Running Head: PROBLEM BASED PAPER 1

Problem Based Paper

Radial Access versus Femoral Access

Delaware Technical Community College Terry Campus

NUR 340 Nursing Research

Brittnay Lengle

Due Date: 2/25/2018

PROBLEM BASED PAPER 2

Introduction

The purpose if this paper is to discuss the benefits of using radial access versus femoral

access. This paper will discuss the benefits and disadvantages of using both approaches and

which approach benefits patient’s outcomes more. This paper will also discuss the patients

population that is generally requiring a procedure that uses radial or femoral access. Certain

cardiac procedures generally use a radial or femoral access site. The most common cardiac

procedure is a cardiac catheterization. A cardiac catheterization can be performed for multiple

reasons. Some of these reasons include Non ST elevated segment, ST elevated segment, low

ejection fraction or for exploratory reasons. There are other reasons why a cardiac catheterization

can be performed but these are the most common.

Problem Significance

The purpose of this paper is to prove and discuss the advantages of using radial access

during a cardiac catheterization versus femoral access. The articles that will be discussed below

in the literature review will prove that radial access has less complications than femoral access

for patients after the procedure. The proposed solution is for hospitals to attempt to use radial

access before using femoral access to prevent and lower complications for patient post

procedure.

Recommendations

The recommendation for this paper is for hospitals to try the radial approach first when

using arterial access for procedures. If the radial approach is contraindicated, then medical

professionals can try the femoral approach. It is proven that using the radial approach has less

complications for the patient.

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Literature Review

The first article reviewed is “Radial versus femoral access for coronary angiography and

intervention in patients with acute coronary syndromes (RIVAL): a randomized, parallel group,

multicenter trial.” This article is a quantitative study. This article studies two groups of people

who receive femoral and radial access. The study showed the rate of non-CABG-related major

bleeding at 30 days was 24 (0·7%) of 3507 patients in the radial group compared with 33 of 3514

patients in the femoral group. Pseudoaneurysm needing closure occurred in 7 of 3507 patients in

the radial group compared with 23 of 3514 in the femoral group. At 30 days, 42 of 3507 patients

in the radial group had large hematoma compared with 106 of 3514 in the femoral group

(Budaj.2011). This article proves that it is safer to use a radial access versus a femoral access.

The next study that was researched is titled “Radial Versus Femoral Access for Coronary

Interventions Across the Entire Spectrum of Patients with Coronary Artery Disease.” This study

is a quantitative study. Twenty-four studies enrolling 22,843 participants were included during

this study. The results of this study showed that radial access had a lower mortality rate than

femoral access. The study was performed on patients who experience a myocardial infarction

(heart attack), coronary artery disease and acute coronary syndromes (Windecker. 2017).

The third study that was used is titled “Radial versus Femoral Access for Coronary

Angiography or Intervention and the Impact on Major Bleeding and Ischemic Events.” This

study examined studies from 1980 to 2008 and reviewed abstracts from 2005 to 2008. This study

is a qualitative study considering it is just reviewing a set of studies that have already occurred.

Researchers came to the conclusion that radial access had less complications than femoral
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access. “Radial artery access reduced major bleeding 73% compared to femoral access (0.05%

vs. 2.3%, p <0.001) and identified a trend for reductions in composite of death, myocardial

infarction (MI), and stroke (2.5% vs. 3.8%, p = 0.058)” (Jolly. 2009).

The fourth study that was reviewed is titled “Ipsilateral radial and ulnar artery

cannulation during the same coronary catheterization procedure.” This study is considered a

quantitative study. This study researches the risks and benefits of switching to a femoral artery

after a failed radial or ulnar artery, which can carry an increased risk considering these patients

are already anticoagulated. This study showed that it increases the patients chance of bleeding if

the medical professional performing the procedure switched from a radial to a femoral approach

during the procedure. Patients are anticoagulated prior to a cardiac catheterization, the reasoning

behind this is to thin the blood and break up the clot so that way if there is a clot the physician

can still use the artery for the procedure. There for using a femoral approach increases the risk of

bleeding because the artery in located in the groin instead of the wrist (Didagelos. 2016).

The last article reviewed is titled “Radial versus femoral access in patients with acute

coronary syndromes with or without ST-segment elevation.” This article is considered a

quantitative study. This study proves that radial access has less complications than femoral

access.

Conclusion

In conclusion radial access has been proven to have less complications than femoral

access after a cardiac procedure. Radial access has been proven to have decreased complications

such as hematomas, aneurysm, bleeding and infection. Trying to switch to femoral access after

already attempting radial access in a cardiac catheterization increases the risk of bleeding
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because patients are already anticoagulated. The recommendation for health care facilities is to

attempt to use radial access versus femoral access to decrease complications for patients post

procedure.
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References

Budaj, A., Chrolavicius, S & Xavier, D., (2011). Radial versus femoral access for coronary

angiography and intervention in patients with acute coronary syndromes (RIVAL): a

randomised, parallel group, multicentre trial. Retrieved from: https://www.

redheracles.net /media/upload/research/pdf/214706711323256902.pdf

Didagelos, M., Ziakas, A & Koutouzis, M. (2016). Ipsilateral radial and ulnar artery cannulation

during the same coronary catheterization procedure. Retrieved from: Hippokrati, 20,(3),

249-251

Eur, H., (2017). Radial versus femoral access in patients with acute coronary syndromes with or

without ST-segment elevation. Retrieved from: https://www.ncbi.nlm.nih.gov/

pubmed/28329389

Jolly, S., Amlani, S., Hamon, M., Yusuf, S., Mehta, J., (2009). Radial versus femoral access for

coronary angiography or intervention and the impact on major bleeding and ischemic

events: a systematic review and meta-analysis of randomized trials., American heart

journal, 157 (1) 132-40

Windecker, S., Reimers, B., & Costa, D., (2016). Radial Versus Femoral Access for Coronary

Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease.

Retrieved from: http://interventions.onlinejacc.org/content/9/14/1419