Arterial blood gas sampling is a vital procedure in emergency departments for managing critically ill patients. Traditionally, clinicians perform radial artery punctures at the distal forearm (DF) site. However, recent trends in interventional cardiology suggest using the anatomical snuffbox (ASB) as a potential alternative. Sharma S et al. recently evaluated if this novel approach matches conventional success in emergency settings.

First-Pass Success in Arterial Blood Gas Sampling

The randomized controlled trial involved 356 adult patients assigned to either the ASB or DF approach. Researchers discovered that the DF approach achieved a significantly higher first-pass success rate of 74.7%. In contrast, the ASB approach only reached 60.7%. Furthermore, the DF group also showed a lower failure rate of 5.1% compared to 21.3% in the ASB group. These findings suggest that the conventional site remains more reliable for initial attempts.

Complications and Clinical Considerations

While both methods are technically feasible, the ASB approach appears more demanding in high-pressure environments. The study noted that procedure-related complications remained similar between both groups during a 12-hour observation period. However, the higher success rate and fewer required attempts make the distal forearm the preferred choice for rapid assessment. Consequently, clinicians should prioritize the conventional forearm site for routine arterial blood gas sampling unless specific local abnormalities exist.

Frequently Asked Questions

Why is the distal forearm preferred for ABG sampling?

The distal forearm is preferred because it offers a significantly higher first-pass success rate and a lower overall failure rate compared to the anatomical snuffbox. This makes it more efficient for rapid clinical assessments in the emergency department.

Is the anatomical snuffbox approach safe?

Yes, the anatomical snuffbox approach is safe and shows similar complication rates to the conventional forearm approach. However, it may be more difficult to perform successfully on the first attempt, leading to more needle passes.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider for medical concerns. Refer to the latest local and national guidelines for clinical practice.

References

Sharma S et al. First-pass success of anatomical snuffbox versus distal forearm approaches for arterial blood gas sampling in the emergency department: a randomized controlled trial. J Vasc Access. 2026 Feb 06. doi: 10.1177/11297298261415955. PMID: 41646008.

Lee JW, Cho SW, et al. Anatomical Snuffbox Versus Dorsum of the Hand for Optimal Access Site in Distal Radial Access: Insight From the KODRA Registry. Korean Soc Cardiol. 2026 Jan. PMID: 40736380.

Ungureanu C, et al. Feasibility and Safety of a Novel Distal Radial Artery Approach for Arterial Blood Gas in COVID-19 Patients. Science Repository. 2020 Dec.