Related Experiment Video
Updated: Feb 20, 2026
Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Back hand approach to radial access: The snuff box approach
Rhian E Davies1, Ian C Gilchrist2
1Penn State University, College of Medicine, Heart & Vascular Institute, United States.
Insights
Left radial artery access for coronary procedures offers benefits but faces challenges with patient body mass and orthopedic issues. Dorsal hand access provides an alternative solution for improved patient and operator positioning.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
Background:
- Transradial access is increasingly standard for coronary procedures.
- Left radial artery access presents advantages for graft cases, including reduced tortuosity.
- Challenges exist regarding patient body mass index and operator ergonomics with left radial access.
Observation:
- Patients with larger body mass or orthopedic limitations (e.g., frozen shoulder) may struggle with standard left radial access positioning.
- The dorsal aspect of the hand offers an alternative access point, allowing natural wrist pronation.
- This approach can accommodate variations in patient anatomy and operator positioning needs.
Findings:
- Dorsal hand radial artery access is a viable alternative to standard radial artery puncture.
- This technique addresses limitations related to patient body habitus and orthopedic constraints.
- It facilitates natural wrist pronation, improving operator and patient comfort.
Implications:
- Expanding radial artery access techniques can enhance procedural success rates.
- This approach may improve patient tolerance and operator experience in transradial interventions.
- Further education on dorsal hand access can broaden interventional cardiologists' skill sets.
Abstract:
Transradial access is becoming the default strategy for routine coronary procedures, but there is still room for improvement. For instance, left radial access is known to offer some advantages for graft cases, less tortuosity, amongst other potential benefits. The downside has been the applicability of this access point on patients with a larger body mass index both from the viewpoint of the patient and the operator. The patient must lay with their arm in a supine position and the operator as a result must stand in a flexed position for an unknown period of time. Additionally, patients with various orthopedic injuries, including frozen shoulders, on may be unable to supinate their wrist for optimal access. One solution to this dilemma is to approach the radial artery from the dorsal aspect of the hand so the wrist can pronate naturally if body habitus requires the arm to be shifted towards the operator. This report outlines the steps and background behind this approach and an educational opportunity for those interested in expanding their access skills.
Related Concept Videos
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation
01:09Bones of the Upper Limb: Radius
The radius has a nail-shaped head, and a...
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
One of the advantages of...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management