ABSTRACT
At the initiation of every case, access must be secured. The basic sheath provides access for medication and contrast, is advanced over a guidewire, may or may not have a radiopaque tip, secures the access site, prevents bleeding during the procedure, and is a place where diagnostic catheters can be introduced. Chapter 3 offers some advice about choosing an access site and making it safe. After the site is chosen, the access needle is placed in the artery, and the initial guidewire choice is introduced, then what?The usual situation is to proceed with placement of a standard access sheath, and then arteriography. A guiding sheath or guiding catheter is typically placed when the decision is made to treat a specific disease segment. Access for endovascular therapy is covered in chapter 14. A sheath is used on every case, from diagnostic arteriography to complex interventions. As soon as the needle is in the blood vessel, you will be ready to place a wire. This chapter includes the steps you need to take between when the needle is in the artery and when the access is secure.
