B-02: Arteriogram - Axillary/Brachial Approach

• Indications
  • Indicated arteriogram with inadequate femoral access
  • Femoral (ABF, bilateral FP, or FF) grafts
  • Interventions in arteries of hand (antegrade brachial puncture)
• Contraindications
  • Contrast allergy (premedicate)
  • Uncorrected coagulopathy
  • Planned thrombolytic therapy (relative)
• Patient Evaluation
  • Impaired shoulder mobility
  • Pulse / pressure deficits in upper extremity
• Preprocedure Orders
  • Routine
• Tools
  • Micropuncture entry set or modified Potts needle
  • Newton wire
  • 90cm 5Fr. pigtail
• Entry site
  • Proximal brachial artery distal to axillary crease
• Technique
  • Newton wire to arch - use variable stiffness of Newton to open pigtail in arch and direct wire into descending aorta. An RC2 or Cobra catheter can be used where the pigtail technique does not work.
• Post-procedure Note
  • Routine - note axillary/brachial puncture site
• Post-procedure Orders
  • Use preprinted standard orders for arteriography via axillary puncture (Appendix C-1)

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