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Radial Compression Device (1.50)

Radial Compression Device (1.50) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Cardiovascular and Infusion

1.50

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
July 10, 2015

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 1.50 A

Original
Revision

Page
1
of 4

Title: Radial Compression Device (Adult)

I. PURPOSE

To describe the care required for a patient with a radial compression device (TR
Band®) including the components of post-device application nursing assessments,
procedure for device removal, complications related to the device, and the nursing
interventions to resolve or minimize complications.

II. POLICY

A. The sheath will be removed at procedure completion by the cath lab
physician/fellow/staff, who will also apply the radial compression device.
B. The recovery area or receiving unit staff will be responsible for the weaning and
removal of the radial compression device post-procedure.

III. EQUIPMENT

A. Radial compression device (TR Band®)
B. Product-specific syringe (TR Band Inflator®)
C. Continuous pulse oximetry monitor and probe
D. Transparent dressing

IV. PROCEDURE

A. Assessment of Site While Device in Place
1. Perform and document neurovascular assessments and vital signs
including pulse oximetry every 30 minutes or as ordered by provider.
a. Use the non-procedure arm to obtain blood pressures for the first
24 hours if possible. If not possible, use of the procedure arm for
obtaining blood pressures is not contraindicated.
b. Any new onset of distal pain, numbness, tingling, duskiness or
bleeding should be reported to the procedural physician.
2. Continuous pulse oximetry should be monitored at the index finger or
thumb on the treated wrist distal to the radial compression device during
compression and weaning of the device.
a. If pulse oximetry waveform is lost, air should be removed 1 mL at
a time until waveform returns. If waveform does not return,
immediately notify procedural physician.
b. If pulse oximetry waveform is lost and there is bleeding at the
access site, re-inflate device until hemostasis is obtained and


Page 2 of 4

immediately notify procedural physician.
3. Assess site for signs of bleeding
a. Puncture site oozing
i. If site oozing occurs, instill air into the device by
increments of 3 mL until hemostasis is achieved, up to a
total of 18 mL.
ii. Notify the provider if unable to achieve hemostasis with
maximum inflation.
b. Forearm hematoma
i. Apply direct, manual pressure to the site of induration
(hematoma) for 10 minutes.
ii. If hematoma persists or recurs, notify procedural physician.
iii. If physician requests, apply a manual blood pressure cuff to
the hematoma. Whenever the blood pressure cuff is in
place, monitor distal perfusion using continuous pulse
oximetry and adjusting cuff pressure to obtain a good
waveform.
iv. Inflate the cuff to 15 mmHg below the systolic pressure for
15 minutes.
v. If swelling, pain, or hematoma persists, inflate the cuff to
15 mmHg below the systolic pressure for an additional 15
minutes.
B. Device Weaning and Removal
1. The goal of using the compression device is to achieve hemostasis while
maintaining radial artery patency. For concerns of radial artery
occlusion, even if the patient is asymptomatic, contact the procedural
physician.
2. Radial compression device is to remain in place for a minimum of 30
minutes after a diagnostic procedure and 90 minutes after an
interventional procedure before weaning. The radial compression device
can remain in place for a maximum of 3 hours or as ordered by the
provider.
3. Deflate air by 3 mL every 15 minutes x 4. If hemostasis is maintained,
then continue to deflate by 3 mL every 5-10 minutes until deflated or as
ordered by the provider.
a. Assess for signs of oozing or hematoma with each deflation.
b. Complete neurovascular assessments with each deflation.
c. Maintain continuous pulse oximetry monitoring during the
weaning process.
4. Once deflated and hemostasis is maintained, remove radial compression
device.
5. Keep the device and attached syringe at the patient’s bedside. Do not
throw device away until patient is discharged.
6. Apply a sterile transparent dressing to the puncture site or as ordered by
the provider.
C. Post-Removal Assessment and Site Care
1. Monitor puncture site for oozing, hematoma or neurovascular changes.
2. If puncture site bleeding occurs:


Page 3 of 4

a. Perform hand hygiene according to UWHC Hospital
Administrative Policy 13.08, Hand Hygiene.
b. Don gloves.
c. Apply direct manual compression using three fingers for at least 10
minutes. Place the first finger directly over the puncture site at the
skin and the remainder just proximal.
d. If unable to obtain hemostasis after applying direct manual
compression, immediately notify the provider.
3. If forearm hematoma occurs:
a. Apply direct, manual pressure to the hematoma for 10 minutes.
b. If hematoma persists, notify procedural physician.
c. Apply a manual blood pressure cuff to the hematoma.
d. Inflate the cuff to 15 mmHg below the systolic pressure for 15
minutes.
e. If swelling, pain, or hematoma persists, inflate the cuff to 15
mmHg below the systolic pressure for an additional 15 minutes.
f. Monitor distal perfusion using continuous pulse oximetry; adjust
cuff pressure to obtain a good waveform.
D. Patient Care Instructions
1. Activity while device in place:
a. May be out of bed if:
i. Heart rate and blood pressure are stable
ii. Hemostasis is achieved by the radial compression device
iii. Discharged from moderate sedation phase II
b. Elevate the patient’s head of bed at a position of comfort.
c. Bedside table and pillow may be utilized to assist with limb
elevation and comfort. The patient may use the affected hand to
eat, use the phone, use the TV remote, etc. more strenuous
activities should be avoided during the weaning period. If the
patient has a difficult time keeping the arm at rest and there is
concern about maintaining hemostasis, an immobilizer may be
used.
2. Activity once device is removed:
a. Non-weight bearing (no lifting >10 pounds) on affected side for 3-
4 days.
b. The access site should not be soaked in water for 7 days post-
procedure. Bathing and washing hands are allowed.
c. Patients may resume usual activities such as cooking, typing,
cleaning, and driving.
d. Patients should avoid forceful, repetitive activities (such as golf,
tennis, and carpentry) for 7 days.

V. UWHC CROSS REFERENCES

A. Hospital Administrative Policy 13.08, Hand Hygiene
B. Nursing Patient Care Policy 13.14, Documentation in the Inpatient’s Clinical
Record
C. Respiratory Care Services Policy 3.20, Pulse Oximetry Check & Continuous


Page 4 of 4

Monitoring (Includes Ambulating SPO2)

VI. REFERENCES

A. Dandekar, V.K., Vidovich, M. I. & Shroff, A.R. (2012). Complications of
transradial catheterization. Cardiovascular Revascularization Medicine, 13, 39-
50.
B. Schueler, A., Black, S.R. & Shay, N. (2013). Management of transradial access
for coronary angiography. Journal of Cardiovascular Nursing, 28 (5), 468-472.
C. http://www.terumois.com/products/sheaths/trband.aspx?page=closer (Accessed
June 8, 2015). Wiegand, D. J. (2011). AACN Procedure Manual for Critical Care
(6th Ed). Philadelphia, PA: WB Saunders Co.

VII. REVIEWED BY

Clinical Nurse Specialist, Cardiology
Clinical Nurse Specialist, Vascular
Nursing Education Specialist, Heart, Vascular and Thoracic
Endorsed by Interventional Cardiologist
Nursing Patient Care Policy and Procedure Committee, June 2015

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer