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(a) Adult study patient with marked hypothetical insertion sites (arrow) and interrogated segments (box) and (b) pediatric study patient with PIV (arrow) and marked ultrasound findings in 10 cm segment (box).
Source publication
Superficial veins of the upper extremity are the primary location for placement of peripheral IV catheters (PIVC). It is believed that a significant portion of PIVCs placed may cross or abut valves and branching veins or occlude a significant portion of the vein, limiting the ability to aspirate blood from the PIVC. Two separate clinical investigat...
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Citations
... Furthermore, the size of the recipient vein is a critical consideration as the lymphatic channels are significantly smaller than that of their venous counterparts. To help alleviate this size discrepancy, multiple lymphatic channels can be intussuscepted into the vein, or if the lymphatic vessels are large enough, an end-to-end anastomosis can be performed with a small vein [67,76] . Utilization of venous branches of the recipient vein has also become an effective method to optimize the size-matching of the lymphatic channel to the recipient vein [67] . ...
Immediate lymphatic reconstruction (ILR) has become increasingly utilized for the prevention of breast cancer-related lymphedema (BCRL). A growing body of evidence has demonstrated the long-term efficacy of ILR in reducing the rate of BCRL. While certain risk factors for BCRL are well-recognized, such as axillary lymph node dissection, regional lymph node radiation, and elevated body mass index, other potential risk factors such as age and taxane-based chemotherapeutics remain under discussion. Our experience with ILR has highlighted an additional potential risk factor for BCRL. Lymphatic anatomy, specifically compensatory lymphatic channels that bypass the axilla, may play a largely underrecognized role in determining which patients will develop BCRL after ILR. Foundational anatomic knowledge has primarily been based on cadaveric studies that predate the twentieth century. Modern approaches to lymphatic anatomical mapping using indocyanine green lymphography have helped to elucidate baseline lymphatic anatomy and compensatory channels, and certain variations within these channels may act as anatomic risk factors. Therefore, the purpose of this review was to highlight ways in which variations in lymphatic anatomy can inform the application and improve the accessibility of this procedure. As ILR continues to advance and evolve, anatomical mapping of the lymphatic system is valuable to both the patient and lymphatic microsurgeon and is a critical area of future study.
... We observed a higher success rate in men than in women (33.3% vs 10.7%), which we hypothesize is due to a larger vein-to-catheter size ratio in men versus women. 12 Ideally, to maintain adequate blood flow, a vein should be larger than twice the diameter of a catheter. There is evidence to suggest that in 50% of women (and only 14% of men), a 20-gauge catheter could occlude too much lumen and limit blood flow 12 ; in this study, more than 75% of the PIVCs used either a 20-or 18-gauge catheter. ...
... 12 Ideally, to maintain adequate blood flow, a vein should be larger than twice the diameter of a catheter. There is evidence to suggest that in 50% of women (and only 14% of men), a 20-gauge catheter could occlude too much lumen and limit blood flow 12 ; in this study, more than 75% of the PIVCs used either a 20-or 18-gauge catheter. A controlled study examining vein-to-catheter ratio in men and women could determine whether differences in this ratio explain the lower PIVC blood draw success rates for women seen in our study or if another mechanism is responsible. ...
Blood collection via venipuncture is the most common invasive procedure for inpatients, who experience an average of 1.6 to 2.2 blood collection episodes per day, for a total of approximately 450 million in US hospitals annually. In addition to being painful, venipuncture incurs the risk of vessel depletion, infection, and staff needlestick injury. A possible alternative is to use peripheral intravenous catheters (PIVCs), because PIVCs are placed in the majority of patients admitted to the hospital. Although there are anecdotal accounts of successfully using PIVCs for inpatient blood collection, the utility of this method has not been rigorously studied. The authors conducted a single-center prospective study among inpatients to evaluate blood collection success, defined as sufficient sample volume (4 mL) and no or minimal hemolysis, in PIVCs with a dwell time between 12 and 87 hours. Only 27% (28/105) of aspiration attempts were successful within this time frame. There was no difference in success rate with respect to PIVC dwell time, gauge, or location. These findings highlight the continued need for innovative, alternative solutions to meet the high demand for inpatient blood collection.
... Valve location establishes an additional factor for con sideration in optimal positioning of a PIVC. 8,[15][16][17][18] Placement of a PIVC at a distance away from valves avoids contact allowing optimal function of the valve and movement of fluid through the vessel. The vascular system in adults cir culates blood at a remarkable volume of 5-6 L/min. ...
... The physical laws of fluid mechanics under score the impact of vein diameter on local blood flow, Velocity of Blood, and the corresponding amount of blood volume and hemodilution. [1][2][3][4][5][6][7][8][15][16][17][18][19][20] Application of the Hemodilution Ratio, which translates the 4Vs and rate of infusion into practical comparative parameters, may allow clinicians to effectively anticipate a patient response to treatment infusions based on the vein used and position of the catheter. 2,15 The cephalic vein in the forearm extends from the wrist to the antecubital fossa and may represent the best location with longer dwell for PIVCs. ...
Background
Multimodal research and guidelines recognize veins in the forearm used for peripheral intravenous catheter (PIVC) insertion can optimize dwell time. Yet, many PIVCs are still placed in areas of flexion or suboptimal locations such as the back of the hand causing premature failure of >50%. This study identified characteristics of the forearm cephalic vein that make the anatomical location highly successful for PIVC insertion. The goal was to increase the understanding of the human vasculature in association with fluid mechanics in veins above the wrist and below the antecubital fossa.
Methodology
A prospective in-vivo study with 10 consented healthy human volunteers (HHVs) was performed with Color Pulse Wave Doppler Ultrasound that captured high-resolution video and images of vein diameter, velocity of blood flow, and location of venous valves in the forearm.
Results
Forearm vein diameter was not directly correlated with higher or lower Velocity of Blood Flow (0.58 cm = 3.0 cm/s). However, Volumetric Blood Flow rates tended to be lower (2.51–8.28 mL/min) with Vein Diameters smaller than 0.29 cm. Ultrasound assessments and Volumetric Blood Flow calculations confirmed natural turbulence in blood and retrograde blood reflux correlated with venous valves opening and closing. Areas of turbulence, with pulse flushing, created backflow with retrograde blood flow around and into the catheter.
Conclusions
Placement of long PIVCs in the cephalic veins of the upper forearm yield adequate flow and hemodilution capacity for veins with at least a 3 to 1 hemodilution ratio. The data from this study, along with previous research, suggest that PIVC placement in the cephalic vein, based on selection criteria, may help to reduce or eliminate intravenous complications such as chemical or mechanical thrombophlebitis causing premature catheter failure. Application of these investigational principles may result in better outcomes and catheter longevity for patients who require intravenous infusions.
... Valve location establishes an additional factor for con sideration in optimal positioning of a PIVC. 8,[15][16][17][18] Placement of a PIVC at a distance away from valves avoids contact allowing optimal function of the valve and movement of fluid through the vessel. The vascular system in adults cir culates blood at a remarkable volume of 5-6 L/min. ...
... The physical laws of fluid mechanics under score the impact of vein diameter on local blood flow, Velocity of Blood, and the corresponding amount of blood volume and hemodilution. [1][2][3][4][5][6][7][8][15][16][17][18][19][20] Application of the Hemodilution Ratio, which translates the 4Vs and rate of infusion into practical comparative parameters, may allow clinicians to effectively anticipate a patient response to treatment infusions based on the vein used and position of the catheter. 2,15 The cephalic vein in the forearm extends from the wrist to the antecubital fossa and may represent the best location with longer dwell for PIVCs. ...
The purpose of this study was to gain a greater understanding of the human vasculature in terms of flow dynamics and application of the hemodilution ratio as outlined by Roethisberger.
... These changes lead to restricted blood flow at the IV catheter tip and the inability to access downstream collateral circulation because of venous valves preventing retrograde blood flow to the IV catheter. 10,11 The development of needle-free technology designed specifically for the purpose of drawing higher-quality blood specimens from peripheral IVs (PIVO TM , Velano Vascular) prompts an assessment of the device's impact on blood specimen quality and IV longevity. This single-use device temporarily attaches to an indwelling peripheral IV catheter and deploys a flexible cannula approximately 3 cm downstream into the vein, where normal blood flow is usually reconstituted (see Figure, Supplemental Digital Content 1, http://links.lww.com/JHQ/A148 that diagrams PIVO use compared with standard venipuncture). ...
Inpatient hospital settings require access to high-quality blood specimens and durable peripheral intravenous (IV) catheters for patient care. The most common standard-of-care method for acquiring each blood specimen-venipuncture-often results in a non-negligible preanalytical error rate, patient discomfort, and tissue inflammation. In a 2-year, multicenter (23 hospitals) retrospective study, a novel blood collection system that collects blood specimens through existing inpatient IVs without a needle (PIVO, Velano Vascular) was compared with the current standard of care, in regards to its effect on specimen quality and IV catheter longevity. Using the PIVOTM device for blood collection decreased the rate of preanalytical errors by 56% compared with other collection methods, including venipuncture and conventional line draws. In addition, peripheral IV catheters that were used with PIVOTM for blood draws also had a 19% lower rate of replacement compared with those that did not. This is the largest study to date of PIVO use and demonstrates significant quality improvement outcomes compared with the current standard of care in blood collection, providing an opportunity to innovate inpatient hospital care.
... This contrasts with previous findings, which found that the location of the draw influenced haemolysis rates with antecubital locations reducing the rate (Phelan et al., 2018). The insertion site of a cannula has been thought to influence the ability to aspirate blood through a PIVC (Gagne & Sharma, 2017). Lippi et al., (2014) also found that haemolysis was increased when blood samples were taken from a PIVC distal to a median sized vein, but this was not found to affect haemolysis rates of the blood samples in the current study. ...
Aims
To explore the relationship between blood sampling techniques and haemolysis.
Background
Haemolysis rates of blood samples have been thought to be influenced by the method of collection. There is a lack of research evidence available to clearly show the comparative risk of haemolysis across different blood sampling methods, including venepuncture and use of peripheral intravenous cannulas.
Design
A prospective cohort study. Reporting followed the STROBE checklist.
Methods
A trained observer was used to record blood sampling techniques over a 10‐week period between April and June 2019. These records were then linked to pathology haemolysis results. Multivariable logistic regression was used to model patient and blood draw characteristics affecting haemolysis.
Results
Most of the blood samples were not haemolysed (n = 324, 87.1%). Multivariable analysis showed haemolysis was associated with increased tourniquet duration and if the level of tube was less than half full. Univariable analysis showed haemolysis was associated with increased age of the patient, the difficulty of cannulation/ venepuncture and increased number of attempts. No difference was found in the haemolysis rate related to the qualification of the blood collector.
Conclusion
There was no significant difference in haemolysis rates associated with sampling blood from a PIVC compared with venepuncture. Research should be undertaken to determine whether education on the factors influencing haemolysis is useful in decreasing haemolysis rates.
Relevance to clinical practice
There was no association with increased haemolysis rates when drawing blood via venepuncture compared with a peripheral intravenous cannula. Haemolysis of blood samples was associated with increased tourniquet duration, if level of the tube was less than half‐filled, increased age of the patient and difficulty of blood draw. Awareness of the risk of haemolysis associated with specific blood sampling methods may assist clinicians to improve care.
... The choice of PIVC insertion site can affect the degree of difficulty blood is able to be aspirated (Gagne & Sharma, 2017). This survey found 64.8% (n = 219) of nurses did not indicate an insertion site they would not sample blood from, including feet and hands. ...
... This survey found 64.8% (n = 219) of nurses did not indicate an insertion site they would not sample blood from, including feet and hands. Location of the insertion site and size of the vein play an important role in the degree of pressure differential and turbulence that may be caused when blood is drawn through a PIVC (Gagne & Sharma, 2017). A higher prevalence of haemolysis was reported in one study when blood was sampled through a PIVC distal to a median sized vein (Lippi, Avanzini, Aloe, & Cervellin, 2014). ...
Background: Sampling blood from a peripheral intravenous cannula offers an alternative to venepuncture. This practice can reduce frequency of venepuncture and patient discomfort. Opponents argue the practice increases the chance of haemolysis, risk of infection and device failure. Aim: To describe the prevalence and practice of blood sampling from peripheral intravenous cannulas by Australian nurses. Methods: This study used a descriptive cross-sectional design and data were collected using an electronic survey. The survey examined Australian nurses’ practice of sampling blood from peripheral intravenous cannulas. Quantitative descriptive data was analysed and presented as frequencies, percentages, medians and ranges. Findings: A total of 542 nurses participated in the survey. Of these, 338 (62.4%) completed the survey. The majority of responses came from the State of Victoria (n = 137, 40.5%) and one-third were emergency nurses (n = 112, 33.1%). Sampling of blood from peripheral intravenous cannulas occurred between 37.5% and 66.7% throughout the State and Territories of Australia. Peripheral intravenous cannula blood sampling was most common in the emergency department (n = 93, 53.4%). The most frequent reasons given were difficulty of access (n = 223, 66.0%) followed by patient comfort (n = 194, 57.4%). Discussion: Blood sampling is required to diagnose and monitor treatment responses. A peripheral intravenous cannula offers the opportunity to sample blood without the need for venepuncture. Practice recommendations on when to sample blood and correct sampling technique are based on limited or conflicting evidence. Conclusion: Findings from this study indicate it is common practice to draw blood samples from a peripheral intravenous cannula. Further research is required to examine the accuracy and safety of this practice to further inform policy.
Finger vein recognition deals with the identification of subjects based on their venous pattern within the fingers. It was shown in previous work that biometric data can include more than only identity related information like e.g. age, gender and ethnicity. In this work, deep learning based methods are employed to find out if finger vein image data includes information on the age and gender of the subjects. In our experiments we use different CNNs and different loss functions (triplet loss, SoftMax loss and Mean Squared Error loss) to predict gender and age based on finger vein image data. Using three publicly available finger vein image datasets, we show that it is feasible to predict the gender (accuracies of up to 93.1%). By analyzing finger vein data from different genders we found out that the finger thickness and especially the total length over all finger veins are important features to differentiate between images from male and female subjects. On the other hand, estimating the age of the subjects hardly worked at all in our experiments.Keywordsfinger vein recognitionagegender
Successful insertion of a peripheral intravenous catheterization requires that veins be sufficiently dilated. This study aimed to clarify the venous dilation effect of including tapping or massaging to the application of a tourniquet at the cutaneous veins of healthy adults’ forearms. This was a quasi-experimental study of 30 healthy adult volunteers. Each participant underwent all three venous dilation procedures, which included the tourniquet application (Control condition), the tourniquet application and tapping the participant’s forearm (Tapping condition), as well as the tourniquet application combined with massaging the participant’s forearm (Massage condition). To clarify the venous dilation effects, venous indices were measured, namely the venous diameter (mm), depth (mm), and palpation score. After applying all venous dilation procedures, the venous diameter and palpation score significantly increased. However, no significant difference was observed between the control condition and each intervention condition. The depth in the control and tapping conditions decreased significantly in contrast to the Massage condition. Moreover, a subgroup (nine participants with a venous diameter less than 3 mm after the control condition) had similar results. This study found that additional tapping or massaging after tourniquet application could be less effective in promoting dilation in the forearm veins of healthy adults. Future studies should examine the efficacy and effectiveness of venous dilation in a wide target population while considering intervention methods.
Difficult vascular access (DVA) is a potentially life-threatening condition that can prevent the delivery of efficient and effective medical care for at-risk patients. Under emergent conditions, DVA can delay the resuscitation of unstable patients by complicating providers’ efforts to administer life-saving fluids and medications. Improved awareness of the causes of DVA, including strategies to overcome these factors, may help to minimize the sequelae of DVA. This chapter proposes four main factors influencing the development of DVA, as well as solutions for DVA management in the emergent setting, based upon established techniques and evidence-based guidelines.
