Optimal TR-band weaning strategy while minimizing vascular access site complications

Shah, Sunay; Gindi, Ryan; Basir, Mir B.; Khandelwal, Akshay; Alqarqaz, Mohammad; Zaidan, Mohammad; Voeltz, Michele; Koenig, Gerald; Kim, Henry E.; O’Neill, William W.; Alaswad, Khaldoon

doi:10.1016/j.carrev.2018.04.013

Cited by 4 publications

(2 citation statements)

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“…However, as mentioned earlier, there are no clear protocols for weaning off the band. There are various protocols that have been reported, including accelerated protocols and standard protocols and protocols that are individualized according the medications given during the procedure, with some studies [ 12 , 13 ] showing that the accelerated protocols are safe with comparable bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesized that standard protocol of early initiation of deflation of air (within an hour) but with longer intervals of deflation would be inferior to the modified protocol that involves a delayed initiation but shorter intervals. Recently, there have been trials which show that an accelerated protocol that starts almost 30 minutes after the sheath removal is safe without an increase in bleeding complications [ 12 , 13 ] but with overall longer time to removal. However, other groups have demonstrated increased bleeding with these accelerated protocols [ 13 , 14 ] and suggested the delayed protocol.…”

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confidence: 99%

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Comparison between two protocols for deflation of the TR band following coronary procedures via the radial route

Riyami¹,

Riyami²,

Nadar³

2020

Journal of the Saudi Heart Association

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Aim Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. Methods All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale. Results A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 ( n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 ( n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 ( p = 0.01). Conclusion A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%