Dilution of Verapamil During Intraarterial Administration

Does Dilution of Verapamil With Normal Saline or Blood Reduce Discomfort Felt During Intraarterial Administration?

This study will be a randomized, single-blind, prospective trial designed to evaluate the efficacy and safety of intra-arterial (IA) Verapamil diluted with normal saline compared to undiluted IA Nicardipine during transradial access (TRA) for percutaneous coronary angiography. Patients who are 18 years or older and undergoing non-emergent percutaneous coronary angiography via TRA will be included. Patients who are non-English speaking, pregnant, or intubated will be excluded. Patients will be randomized to one of the two following groups: Group 1 will receive IA Verapamil 5 mg (2mL) diluted with 8 mL of normal saline Group 2 will receive IA Nicardipine 400 mcg (undiluted, 8 mL) The investigators will document the patient's level of discomfort on the Visual Analogue Scale 30 seconds before and after administration of IA Verapamil/Nicardipine. The investigators will also document the presence of radial artery spasms.

All patients routinely receive intra-arterial calcium channel blockers during transradial access for coronary angiography.

The investigators will document the presence or absence of radial artery spasms with either 0,1, or 2. 0 will indicate no radial artery spasms. 1 will indicate radial artery spasms that did not require a change in strategy. 2 will indicate radial artery spasms that required a change in strategy such as alternate access.

Pain prior to intra-arterial calcium channel blocker administration will be assessed through the Visual Analogue Pain scale (from 0 to 10).

Pain after intra-arterial calcium channel blocker administration will be assessed through the Visual analogue Pain Scale (from 0 to 10).

Inclusion Criteria English Speaking patients who are age 18 or older Patient must be able to provide own consent and communicate with staff Patient's undergoing transradial access (TRA) for the left heart catheterization (LHC) Exclusion Criteria Intubated or sedated patients Agitated patients requiring moderate sedation prior to TRA Patient's undergoing femoral access for the LHC Non-English speaking patients Contraindications to Verapamil or Nicardipine: including allergies to these medications, hypotension (mean arterial pressure <65), Bradycardia (heart rate<40) Emergent cardiac catheterization Inability to obtain radial artery access Conversion to radial artery access from another access site