02 aimradial2016 thu2 T Matsukage
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Puncture: radial and ulnar, T Matsukage
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02 aimradial2016 thu2 T Matsukage
- 1. Pu n c t u r e R a d i a l a n d U l n a r A r t e r y Takashi Matsukage, Tokyo, Japan
- 3. Saito et al. Catheter Cardiovasc Interv. 1999 Feb;46(2):173-8. 3
- 5. Tips and Tricks appropriate position 5
- 6. The ideal puncture point was found to be at least 10 mm proximal to the Radial-Ulnar line Fujii T, et al. J Invasive Cardiol. 2010 Aug;22(8):372-6. 6
- 7. Tips and Tricks appropriate position cannulation 7
- 8. 8
- 10. skin incision 10
- 11. puncture 11
- 12. puncture 12
- 13. puncture 13
- 14. puncture 14
- 15. puncture 15
- 16. puncture 16
- 17. puncture 17
- 25. Tips and Tricks appropriate position cannulation difficult to puncture 25
- 26. puncture 26
- 28. radial puncture ultrasound guidance Shiloh AL et al. Chest. Mar;139(3):524-9. 28
- 29. Radial Artery Radial Vein radial puncture ultrasound guidance Shiloh AL et al. Chest. Mar;139(3):524-9. 29
- 30. radial puncture ultrasound guidance Shiloh AL et al. Chest. Mar;139(3):524-9. 30
- 32. 32 puncture Radial Bone Ulnar Bone Radial Artery Radial Nerve Ulnar Artery Ulnar Nerve
- 33. 33 puncture Master of Trans Ulnar Intervention
- 34. radial or the other side? ulnar? femoral? 34
Editor's Notes
- Good afternoon ladies and gentleman. I was very honored to receive this kind of invitation from AIM RADIAL. Today, I would like to talk about radial puncture. But I think all here knew about it.
- Good afternoon ladies and gentleman. I was very honored to receive this kind of invitation from AIM RADIAL. Today, I would like to talk about radial puncture. But I think all here knew about it.
- This slide shows the initial report about radial artery diameters was published in the journal CCI by Dr. Saito. According to the article, radial artery diameters of Japanese were average at 3.1mm for male and 2.8 mm for female patient.
- In other words, radial artery as absolutely small vessel is difficult to puncture than femoral artery.
- What do you feel are some of the very vital points in your experience of preparation of TRI? We think that finding a proper positioning is one of the important point.
- Dr. Fujii of my friend described using the line between the styloid process and the ulnar styloid process (R-U line) as an anatomical reference point. Radial puncture at 10 mm proximal to the R-U line could avoid bifurcation in more than 90% of cases. The radial puncture level should be proximal to the radial bifurcation, because of its larger lumen size. The point is approximately 2 to 3cm cranial to the bony prominence of the distal radius.
- How should we puncture for sure approach?
- We would like to our proposal of useful method of puncture for radial artery based on a lot of references with daub illustrations. .
- Administer small amount of lidocaine into the skin. A topical anesthetic cream or patch, placed over the planned puncture site early in the patient preparation area, helps to decrease discomfort and the amount of local lidocaine infiltration over the radial pulse. Avoid large amounts of lidocaine, as the wheal may obscure the pulse and make cannulation more difficult, if not impossible.
- Making a small incision for skin sometime decreased resistance of advance the needle.
- Use the catheter-over-needle cannula assembly at a 30 to 45 degree angulation. Using light palpation, center the needle over the artery, and keeping the needle at 30 degrees from the horizontal plane.
- Advancing needle to inside at 30 to 40 degree angle to stabilize radial artery by fleor carpi radialis muscle and radial bone.
- Patient dorsiflexes wrist also makes strike up and stabilize a radial artery.
- Enter needle into the skin just distal to palpated artery site.
- Slowly advance the needle until spontaneous blood enters.
- After appearance back flow of blood in a cannula, turn shallow angle.
- Next, advance the needle slightly and slowly, observing for blood. Blood will not pulse strongly due to the small bore of the needle. After entering the artery, do not move the needle.
- And remove an inner needle.
- Advance the guidewire into the artery. After the puncture, this is the second most difficult maneuver. When the guidewire does not advance smoothly, quickly consider why, and work to correct the problem and gain wire access before clot forms. The wire may not advance because of spasm, entry into a small branch, tip of guidewire in sub-intimal space or consider if the needle may be partly in the artery wall.
- Slowly advance outer cannula along the guidewire.
- A small amount of intradermal lidocaine additionally can be used before insert the sheath.
- And remove an outer needle.
- Insert put a wet sheath. Using a gentle rotational motion while advancing may facilitate placement. For skin that is less compliant to sheath advancement, some operators perform a superficial skin nick, being careful to avoid the arterial wall.
- Finally remove the guidewire.
- This method has been successful in daily practice in a large percentage of cases. However, we sometime encounter cases of difficult to puncture for small radial artery.
- If a 1st needle did not take a radial artery, inserting a 2nd needle leave a 1st needle may be easy to take a radial artery.
- This is an actual case of successful puncture using dual needle method. Sometimes, it be in a better position to puncture result from a radial artery secured by leaving a 1st puncture needle.
- Nowadays, ultrasound guided radial artery cannulation was reported good result for certainly and safety conscious.
- Actually radial artery is really small artery. But it is visualized easily by ultrasound because it be located under the thin skin. Dr. Jonathan Roberts a puncture of expert will probably explain about that in detail after this.
- This is an actual case of successful puncture using ultrasound. Let me get your attention up here. This is a relatively simple procedure.
- To improve and stable achievements of ulnar artery puncture, it also use similar method for radial puncture.
- But, we have to care for anatomical structure and running of ulnar artery. Ulnar artery located right by ulnar nerve.
- Fortunately, Dr. Sasko Kedev in here. Please apply to him for further particulars.
- In case of failure to puncture for radial artery, making a prompt decision is important things to change the contra lateral radial, ulnar or femoral artery. But very important things is performing reliable puncture of radial artery.