Which arterial site is considered a suitable alternative when radial artery is not accessible?

• A. Femoral artery
• B. Ulnar artery
• C. Brachial artery
• D. Popliteal artery

Answer: (C)

When the radial artery isn’t accessible, the brachial artery is the best alternative for arterial access because it is large and easier to palpate in the antecubital area, making cannulation more reliable and quicker. Its central location often provides robust pulsatile flow, which helps obtain a clear arterial sample or establish a line when distal sites are unavailable. However, this site carries higher risk of nerve or vascular injury and hematoma due to its proximity to the median nerve and deeper position, so it should be used only when indicated and with careful assessment of limb perfusion.

Other sites have drawbacks: the femoral artery has higher infection and bleeding risks and is less comfortable for the patient; the ulnar artery can be used in some cases but relies on intact collateral circulation and carries a risk of hand ischemia if collateral flow is compromised; the popliteal artery is deep and hard to access, with greater risk of complications, making it unsuitable for routine arterial access.