Cannulation using the vein is the most common site for blood extraction, also known as phlebotomy, gaining venous blood as a specimen of choice for many clinical laboratory testing for the diagnosis of diseases. Moreover, cannulation is being used in performing technical procedures in emergency medicine. It includes peripheral intravenous catherization (PIVC) that remains challenging for many clinicians to complete successfully on the first attempt . This procedure is considered as one of the pre-analytical steps that can be a possible source of variability in the laboratory results affecting proper diagnosis and treatment process . It shows that pre-analytical phase in clinical laboratory testing in various studies has the highest percentage error as compared to the analytical and post analytical phases from 46.00% up to 77.10% with the average of 61.55%.
In venipuncture, there are means on how to help the phlebotomist view the vein properly, among those were by slightly tapping the site , use of tourniquet, and applying cold vibration close to the site for venipuncture or fist clenching, which are considered and studied to cause physiological disturbance on veins and significant variability in several laboratory test results .
The procedure for venipuncture cannot be considered as a gold standard yet, since errors are still being detected with continuous recommendations for improvements were supplemented. The CLSI H03-A6 document which suggested modifications in some of the steps in venipuncture, such as to cleanse the site and to allow drying before applying tourniquet to view and select the vein and finally to release the tourniquet immediately when the filling of the first tube started. It is able to reduce the tourniquet application time, as the result showed in the study by Oliveira G. et al., in 2013. Moreover, it was mentioned that the transilluminator (
vein finder) can make for more accurate visualization of the vein course, it is widely used now.
The patient’s vein is the main site for blood specimen collection for testing, entry point for medications, and the site for and blood transfusions. Venipuncture should be performed with care and precise considering the limited number of easily accessible veins in the body.
Aside from venipuncture, the near infrared (NIR) transilluminator imaging was used to
enhance vein treatment by helping in the identification of veins which were noted to be invisible to the naked eye but too shallow for ultrasound detection . It is even used for optical imaging of the skin to guide dermatologist for proper diagnosis of diseases and skin care, specifically in the study by Huang K et al., 2012, shows black/white mole skin roughness imaging in epidermis and skin tissue aging or skin lesions.
Cannulation is being considered as challenging due to many factors. To mention, the following are the known risk factors that
cause difficulties during this procedure: Dehydration, dark skin, obesity, hypotension, peripheral vasoconstriction, poor vein quality, aging, young age including preterm and term neonates, vein site used in drug abuse and chemotherapy, telangiectasia, site with skin rash, including even the low skill of the personnel performing the procedure .
These challenges necessitate for the improvement of steps in performing cannulation. It includes development and use of a
vein finder to assist in locating vein as the site for different procedures, which aim to lessen missed vein during needle insertion on the first trial by medical practitioners.
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