Venipuncture Attempts Research Articles

Virtual reality in the outpatient: reducing anxiety and fear in venous puncture

To analyze whether the use of virtual reality (VR) headsets during venipuncture can modify the perception of pain, anxiety, and fear in pediatrics. Open label, randomized clinical trial. The presence of intellectual, visual, or hearing impairment were considered exclusion criteria. Two anxiety and fear scales were administered before and after the procedure, and the Wong-Baker face pain scale at the end. The following were recorded: number of venipuncture attempts, duration of the procedure, and side effects. 78 patients were included, 38 males and a mean age of 9.63 years. In the intervention group, the mean pain value was 2.87, with a mean difference (MD) of -0.85 compared with the control one (95% confidence interval (CI) -2.02 to 0.33). There was a significant reduction in the level of anxiety and fear, with MDs of -2.59 (95%CI: -3.92 to -1.26) and -0.85 points (95%CI: -1.45 to -0.24), respectively. the use of VR headsets in venipuncture in hospital daytime care decreases the level of anxiety and fear in children and seems to reduce pain, without adverse effects. The venipuncture procedure has the same success rate and does not increase its duration.

Economic analysis and time monitoring of pediatric venipuncture procedures; audio-visual distraction and Buzzy® device versus standard care: protocol of an interventional randomized controlled trial

Background: reducing anxiety and pain during an invasive procedure like venipuncture is crucial for preventing the onset of stress and making the nurse’s procedures faster and smoother. Distraction techniques appear to be a viable solution. The aim of this study is to compare the effectiveness of two different distraction methods in terms of cost-effectiveness and time to perform venipuncture in a hospital setting. Materials and Methods: a randomized, controlled, interventional-blinded 3-arm parallel-group study with inpatients aged 3 to 18 years old, awake and conscious, at the first venipuncture attempt and only after children and parents signed informed consent. The pain rating scales Wong-Baker FACES, Numerical Rating Scale, and Children’s Fear Scale will be used. Conclusions: pediatric pain is a challenge for medical professionals as well as a health need that must be addressed rapidly. It is crucial to assess and apply the most effective methods for adequate analgesia in shorter periods, while also reducing healthcare costs.

Effect of Near-Infrared Vein Finder Technology on Success Rate of Cannulation in Obese Diabetic Patients

Background: Intravenous cannulation is needed in about 90% of patients admitted to hospitals to administer medications or replace fluids, which is difficult to perform in obese patients with diabetes. Objectives: The present study aimed to assess the effect of using near-infrared vein finder technology on the success rate of cannulation in obese patients with diabetes. Methods: This randomized controlled trial was conducted on 92 eligible patients with type 2 diabetes and obesity at Al-Rusafa hospitals in Baghdad, Iraq, in September 2021. The subjects were divided into the intervention (n = 46) and control (n = 46) groups. However, cannulation using near-infrared vein finder technology was only performed for the intervention group. The data were collected using a demographic and clinical data questionnaire and a chronometer. Results: The success rates of cannulation for the first time were 60.9% and 15.2% in the intervention and control groups, respectively. The mean values of procedural time were 53.2 ± 28.9 and 94.3 ± 41.5 seconds in the intervention and control groups, respectively. The independent effects of patients’ body mass index (P = 0.002) and skin color (P = 0.040) on procedural time were significant. Conclusions: The use of near-infrared vein finder technology in obese diabetic patients reduces procedural time and venipuncture attempts.

Efficacy of Distraction for Reducing Pain and Distress Associated With Venipuncture in the Pediatric Posttransplant Population: A Randomized Controlled Trial.

Distraction can reduce pain and distress associated with painful procedures but has never been studied in children with solid organ transplants. We aimed to determine whether there is a difference in pain and distress associated with venipuncture in pediatric posttransplant patients who receive distraction compared with those who do not. Randomized controlled trial of children aged 4 to 17 years with solid organ transplants undergoing venipuncture in the outpatient setting. Patients were randomized to receive distraction or no distraction. The primary outcome was the Faces Pain Scale-Revised. Secondary outcomes were the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale. Exploratory outcomes included the number of venipuncture attempts, time to successful venipuncture, and satisfaction of phlebotomists and parents. Median age of the 40 children enrolled was 11.5 years. Type of transplants included the heart (67.5%), kidney (22.5%), liver (7.5%), and more than 1 organ (2.5%). There was no difference between the Faces Pain Scale-Revised scores in distraction and no distraction groups (1.4; 95% confidence interval, 0.9-1.9; and 1.3, 95% confidence interval, 0.5-2.1, respectively). There was also no difference in the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale scores, number of venipuncture attempts, or time to successful venipuncture. Phlebotomists were more satisfied with the venipuncture when distraction was implemented. In children with solid organ transplants, there was no difference in pain and distress associated with venipuncture between those who did and did not receive distraction. There was also no difference in other procedure-related outcomes except for greater phlebotomist satisfaction when distraction was implemented.

SUN-199 PHLEBOTOMY PRACTICE IN A TERTIARY CARE PEDIATRIC HOSPITAL - AUDIT FOR IMPLEMENTING "SAVE YOUR VEINS" INITIATIVE

Venipuncture is often done indiscriminately in hospitals leading to phlebitis and stenosis of veins. Patients with chronic diseases have difficult venous access and it is catastrophic in pediatric patients, more specifically those with chronic kidney diseases, hematological disease and cancers. Due to long life expectancy for paediatric chronic kidney patients, now all efforts must be focused on vein preservation for future use. Campaigns to preserve veins in kidney patients have been conducted worldwide, but not in developing countries. No paediatric specific data or campaigns are available. Hence, we reviewed the current practice of venipuncture in our pediatric department with special focus on nephrology patients. We aimed to assess the knowledge about vein preservation among our phlebotomists, nurses and junior doctors and review the current phlebotomy practice in pediatric patients in our center. A survey designed to test the knowledge among phlebotomists, nurses and junior doctors regarding vein preservation, assess current practice and willingness to get training was conducted and data was collected. Simultaneously we noted all venipunctures performed at the emergency department(ED), paediatric ward (PW) and paediatric outpatient department (OPD) in our hospital for 30 days. Data on admitting department, diagnosis, type of venipuncture (needle stick or cannula), purpose (sample collection or drug instillation), number of pricks and site preferred were collected. Outcomes like percentage of phlebotomies done by each group of health care personnel, preferred site and department or diagnosis associated with difficult venous access (2 or more attempts) were analysed. Out of 320 venipunctures recorded, 203 were considered for analysis (117 - insufficient data). The mean age of patients was 4.7 years. 85 (41.9%), 85(41.9%) and 33(16.2%) procedures were done in OPD, ED and PW respectively. General paediatrics department (n=116, 57.1%) had most patients, followed by nephrology (n= 34, 16.7%) and hematooncology (n= 33, 16.2%). 84/203 (41.3%) children were suffering from chronic disease. Nurses performed 103(50.7%), followed by phlebotomists (90 (44.3%)) and junior doctors (10(4.9%)). Only 17.2% requests had physician instruction regarding vascular access. 124 patients (61.1%) had needle stick and 79 patients (38.9%) had cannula placed. The preferred site used for needle stick method was cubital fossa (n=62, 50%) followed by dorsum of hand (n= 60, 48.3%). For cannula placement, 77/79 venipuncture attempts were made in dorsum of hand. 7% of patients required more than 1 attempt to obtain sufficient blood samples. Of 203 patients, 46 had difficult access and all these patients (100%) who had this difficult venous access were chronic disease patients (Kidney 50%, hematology 37.5%, endocrine 12.5% ). Only 60% of doctors and 33.3% of phlebotomists preferred dorsum of hand as first site. Vein preservation education is lacking and should be implemented in all hospitals. This strategy benefits children with chronic disease most, especially kidney disease. Interventions like flagging patients with chronic disease, use of wrist bands and bracelets, educating parents/children on vein preservation can help these patients.

Comparison of two intramuscular sedation protocols on sedation, recovery and ease of venipuncture for cats undergoing blood donation.

The aim of this study was to compare the quality of sedation and recovery, and ease of venipuncture following sedation for feline blood donation using two intramuscular (IM) sedation protocols: alfaxalone/butorphanol (AB) and dexmedetomidine/butorphanol (DB). This was an experimental randomized, blinded, crossover study. Ten client-owned healthy cats were recruited to participate in the study. Cats were sedated with AB (alfaxalone 2 mg/kg and butorphanol 0.2 mg/kg) for one donation and DB (dexmedetomidine 10 μg/kg and butorphanol 0.2 mg/kg) for another. Reaction to injection, quality of sedation and quality of recovery were assessed by a blinded observer. Time to lateral recumbency, number of venipuncture attempts, time required for blood collection and time to return to sternal recumbency were recorded. Cats were monitored for evidence of gastrointestinal distress. Each donation consisted of a maximum of 53 ml whole blood drawn over 3-22 mins. Donors received 100 ml subcutaneous lactated Ringer's solution in recovery. Owners, unaware of sedation protocol, were asked to complete a questionnaire evaluating their cat's behavior following sedation. IM injections were well tolerated by both treatment groups. There was no significant difference between treatment groups in sedation scores for posture ( P = 0.30) or behavior ( P = 0.06). Cats sedated with DB had significantly higher muscle relaxation scores ( P = 0.03) compared with AB. There was no significant difference between treatment groups in time to lateral recumbency ( P = 0.12), number of venipuncture attempts ( P = 0.91) and time for blood draw ( P = 0.29). There was no difference in quality of recoveries between treatment groups based on simple descriptive scores ( P = 0.18) and owner evaluation 24 h following sedation. One cat vomited following administration of DB. Alfaxalone is a suitable alternative to dexmedetomidine when combined with butorphanol and used as part of an IM sedation protocol for cats undergoing blood donation.

The Use of Ultrasound to Improve Axillary Vein Access and Minimize Complications during Pacemaker Implantation.

The Agency for Healthcare Research and Quality in the United States recommends the use of ultrasound (US) for central venous access to improve patient outcomes. However, in a recent publication, US is still underutilized for axillary vein access during pacemaker implantation. We sought to describe a technique for US-guided axillary vein access during pacemaker implantation and to report complication rates and success rate. Retrospective data collection included success rate and complications on all pacemaker implants by one operator since implementing the systematic use of US at our institution, from November 2012 to January 2015. For the last 59 cases, data were collected prospectively to include time of venous access and number of attempts. A total of 403 consecutive patients were included in the analysis. Two leads were implanted in 255 cases and one lead was implanted in 148 cases. The rate of successful US-guided access was 99.25%. There were no access-related complications. The average number of venipuncture attempts was 1.18 per patient. The average time to obtain venous access was 2.24 minutes including the time to apply the sterile US sleeve. The described technique has the potential to improve the success rate of axillary vein access and minimize complications during pacemaker implantation.

Prospective evaluation of venous access difficulty and a near-infrared vein visualizer at four French haemophilia treatment centres.

Although a serious impediment in haemophilia patients, difficulty accessing peripheral veins has received little attention in clinical studies. New peripheral vein visualization devices could potentially ameliorate difficult venous access (DVA), but their utility remains unproved. The study aim was to survey the frequency, causes and clinical manifestations of DVA and evaluate the clinical utility of a near-infrared (NIR) vein visualizer. In this multicentre prospective study, methods, difficulties and outcomes of venous access were assessed for a single venipuncture in consecutive patients. The impact of an NIR vein visualizer on vein localization, the number of venipuncture attempts and patient stress and pain was determined. Among 450 total patients enrolled, venous access was judged to be difficult in 165 (36.7%), most often because of poor vein condition, young patient age, overweight and difficulty in finding veins. Of the patients with DVA, difficulty in locating veins was encountered in 82.4%, and more than one venipuncture attempt was required in 24.8%. Veins were difficult to locate in significantly fewer DVA patients (P = 0.002) when the NIR vein visualizer was used (76.0%) than not used (92.3%). Pain during venipuncture in DVA patients was also significantly less common (P = 0.019) with use of the NIR vein visualizer (34.0% vs. 55.4%). No effect was observed on venipuncture attempts. DVA affects more than one-third of patients at haemophilia treatment centres. An NIR vein visualizer showed significant promise for facilitating vein location and mitigating patient pain in those patients.

Perioperative Management of Acquired Hemophilia A: A Case Report and Review of Literature

Introduction:Acquired hemophilia A is a rare bleeding disorder with a high mortality rate. Diagnosis and treatment of this disorder can be very challenging to anesthesiologists because of lack of a personal or familial abnormal bleeding history.Case presentation:We report a 60-year-old woman who presented to the operating room for an urgent fasciotomy. She was initially diagnosed to have compartment syndrome of her left upper extremity secondary to an expanding hematoma after multiple unsuccessful venipuncture attempts. After surgical intervention, she developed recurrent intramuscular hematomas, became severely anemic, and required surgical re-exploration and multiple blood product transfusions. Ultimately, she was found to have an elevated activated partial thromboplastin time (aPTT), very low FVIII activity, and high FVIII inhibitor titers consistent with the diagnosis of acquired hemophilia A.Conclusions:Treatment strategies in acquired hemophilia are based on two major objectives. During the acute stage, effective control of bleeding is critical. The ultimate therapeutic goal during the subacute phase is the elimination of the inhibitors targeting factor VIII. Here, we present this case and will review current literature regarding therapeutic approaches to this rare condition in the operating room setting and postoperative course.

Indigenous Device for Intra-atrial ECG-Guided Central Venous Catheter Placement

Central venous catheters (CVCs) are frequently inserted in the operating room or the intensive care unit (ICU) for fluid management and haemodynamic monitoring. There are two main concerns during central venous catheterization. One is to locate and cannulate the vein rapidly and safely, avoiding accidental arterial puncture and acute pleuropulmonary complications (such as pneumothorax). Another is correct positioning of the catheter tip. Accurate placement of the catheter tip is not easy, and malpositions are a frequent complication of central venous cannulation. The ultrasoundguided CVC insertion provide visualization of vein and its anatomical variations, improves the success rate1 and decrease the number of venipuncture attempts and complications associated with it but does not guide the subsequent correct positioning of catheter tip. Different methods have been advocated for guidance of correct positioning of the catheter tip because incorrect CVC position can be associated with serious adverse effects2 like cardiac tamponade, malignant arrhythmias, placement in coronary sinus and tricuspid valve. The accurate length of the catheter to be inserted, can be estimated by anatomical landmarks3 or by ready-to-use algorhythms, radiological methods4 (intraoperative fluoroscopy or postoperative chest radiography), electrocardiographic (ECG) methods, echocardiographic5,6 methods (standard or transesophageal echocardiography). Intra-atrial ECG (IAECG) guidance is a simple, inexpensive, and safe method which can be used for this purpose. Although ECG guidance for CVC positioning was suggested in 1949 with several7-9 studies indicating the usefulness of the technique, this is not widely used. It could be due to the non availability of the device used for IAECG monitoring. This is an electrical switching device for alternating between the skin lead and intra-atrial lead. Here, we are reporting an indigenous device for the IAECG which can be used in place of the devices supplied by the various manufacturers, like Certodyn Universal Adaptor (B Braun Melsungen, Germany) or Tyco/Arbo VIDM-P73 complete cable.

Benefits of Establishing an Intravenous Team and the Standardization of Peripheral Intravenous Catheters

The purpose of this study was to show the importance of a team dedicated to intravenous (IV) insertion and the standardization of peripheral IV catheters in reducing venipuncture attempts, reducing cases of phlebitis, and optimizing costs. The benefits achieved by the team were a decrease in venipuncture attempts, a decrease of phlebitis (from 0.47% to 0.35%), the optimization of the team's time, and a 29.47% reduction in the use of catheters. The study corroborates the IV team's importance in the process of managing nurses' workflow, since it provides important indicators for quality management.

Avoiding Common Technical Errors in Subclavian Central Venous Catheter Placement

Proficiency in placing infraclavicular subclavian venous catheters can be achieved through practice and repetition. But few data specifically document insertion technical errors, which mentors could teach novice operators to avoid. Surgical, medical, and anesthesia textbooks and procedural handbooks were reviewed. Subclavian catheter placement technical errors described were identified and consolidated. Video captures from 86 consecutive patients receiving subclavian central venous catheterizations at an urban trauma center were evaluated. In each video segment, the number of attempts at insertion, the number of failures at insertion, and the technical error observed during failed attempts were recorded and tabulated. Of the 86 subclavian line placements attempted, 77 were successful (89.5%), with a total of 357 subclavian venipuncture attempts and 279 failures (78% attempt failure rate). There was a mean of 3.2 failed attempts per line (left side, 2.1 attempts; right side, 5.5 attempts). Junior residents (PGY 1 to 2) had more failures per line than senior residents (PGY 3 to 5): 4.1 versus 3.6. The most common technical errors observed were improper site for needle insertion relative to the clavicle; insertion of the needle through the clavicular periosteum; too shallow of a trajectory for the needle; improper or inadequate anatomic landmark identification; aiming the needle too cephalad; and inadvertent movement of the needle out of the vein before or during wire placement. In subclavian central venous access attempts, there are six common technical errors. Mentors can improve novice operators' proficiency by teaching them to avoid these errors.

Difficult Peripheral Venous Access: Recognizing and Managing the Patient at Risk

Nurses commonly face challenges placing peripheral intravenous (IV) lines in adults and children, a situation described as difficult venous access (DVA). Multiple venipuncture attempts can heighten patient anxiety and suffering, delay vital treatment, and increase costs. Numerous factors such as small, fragile or hidden veins can predispose patients to DVA, and collapsed veins due to dehydration are especially problematic. Several techniques can improve venous prominence, but when IV access cannot be achieved promptly, other routes of administration can be valuable. For rehydration fluids and certain drugs, subcutaneous administration may be a safe and effective alternative, providing cost and ease-of-use advantages.

Randomized Controlled Trial of Vascular Access in Newborns in the Neonatal Intensive Care Unit

To compare the effectiveness of two methods of vascular access in newborns. Randomized controlled trial. Neonatal intensive care unit in Regional Hospital of Valdivia, Chile. Seventy-four high-risk newborns. Peripherally inserted central catheter and peripheral intravenous catheter. Length of neonatal intensive care unit stay and incidence of sepsis and phlebitis. RESULTS/DATA ANALYSIS: There were no statistically significant differences in the length of the neonatal intensive care unit stay and in the incidence of sepsis between groups. There was a significant higher incidence of phlebitis in the peripheral intravenous catheter group. Although there was not a significant effect of the kind of catheter on length of neonatal intensive care unit stay, the peripherally inserted central catheter is recommended because of the decreased risk of phlebitis and the decreased number of venipuncture attempts and catheters needed to complete intravenous therapy.

Cateterismo venoso central de inserción periférica en recién nacidos de cuidado intensivo

Objective: To evaluate the use of peripherically-inserted central venous catheter (PICC) in newborns of intensive care units. Patients and Methods: 46 catheters inserted in 40 neonates were evaluated prospectively analyzing 4 variables: number of venipuncture attempts, time of installation, reasons for removal and complications. Results: 49% were settled in the first attempt and 69,5% in antecubital veins, locating 63% in superior vena cava. The mean venipuncture attempts was 2,1, being significantly lower in low birth weight neonates ( 1 500 g = 2,5 ± 1,5; p = 0,045). The average time of installation was 20 minutes for very low birth weight newborns and 25 for the greater ones. The duration period was similar. 50% were retired by the end of intravenous therapy, 19,6% due to occlusion and 8,7% because of phlebitis. Conclusions: PICC constitute a first line alternative for very low birth weight newborns where installation is easier, being a safe and effective intervention.

Subcutaneous pulsating neck mass after left internal jugular venipuncture

78-YEAR-OLD FEMALE patient was transferred to this hospital. She had a past history of coronary artery bypass grafting, sick sinus syndrome with pacemaker implantation, and chronic heart failure. Her symptoms were productive cough and orthopnea. Central venous cannulation via the left internal jugular vein was attempted. After local anesthesia with 1% lidocaine into the skin and subcutaneous tissue, the left internal jugular vein was approached anteriorly. At first, nonpulsatile and dark venous-like blood was obtained. However, the guide wire could not be advanced because of unusual high resistance. On the second try, nonpulsatile and dark red blood was obtained again. The catheter was inserted by the Seldinger method, but, surprisingly, pulsatile bleeding with bright red arterial blood was found to be coming from the catheter. The catheter was then withdrawn. A central venous pressure catheter was then placed in the femoral vein. Continuous arteriovenous hemodialysis with a heparin infusion was begun to treat her renal dysfunction because of a low cardiac output syndrome. Three days later, a subcutaneous mass was noticed in the left side of her neck at the site of the previous venipuncture attempt. The mass was growing gradually to the size of an egg with pulsation. Figure 1 shows a surface echo-examination of this mass. What is the diagnosis?

Is a routine chest x-ray necessary for children after fluoroscopically assisted central venous access?

Purpose: The aim of this study was to determine in a pediatric population whether a routine chest x-ray after central venous access is necessary when the central venous catheter is placed with intraoperative fluoroscopy. Methods: This was a retrospective review of the charts of all patients at Children’s Hospital in Denver, Colorado who underwent subclavian or internal jugular central venous catheter placement from January 1, 1998 through December 31, 2001. Age, sex, primary reason for access, access site, number of venipuncture attempts, type of catheter, intraoperative fluoroscopy results, chest x-ray results, location of the tip of the catheter, and complications were analyzed. Results: There were 1,039 central venous catheters placed in 824 patients, 92.6% in the subclavian vein and 7.4% in the internal jugular vein. There were 604 (58.1%) children who had both fluoroscopy and a postprocedure chest x-ray, there were 308 (29.6%) who had only fluoroscopy, there were 117 (11.3%) who had only a postprocedure chest x-ray, and there were 10 (1.0%) who had neither fluoroscopy nor chest x-ray. On completion of the procedure, there were 12 (1.1%) children with misplaced central venous catheters, only 1 (0.1%) when intraoperative fluoroscopy was used. There were 17 (1.6%) complications; 9 (0.9%) were pulmonary (pneumothorax, hemothorax, or an effusion). All children with pulmonary complications experienced clinical signs and symptoms suggestive of the complication after their central venous catheter insertion but before their postprocedure chest x-ray. Conclusions: The number of complications encountered in children who had central venous access of the subclavian vein or internal jugular central vein with intraoperative fluoroscopy was infrequent, the number of misplaced catheters was minimized with intraoperative fluoroscopy, and all children with pulmonary complications showed clinical signs suggestive of pulmonary complications before postoperative chest x-ray. Therefore, children who have had central venous access of the subclavian and internal jugular vein with intraoperative fluoroscopy do not appear to require a routine chest x-ray after catheter placement unless clinical suspicion of a complication exists.

Combined superficial peroneal and saphenous nerve block for ascending venography

Needle insertions into the veins of the dorsum of the foot are an overlooked source of pain and discomfort during ascending venography. As a solution to this problem a regional anaesthetic technique is presented, the combined superficial peroneal and saphenous nerve block, after being studied prospectively on 42 patients referred for bilateral venography. The nerve blocks were always performed unilaterally. At the end of each bilateral study patients were asked to express a preference for one of the two venograms, on the basis of pain and discomfort from the needle insertions. Of the 42 patients, 27 (64.3%) opted for venography with regional anaesthesia, 9 (21.4%) for venography without regional anaesthesia, while 6 (14.3%) did not state a definite preference. As shown by the sign test, preference for venography with regional anaesthesia was highly significant. By observing the reactions of the patients during the needle insertions, the radiologist classified arbitrarily the pain produced in each individual venogram as minimal, moderate or severe. The statistical significance of these observations was verified with the chi-squared test for trend and the sign test. In addition to diminishing effectively the pain from the venography needle, this simple technique proved to be safe and causing negligible discomfort. It is recommended for all patients who are apprehensive or have already experienced considerable pain on a first unsuccessful venipuncture attempt, or when multiple punctures are expected because of lack of suitable veins or presence of oedema.

Recognition of accidental arterial cannulation after attempted central venipuncture

Central venous catheters facilitate the safe administration of parenteral nutrition and concentrated drug and electrolyte solutions, allow measurement of central venous pressures, and permit establishment of reliable venous access in patients with inadequate peripheral venous access. Unfortunately, insertion of such catheters is not risk free. Historically, numerous associated complications have been described, including arterial puncture, which has occurred in about 5% of central venipuncture attempts (range 2% to 15%) (1–5). In certain patients, classic signs of arterial puncture may be absent, and cannulation may occur. Yet, few studies have been published that document the predisposing factors, radiographie findings, and complications of accidental central arterial cannulation. Three illustrative cases are presented.

Evaluation of venous distension device: Phase II: Cannulation of nonemergent patients

A device designed to augment venous filling by applying a vacuum to the arm during tourniquet application was evaluated in adult patients considered to have difficult peripheral venous access and in need of nonemergent venipuncture or intravenous cannulation. Patients taking medications that affected platelet activity or who had venipuncture attempts within 1 week in the same extremity were excluded. A total of 21 patients (age, 38.8 ± 15 years; weight, 77.3 ± 22.5 kg) were studied. The majority were obese (62%) and/or did not have prominent veins even when a standard tourniquet cuff was placed (71%). Use of the device was successful in 19 patients (90%), with a mean time to venipuncture after vacuum removal of 38 ± 30 seconds. In the 2 patients in whom the device was unsuccessful, both patients were intravenous drug users and subsequently required either external jugular or central venous line placement. Seven patients had unsuccessful attempts at venipuncture or intravenous cannulation on the opposite extremity immediately before use of the device. In these 7 patients, subsequent use of the device was 100% successful ( p = 0.0003, Fisher's exact test, assuming all attempts using standard techniques would have been unsuccessful). When conventional tourniquets are unsuccessful for venipuncture, the use of the venous distension device may obviate the need for more invasive forms of venous access.