Recommendations:

• A skin incision is made, only to allow passage of the sheath.

• Use a # 11 surgical blade with a rounded tip, in order to prevent damage of the radial artery.

• Make a small incision just superficially in the skin, almost parallel to the skin. If the incision is to small, friction is felt by the operator during insertion of the introducer sheath. This friction might be indistinguishable from friction encountered during passage of intravascular obstructions. In addition, the sheath can become damaged at insertion through a small opening.

• Be careful not to insert the blade to deep. This might damage the radial artery. Therefore a tip with a rounded blade is preferred since insertion for only a few millimeters will create an adequate opening . With a narrow tipped blade, risk for radial artery damage is greater.

  Alternatively a dedicated blade for TRI can be used (Terumo)