Transcript radial artery cannulation

Radial Approach
Anatomy: Upper limb Arteries
 Upper Limb:
 Hand:
 Radial artery
 Ulnar artery
 Deep palmar arch
 Superficial palmar arch
 Digital arteries
 Radial artery
 Ulnar artery
 Recurrent artery
 Brachial artery
 Axillary artery
 Subclavian artery
 inominate artery
 radial artery cannulation:
 short needle
 30°C angulation for cutaneous puncture
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Arterial
Access
Radial Approach
Arterial
Access
Patient Selection: Allen Test
 To 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:: Oxymeter
Only radial artery compression
No significative variation
Radial Approach
Arterial
Access
Right Transradial 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.
Radial Approach
Arterial
Access
Materials and Medications
Isoptine 5mg
5F short
radial sheath
xylocaïne
 Different materials are now available for the arterial puncture. Since the usage of verapamil
for arterial spasm prevention short sheaths are most frequently used and easy to retrieve at the
end of the procedure.
 Spasmolytic coktail: because the radial aretry is very spastic as soon as the sheath
is inserted in the artery 5mg of verapamil is directly injected in the artery as a bolus.
 Anticoagulation: systematic anticoagulation even during a dignostic procedure is
recommended to limit the occurrence of subsequent radial artery occlusion following the procedure.
Heparin is injected intravenously (5 OOO UI IV as a bolus).
Radial Approach
Arterial
Access
Sheath Installation, Arterial Cannulation
 After local anesthesia the short needle is used for radial artery puncture and the soft 0.018
wire 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 easier
to place and to remove (5F, 6 F).
Radial Approach
Sheath Removal: Compression
 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.
Arterial
Access