Things I always do. Make sure pt has voided, tell them not to tighten their stomach ( that will make it harder for you ) Make sure they are lying flat. Good bed height for you and if you can't feel the pulse before you pull the sheath then you need to apply pressure where you feel the sheath under the skin ( just wiggle the sheath and you can feel it under the skin) these things make it easier at least for me I have been doing it a year and no problems.. Also use the clamp if you have a really deep person. And I found out some thin people are hard to hold the artery rolls around you really have to bear down on that sucker....