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CLINICAL ISSUES

I NEVER
MISS A
VEIN.

Take the guesswork


out of venipunctures
By Dennis J. Ernst, MT(ASCP)

S uperman would make a great phlebotomist. With his X-ray


vision, he would never miss a vein, or have to apologize to
a patient, or send in another superhero to try to draw blood.
STAT draws would take half the time, and morning collections
would be completed faster than a speeding bullet.
the manufacturer, the AV300 relies on the physical property of
hemoglobin in that it absorbs infrared light. When the device is
held about seven inches above the skin and activated, it detects
the difference in the hemoglobin concentration between the veins
and surrounding tissue. Once
Unfortunately, most of us are not from Krypton. While detected, the reflected infrared
the jobs of other healthcare professionals have been infinitely light indicates the size and posi-
simplified by robotics, nanotechnology, and digital imaging, tion of veins beneath the surface
those who draw blood are resigned to relying on old technology of the skin by instantly projecting
like instinct and the human fingertip. But just when you think a precise map of the veins on the
you have the only job in healthcare that cannot be improved by skin above them. The device,
technology, someone shouts, “Look! Up in the sky. It’s a bird! the size of a cordless phone, can
It’s a plane! It’s a vein-detection device!” Not just one device be hand-held or positioned on a
but a veritable bevy … a flock … a gaggle, even … so many hands-free accessory so the pro-
that it requires an entire magazine article to summarize them all. cedure can be performed while
Here is that article: the map is projected.
“It is portable and works in
Standard eyes any kind of ambient light and on The AV300 is the size of a cord-
less phone.
What follows is a summary of devices designed to locate veins any color of skin,” says Vinny
from which blood can be drawn. They utilize a variety of tech- Luciano, vice president of Marketing for Accuvein. “The AV300
nologies, designs, and applications for patients of all ages and never comes in contact with the patient, so it does not need to be
skin pigmentation. Although phlebotomy will never be automated, sterilized between uses. It operates on batteries or can be plugged
these devices bring today’s technological advancements into one into a wall outlet, whichever is most convenient for the user. Once
of the last otherwise entirely manual procedures in healthcare. the device is activated, there is no lag time before you know pre-
Why is it important to see all options beneath the skin? It is all cisely where the veins lie.”
about the standards. VeinViewer (Luminetx, Memphis, TN): Using near infrared
Being able to see the exact location of veins not only makes the light and “other technologies,” the VeinViewer is a mobile bio-
procedure more frequently successful but also facilitates a lab’s medical device that illuminates subcutaneous veins, then projects
compliance with standards established by the Clinical and Labora- an image of the vasculature onto the surface of the skin. Accord-
tory Standards Institute (CLSI). According to the organization’s ing to the manufacturer,
venipuncture standard (H3), a thorough survey of available veins the VeinViewer uses a
must be conducted to minimize the risk of injury to the patient. flexible head unit that
This recommendation is based on the close proximity of the me- positions the infrared
dial antebrachial cutaneous nerves to the basilic vein, which lies light over any part of
in the inside or medial aspect of the antecubital area. If pierced the anatomy. The light
by a misguided needle, these nerves can be permanently injured, makes veins visible to
subjecting the patient to long-term pain and complications. Failure a digital video camera,
to comply with this standard requirement can translate to a labora- which then transmits
tory’s liability for those injuries. Because the standards require an live video to an image The VeinViewer is a mobile biomedical
avoidance of the basilic vein unless no safer vein can be located, processor. The processor device using near infrared light.
any device that lets the user see the available veins beneath the skin then enhances and aligns the images for output through a projec-
not only manages the risk of injury but also facilitates compliance tor that displays the enhanced image in real time. By imaging
with the standards. the vasculature, the company’s website states “… clinicians have
the ability to visualize the location of the target area and observe
Devices that utilize laser/infrared technology any movement of the vasculature regardless of a patient’s age,
AV300 (AccuVein, Cold Spring Harbor, NY): According to body type, or skin tone.”

18 April 2009 ■  MLO www.mlo-online.com


CLINICAL ISSUES

Luminetx has created a subsidiary For neonatal applications, Veno-


to adapt its vein-finding technology to scope also offers the Neonatal Transil-
other applications within and outside luminator, which functions under the
of healthcare. Using vein-pattern rec- same principle in a smaller and more
ognition technology, a tabletop device portable design. The illuminating lights
captures the vein pattern present in the are cool and bright enough to illuminate
palm of a person’s hand, then generates without burning.
a numeric biometric “key,” which is Wee Sight (Children’s Medical
unique to every individual. The key is Ventures, Monroeville, PA): Also The Veintector runs on two oxyride batteries
used to enroll the person in a biometric designed for neonatal patients, the and includes a strap for hands-free use.
system as a fraud-proof method for is placed between patient and device
verifying identity. Any attempt to use a to prevent patient-device contact. A
biometrically enabled system generates color-adjustment button allows the user
a new key that is matched against the to change settings for optimal contrast.
person’s enrolled key. The device runs on two oxyride batteries
and includes a strap for hands-free use.
Devices that illuminate tissue Lights can be disinfected with alcohol.
Venoscope (Venoscope, Lafayette, Veinlite Transilluminators (Trans-
LA): The Venoscope II Transillumi- Wee Sight allows one person to both operate the Lite LLC, Sugar Land, TX): TransLite
nator is a hand-held device used to device and perform the prodedure. uses the side-transillumination method
locate veins us- in all its Veinlite
ing high-intensity Wee Sight Transilluminator utilizes a models. A bright
red and white strong LED light to reveal vein loca- ring of light is
LEDs that pen- tion without emitting heat. The device placed against
etrate deep into the is designed to lie flat on a surface to the skin, and
subcutaneous tis- allow users to position the baby’s arm light is focused
sue. When placed or leg over it for enhanced illumination. into the tissue
on the patient’s Alternatively, it can be held in the hand and towards the
skin, the device of the user and positioned against the center of the ring
illuminates the patient’s limb. According to the com- creating a vir-
subcutaneous tis- pany’s website, the design allows one tual light source
sue with an array person to both operate the device and under the skin Veinlite Transillumina-
of high intensity perform necessary procedure. that uniformly tors offer haolgen-light
LED lights high- Vein Locator (Sharn Inc., Tampa, illuminates the fiber-optic units and bat-
lighting the veins, FL): The Vein Locator is a portable, superficial tis- tery-operated, LED-based
battery-operated device that uses pocket models.
The Venoscope II can which absorb the sues within the
be attached to a pa- light rather that ring. The deoxygenated blood in veins
tient with a Velstretch
reflect it. While causes them to show up as dark lines
strap.
directing light into in contrast with the surrounding tissue.
the subcutaneous tissue, the manu- An opening in the ring facilitates blood
facturer recommends dimming the draws or injections. Veinlites can either be
ambient lighting as much as possible halogen-light fiber-optic units or battery-
to provide the contrast needed to see operated, LED-based pocket models.
veins. A white light provides definition Halogen-light Veinlites have a vari-
between the tissue, which is lighter in able intensity light source and a metal
intensity; and the veins, which appear The Vein Locator is disgarded after use. ring illuminator with a fiber-optic cable.
as dark lines or shadows between the three LED lights to transilluminate A large ring illuminator is used for adult
device’s two illuminating arms. The the patient’s tissue, highlighting veins. vein access, whereas a small ring il-
unit is powered by three AA alkaline Limited for neonatal, pediatric, and frail luminator is used for pediatric venous
batteries and has a built-in low-battery adult patients, the Vein Locator is self- access. LED-based Veinlites achieve the
indicator that signals when batteries contained and can be cleaned as needed. best contrast for vein imaging by using
need to be changed. The Venoscope II The device’s batteries provide 40 hours a combination of bright orange LEDs
can be attached to the patient’s arm by of use and are not replaceable. Once (for strong illumination), combined with
attaching a Velstretch strap (provided), exhausted, this device is discarded. deep red light (for high penetration of
effectively stabilizing the vein to pre- Veintector (Carolina Liquid Chem- dark pigmented skins). Light shields
vent rolling and liberating both of the istries, Brea, CA): The Veintector snap on to the units to stop interference
user’s hands for the venipuncture. After uses 38 red and yellow LED lights to from overhead light. Pediatric or neonate
use, the device may be wiped with an illuminate the tissue beneath the skin adapters can be used to enhance the light
alcohol or bleach solution. upon which it rests. A protective sheet area for use with babies and children. All

20 April 2009 ■  MLO www.mlo-online.com


v ein SfUinB Jd Ee Cr Ts

LED-based models come with dispos-


able plastic covers to prevent infection. Accuvein Sharn Inc.
Veinlite LED is rechargeable and has 816-298-6991 800-325-3671
24 LEDs (12 orange and 12 red). Two www.accuvein.com www.sharn.com
switches are used to select either or both Luminetx Carolina Liquid Chemistries
colors for optimum vein imaging in all 910-252-3752 336-722-8910
www.luminetx.com http:/www.carolinachemistries.
skin types. com/CLC/index.dfm/hurl/idsPage-
TransLite offers two other models for Venoscope
800-284-7655 ID=154/Type=39/Helps-to-find-
use in phlebotomy: the Veinlite EMS and www.venoscope.com those-hard-to-find-veins
the Veinlite PEDI. Veinlite EMS is a sim- TransLite
Children’s Medical Ventures
pler version of the Veinlite LED but uses 800-345-6443 281-240-3111
16 LEDs (eight orange and eight red). Ac- http://weesight.respironics.com www.veinlite.com
cording to the manufacturer, it provides a
[In order of appearance in this article]
lower-cost option for venous access and is
well suited to emergency response teams.
It uses two AA alkaline batteries and has “It seems to me that the motto of our profession as always been ‘YES, WE CAN!’
a single switch to illuminate both orange It continually astonishes me how much we accomplish under the most chal-
and red LEDs. The Veinlite PEDI the lenging of circumstances. Not just doing business as usual or more with less,
smallest vein transilluminator and is de- but the intelligence, resourcefulness, creativity, and tenacity characteristic of
signed for babies and neonates. It has 12 laboratory professionals. We are still largely unknown by name to the general
LEDs (eight orange and four red) and one public but the passion and commitment to excellence that typify our contribu-
CR2 lithium battery. Two switches allow tion to healthcare are reward enough. We are professionals in every sense of
for selection of either or both colors for the word!”—Sharon M. Miller, PhC, MT(ASCP), CLS(NCA), Professor Emerita,
optimum vein imaging. A snap-on neona- Clinical Laboratory Sciences, College of Health & Human Sciences, Northern
tal adapter is designed to shine six closely Illinois University, DeKalb, IN.
packed LEDs through a small opening for
safe through-the-body transillumination
of small limbs in neonates.
The magic of veinfinders
Whether you use supernatural powers,
the technologies of Planet Earth, or the
good old-fashioned fingertip, locating
the best vein for venipuncture is critical
to patient satisfaction, specimen integ-
rity, staff productivity, and compliance
with the standards. Arthur Clarke, author
of 2001: A Space Odyssey, once wrote,
“Any sufficiently advanced technology
is indistinguishable from magic.” Some
of these devices may seem to be employ
magic, but healthcare professionals
should use them as supplements to
their keenly developed senses of vision,
palpation, and instinct, not substitutes
for them.
Vein finders may not enable a labora-
tory’s staff to leap tall buildings in a single
bound or make them more powerful than
a locomotive. But if they can draw on the
first stick, they might just become super
heroes to difficult patients.

Dennis J. Ernst, MT(ASCP), is the director of the Center


for Phlebotomy Education in Corydon, IN. The author
of several books on phlebotomy, Ernst also chairs the
revisions of several CLSI specimen-collection standards
and serves as the editor of the Phlebotomy Today family
of e-newsletters. As an industry consultant, Ernst con-
sults with companies serving the preanalytical market,
including Accuvein.

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