–Radial artery puncture is becoming more and more widely used in clinical practice, and both anesthesiologists and everyday health care workers need to master this skill. In recent years, as interventional techniques continue to expand, more interventionalists and cardiovascular surgeons are gradually adopting transradial coronary angiography and angioplasty, but the success rate of puncture varies. This both affects the smooth performance of the procedure and also has some constraints on the popularity of the technique. The following are some of the author’s experiences on how to master this skill in a short time and improve the success rate, which I hope will be helpful to clinical workers. The radial artery is located on the superficial surface of the biceps tendon and is one of the terminal branches of the brachial artery, starting from the brachial artery at the neck of the radius, starting about 1 cm below the transverse crease of the flat elbow. The dorsum of the hand, through the first metacarpal space to the deep palm of the hand, divides into the main thumb artery and then anastomoses with the deep palmar branch of the ulnar artery to form the deep palmar arch. The position of the radial artery near the radial styloid process is superficial and its pulsation is easily palpable, which is a suitable location for clinical touch and pressure. 2~3 cm from the proximal end of the radial styloid process, the strongest pulsation point is one of the most commonly used sites for puncture. Next, palpation is performed with the belly of the finger or the fingertip. The correct course of the artery (i.e., the main branch) is sought. You can follow the Chinese medicine method of pulse cutting, using the radial styloid process as the marker, its medial side as the guan, the front of the guan (wrist side) as the inch, and the back of the guan (elbow side) as the ruler, with the index, middle, and ring fingers aligned, the middle finger designating the guan, the index designating the inch, and the ring finger setting the ruler. Touching can be done using both fingers (or by piercing between the two fingers) or even a single finger. The specific method varies from person to person, but the focus of palpation is on how to grasp the radial artery as early as possible and as soon as possible to prepare for the next puncture step. The possibility of vascular tortuosity should also be considered. YooBS et al. measured a radial artery tortuosity rate of 4.2% in 1191 healthy Koreans, with a higher incidence in the elderly, and Valsecchi et al. reported a 3.8% incidence of radial artery tortuosity. In daily practice, some special cases such as small radial artery, high radial artery, collateral radial artery and “reverse guan pulse” (TCM term, the radial artery travels out of its normal position and the distal end travels dorsal to the wrist joint) should be taken into account. Therefore, an ultrasound of the radial and ulnar arteries can be performed in hospitals where available. Measure the caliber of the proximal and distal radial artery, observe whether the ulnar artery is abnormal, the direction of blood flow in the superficial palmar arch and deep palmar arch, and whether there is still blood flow from the ulnar side to the radial side after compression of the ulnar artery. Do the ALLEN test or anti-ALLEN test before surgery. Thus, we can have a good idea. After roughly feeling the vascular line, anesthesia can be performed, and many people like to make a small mound under the skin, such as “orange peel-like”. Others prefer to inject anesthetic to the deeper layers. Our conventional method of anesthesia along the direction of arterial travel, as close as possible to the vascular travel. It can be said that anesthesia is a double-edged sword. On the one hand it is one of the most effective ways to reduce pain through adequate local anesthesia. On the other hand, inadequate doses of anesthetics can easily induce radial artery spasm and vagal reflexes due to pain, and at the same time prevent anesthetics from entering the blood vessels. Therefore, for many beginners, it is difficult to grasp the specific scale (a small amount of anesthetic is injected during conventional puncture, and then a sufficient amount of anesthetic is added before entering the sheath), and after too large a dose, the radial movement may not be felt, but increases the difficulty of puncture. This situation is described below. The results of the comparative analysis of the two puncture sets show that ① the cannula puncture needle causes less damage to the artery than the hollow steel needle ② the puncture set with the sheath, the plastic sheath is easy to maintain coaxiality with the lumen after withdrawing the needle core, which facilitates the feeding of the guidewire. The direction of the needle surface of the hollow steel needle and the angle between the puncture needle and the artery determine the success rate of guidewire delivery. The puncture methods are divided into contralateral wall penetration and single wall penetration. The contralateral wall penetration method follows the classical Seldinger technique, in which the steel needle penetrates the anterior wall to return blood, then the sheath and needle continue to advance forward and then begin to retract, stop retracting when the arterial blood gushes out, and deliver the guidewire. Applicable to sheathed tube puncture needles. The single wall puncture method tries to adjust the direction of the puncture needle after the steel needle penetrates the anterior wall and sees the blood back spurting, which facilitates better guidewire feeding, and this method is more suitable for puncture with a hollow steel needle. Our experience is that sheath puncture needles are easier for beginners to master. For patients whose pulsations are not clear after anesthesia as mentioned above, and for patients with weak pulsations, easily spasmodic vessels (especially in obese women), and patients with twisted and slippery vessels, the Cordis needle is often used to increase the chances of success. In practice, a 5 or 10 ML syringe can be attached to the Cordis puncture needle to increase the support, and the needle can be slowly withdrawn and pushed after the return of blood. Regardless of the method chosen, the principle of implanting the guidewire is “back into the guidewire”, which seems simple but is in fact very important. The angle of puncture is also very critical, the direction of the puncture needle and the radial artery travel in the same direction, the angle between the puncture needle and the skin is usually 30 ° ~ 45 °. In clinical practice, the angle between the puncture needle and the skin is not absolutely fixed. For example, the angle between the needle and the skin depends on the fatness of the patient and the depth of the artery, generally the thinner and more superficial the smaller the angle; at the same time, it is related to the thickness of the radial artery, the radial artery is thin, the angle of the needle should be correspondingly small, so that the travel of the puncture needle in the lumen of the small artery is relatively longer, and the chance of returning blood is higher. Radial artery puncture for a needle to see blood, it can be said that a successful puncture means that half of the operation is completed. Of course, in practice, it is often encountered that the puncture and the return spray are very good, but the guidewire cannot enter. At this time, it is necessary to calm down, find the reason, or push the puncture needle back under the skin, feel the vascular route, and then perform puncture several times to find the “real cavity”. We need to have a certain gain after each puncture, to experience the feeling of “penetration” with our hands and hearts. Sometimes we see many masters of the “so-called blind puncture” technique, which is based on solid anatomical and puncture experience. For beginners, try not to use it, and if you can’t, you can change to the opposite side for puncture. Diligence can make up for clumsiness, and practice makes perfect. More study, more reading, more questions, more practice, more experience, and more summaries will surely yield the expected results. It can be said that the more successful cases of puncture, the stronger the self-confidence, and the more problems will be solved if you know how to face difficulties.