Disorder of Vein Clinical Trial
Official title:
Pen Torch Transillumination: Shedding Light on Difficult Venepuncture
Our novel technique of pen-torch transillumination (PTI) uses a cheap and easily available
instrument (Penlite-LP212®, Energizer®, Missouri, USA) to visualize superficial veins
invisible to the naked eye. The investigators evaluate the efficacy of PTI in improving
venepuncture success rate (SR) for patients with poor venous access.
This prospective randomized controlled trial looks at adult patients aged 21 to 90 with
difficult venous access (history of ≥3 consecutive attempts required for successful
cannulation during the current admission) requiring non-emergent venepuncture. Patients will
undergo venepuncture over the upper-limb using one of the following: Conventional
venepuncture (control); Veinlite® (TransLite®, Texas, USA), a commercial transillumination
device; PTI. Outcome measures are: successful cannulation within 2 attempts; duration of
each successful attempt. Fisher's exact and Kruskal-Wallis tests will be performed.
This is a prospective randomized controlled trial. Patients with a history of difficult
venepuncture who agree to be entered into the study will be randomized into one of 3 groups
using a sealed envelope system: 1. Conventional venepuncture (Control Group, n=25); 2.
Veinlite® a commercial LED transilluminator device (Experimental Group 1, n=25); 3. Pen
torch transillumination (Experimental Group 2, n=25). Hemodynamically unstable patients are
excluded. The nurse involved in the care of the patient will attempt venepuncture over the
upper limb. A maximum of 4 times attempts is allowed, before escalation to a
doctor/phlebotomist.
A standardized venepuncture technique using standardized instruments will be utilized. Veins
will be localized using one of the above techniques. Pen torch transillumination and
veinlite are non-invasive techniques for locating veins. For pen torch transillumination,
the tip of the pen torch is pressed onto the skin, causing the shadow of the vein to show
up. Veinlite uses a device that emits red light. Placing it onto the skin will cause the
outlines of the veins to show up. Once a suitable vein is localized, a tourniquet is applied
(Braun® International, USA). The area of the skin to be cannulated is disinfected with an
alcohol wipe (Webcol®, Covidien®, USA). For the setting of IV cannulation, a standardized
23G IV cannula is used (Introcan Safety®, Braun®, USA). Normal saline (PosiFlush® 3ml, BD®,
USA) will be used for flushing the cannula after successful cannulation. For blood taking, a
syringe (Terumo®, Philippines) ranging from 2ml to 20ml and a 23G needle (Venofix®, Braun®,
USA) will be used. All instruments needed for venepuncture, including 4 IV cannula or 4
needles should be by the patient's bedside prior to the start of each venepuncture.
Duration of the procedure will be recorded using a stop watch. This is defined as the time
(in minutes) from the start of attempt to localize a vein to its successful cannulation.
Successful cannulation is defined either as the ability to flush 2ml of normal saline into
the IV cannula or the ability to draw 2ml of blood from the vein.
A post-procedure questionnaire will be filled up by the nurses after attempt at venepuncture
(refer to attached file). Outcome data include: number of attempts and duration needed for
successful venepuncture. Patient data include: age, sex, race, body-mass index, history of
intra-venous drug abuse, and renal function.
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