The use of radial artery access for coronary intervention has grown in popularity worldwide. Its use reduces significantly vascular access complications when compared to the more established femoral artery access.
Use of the radial artery however, is prone to development of spasm which can be painful to the patient and in severe instances prevent procedure completion. The use of radial sheaths is designed to minimise this complication. The Terumo radial sheath is a hydrophilic outer sheath with a side arm and comes with its own dilator. I have used both the 5F and 6F sizes. The pack comes with its own needle and plastic sheath and a hydrophilic wire.
The recommended technique used for the Terumo kit is the “back wall” puncture. As someone who is used to an “open needle” technique for radial artery punctures, this was not initially intuitive but after 3 successful attempts I was happy to use the kit.
The most obvious feature is the high quality of the needle and sheath that is apparent from the initial tactile feedback. Compared to other sheaths I use, this is stiffer and has a dilator that is by far the best I have seen to date. Once the artery has been canulated with the needle and its plastic sheath, the needle is withdrawn and the plastic sheath advanced into the artery lumen. With good flow back of blood established, the hydrophilic wire is advanced through the plastic sheath and the latter withdrawn once the wire is advanced without resistance. The radial sheath with dilator is then advanced over the wire.
Hydrophilic sheath and dilator are of robust construction. The wire is a straight tip hydrophilic wire. The latter is 0.021” and is straight tip. This is very different from the 0.018” non hydrophilic wires used by other manufacturers and initial impression is that the wire is the weak link of the Terumo kit. For this operator the “J” floppy tip 0.018 wire present in the Cook radial sheaths is the gold standard.
I have used the device 5 times with 100% success and no radial spasm. Of interest, trainees appear to have a preference for this sheath and now use this as their default kit.
I use the Kimmel 11cm radial sheath with a Vygon paediatric needle. Whilst the Terumo feels superior and undoubtedly has a superior dilator and sheath, two reasons prevent me from using the Terumo for all cases:
1) the straight tip hydrophilic wire and
2) increased cost.
An excellent radial sheath that is let down by a bulky wire that is difficult to torque.
Dr Azfar Zaman
Consultant Cardiologist, Freeman Hospital, Newcastle upon Tyne
No conflict declared.
posted by phil on 27 November 2009 20:54:07
Rajagopal, There is a 7F version:
http://www.terumo-europe.com/_angio_pdf/introducers_en.pdf
but I would not be overly keen to have a sheath this size in the average radial artery. I'm not a cardiologist, maybe this is normal practise ?
posted by Rajagopal on 27 November 2009 18:32:46
I tend to disagree with the wire part. Unlike the metal J tipped wire , the terumo wire never passes into false lumen and even if it does, it will not create a hematoma. I have used this in more than 2000 cases and feel that this is the best. using a Cook's needle and a Terumo wire produces the best results
I would like to know if Terumo markets 7F radial sheaths?
posted by Rajagopal on 26 November 2009 18:12:20
I tend to disagree with the wire part. Unlike the metal J tipped wire , the terumo wire never passes into false lumen and even if it does, it will not create a hematoma.
I have used this in more than 2000 cases and feel that this is the best. using a Cook's needle and a Terumo wire produces the best results
