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Comparison of the dilatory effect of three strategies on peripheral veins

"The combination of electrical stimulation followed by tourniquet application resulted in the greatest increase in venous size and is therefore considered as most effective to improve peripheral intravenous cannulation success" van Loon et al (2021).

Abstract:

Background: Dilated veins are associated with increased success of peripheral intravenous cannulation, due to its improved visibility and palpability. Comparison of three strategies to achieve venodilation (tourniquet, electrical stimulation, or a combined strategy) on increase in venous size.

Methods: A total of 54 volunteers participated in this cross-over observational study with healthy adults, measuring venous cross-sectional area and diameter at six different sites of the upper extremity. Measurements are performed with ultrasound after performing any dilation strategy, and compared with its non-dilated venous size. An increased cross-sectional area of 25 square millimetres was denoted as clinical relevant, which was detected with paired t testing, Wilcoxon signed rank testing or with ANOVA testing.

Results: The cephalic vein is the greatest at all sites (t=12.43, df=39, P<0.001 for the crosssectional area), unless the largest increase in venous size was obtained in the basilic veins (t=12.11, df=39, P<0.001 for the cross-sectional area). The largest increase in venous size was obtained after electrical stimulation followed by tourniquet application at all measurement sites. Percentage-wise increased the basilic vein with 44% in cross-sectional area and 21% in diameter, which were 37% and 17% for the cross-sectional area and diameter of the cephalic vein.

Conclusions: In general, the largest sized veins are situated in the upper arm, of which the cephalic vein has the largest cross-sectional area and diameter. The combination of electrical stimulation followed by tourniquet application resulted in the greatest increase in venous size and is therefore considered as most effective to improve peripheral intravenous cannulation success.

Reference:

van Loon FH, Korsten HH, Dierick-van Daele AT, Bouwman AR. Comparison of the dilatory effect of three strategies on peripheral veins of the upper extremity in adults. Minerva Anestesiol. 2021 Feb 17. doi: 10.23736/S0375-9393.21.15291-5. Epub ahead of print. PMID: 33594876.