles a watch and uses a Velcro strap. The TR band contains an air diaphragm that can be inflated to put gentle pressure on the access site after a radial procedure. Catheters designed specifically for the radial approach have also made it easier to engage the coronary arteries through the small blood vessels in the wrist.
In a small percentage of cases, tortuosity of the blood vessels in the arm or the need for larger catheters in very complex procedures may make femoral access a better option. But according to Dr. Wang, “More than 90 percent of our patients can undergo diagnostic cardiac catheterization using the radial approach.”
Dr. Wang performs more than 1,000 total procedures per year, of which 90 percent are performed radially. The total number performed by MedStar practitioners is approach- ing 10,000. “In 2010, we were doing fewer than 5 percent of cardiac stent procedures radially, and now that figure is well over 80 percent—and that’s compared to a national average between 30-40 percent,” he says.
“The reaction of our patients to the new lounge has been fantastic,” he continues. “Our goal is always to provide high- quality care in a way that lets people get back to their lives as quickly as possible—and this way of delivering service is truly patient-centered.”
Radial Catheterization Procedure
- John Wang, MD, inserts a short needle and is exchanged for a short radial sheath.
2. A guidewire is advanced into needle into the needle and is exchanged for a short radial sheath.
3. A catheter is advanced through the sheath to perform the catheterization.
4. An inflatable compression band around the wrist puts gentle pressure on the access site at the conclusion of the case.