PICC Lines

PICC Lines— Lesson Overview

What Is Arterial Access?

Arterial access refers to the deliberate cannulation of an artery to serve as the entry point for a wide range of diagnostic and therapeutic endovascular procedures. Unlike venous access, arteries carry oxygenated blood under significantly higher pressure, which demands precise technique, careful site selection, and meticulous post-procedural management to avoid serious complications.

In interventional radiology, arterial access is the foundational first step for the majority of procedures performed — from diagnostic angiography and cancer-directed therapies to peripheral arterial interventions and trauma embolization. The common femoral artery remains the most widely used access site due to its large caliber and compressibility, though the radial, brachial, and popliteal arteries are increasingly utilized depending on the clinical scenario and operator preference.

Access is obtained using the Seldinger technique or its modified variant, guided by ultrasound for vessel visualization and fluoroscopy for confirmation, allowing the operator to safely introduce sheaths, wires, and catheters into the arterial system to navigate virtually anywhere in the body.

What You'll Learn in This Video

By the end of this lesson, you will be able to:

• Identify the indications and contraindications for arterial access, and understand how clinical context drives site selection

• Recognize the relevant anatomy of the major arterial access sites — common femoral, radial, brachial, and popliteal arteries — including key surface landmarks and adjacent structures to avoid

• Compare access site options and understand the tradeoffs between femoral and radial approaches in terms of sheath size, patient comfort, and closure strategy

• Understand the equipment involved in arterial access, including micropuncture kits, access needles, hydrophilic wires, and introducer sheaths of varying French sizes

• Walk through the procedural steps of ultrasound-guided arterial puncture and the Seldinger technique, from sterile preparation through sheath placement and flush

• Interpret fluoroscopic and ultrasound imaging used to confirm intraluminal position and avoid inadvertent venous or posterior wall puncture

• Identify and manage common complications including hematoma, pseudoaneurysm, arteriovenous fistula, arterial thrombosis, and retroperitoneal hemorrhage

• Understand closure and hemostasis strategies, including manual compression, closure devices (Perclose, Angio-Seal), and post-procedure monitoring protocols