What is your standard approach (i.e. choice of medication, type of sheath) in the cath lab to reduce the likelihood of radial artery spasm?

Adrenaline is the key vasoconstrictor here, especially in patients with vessels prone to repetitive nicotine-induced constriction, so conscious sedation helps blunt the ‘fright/flight/constrict’ of adrenaline, while a CCB vasodilator (verapamil or nicardipine) addresses local vasoconstriction. A small caliber (3/4 Fr or 4/5 Fr) hydrophilic sheath minimizes local mechanical vasoconstriction. Heparin (IV) is also part of our regimen, to minimize radial artery thrombosis.

So important that the patient is comfortable - needs good verbal interaction and adequate sedation. Hydrophilic sheath, vasodilators, and imaging.

Verapamil and nitroglycerin

We use nitro/verapamil and hydrophilic sheath.

Ultrasound-guided access, hydrophilic sheath, nitroglycerin, and adequate conscious sedation.

Well-informed patient, good sedation, hydrophilic sheath, NTG and Verapamil...