The radial artery is the ideal site for an arterial puncture for the following reasons:

• It is superficial and easily accessible.
• It is easily compressible with better control of bleeding.
• There is no nerve near by to worry about.
• The collateral arch with ulnar artery minimizes the risk of occlusion.

Refer to the articles listed for a discussion of the selection of site for arterial puncture.

REF: Mathiew A, et al. Expanding aneurysm of the radial artery after frequent puncture. Anesthesiology 1973; 38:401-403.

Dalton B, et al. Vasospasm with an indwelling radial artery cannula. Anesthesiology 1971; 34:194-197.

The femoral and brachial vessels are deeply situated and are difficult to compress. Extensive unrecognized bleeding into the soft tissues can occur if the vessel is not effectively compressed.

In the antecubital fossa, the brachial artery and the median nerve pass underneath the biceptal aponeurosis. This band is unyielding and any hematoma formation in the antecubital fossa is poorly tolerated.

Compression of the brachial artery or median nerve can result in ischemia or both.

REF: McCready RA. et al. Brachial artery puncture: A definite risk to the hand. ARRD 1979; 120:795-798.

The carotid artery should never be tapped for fear of dislodging an atherosclerotic plaque. Alternate vessels for arterial puncture are ulnar, dorsalis pedis and posterior tibial arteries. These vessels are small and, hence, are not used routinely.