Randomized trial of task-shifted radial sheath insertion in coronary angiography and PCI: impact on patient experience and procedural efficiency

Background

Radial access is the default strategy for coronary angiography (CAG) and percutaneous coronary intervention (PCI). Traditionally, sheath insertion is performed by the interventional cardiologist. Previous nurse-led interventions in cardiovascular care, such as venous sheath removal and post-procedural monitoring, have been shown to be safe and effective. Optimising cath lab workflow and patient-centred care is increasingly important in high-volume centres. We investigated whether task-shifted radial sheath insertion performed by trained cath lab nurses is safe and associated with improved patient experience and procedural efficiency compared with conventional physician-led insertion.

Methods

In this single-centre, randomised controlled trial, 1,188 patients undergoing CAG and/or PCI were allocated 1:1 to radial sheath insertion performed by trained cath lab nurses or physicians. Co-primary endpoints were patient-reported pain (Numeric Rating Scale [NRS], 0–10) and patient-reported comfort/safety (Comfort Rating Scale [CRS], 0–10). Secondary endpoints included sheath insertion time (from sterile preparation to sheath placement), radial artery occlusion (RAO) before discharge, ultrasound use, and procedural success.

Results

A total of 1,188 patients were included (73% male; median age 68 years [IQR 61–75]). Baseline characteristics were balanced between the groups (Table 1). Nurse-led sheath insertion was associated with significantly lower patient-reported pain compared with physician-led insertion (mean NRS 1.46 (SD 1.67) vs 2.82 (SD 2.45); mean difference -1.37 (95% CI -1.61 to -1.12), p<0.001). Patient-reported comfort was modestly but significantly higher (mean CRS 9.78 (SD 0.75) vs 9.38 (SD 1.25); mean difference 0.39 (95% CI 0.26 to 0.52), p<0.001).

Nurse-led insertion markedly reduced mean sheath insertion time (4.65 (SD 4.63) vs 11.55 (SD 6.68) minutes; mean difference -6.90 minutes (95% CI -7.57 to -6.23), p<0.001), representing a substantial improvement in procedural efficiency (Figure 1).

Procedural success was high and similar between groups (99.6% vs 98.9%, p=0.131). RAO rates were low with no significant difference (0.38% vs 0.35%, p=0.296). Ultrasound guidance was more frequently used in the nurse-led group (8.5% vs 4.2%; p=0.003).

Conclusions

In a large randomised trial, task-shifted radial sheath insertion performed by trained cath lab nurses improved patient-reported pain and comfort and substantially reduced insertion time without compromising procedural success or early vascular safety outcomes.

These findings support structured task-shifting strategies as a potential approach to enhance patient-centred care and cath lab efficiency in contemporary radial practice.For image description, please refer to the figure legend and surrounding text.Figure 1For image description, please refer to the figure legend and surrounding text.