ArterialAccess

Radial ApproachAn

atom

y : U

pper

Lim

b Ar

terie

s

hamon-m@chu-caen.fr

Hand:Hand: Radial artery Ulnar artery Deep palmar arch Superficial palmar arch Digital arteries

Upper Limb:Upper Limb: Radial artery Ulnar artery Recurrent artery Brachial artery Axillary artery Subclavian artery inominate artery

radial artery cannulation:radial artery cannulation: short needle 30°C angulation for cutaneous puncture

Anatomy: Upper limb Arteries

ArterialAccess

Radial ApproachPa

tient

Sel

ectio

n : A

llen

Test

To assess contribution of radial and ulnar arteries in blood supplyof handTo assess contribution of radial and ulnar arteries in blood supplyof hand:make chenked fist and occlude both radial and ulnar arteries. When fist is open skin is pale, colour should return rapidly on release ofvulnar artery as shown in the above figures. An obvious delay after releasing ulnar artery indicates that the radial aretry is dominant and that procedures that Might damage the radial artery (eg cannulation) should be avoided.

Alternative to the Allen test:: Alternative to the Allen test:: OxymeterOxymeter

Only radial artery compressionOnly radial artery compression No significative variationNo significative variation

Patient Selection: Allen Test

ArterialAccess

Radial Approach

A table extension is required for the upper limb installation. Right trans-radial approach A table extension is required for the upper limb installation. Right trans-radial approach allows the operator to work in conditions very closed to the traditional femoral access site.Different steps of patient installation are depicted in the above figures. Note that for the arterial puncture the arm is in abduction and as soon as the sheath is placed in the artery the articulated extension of the table makes possible to put the arm along the body.

Righ

t Tra

nsra

dial

App

roac

h

Right Transradial Approach

ArterialAccess

Radial Approach

Different materialsDifferent materials are now available for the arterial puncture. Since the usage of verapamil are now available for the arterial puncture. Since the usage of verapamilfor arterial spasm prevention short sheaths are most frequently used and easy to retrieve at theend of the procedure. Spasmolytic coktail: because the radial aretry is very spastic as soon as the sheathis inserted in the artery 5mg of verapamil is directly injected in the artery as a bolus. Anticoagulation: systematic anticoagulation even during a dignostic procedure isrecommended to limit the occurrence of subsequent radial artery occlusion following the procedure.Heparin is injected intravenously (5 OOO UI IV as a bolus).

xylocaïneIsoptine 5mg

5F shortradial sheath

Mat

eria

ls An

d M

edica

tions

Materials and Medications

ArterialAccess

Radial Approach

After local anesthesia the short needle is used for radial artery puncture and the soft 0.018After local anesthesia the short needle is used for radial artery puncture and the soft 0.018wire inserted in the artery as soon as the blood flow is good.Never forced to put the wire within the artery.Given the small caliber of the radial artery short needles are recommended (blood return) and gentle bevel preferred (wire manipulation) with straight floppy tip wires. Shorter steaths are easierto place and to remove (5F, 6 F).

Shea

th In

stal

latio

n, A

rteria

l Can

nula

tion

Sheath Installation, Arterial Cannulation

ArterialAccess

Radial Approach

At the end of the procedure the sheath is immediately removed by the operator.At the end of the procedure the sheath is immediately removed by the operator.A compressive bandage is then applied on the arterial access site for 4 hours.

Sheath Removal: Compression

Shea

th R

emov

al:

Com

pres

sion