For decades, cath lab clinicians essentially had only one option for achieving hemostasis management following a procedure – compression. That changed in the 1990s with the introduction of vascular closure devices and hemostatic pads, which were designed to significantly shorten the time it took to close the wound left at the access site.

According to the American College of Cardiology (ACC), each year nearly 400,000 patients are admitted to U.S. hospitals with ST segment elevation myocardial infarction (STEMI). National ACC/American Heart Association (AHA) guidelines state that hospitals treating STEMI patients with emergency percutaneous coronary interventions (PCI) should reliably achieve a door-to-balloon time (D2B) of 90 minutes or less, and studies have demonstrated strong associations between time to primary PCI and in-hospital mortality risk.

When a lab is transitioning from transfemoral to transradial cardiac catheterizations, the process can be either encouraging or discouraging to all staff involved. To ease the transition, it might be useful to employ previously implemented ideas, techniques and equipment selections that have had positive outcomes. This article will discuss patient preparation, equipment selection and address common inventory concerns that occur when developing a transradial catheterization program. The ideas and initiatives discussed in this article are those that we undertook at the Jesse Brown VA Medical Center in Chicago and may not reflect other cath labs’ setup. However, most of the concepts are applicable to all catheterization labs.

Imaging technology and diagnostic tools for interventional cardiologists have changed dramatically over the past few years with the introduction of optical coherence tomography (OCT), improvements in intravascular ultrasound (IVUS) and pressure guide wires used in fractional flow reserve (FFR). Product innovation and integration of these technologies, as well as a growing base of clinical evidence, are transforming the way physicians diagnose, treat and follow-up patients undergoing percutaneous coronary intervention (PCI).