How to TRY TRI

Puncture

How to Puncture

TRI Basics Puncture  

How to puncture radial artery and place introducer sheath.

Needle Handling

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Pencil style

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Syringe style

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Bevel side up

Two Types of the Puncture with Proper Needle
  Anterior puncture Double wall puncturen
Pros One action Easy to target small artery Less bleeding until wire insertion.
Cons Shallow angle is critical to avoid possible perforation Need double action
Needle

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Metal needle

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Plastic needle
Method

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Insert the needle into the artery; blood flush

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 Insert guidewire

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Insert the needle into and over the artery; no flush 

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Remove inner needle

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 Blood flush

RATE trial *1 showed both are equally safe, and double wall puncture was quicker. Access time (sec.) : 134.2 + 87.5 vs 78.3 + 37.7, p<0.001

Puncture Using Ultrasound

Top Body

RAUST (Radial Artery Access With Ultrasound Trial) *2 suggest “Seeing is more accurate than feeling”. Ultrasound guidance improves the success and efficiency of radial artery cannulation.

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Reference