Pen Torch Transillumination: Shedding Light on Difficult Venepuncture
Condition: Disorder of Vein
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Veinlite; Pen-torch Transillumination; Conventional Venepuncture
Intervention type(s): Device; Device; Procedure
Intervention description(s): Veinlite is a device that emits red light. It provides a non-invasive technique of inserting intra-venous cannula. Placing it onto the skin will cause the outlines of the veins to show up.; Pen-torch Transillumination is a non-invasive technique that utilizes 2 pen-torches to provide illumination.The tips of the pen torches are pressed onto the skin, causing the silhouette of the vein to show up; This involves the conventional method of identifying veins suitable for venepuncture, which involves visualization and palpation.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Venepuncture; Transillumination