Twisting method for reducing friction during insertion of a sheath introducer and a sheathless guiding catheter
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ORIGINAL ARTICLE
Twisting method for reducing friction during insertion of a sheath introducer and a sheathless guiding catheter Yoshitoki Takagawa1
•
Tetsuaki Furukawa1
Received: 11 July 2016 / Accepted: 21 September 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract A sheathless system that inserts a catheter directly into the artery can reduce puncture site-related complications through a 2-Fr reduction of the outer diameter. However, the gap between the dilator and the guiding catheter of the sheathless system is larger than the gap between the dilator and sheath of the introducer system, resulting in stronger insertion resistance. A twisting method with rapid alternating rotation of a device to the left and right during insertion can reduce the insertion resistance. This method can be effective with the sheathless system which has a larger gap. To examine the effect of size reduction on the sheathless system and the effect of insertion resistance reduction using the twisting method, we developed an insertion simulator and compared insertion resistance to a 5-Fr sheath introducer and a 5-Fr sheathless system, with and without the twisting method. The insertion simulator pushed a sheath introducer or a sheathless system toward a mock artery consisted with a 5-mm urethane and a 1-mm rubber sheet by an electrical motor with or without twisting motion generated by a crank shaft. Insertion resistance during the penetration was measured by a tension meter. The insertion resistance was less with the 5-Fr sheathless system than with the 5-Fr sheath introducer. The resistance reduced further with use of twisting for both the sheathed and sheathless catheters. In conclusion, the experiment suggests the benefits of twisting insertion of a sheathless guiding catheter for reduction of puncture site-related complications.
& Yoshitoki Takagawa [email protected] 1
Department of Cardiovascular Medicine, Otaru General Hospital, 1-1-1 Wakamatsu, Otaru 047-8550, Japan
Keywords Transradial intervention Puncture site-related complication Twisting method Sheathless guiding catheter Sheath introducer
Introduction The transradial approach has several advantages over the transfemoral approach, including a lower incidence of bleeding complication, lower mortality and earlier ambulation in acute coronary syndrome, lower cost, and higher patient comfort [1–5]. However, the devices for use in the transradial approach have a size limitation because the radial artery has a relatively small vessel diameter. Furthermore, forced insertion of a sheath larger than the radial artery may cause arterial stenosis or obstruction [6, 7]. A sheathless system can reduce the maximum outer diameter of devices inserted into the radial artery by about 2-Fr through direct insertion of a guiding catheter. The sheathless insertion of a guiding catheter is assisted with a dilator. With the sheathless system, use of devices and techniques that were only thought possible with a transfemoral approach can al
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