{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:37:31Z","timestamp":1792427851018,"version":"4.5.0"},"reference-count":10,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Invasive arterial blood pressure monitoring is essential for perioperative hemodynamic management. While proximal radial artery cannulation is widely used due to its ease and low complication rate, it is unsuitable for patients with upper-limb trauma, wrist\/forearm surgery, local soft-tissue injury, or prior vascular injury from puncture. Distal radial artery access at the Hegu (LI4) region\u2014originally developed for cardiovascular procedures\u2014offers a viable alternative: it lies superficially, is less affected by wrist motion, and benefits from collateral perfusion via the ulnar artery and palmar arches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>Two patients required alternative arterial access due to limited conventional proximal radial artery access. Case 1: a 41-year-old woman after emergency right upper-limb replantation for traumatic amputation. Case 2: a 50-year-old man after debridement, internal fixation, and free anterolateral thigh flap reconstruction for a severe right-hand crush injury. In both, the left distal radial artery (Hegu region) was used for invasive arterial pressure monitoring. Under local anesthesia and ultrasound-guided out-of-plane puncture, a 20-gauge arterial catheter was successfully placed on the first attempt (puncture-to-placement time: 25\u201330\u202fs). Catheters remained in place for 24\u201348\u202fh. Waveforms were clear, stable, and unaffected by wrist motion. Invasive pressures matched non-invasive measurements at concurrent time points\u2014though formal agreement analysis was not performed. After removal, puncture sites healed without complications (no bleeding, hematoma, infection, nerve injury, radial artery occlusion, or hand ischemia). One patient reported mild soreness (VAS\u202f=\u202f1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Distal radial artery cannulation in the Hegu region may be a feasible and well-tolerated alternative for perioperative invasive arterial pressure monitoring when conventional proximal radial artery access is unavailable or undesirable. Potential advantages include a puncture site away from the wrist joint, stable catheter fixation, good patient tolerance, and preserved collateral circulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1929045","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T05:29:37Z","timestamp":1786080577000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Distal radial artery cannulation in the Hegu (LI4) region for perioperative invasive arterial blood pressure monitoring: two case reports"],"prefix":"10.3389","volume":"13","author":[{"given":"Long","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Ningbo No. 6 Hospital","place":["Ningbo, Zhejiang, China"]},{"name":"Ningbo Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunli","family":"Diao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Ningbo No. 6 Hospital","place":["Ningbo, Zhejiang, China"]},{"name":"Ningbo Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianlin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Ningbo No. 6 Hospital","place":["Ningbo, Zhejiang, China"]},{"name":"Ningbo Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Ningbo No. 6 Hospital","place":["Ningbo, Zhejiang, China"]},{"name":"Ningbo Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Ningbo No. 6 Hospital","place":["Ningbo, Zhejiang, China"]},{"name":"Ningbo Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangguang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Ningbo No. 6 Hospital","place":["Ningbo, Zhejiang, China"]},{"name":"Ningbo Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.bja.2024.04.046","article-title":"Perioperative quality initiative (POQI) international consensus statement on perioperative arterial pressure management","volume":"133","author":"Saugel","year":"2024","journal-title":"Br J Anaesth"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1007\/s00134-022-06798-8","article-title":"Invasive arterial pressure monitoring: much more than mean arterial pressure","volume":"48","author":"Hernandez","year":"2022","journal-title":"Intensive Care Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"133645","DOI":"10.1016\/j.ijcard.2025.133645","article-title":"Distal radial access in elderly patients aged 70 years and older for coronary procedures: lessons from the KODRA registry","volume":"439","author":"Lee","year":"2025","journal-title":"Int J Cardiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1186\/s13054-020-02859-w","article-title":"How to measure blood pressure using an arterial catheter: a systematic 5-step approach","volume":"24","author":"Saugel","year":"2020","journal-title":"Crit Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1177\/11297298211005256","article-title":"Distal snuffbox versus conventional radial artery access: an updated systematic review and meta-analysis","volume":"23","author":"Rigatelli","year":"2022","journal-title":"J Vasc Access"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1177\/11297298221101784","article-title":"Severe ischemia after radial artery catheterization: a literature review of published cases","volume":"25","author":"Ying","year":"2024","journal-title":"J Vasc Access"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/MCA.0000000000001489","article-title":"Comparing distal and proximal radial access for percutaneous coronary intervention and angiography: a comprehensive meta-analysis and systematic review of randomized controlled trials","volume":"36","author":"Mahmoud","year":"2025","journal-title":"Coron Artery Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1136\/neurintsurg-2021-017871","article-title":"Radial artery access anatomy: considerations for neuroendovascular procedures","volume":"13","author":"Narsinh","year":"2021","journal-title":"J Neurointerv Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e79541","DOI":"10.7759\/cureus.79541","article-title":"Rare complication of distal radial artery puncture: arteriovenous fistula formation following percutaneous coronary intervention","volume":"17","author":"Yamazaki","year":"2025","journal-title":"Cureus"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1038\/s41372-023-01860-9","article-title":"Implementation of an ultrasound-guided approach for arterial line placements in neonates-quality improvement project","volume":"44","author":"Culjat","year":"2024","journal-title":"J Perinatol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1929045\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T05:29:37Z","timestamp":1786080577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1929045\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":10,"alternative-id":["10.3389\/fmed.2026.1929045"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1929045","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"article-number":"1929045"}}