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How to TRY TRI with confidence

How to Puncture

Needle handling

Two types of the puncture with proper needle

Anterior puncture Double wall puncture
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

Plastic needle


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.


  • 1. Pancholy SB et al., Catheter Cardiovasc Interv. 2012;80(2):288-291.
  • 2. Seto AH et al. JACC Cardiovasc Interv. 2015 Feb; 8 (2): 283-291

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