CathLabHub complications toolkitcathlabhub.com/toolkit/radial-spasm-occlusionIn review, October 24, 2026
Recognize
The signs on the monitor, the image and the patient.
- PatientForearm pain with catheter movement; resistance to advancing or withdrawing a catheter 1.
- ImageA narrowed radial artery around the catheter on a forearm angiogram.
- PatientOcclusion: usually no symptoms; rarely hand pain; absent radial flow on duplex, though a pulse may come from the palmar arch 12.
Act now
In the order the operator does them. The first three come first, whatever else is happening.
- Stop moving the catheter; never pull against resistance, which can avulse the artery 1.
- Intra arterial vasodilator through the sheath: verapamil 2 to 3 mg, nitroglycerin 100 to 200 mcg, or nicardipine 100 to 200 mcg 2.
- More sedation and analgesia 1.
- Warm compresses over the forearm 1.
- Inflate a cuff above systolic on the upper arm for 5 minutes, then release 1.
- Severe and refractory: deep sedation or general anesthesia 1.
- Occlusion: most need no treatment; consider anticoagulation; recanalization only for symptoms 1.
Equipment
From the complications cart. Linked items open in the equipment directory.
- Thin wall radial sheaths of the smallest useful sizeDirectory: Glidesheath Slender, Rain Sheath transradial thin walled introducer.
- Radial band with patent hemostasisDirectory: TR Band, PreludeSYNC DISTAL.
- Blood pressure cuff and warm towelsNot in the directory yet.
Drugs
Adult doses as the cited source gives them. Check your formulary and the label.
- Verapamil intra arterial2 to 3 mg 23.Product in the directory
- Nitroglycerin intra arterial100 to 200 mcg 2.Product in the directory
- Heparin for radial patency50 units/kg up to 5000 units for diagnostic cases; 100 units/kg may be more effective 2.Weight based dose in the Cath Med App
Who to call
The escalation ladder, first call first.
- Operator: before any forceful withdrawal.
- Anesthesia: for deep sedation in refractory spasm 1.
- Hand or vascular surgery: for a forearm hematoma after a radial injury or hand ischemia.
The bailout step by step
Freeing a catheter trapped by radial spasm 12
- Stop; keep the catheter still.
- Give an intra arterial vasodilator through the sheath side arm 2.
- Increase sedation and analgesia.
- Warm saline soaked gauze around the forearm for several minutes 1.
- Upper arm cuff above systolic for 5 minutes, then deflate and try a gentle pull 1.
- Still stuck: deep sedation or general anesthesia before any further traction 1.
Prevent
- Ultrasound guided access, adequate local anesthesia and sedation 1.
- A vasodilator after access, and a thin wall sheath of the smallest possible size 12.
- Heparin during the case; patent hemostasis with compression for 2 hours or less; ulnar compression helps 145.
- Distal radial access lowers occlusion risk 1.
After care and documentation
- Check radial patency before discharge (plethysmography or duplex) 5.
- Document the vasodilators, the sheath size and the hemostasis method.
Practice
No emergency simulator case for radial spasm yet. Browse the case library.
References
- Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 29, Vascular access complications.
- Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 4, Access.
- Brilakis ES. Manual of Percutaneous Coronary Interventions: A Step-by-Step Approach. Academic Press, Elsevier; 2021. Chapter 3, Medications.
- Brilakis ES. Manual of Percutaneous Coronary Interventions. Elsevier; 2021. Chapter 11, Access closure.
- Bernat I, Aminian A, Pancholy S, et al. Best practices for the prevention of radial artery occlusion after transradial diagnostic angiography and intervention: an international consensus paper. JACC Cardiovasc Interv 2019;12:2235-2246.
Educational reference for cath lab teams, not medical advice and not a standard of care. Your local policy, the device instructions for use and current guidelines govern. Verify every dose before use. Printed from cathlabhub.com/toolkit/radial-spasm-occlusion. First version, in clinical review: an interventional cardiologist is checking every card before it is final. Every number cites its source on the card.