Radial Access

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Pre-Procedure Prep

Pre-Procedural Evaluation

• Evaluate circulation of ulnopalmar arch with modified Allen or Barbeau test
• Type D is only contraindication for radial access (some institutions forgo Barbeau test because of ulnar-palmar collateralisation)
• Is patient on dialysis or nearing dialysis and may need radial artery for potential access
• US to evaluate the size of the radial artery - 2 cm is reasonable minimal diameter

Left vs right radial artery
• Catheter will only cross left vertebral artery
• Extra working length of catheter
• Less chance of radial loop or difficult anatomy
• Can position arm by side which closely approximates femoral set up
• Helpful for neurointerventional procedures involving carotids or intracranial vasculature

Procedure Steps

Day of Procedure

• 30 mg of topical nitroglycerin to left wrist
• EMLA cream (lidocaine 2.5% and prilocaine 2.5%) to left wrist
• Apply 30 minutes prior to procedure and cover with tegaderm


• Wrist extended with palm facing up
• Arm abducted vs adducted - operator preference
• 2 cm proximal to the radial styloid
• Puncture angle of ~ 30-45°
• Recommend a radial access kit: many products available.
• US guidance with single wall puncture using 21g needle
Insert 0.018" guidewire
Visualize wire with any signs of resistance
Important to use hydrophilic sheath - make sure sheath is wet to activate coating


• Dermatotomy typically unnecessary
• Do not overuse lidocaine. Can spasm radial artery
• Keep patient calm and room warm

Radial Cocktail

• Some operators do not use
• Many combinations of drugs: 2.5 mg verapamil, 200 µg of nitroglycerin, 3000 units heparin
• Hemodilution - draw up the radial cocktail in a 20 or 30 ml syringe and dilute the cocktail with arterial blood from recently placed sheath. Administer slowly during diastole.
• Consider securing sheath to wrist - can cut "X" in tegaderm and place over sheath


Key Concept

• Patent hemostasis (non-occlusive) minimizes risk of radial artery occlusion

Sheath Removal

• Radial compression device following procedure: many products
• Tip: partially removing sheath 1-2 cm and place gauze proximal to access site: will allow room for compression band and wick away oozing during sheath removal/band placement
• Slowly inject air into band (usually ~15 ml) while removing sheath - confirm no oozing
• Remove 1 ml of air incrementally until oozing at access site occurs
• Inject 1-2 ml of air
• Confirm radial pulse is present following compression band placement - evaluate waveform

Deflation Protocol

• Depends on patient, procedure and sheath size
• For routine procedure without anticoagulation and 5 Fr access sheath a reasonable protocol is as follows: begin deflation 30-60 minutes after band placement, remove 3 cc of air Q5 minutes until sheath deflated. If bleeding occurs during deflation, reinflate band with air until hemostasis achieved and restart deflation protocol in 20 minutes.
• Observe patient for 30 minutes before discharge
• Check pulse and site before discharge

Discharge Instructions

• No lifting above 2 lbs x 24 hours
• No strenuous activity x 24 hours
• Keep bandage on for at least 24 hours.
• Ok to shower, but do not submerge access site for 48 hours

Related Content

No related content.


Transradial Access: Basic to Advanced

Transradial Access Podcast with Dr. Aaron Fischman


Radial vs. Femoral Access in IO Procedures

Radial vs. Femoral Access Podcast with Dr. Jason Iannuccilli

Blog Article

Minimizing Complications During Radial Access Procedures

Demo Video

How To Do The Barbeau Test


Radial Access Podcasts


Podcasts are not yet available for this procedure.

Please check back soon.

Transradial Access Podcast with Dr. Aaron Fischman

Dr. Aaron Fischman

Dr. Christopher Beck

Dr. Aaron Fischman gets into the details of his technique, equipment and tips/tricks for transradial access, as well as its advantages in a variety of IR interventions.


Radial vs. Femoral Access Podcast with Dr. Jason Iannuccilli

Dr. Jason Iannuccilli

Dr. Christopher Beck

Dr. Christopher Beck and Dr. Jason Iannuccilli discuss radial vs femoral access in IO procedures, including the pros and cons of both, and a very informative "how I do it" for radial access by Dr. Iannuccilli.



Radial Access Articles

Blog articles are not yet available for this procedure.

Please check back soon.


Minimizing Complications During Radial Access Procedures

Transradial access (TRA) has been shown to improve discharge and recovery times when compared to transfemoral access, though complications may arise. These c...


How To Set Up Your Cath Lab for Better Radial Access Ergonomics

Trans-radial access can provide distinct advantages over a femoral approach in oncologic embolization cases, but many interventional radiologists still find ...


Rationale for Use of Radial vs. Femoral Access in Oncologic Embolization Procedures

For many interventional radiologists, the decision to go femoral or radial is often a matter of prior experience and comfort with the technique. In our recen...


Choosing the Right Equipment for Radial Access Success

Initial transradial access (TRA) techniques in interventional radiology were limited by medical device availability, as many devices were adopted from those ...


Vascular Closure Devices for Radial Artery Interventions

Following vascular access of the radial artery, hemostasis can be achieved by using a vascular closure device or manual compression. A vascular closure devic...


My Radial Access Technique in Oncologic Embolization Cases’ by Dr. Jason Iannuccilli

If you’re working through the technical elements of radial access for oncologic embolization, be sure to check out this in-depth ‘how to’ guide. Intervention...


Radial Access Demos

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Transradial Femoral Artery Atherectomy and Angioplasty

At Mount Sinai Hospital in New York City, Vascular Surgeon Rami Tadros and Interventional Radiologists Mircea Cristescu and Manu Singh perform angiography, CSI orbital atherectomy, and angioplasty as a minimally invasive non-surgical treatment for claudication via the radial artery in the wrist.

How To Do Left Radial Access

Yamasaki explains the advantage of left radial access, tips and tricks.

TRA For Addressing Mesentric, Celiac & SFA Lesions

Management of celiac, mesenteric and superficial femoral arterial system endovascular lesions using TRA.

How To Do The Barbeau Test

The Barbeau test is used to determine if a patient is a candidate for radial artery access. Dr. Chris Beck, an Endovascular specialist, demonstrates how to do the Barbeau test and explains the Barbeau test results of type A, B, C, & D. Learn more!

Transradial Prostate Artery Embolization for Benign Prostatic Hyperplasia (BPH)

At Mount Sinai Hospital in New York City, Interventional Radiologists, Drs. Aaron Fischman, Art Rastinehad and Marcin Kolber perform embolization of both prostatic arteries (PAE) as a minimally invasive non-surgical treatment for benign prostatic hyperplasia (BPH) via the radial artery in the wrist.

Transradial Embolization of a Splenic Artery Aneurysm and Access

At Mount Sinai Hospital in New York City, Interventional Radiologist, Dr. Aaron Fischman performs transradial access for peripheral embolization of a splenic artery aneurysm.


Radial Access Tools

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Radial Access Literature

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Join The Discussion


[1] Scalise RFM, Salito AM, Polimeni A, et al. Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches. J Clin Med. 2019;8(10):1727. Published 2019 Oct 18. doi:10.3390/jcm8101727
[2] Ferrante G, Rao SV, Jüni P, et al. Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials. JACC Cardiovasc Interv. 2016;9(14):1419‐1434. doi:10.1016/j.jcin.2016.04.014
[3] Bishay VL, Biederman DM, Ward TJ, et al. Transradial Approach for Hepatic Radioembolization: Initial Results and Technique. AJR Am J Roentgenol. 2016;207(5):1112‐1121. doi:10.2214/AJR.15.15615
[4] Fischman AM, Swinburne NC, Patel RS. A Technical Guide Describing the Use of Transradial Access Technique for Endovascular Interventions. Tech Vasc Interv Radiol. 2015;18(2):58‐65. doi:10.1053/j.tvir.2015.04.002
[5] BackTable, LLC (Producer). (2018, April 4). Ep 26 – Radial vs. Femoral Access in IO Procedures [Audio podcast]. Retrieved from https://www.backtable.com/podcasts
[6] BackTable, LLC (Producer). (2018, June 27). Ep 30 – Transradial Access: Basic to Advanced [Audio podcast]. Retrieved from https://www.backtable.com/podcasts

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.