In modern interventional cardiology, the central circulation is accessed for many reasons, ranging from coronary imaging and intervention, to hemodynamic measurement, myocardial biopsy, valvular interventional procedures, diagnosis and treatment of congenital heart disease, and multiple other indications. Each of these indications requires a careful assessment of potential sites for vascular access. Each access point may have distinct advantages and disadvantages. For example, radial arterial access or brachial venous access may be particularly appropriate in some patients with coagulopathy due to a lower incidence of bleeding. Femoral venous access on the right is often the preferred approach for patients needing a trans-septal approach to the left side of the heart. Thus each procedure requires careful consideration of both patient-specific and procedural factors can vary widely. Technical factors play an important role as does the coagulation system. Some patients have inherent abnormalities of hemostasis (such as hemophilia) while others may have acquired bleeding risk (such as thrombocytopenia in hepatic failure). Some patients will have cultural issues that interact with the treatment of bleeding such as in Jehovah’s Witness patients. A rapidly expanding array of anticoagulation medications used to treat thrombotic disorders add complexity to interventional procedures.

Course Details

In this course, you will learn:
  • To describe the unique aspects of vascular access into the internal jugular vein including technique, indications, and avoidance of complications
  • To describe the unique aspects of vascular access into the brachial artery including technique, indications, and avoidance of complications
  • To describe the unique aspects of vascular access into the radial artery including technique, indications, and avoidance of complications

Method and medium:

Learners participate in the interactive learning modules by correctly answering multiple choice questions dispersed throughout. Learners will be prompted to try again if a question is answered incorrectly.

The course will open in a new tab – to exit the course, simply close that tab.


Estimated time to Complete: 30 minutes
Credit/contact hours: .5
Expiration date: Nov 6, 2022
Publication date: Nov 6, 2019

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Course Author

Michael Ragosta III, MD

Professor of Medicine/Cardiology

Dr. Michael Ragosta is an attending cardiologist at the University of Virginia Health System with a sub-specialty in interventional cardiology. 
Learn More about Michael Ragosta III, MD.

DISCLOSURE: This individual reports no relevant financial relationships with commercial entities.