Trans-radial

Cardiac catheterization is a medical procedure in which a tube is threaded into an artery to pinpoint narrowed segments or blockages of blood to the heart. Catheterization also can detect faulty heart valves or it can be used to insert stents to widen narrow vessels – all without invasive surgery.

Dr. Steven Bruhl, a cardiologist, earned a medical degree in 2005, came to Tiffin in 2011 and helped to plan Mercy Tiffin Hospital’s heart catheterization lab. It opened in October 2012.

More recently, Bruhl has adopted a newer heart catheterization method done through the radial artery in the wrist, rather than through the femoral artery in the groin. He said about 16 percent of catheterizations in the U.S. are done this way, in contrast to higher percentages in other countries. Bruhl is sold on the trans-radial procedure. Even with everything in order, problems can occur.

“The best cardiologists in the world have complications … even the most careful people, unfortunately, have serious complications, but these risks can be reduced through a trans-radial approach,” Bruhl said.

Having gathered statistics at Mercy Tiffin, Bruhl said about 90 percent of the last 400 heart catheterizations have been done trans-radially.

“In addition to (being) safer, it is patient-preferred 9-to-1 over going through the leg,” Bruhl said. “The first three months of starting out on my own, I made a commitment; we’re going to do all of them through the wrist, if possible.”

Two studies in the last year have shown the trans-radial procedure lowers the risk of complications and death, while improving patients’ comfort level. Patients who undergo trans-femoral catheterization must lie on their backs for two to six hours or longer in order to stop bleeding from the entry site. People with back problems may become uncomfortable in that position. Catheterization through the wrist shortens or even eliminates the time needed for lying flat.

Bruhl said trans-radial catheterization takes a bit more time because it is technically more difficult. Busy doctors may choose the traditional method to save time. Also, additional training is required for doctors and lab staff, and different catheters need to be purchased. Most of the medical programs in the U.S. teach the traditional method.

Bruhl said he received training at University of Toledo Medical Center, but several other centers in the U.S. are offering two-day, hands-on training. With planning, any cath lab could make the switch at minimal cost, Bruhl said. A willingness to change and to get training are the most important elements.

Catheterization patients can choose to be anaesthetized or they can remain awake and watch the procedure on the screen as it is performed. Bruhl explains what he observes and takes questions from patients. Generally, they only need about two hours of observation after the procedure. He said most patients have been pleased with the comfort level.

“The patients are equally happy they are able to get up, eat, drink and use the bathroom immediately after the procedure,” Bruhl said. “I have no doubt, this is the future.”

A small percentage of patients are not good candidates for trans-radial catheterization, he added. They include people needing the placement of larger stents, who have blockages in the shoulder area or whose radial arteries are damaged.

Bruhl said even patients with carpal tunnel problems can have successful catheterization through the wrist. Usually, the procedure is done on the right wrist, although patients older than 85 get better results through the left arm.

In a visit to the cath lab, Bruhl pointed out the various equipment. X-rays are used to guide a wire through the blood vessels. Then a tube is inserted and dye is injected to make blockages more visible. A fluoroscope rotates around the patient, and the table can be moved to various positions to get the best view of a trouble spot. Bruhl called the device “a kind of movie camera X-ray” that allows him to see the heart in motion.

“As the wire goes up there, I’m watching it the entire time to make sure it’s going to the right spot. As the catheter is coming up, we take the wire out and the catheter we manipulate to go into the coronary arteries. Once it’s in the arteries, then we shoot in clear liquid that goes through the catheter, and down the arteries to see if the arteries have blockages,” Bruhl said.

Doctors at distant Mercy hospitals also can view the catheterization in real time and request to view the patients’ arteries from different angles. Bruhl said what looks normal in one position may show a bulge or blockage when viewed from a different angle. If a patient needs surgery to the heart or vessels, the videos are kept on file for reference.

Patients with severely blocked arteries may need to have by-pass surgery in which healthy blood vessels are implanted to re-route blood around the blockage. Bruhl said arteries from other parts of the body can be removed and transplanted to the places they are needed. He said it is amazing to watch the surgeons suture the vessels on either side of the blockage and bypass the diseased segments.

Bruhl said he and his partner cardiologist at Mercy Willard Hospital, Dr. Gregory Vigesaa, are trained to perform trans-radial catheterizations, as is the staff at Mercy Tiffin Hospital. Denise Brooks is the head registered nurse in the Mercy Tiffin cath lab. Bruhl said caring and competent staff are crucial to good patient outcomes.

“I happen to think I have the greatest cath lab staff anywhere around. … To be able to hand-pick people from the beginning has made it a great place to work. Very dedicated people makes it so much more enjoyable,” Bruhl said.

Trans-radial

Cardiac catheterization is a medical procedure in which a tube is threaded into an artery to pinpoint narrowed segments or blockages of blood to the heart. Catheterization also can detect faulty heart valves or it can be used to insert stents to widen narrow vessels – all without invasive surgery.

Dr. Steven Bruhl, a cardiologist, earned a medical degree in 2005, came to Tiffin in 2011 and helped to plan Mercy Tiffin Hospital’s heart catheterization lab. It opened in October 2012.

More recently, Bruhl has adopted a newer heart catheterization method done through the radial artery in the wrist, rather than through the femoral artery in the groin. He said about 16 percent of catheterizations in the U.S. are done this way, in contrast to higher percentages in other countries. Bruhl is sold on the trans-radial procedure. Even with everything in order, problems can occur.

“The best cardiologists in the world have complications … even the most careful people, unfortunately, have serious complications, but these risks can be reduced through a trans-radial approach,” Bruhl said.

Having gathered statistics at Mercy Tiffin, Bruhl said about 90 percent of the last 400 heart catheterizations have been done trans-radially.

“In addition to (being) safer, it is patient-preferred 9-to-1 over going through the leg,” Bruhl said. “The first three months of starting out on my own, I made a commitment; we’re going to do all of them through the wrist, if possible.”

Two studies in the last year have shown the trans-radial procedure lowers the risk of complications and death, while improving patients’ comfort level. Patients who undergo trans-femoral catheterization must lie on their backs for two to six hours or longer in order to stop bleeding from the entry site. People with back problems may become uncomfortable in that position. Catheterization through the wrist shortens or even eliminates the time needed for lying flat.

Bruhl said trans-radial catheterization takes a bit more time because it is technically more difficult. Busy doctors may choose the traditional method to save time. Also, additional training is required for doctors and lab staff, and different catheters need to be purchased. Most of the medical programs in the U.S. teach the traditional method.

Bruhl said he received training at University of Toledo Medical Center, but several other centers in the U.S. are offering two-day, hands-on training. With planning, any cath lab could make the switch at minimal cost, Bruhl said. A willingness to change and to get training are the most important elements.

Catheterization patients can choose to be anaesthetized or they can remain awake and watch the procedure on the screen as it is performed. Bruhl explains what he observes and takes questions from patients. Generally, they only need about two hours of observation after the procedure. He said most patients have been pleased with the comfort level.

“The patients are equally happy they are able to get up, eat, drink and use the bathroom immediately after the procedure,” Bruhl said. “I have no doubt, this is the future.”

A small percentage of patients are not good candidates for trans-radial catheterization, he added. They include people needing the placement of larger stents, who have blockages in the shoulder area or whose radial arteries are damaged.

Bruhl said even patients with carpal tunnel problems can have successful catheterization through the wrist. Usually, the procedure is done on the right wrist, although patients older than 85 get better results through the left arm.

In a visit to the cath lab, Bruhl pointed out the various equipment. X-rays are used to guide a wire through the blood vessels. Then a tube is inserted and dye is injected to make blockages more visible. A fluoroscope rotates around the patient, and the table can be moved to various positions to get the best view of a trouble spot. Bruhl called the device “a kind of movie camera X-ray” that allows him to see the heart in motion.

“As the wire goes up there, I’m watching it the entire time to make sure it’s going to the right spot. As the catheter is coming up, we take the wire out and the catheter we manipulate to go into the coronary arteries. Once it’s in the arteries, then we shoot in clear liquid that goes through the catheter, and down the arteries to see if the arteries have blockages,” Bruhl said.

Doctors at distant Mercy hospitals also can view the catheterization in real time and request to view the patients’ arteries from different angles. Bruhl said what looks normal in one position may show a bulge or blockage when viewed from a different angle. If a patient needs surgery to the heart or vessels, the videos are kept on file for reference.

Patients with severely blocked arteries may need to have by-pass surgery in which healthy blood vessels are implanted to re-route blood around the blockage. Bruhl said arteries from other parts of the body can be removed and transplanted to the places they are needed. He said it is amazing to watch the surgeons suture the vessels on either side of the blockage and bypass the diseased segments.

Bruhl said he and his partner cardiologist at Mercy Willard Hospital, Dr. Gregory Vigesaa, are trained to perform trans-radial catheterizations, as is the staff at Mercy Tiffin Hospital. Denise Brooks is the head registered nurse in the Mercy Tiffin cath lab. Bruhl said caring and competent staff are crucial to good patient outcomes.

“I happen to think I have the greatest cath lab staff anywhere around. … To be able to hand-pick people from the beginning has made it a great place to work. Very dedicated people makes it so much more enjoyable,” Bruhl said.