Comparison of the dilatory effect of three strategies on peripheral veins of the upper extremity in adults.

Abstract

Dilated veins are associated with increased success of peripheral intravenous cannulation, due to their improved visibility and palpability. We compared three strategies to achieve venodilation (tourniquet, electrical stimulation, or a combined strategy) on increase in venous size. 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 were performed with ultrasound after performing any dilation strategy and compared with non-dilated venous size. An increased cross-sectional area of 25 square millimeters was denoted as clinically relevant, which was detected with paired t-test, Wilcoxon signed rank test, or ANOVA. The cephalic vein was the greatest at all sites (t=12.43, df=39, P<0.001 for the cross-sectional area), but the largest increase in venous size was obtained in the basilic vein (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. The basilic vein increased by 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. 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 the most effective to improve peripheral intravenous cannulation success.