Radial arterial cannulation is a core skill in anesthesiology, intensive care, emergency medicine, and other acute care specialities. This video summarizes key principles for success with the anatomical landmark-guided (LMG) technique while minimizing complications.
These include: (1) developing a tactile sense for locating the artery by palpation; (2) accurate alignment during cannula advancement; (3) adopting an appropriately shallow trajectory to avoid transfixion (which increases risk of complications such as hematoma, thrombosis, etc); (4) confirming intra-luminal cannula placement before attempting to thread it in.
Ultrasound guidance may still be needed to rescue difficult LMG arterial lines. Two common scenarios for this are presented: (a) anomalous superficial radial artery; (b) calcified radial artery. See a short guide to USG-arterial lines here - https://youtu.be/2Wk-hP1CYmI?si=6QqwxShfWq8AwGpA
See also a superb discussion in the comments about rescuing failed attempts with transfixion, with great tips from @mdkc . These include (a) the importance of a flat trajectory (b) not withdrawing the stylet too far back into the cannula - the rigidity that the stylet provides is needed for the floppy cannula to overcome the resistance/friction to advancement through the skin/tissues/arterial wall; it will buckle otherwise.
Chapters
00:05 - Long vs short cannula
00:32 - Position and taping
01:06 - Line of sight insertion
01:44 - Draping the hand
02:01 - Palpation of artery
02:15 - Insertion point
02:35 - "Poke" vs "Puncture" point
03:07 - Insertion trajectory
03:53 - Advancing the cannula
04:25 - Confirming intraluminal cannula tip placement
06:08 - Connection of line tubing
06:45 - Securing the cannula in place
07:39 - Redirection to locate artery
08:24 - Superficial radial artery
09:35 - Calcified radial artery