Venipuncture: when you can’t find the vein.

“They always, always have trouble getting blood from me”.
How many times have you had a patient say this to you just as you are mentally psyching yourself up for that one-stab, perfect-hit, venipuncture or cannulation to impress the new-grads?

So you try the usual strategies such as:

  • Hanging the arm below the heart level for a few seconds ‘gravity’ fill the veins.
  • Applying heat packs.
  • Asking the patient to pump their fist.
  • Using devices that illuminate the veins such as the AccuVein (which personally I don’t find useful)
  • Looking around for someone else to delegate this task to.

Here is a another quick tip that I have read about (and had varying degrees of success with) that just may help when trying to perform a veinipuncture or cannulation on a patient with shy vasculature.

  1. Attach a Blood Pressure cuff to the upper arm and inflate to around 200mmHg for 6 seconds (although times of up to 3 minutes have been proposed ).
  2. Release the cuff.
    Reactive hyperaemia (or the transient increase in blood flow that occurs following a brief period of ischaemia) will produce an increased bloodflow to the arm.
  3. After a few seconds to allow the veins to engorge, apply tourniquet and proceed as usual.
  4. Watch the new-grads nod in a moment of quiet awe, before walking away to Google-up on Reactive Hyperaemia

One thought on “Venipuncture: when you can’t find the vein.

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