TRI Puncture

How to TRY TRI

How to Puncture

TRI Basics Puncture  

How to puncture radial artery and place introducer sheath.

Needle handling
Pencil style of needle handling (image)

Pencil style

Syringe style of needle handling (image)

Syringe style

Tip of the needle (image)

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
Metal needle (image)
Metal needle
Plastic needle (image)
Plastic needle
Puncture method (image)

Insert the needle into the artery; blood flush

Puncture method (image)

 Insert guidewire

Puncture method (image)

Insert the needle into and over the artery; no flush 

Puncture method (image)

Remove inner needle

Puncture method (image)

 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.

Ultrasound vs. Palpation (image)