Transillumination of the palm for venipuncture in infants
Avner GorenJoseph LauferNir YativJacob KuintMICHAEL BEN ACKONMarina RubinshteinGideon ParetArie Augarten
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Abstract:
To assess the efficacy of transillumination of the palm of the hand in establishing venous access in small infants.One hundred infants aged 2 to 36 months were considered for venipuncture under transillumination following failure to find an accessible vein or a failed venipuncture attempt.In 40 of the 100 infants, a vein was visible with transillumination. In 22 of these children, previous attempts to achieve a venous line failed (mean number of failed venipunctures 2.11 +/- 0.6) and in 18 infants, no vein could be identified. Using transillumination, venous access was established with just one venipuncture in 39 of the 40 patients.Transillumination of the palm can aid in establishing venous access in infants. This can be easily carried out using a common otoscope.Keywords:
Transillumination
Venipuncture
Cephalic vein
To assess the efficacy of transillumination of the palm of the hand in establishing venous access in small infants.One hundred infants aged 2 to 36 months were considered for venipuncture under transillumination following failure to find an accessible vein or a failed venipuncture attempt.In 40 of the 100 infants, a vein was visible with transillumination. In 22 of these children, previous attempts to achieve a venous line failed (mean number of failed venipunctures 2.11 +/- 0.6) and in 18 infants, no vein could be identified. Using transillumination, venous access was established with just one venipuncture in 39 of the 40 patients.Transillumination of the palm can aid in establishing venous access in infants. This can be easily carried out using a common otoscope.
Transillumination
Venipuncture
Cephalic vein
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A large number of methods for obtaining blood from mice have been published. In our facility, saphenous venepuncture is considered the method of choice for bleeding mice and is believed to have a number of welfare advantages when performed correctly. The aim of this study was to compare levels of haemolysis and plasma glucose in blood samples obtained by saphenous venepuncture and tail vein incision. The results indicate that saphenous venepuncture is the preferred method.
Venipuncture
Tail vein
Haemolysis
Blood sampling
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To the Editor: We read with great interest the article by Usichenko et al. (1) reporting the reduction of venipuncture pain by cough trick (CT). Finding a way to reduce the venipuncture pain is important, however, we believe that there were several problems with the study. There are at least two most important goals to achieve during venous cannulation (VC). First, there should be little or no pain, and second, to achieve success during first attempt, especially at least during when there is only one visible peripheral vein. Although, authors of the present study have shown the effectiveness of their study in reducing the venipuncture pain; they failed to analyze the success or failure of the method they described. The success or failure of a VC largely depends on various factors and includes size and type of cannula and vein chosen, visibility of vein, and movement or steadiness of the arm during VC. It is never easy to cannulate the vein if the arm is not in steady state, and one can understand that keeping the vein in the steady state while patient is coughing is not only difficult but also has the potential to cause injury to patients and/or assistants holding the hand of the patient involved in the procedure. This could happen by “open needle and cannula” if the patient suddenly moves the arm during the procedure while coughing. Furthermore, we also believe that the merits of the study are doubtful under the condition in which there is poor visibility of vein because of any reason (dark skin, cold extremity, “shock state”) or in neurosurgical patients when increase in intracranial pressure is a concern. Authors have described the incidence of arm movement with CT, but how they differentiated between the arm withdrawal due to pain or CT we could not fully understand. Usichenko et al. (1) further reported the tendency of heart rate to decrease during the procedure. Surprisingly, in a volunteer study (2), it was shown that in the absence of arterial hypotension, there was a concomitant increase in supine heart rate and blood pressure and a sustained postcough increase in supine heart rate that, in contrast, is contradictory to the findings of Usichenko et al. (1). Moreover, they failed to mention about the vasovagal reaction, a potential side effect of coughing and venipuncture (3,4) that could have the synergistic effect if performed simultaneously. The authors’ study, we feel, would have been strengthened had they analyzed the risk versus benefit ratio. If we had to choose between either inflicting a minor pain to the patient during VC (which can be easily alleviated by local anesthetic spray or injection) or “loosing” a vein (especially if it is single) because of sudden movement of the arm that could occur while coughing, we would definitely prefer to choose the former. However, we would be little hesitant to insert the IV cannula in a patient who is asked to cough simultaneously during the procedure. Prabhat Kumar Sinha, MD Sethuraman Manikandan, MD Department of Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
Venipuncture
Visibility
Superficial vein
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Venipuncture sites in the neck, arms, legs and tail have been described and illustrated. Our experience indicates that each of these sites may be used successfully, but we prefer to enter either the short saphenous vein, the cephalic vein or the ventral caudal vein.
Venipuncture
Cephalic vein
Tail vein
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Citations (1)
Summary Although a serious impediment in haemo‐philia patients, difficulty accessing peripheral veins has received little attention in clinical studies. New peripheral vein visualization devices could potentially ameliorate difficult venous access ( DVA ), but their utility remains unproved. The study aim was to survey the frequency, causes and clinical manifestations of DVA and evaluate the clinical utility of a near‐infrared ( NIR ) vein visualizer. In this multicentre prospective study, methods, difficulties and outcomes of venous access were assessed for a single venipuncture in consecutive patients. The impact of an NIR vein visualizer on vein localization, the number of venipuncture attempts and patient stress and pain was determined. Among 450 total patients enrolled, venous access was judged to be difficult in 165 (36.7%), most often because of poor vein condition, young patient age, overweight and difficulty in finding veins. Of the patients with DVA , difficulty in locating veins was encountered in 82.4%, and more than one venipuncture attempt was required in 24.8%. Veins were difficult to locate in significantly fewer DVA patients ( P = 0.002) when the NIR vein visualizer was used (76.0%) than not used (92.3%). Pain during venipuncture in DVA patients was also significantly less common ( P = 0.019) with use of the NIR vein visualizer (34.0% vs. 55.4%). No effect was observed on venipuncture attempts. DVA affects more than one‐third of patients at haemophilia treatment centres. An NIR vein visualizer showed significant promise for facilitating vein location and mitigating patient pain in those patients.
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The creation of an internal arterio-venous fistula according to Brescia and Cimino (1966) changes the functional conditions of cephalic vein and radial artery. Arterial blood enters under high pressure the cephalic vein and turbulent blood flow appears. The pathomorphology of the cephalic vein incorporated in the internal native arterio-venous fistula (NAVF) for chronic hemodialysis was studied. Single portions of the vein were surgically removed from 16 patients aged from 20 to 60 years with failed NAVF and then excised because of repeated NAVF creation (group one) and from 3 patients where the vein was removed during the primary NAVF creation (group two). Light and transmission electron microscopy was used. In the first group, the intima and media of the cephalic vein was much ticker than that of the veins of the patients of the second and control group. The increased thickness of the venous intima was accompanied by an augmented number of smooth muscles cells and appearance of new layers while that of the media was followed by structural changes of its elastic network. These alterations depend on the duration of NAVF functioning.
Cephalic vein
Superficial vein
Venous hypertension
Brachial artery
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Objective To investigate how to increase the successful rate with improving vein puncture in poor venous filling patients.Methods A total of 50 patients with poor venous engorgement were adopted.The observation group was given the method of impoving puncture,the control group was given traditional venipuncture.The rates of returning blood and penetration of success and reaction of pains were compared in two groups.Results The degree of vein filling and returning blood was significant higher in the observation group than that in the control group (P ＜ 0.01),but reaction of pains was lower (P ＜0.05).Conclusions The method of improving vein puncture could enhance the rate of successful puncture and relieve pains of patients.
Key words:
Poor venous filling; The method of puncture
Venipuncture
Venous blood
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A 42-year-old female suffered excruciating pain and paraesthesia on venepuncture of the cephalic vein in her left wrist. The left superficial radial nerve was injured. A flexed wrist during venepuncture renders the superficial radial nerve immobile and vulnerable to being punctured by the needle. To reduce the risk of nerve injury during venepuncture, the phlebotomist should choose a large and visible vein and insert the needle at a 5-15 degrees angle with the skin. The wrist should be selected only if the veins in the antecubital area are deemed unsuitable. The feeling of an electric shock along the distribution of the nerve, or rupture of the vein during venepuncture, should alert the phlebotomist to the possibility of nerve injury and the procedure should be stopped immediately.
Venipuncture
Cephalic vein
Radial nerve
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Department of Anesthesiology Cornell University Medical College and The New York Hospital 1300 York Avenue New York, NY 10021
Venipuncture
Transillumination
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Transillumination of an extremity during venipuncture in infants or obese children is described. Transillumination facilitates accurate placement of the needle tip within the vein.
Transillumination
Venipuncture
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Citations (36)