Is it always useful to prepare the femoral access before a coronarography?

Abstract

Our department performs 1600 coronarographies and 800 angioplasties each year. We started the radial artery approach in 2002. In 2016, 94% of the procedures were performed via radial access. The remaining 6% performed via femoral artery occurs when the radial access is impossible or led to a failure. The standard protocol to prepare the patient includes the 2 options: the patient is shaved at the 2 radial arteries and the 2 groin folds widen in the shape of shorts, then disinfected with Betadine. The patient preparation time is 10 minutes, which represents 280 hours per year. The groin folds shaving is sometimes not well understood and perceived by modest patients, and caregivers sometimes feel uncomfortable. After the learning period, the conversion rate from radial to femoral access appeared to be extremely low to the point that we no longer prepared patients for a femoral access procedure if it is not a first-line indication. A new protocol has been created: simple soap wash around the groin folds (widen area) before the examination and cardiac catheterization procedure. In the event of failed right and left radial artery approach, the protections below the surgical area are removed, the groin is smeared with Betadine through the window that has been created. Femoral artery puncture will be performed without preliminary shaving. Three patients among more than 1600 underwent an unplanned femoral access intervention. Patient follow-up showed no complication, especially no infectious complication. In an institution specialized in radial access, femoral access conversion is exceptional. With an appropriate patient selection, preparing patients for a femoral access procedure by shaving them in the femoral area is not necessary. This protocol, established with the hospital hygiene committee, reduces the patient preparation time and makes modest patients more comfortable.