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anesthesia with lidocaine infiltration at the intended puncture site, insert the overthe-needle catheter over the radial artery 0.5 to 1 cm proximal to the distal wrist
crease and slowly advance toward the arterial pulse. After puncturing the artery
and obtaining blood flow, advance the needle 1 to 2 mm farther, and then hold the
needle steady and slowly advance the catheter into the vessel.

FIGURE 130.3 Radial artery puncture or cannulation.

If blood flow never occurs or stops spontaneously, the needle tip may have
penetrated the posterior wall of the vessel, as shown in Figure 130.3 . Remove
the needle, holding the catheter steady, and begin pulling back the catheter 1 mm
at a time until a sudden flash of arterial blood is identified ( Fig. 130.3 ). Then,
advance the catheter forward into the artery. If no blood returns, make another
attempt starting over again with new equipment as previously described.
If blood flow is satisfactory in the position shown in Figure 130.3 , attach the
connecting tubing to the catheter with a T-connector, stopcock, and syringe, and
recheck arterial flow. The catheter should be securely taped or sewn to the
forearm to prevent dislodgment. Use of a transparent sterile dressing is
recommended to enhance visibility and security.
Alternatively, the Seldinger technique can be used by passing a thin guide wire
through a 22-gauge introducer needle that is used to gain access to the lumen of
the radial artery and then removing the needle (leaving the wire in place) and