Tables 5 and 6 list the SCAI expert consensus document requirements for PCI programs without on-site surgical backup. Table 7 gives the requirements for primary PCI and emergency CABG at hospitals without on-site cardiac sur- gery, and Table 8 lists the requirements for patient and lesion selection and backup strategy for nonemergency PCI.352 5. Procedural Considerations 5.1. Vascular Access: Recommendation Class IIa 1. The use of radial artery access can be useful to decrease access site complications.255,260,356 362 (Level of Evidence: A) See Online Data Supplement 21 for additional data regarding radial access. Femoral artery access remains the most commonly used approach in patients undergoing PCI in the United States. Choosing a femoral artery puncture site is facilitated by fluoroscopic landmark identification or ultrasound guidance. Low punctures have a high incidence of peripheral artery complications, whereas high punctures have an increased risk of retroperitoneal hemorrhage. In patients with a synthetic graft, arterial access is possible after the graft is a few months old and complication rates are not increased.254 Radial site access is used frequently in Europe and Canada but not in the United States.260 A learning curve exists for the radial approach that will affect procedure time and radiation dose, with a trend toward lower procedural success rates for radial versus femoral access.255 However, compared with femoral access, radial access decreases the rate of access- Table 5. SCAI Expert Consensus Document Personnel and Facility Requirements for PCI Programs Without On-Site Surgical Backup Experienced nursing and technical laboratory staff with training in interventional laboratories. Personnel must be comfortable treating acutely ill patients with hemodynamic and electrical instability. On-call schedule with operation of laboratory 24 h/d, 365 d/y.* Experienced coronary care unit nursing staff comfortable with invasive hemodynamic monitoring, operation of temporary pacemaker, and management of IABP. 