Radial artery puncture is becoming more and more widely used in clinical practice, whether it is the anesthesia doctors, or the daily work of the medical personnel need to master this skill. How to master this skill in a short time and improve the success rate, the following is the author of some of the experience, hope to have some help to the clinical workers.
First of all, to understand certain anatomic relationship, the radial artery in the shallow surface of tendon of biceps brachii, brachial arteries and the terminal branches of, in radial neck at the beginning of the brachial artery in, beginning about flat horizontal elbow 1cm. Issued outward and downward to the brachioradialis muscle and rotation of circular muscle, then in downward between the tendon of flexor tendon of brachioradialis and extensor carpi radialis, to lower end of radius around the styloid process of radius to the back of the hand, put the first metacarpal space into the palm of the hand deep. After separation of principal artery of thumb, the end of the ulnar artery and palm deep branch anastomosis to form deep palmar arch. The styloid process of radius near the position of the radial artery is shallow, the beat easy touch is clinical touch, pressing the appropriate position, from the styloid process of radius nearly at the proximal end of the 2 ~ 3cm beat the strongest point is puncture the most commonly used one of the sites.
Next to touch with your fingers or fingers. To find the correct way to go (that is, the main branch). According to the TCM pulse taking method, the radial styloid process marked, the medial off before closing (carpal) inch, mark (elbow) as a ruler, forefinger and middle finger, ring finger and Qi, specified in, index finger inch, nameless specified feet can be. Can use the double finger (or use in the two fingers between the needle), and even single finger touch. Specific methods vary from person to person, the key lies in how to touch as soon as possible, as soon as possible to grasp the radial artery, the next step is to prepare for the next step. At the same time, to consider the possibility of vascular tortuosity, Yoo BS et al measured 1191 healthy Korean tortuous radial artery rate was 4.2%, the elderly more incidences of high and Valsecchi reports of radial artery tortuosity occurrence rate of 3.8%. In daily practice, also want to consider some special cases such as small radial artery, radial artery at high level, side of radial artery and "anti off pulse" (TCM terms, radial artery walking is not in the normal position, the distal row in wrist dorsal) etc.. Therefore, in a conditional hospital can do radial ulnar artery ultrasound. To measure the diameter of the proximal and distal radial artery, the blood flow direction of the ulnar artery, the superficial and the deep bow, and the blood flow from the ulnar side to the radial direction were observed. ALLEN test or ALLEN test before operation. To know the score.
In the rough out the blood vessels after anesthesia, can, many people like to make a small subcutaneous Pichugin, such as "cellulite". Some people like to deep injection. Our routine method of anesthesia, along the direction of the arteries, as far as possible to stick blood vessels. It can be said that anesthesia is a double-edged sword. On one hand, it is one of the most effective ways to reduce pain by using local anesthesia. On the other hand dose of local anesthetic can occur due to pain induced by radial artery spasm and vagus reflex, while also preventing drug into the blood vessels. So for many beginners, specific scale is difficult to grasp (conventional puncture when a small amount of injection of local anesthetic into the sheath in front of the tube and then add enough anesthetic), the dose is too large radial artery may touch is not clear, but increased difficulty of puncture at this time how to puncture? This case has a special introduction.
Choose the appropriate puncture needle, radial artery puncture needle is divided into two kinds: hollow steel needle and a sleeve needle, the former to cordis Corporation as the representative, the latter to Terumo Corporation as the representative. Current clinical more common application of puncture needle types: ordinary radial artery puncture needle (21g); American cordis radial artery puncture outfit (21g needle, 25cm 0.021 'straight guide wire and 11cm 6F arterial sheath); the arrow company radial artery puncture outfit (22G needle, 25cm 0.018' 'straight guide wire and 24cm 6F-7F arterial sheath tube); Japan TERUMO company of radial artery puncture outfit (20g needle, 0.025' straight guide wire and 16cm 6F arterial catheter tube); Japan TERUMO company 26cm long sheath tube.
Two kinds of puncture outfit comparative analysis results show that: (1) trocar puncture needle compared to the hollow steel needle on arterial injury; II with sheath puncture outfit, the withdrawal of the needle core after plastic sheath tube easily and lumen maintain coaxial and convenient guide wire into the. The hollow needle needle direction and the puncture needle and the guide wire into the artery angle determines the success rate. Puncture method is divided into the lateral wall penetrating method and the single wall penetrating method. On the side wall penetrating method operation follows the classic Seldinger needle penetrating the anterior wall of the blood return after, with sheath and the needle continues to move forward, and then began to withdraw, when a gush of blood stop retreat, into the guide wire. Applies to the needle with sheath needle. Method of single wall puncture needle penetration front wall see blood back after spraying, try to adjust the direction of the puncture needle, to guide into the wire is better. This method is more suitable for the hollow steel needle puncture. Our experience is that the needle is more easy to master for beginners. For patients with above mentioned after anesthesia pulse is not very clear, and some less pulsatile, easy to spasm of the blood vessels (especially obese female patients), distortion of the blood vessels, is easy to slide patients by cordis needle tend to increase the probability of success. In practice, can be used in the Cordis needle to pick up after 5, 10ML syringe to increase the support force, see back to the blood after slowly back to push the needle. Regardless of the selection of the method, the principle of implantation of the guide wire is back into the lead wire, which seems to be simple, in fact, is very important.
The puncture angle is also very critical. The needle and radial artery are the same, and the needle and skin are usually 30 ~ 45. In clinical practice, the needle and skin are not the same. For example, the angle of needle and skin according to the depth of the fat and artery of the patient and is generally thinner and more superficial the angle is small; at the same time and the thickness of radial artery, radial artery partial thin, needle angle to corresponding smaller, so that the puncture needle in tiny artery intraluminal walking relatively prolonged, back to the blood that have a greater chance of some.
Radial artery puncture for The first hit is pierce to the heart of the matter, "the best!". It can be said that the success of the puncture means that half of the surgery. Of course, in the actual work, often encounter puncture, back spray is very good, but the guide wire into the. Then need to stay calm, to find the reasons, or the puncture needle was pushed back subcutaneous, find out the blood vessels running after, repeated puncture, looking for the "true lumen".
We must have a certain harvest after each puncture, with the hand and the heart to experience the "penetrating" feeling. Sometimes we can see a lot of experts "so-called blind wear" technology, they are based on a solid anatomy and puncture experience to complete. For beginners try not to use, it is not possible to change to the side of the puncture.