How to TRY TRI
Puncture
How to Puncture
TRI Basics Puncture
How to puncture radial artery and place introducer sheath.
Needle handling
Pencil style
Syringe style
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 |
 |
 |
| Method |
 Insert the needle into the artery; blood flush  Insert guidewire |
 Insert the needle into and over the artery; no flush  Remove inner needle  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
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.
