From the Guidelines
The recommended wrist position for radial artery puncture is hyperextension (dorsiflexion) of the wrist, as this position helps to bring the radial artery closer to the skin surface, making it more accessible and palpable. The patient's forearm should be supinated and stabilized on a flat surface, with the wrist extended but not excessively hyperextended, as extreme extension can potentially occlude the artery. This positioning is supported by recent studies, including a 2025 scientific statement from the American Heart Association 1, which mentions wrist dorsiflexion as a technical consideration for radial access approach to peripheral vascular interventions. Although the exact angle of dorsiflexion is not specified in the provided evidence, a commonly recommended range is approximately 20-30 degrees, with the hand placed on a firm surface and the palm facing upward. Proper positioning helps minimize patient discomfort and increases the likelihood of obtaining an adequate arterial sample on the first attempt. Key considerations for radial artery puncture include:
- Hyperextension (dorsiflexion) of the wrist
- Supination and stabilization of the forearm
- Avoiding excessive hyperextension to prevent occlusion of the artery
- Using a firm surface and proper support to maintain the desired position. The evidence from the American Heart Association 1 supports the use of radial access approach for peripheral vascular interventions, highlighting its benefits in reducing access site complications, bleeding, and mortality rates.
From the Research
Recommended Wrist Position for Radial Artery Puncture
- The optimal wrist position for radial artery puncture is a topic of discussion among medical professionals.
- According to a study published in 2012 2, a wrist extension of 45 degrees appears to be the optimal wrist joint extension for a successful radial artery cannula insertion.
- Another study published in 2013 3 found that a wrist joint angle of 45 degrees is optimal for long and short axis ultrasound-guided radial artery cannulation.
- The study found that short axis width was statistically significantly increased at 45 degrees compared to at 0 degrees, and short axis radial artery distance between skin and height at 45 degrees were statistically significantly decreased than at 0 degrees.
- However, it is essential to note that the wrist position may vary depending on the individual patient and the specific procedure being performed.
- There is no evidence to support the claim that the radial artery should be accessed 5 cm proximal to the radial styloid to avoid injury of the medial nerve.
- The recommended wrist position during radial artery puncture is dorsiflexion, with a 45-degree extension being the optimal position, as supported by the studies 2, 3.
- Radial deviation is not a recommended wrist position during radial artery puncture, as it may increase the risk of complications.
- The anatomic position of the wrist is not the optimal position for radial artery puncture, as it may not provide the best access to the radial artery.