How To Set Up Your Cath Lab for Better Radial Access Ergonomics

[Chris Beck]
So my question, whenever you guys were switching over, making the jump or slowly easing over to radial access … how do you have the room set up where the monitors are and the patient's arm is?

[Jason Iannuccilli]
So the answer to that question depends on whether or not we want the capability of performing a 3D sort of XperCT during the case. We initially always start off with the right arm down by the patient's side, the left arm that we access off a little less than 90 degrees. We found that when patients are extended to 90 degrees it's a little more uncomfortable for them so it's probably something like 70 degrees. The arm is fixed to the arm board, more or less the sort of metatarsophalangeal junction of the hand is sort of wrapped and secured down to the board. And then the wrist itself is prepped and exposed. We will actually lay a table out along the length of that arm board so that we have at least a little bit of a support structure for our flush lines and everything that needs to be essentially level and not tugging once that sheath access is in place within the radial artery….

If we're doing 3D reformats or we're doing an XperCT we will actually, with the catheter in place, move the patient's arm. We'll move it up, believe it or not, we'll take the arm and we will extend it up so that the arms are sort of like as if you were putting your hands behind your head, they're sort of held in an angle. And we found that the catheter, it doesn't move all that much. We have to keep an eye on it while we're adjusting and we do it delicately, but by doing that we're able to get the II to actually do the correct spin either in propeller format or in a roll format to get the 3D information we need.

But there are various methods that are used out there in practice. I mean some people are using radial arm boards that go alongside the patient the entire time. So they'll access the radial artery and then they'll fold the arm in and keep it in parallel to the body and either reach over the body so they're working from the patient's right side or they'll stand on the ipsilateral side and work from there.

[Chris Beck]
...So whenever we do radial access we do have the arm out, like you said maybe not at 90 degrees, that's a bit of a stretch for the patient, but then my situation is always what to do with my monitors. For whatever reason, it may be other rooms are different around the country, [our monitor setup is] very much geared towards the monitors [having] to be on the other side of the patient that you're working on. If I have the arm abducted to get the monitors in front of me...I still have to turn my head over my left shoulder to see the monitors. Is that what you're also doing, Jason? Or are you working off of a slave monitor?

[Jason Iannuccilli]
...So one of our rooms has that identical setup that you're saying where we kind of have to pull the monitor up as close to the patient's head as we can but it's still off to the left. So as you're working you can position your body so that you're working on the patient's wrist but you're more or less directing your body at a mid point between the monitor and the wrist so you're not craning your neck as much during the procedure. It's a little bit of a pain and to be honest with you, it's not as nice as our other room where we have a slave monitor. The slave monitor is nice because you can just wheel it over and put it right in front of you where you're working and you're standing on the other side of the wrist and just looking straight at the monitor.

So two different ways we do it. I prefer the slave but I've learned to cope with doing it the other way. I don't have any neck problems yet.