RCIS Vascular Access and Closure Devices 2 — Questions and Answers
Question 1: Radial artery spasm during transradial catheterization is best managed initially with:
- Immediate sheath removal
- Intra-arterial nitroglycerin or verapamil through the sheath (Correct answer)
- Conversion to femoral access
- Increasing heparin dose
Correct answer: Intra-arterial nitroglycerin or verapamil through the sheath
Intra-arterial vasodilators such as nitroglycerin or verapamil administered through the sheath are first-line treatment for radial artery spasm.
Question 2: What is the recommended activated clotting time (ACT) target during percutaneous coronary intervention (PCI) with unfractionated heparin?
- 150–200 seconds
- 250–300 seconds (Correct answer)
- 300–350 seconds
- 400–450 seconds
Correct answer: 250–300 seconds
An ACT of 250–300 seconds is the standard anticoagulation target during PCI with unfractionated heparin to prevent catheter-related thrombosis.
Question 3: After femoral sheath removal, a pulsatile mass develops at the access site — this is most consistent with:
- Arteriovenous fistula
- Retroperitoneal hematoma
- Femoral pseudoaneurysm (Correct answer)
- Lymphocele
Correct answer: Femoral pseudoaneurysm
A pulsatile mass at the femoral access site after sheath removal is the classic presentation of a pseudoaneurysm, confirmed by ultrasound with a characteristic to-and-fro Doppler signal.
Question 4: Which hemostasis device is most commonly used to achieve radial artery compression after transradial catheterization?
- Figure-of-eight suture
- TR Band (transradial compression device) (Correct answer)
- AngioSeal closure device
- Perclose ProGlide
Correct answer: TR Band (transradial compression device)
The TR Band is a pneumatic wristband device specifically designed for radial artery hemostasis after transradial catheterization.
Question 5: Subclavian vascular access for catheterization carries the highest risk of which complication compared to femoral or radial access?
- Arteriovenous fistula
- Retroperitoneal hematoma
- Pneumothorax (Correct answer)
- Pseudoaneurysm
Correct answer: Pneumothorax
Subclavian vascular access carries a significant risk of pneumothorax due to the proximity of the subclavian vessels to the lung apex.
Question 6: What is the primary purpose of using hydrophilic-coated sheaths for transradial access?
- Reduce radiation exposure
- Decrease sheath insertion force and reduce arterial trauma and spasm (Correct answer)
- Improve contrast injection pressure
- Enable larger catheter sizes
Correct answer: Decrease sheath insertion force and reduce arterial trauma and spasm
Hydrophilic-coated sheaths reduce friction during insertion and withdrawal, minimizing trauma to the radial artery and decreasing the risk of spasm.
RCIS Vascular Access and Closure Devices 2
Radial artery spasm during transradial catheterization is best managed initially with: