CLINICAL ISSUES

I NEVER
MISS A
VEIN.

Take the guesswork

out of venipunctures
By Dennis J. Ernst, MT(ASCP)

S uperman would make a great phlebotomist. With his X-ray

vision, he would never miss a vein, or have to apologize to
a patient, or send in another superhero to try to draw blood.
STAT draws would take half the time, and morning collections
would be completed faster than a speeding bullet.
the manufacturer, the AV300 relies on the physical property of
hemoglobin in that it absorbs infrared light. When the device is
held about seven inches above the skin and activated, it detects
the difference in the hemoglobin concentration between the veins
and surrounding tissue. Once
Unfortunately, most of us are not from Krypton. While detected, the reflected infrared
the jobs of other healthcare professionals have been infinitely light indicates the size and posi-
simplified by robotics, nanotechnology, and digital imaging, tion of veins beneath the surface
those who draw blood are resigned to relying on old technology of the skin by instantly projecting
like instinct and the human fingertip. But just when you think a precise map of the veins on the
you have the only job in healthcare that cannot be improved by skin above them. The device,
technology, someone shouts, “Look! Up in the sky. It’s a bird! the size of a cordless phone, can
It’s a plane! It’s a vein-detection device!” Not just one device be hand-held or positioned on a
but a veritable bevy … a flock … a gaggle, even … so many hands-free accessory so the pro-
that it requires an entire magazine article to summarize them all. cedure can be performed while
Here is that article: the map is projected.
“It is portable and works in
Standard eyes any kind of ambient light and on The AV300 is the size of a cord-
less phone.
What follows is a summary of devices designed to locate veins any color of skin,” says Vinny
from which blood can be drawn. They utilize a variety of tech- Luciano, vice president of Marketing for Accuvein. “The AV300
nologies, designs, and applications for patients of all ages and never comes in contact with the patient, so it does not need to be
skin pigmentation. Although phlebotomy will never be automated, sterilized between uses. It operates on batteries or can be plugged
these devices bring today’s technological advancements into one into a wall outlet, whichever is most convenient for the user. Once
of the last otherwise entirely manual procedures in healthcare. the device is activated, there is no lag time before you know pre-
Why is it important to see all options beneath the skin? It is all cisely where the veins lie.”
about the standards. VeinViewer (Luminetx, Memphis, TN): Using near infrared
Being able to see the exact location of veins not only makes the light and “other technologies,” the VeinViewer is a mobile bio-
procedure more frequently successful but also facilitates a lab’s medical device that illuminates subcutaneous veins, then projects
compliance with standards established by the Clinical and Labora- an image of the vasculature onto the surface of the skin. Accord-
tory Standards Institute (CLSI). According to the organization’s ing to the manufacturer,
venipuncture standard (H3), a thorough survey of available veins the VeinViewer uses a
must be conducted to minimize the risk of injury to the patient. flexible head unit that
This recommendation is based on the close proximity of the me- positions the infrared
dial antebrachial cutaneous nerves to the basilic vein, which lies light over any part of
in the inside or medial aspect of the antecubital area. If pierced the anatomy. The light
by a misguided needle, these nerves can be permanently injured, makes veins visible to
subjecting the patient to long-term pain and complications. Failure a digital video camera,
to comply with this standard requirement can translate to a labora- which then transmits
tory’s liability for those injuries. Because the standards require an live video to an image The VeinViewer is a mobile biomedical
avoidance of the basilic vein unless no safer vein can be located, processor. The processor device using near infrared light.
any device that lets the user see the available veins beneath the skin then enhances and aligns the images for output through a projec-
not only manages the risk of injury but also facilitates compliance tor that displays the enhanced image in real time. By imaging
with the standards. the vasculature, the company’s website states “… clinicians have
the ability to visualize the location of the target area and observe
Devices that utilize laser/infrared technology any movement of the vasculature regardless of a patient’s age,
AV300 (AccuVein, Cold Spring Harbor, NY): According to body type, or skin tone.”

18 April 2009 ■  MLO www.mlo-online.com

CLINICAL ISSUES
Luminetx has created a subsidiary
to adapt its vein-finding technology to
other applications within and outside
of healthcare. Using vein-pattern rec-
ognition technology, a tabletop device
captures the vein pattern present in the
palm of a person’s hand, then generates
a numeric biometric “key,” which is
unique to every individual. The key is
used to enroll the person in a biometric
system as a fraud-proof method for
verifying identity. Any attempt to use a
biometrically enabled system generates
a new key that is matched against the
person’s enrolled key.
Devices that illuminate tissue
Venoscope (Venoscope, Lafayette,
LA): The Venoscope II Transillumi-
nator is a hand-held device used to
locate veins us-
ing high-intensity
red and white
LEDs that pen-
etrate deep into the
subcutaneous tis-
sue. When placed
on the patient’s
skin, the device
illuminates the
subcutaneous tis-
sue with an array
of high intensity
LED lights high-
lighting the veins,
The Venoscope II can which absorb the
be attached to a pa- light rather that
tient with a Velstretch
reflect it. While
strap.
directing light into
the subcutaneous tissue, the manu-
facturer recommends dimming the
ambient lighting as much as possible
to provide the contrast needed to see
veins. A white light provides definition
between the tissue, which is lighter in
intensity; and the veins, which appear
as dark lines or shadows between the
device’s two illuminating arms. The
unit is powered by three AA alkaline
batteries and has a built-in low-battery
indicator that signals when batteries
need to be changed. The Venoscope II
can be attached to the patient’s arm by
attaching a Velstretch strap (provided),
effectively stabilizing the vein to pre-
vent rolling and liberating both of the
user’s hands for the venipuncture. After
use, the device may be wiped with an
alcohol or bleach solution.
20 April 2009 ■  MLO www.mlo-online.com
For neonatal applications, Veno-
scope also offers the Neonatal Transil-
luminator, which functions under the
same principle in a smaller and more
portable design. The illuminating lights
are cool and bright enough to illuminate
without burning.
Wee Sight (Children’s Medical
Ventures, Monroeville, PA): Also
designed for neonatal patients, the
Wee Sight allows one person to both operate the
device and perform the prodedure.
Wee Sight Transilluminator utilizes a
strong LED light to reveal vein loca-
tion without emitting heat. The device
is designed to lie flat on a surface to
allow users to position the baby’s arm
or leg over it for enhanced illumination.
Alternatively, it can be held in the hand
of the user and positioned against the
patient’s limb. According to the com-
pany’s website, the design allows one
person to both operate the device and
perform necessary procedure.
Vein Locator (Sharn Inc., Tampa,
FL): The Vein Locator is a portable,
battery-operated device that uses
The Vein Locator is disgarded after use.
three LED lights to transilluminate
the patient’s tissue, highlighting veins.
Limited for neonatal, pediatric, and frail
adult patients, the Vein Locator is self-
contained and can be cleaned as needed.
The device’s batteries provide 40 hours
of use and are not replaceable. Once
exhausted, this device is discarded.
Veintector (Carolina Liquid Chem-
istries, Brea, CA): The Veintector
uses 38 red and yellow LED lights to
illuminate the tissue beneath the skin
upon which it rests. A protective sheet
The Veintector runs on two oxyride batteries
and includes a strap for hands-free use.
is placed between patient and device
to prevent patient-device contact. A
color-adjustment button allows the user
to change settings for optimal contrast.
The device runs on two oxyride batteries
and includes a strap for hands-free use.
Lights can be disinfected with alcohol.
Veinlite Transilluminators (Trans-
Lite LLC, Sugar Land, TX): TransLite
uses the side-transillumination method
in all its Veinlite
models. A bright
ring of light is
placed against
the skin, and
light is focused
into the tissue
and towards the
center of the ring
creating a vir-
tual light source
under the skin Veinlite Transillumina-
that uniformly tors offer haolgen-light
illuminates the fiber-optic units and bat-
superficial tis- tery-operated, LED-based
pocket models.
sues within the
ring. The deoxygenated blood in veins
causes them to show up as dark lines
in contrast with the surrounding tissue.
An opening in the ring facilitates blood
draws or injections. Veinlites can either be
halogen-light fiber-optic units or battery-
operated, LED-based pocket models.
Halogen-light Veinlites have a vari-
able intensity light source and a metal
ring illuminator with a fiber-optic cable.
A large ring illuminator is used for adult
vein access, whereas a small ring il-
luminator is used for pediatric venous
access. LED-based Veinlites achieve the
best contrast for vein imaging by using
a combination of bright orange LEDs
(for strong illumination), combined with
deep red light (for high penetration of
dark pigmented skins). Light shields
snap on to the units to stop interference
from overhead light. Pediatric or neonate
adapters can be used to enhance the light
area for use with babies and children. All
 v ein SfUinB Jd Ee Cr Ts

LED-based models come with dispos-

able plastic covers to prevent infection. Accuvein Sharn Inc.
Veinlite LED is rechargeable and has 816-298-6991 800-325-3671
24 LEDs (12 orange and 12 red). Two www.accuvein.com www.sharn.com
switches are used to select either or both Luminetx Carolina Liquid Chemistries
colors for optimum vein imaging in all 910-252-3752 336-722-8910
www.luminetx.com http:/www.carolinachemistries.
skin types. com/CLC/index.dfm/hurl/idsPage-
TransLite offers two other models for Venoscope
800-284-7655 ID=154/Type=39/Helps-to-find-
use in phlebotomy: the Veinlite EMS and www.venoscope.com those-hard-to-find-veins
the Veinlite PEDI. Veinlite EMS is a sim- TransLite
Children’s Medical Ventures
pler version of the Veinlite LED but uses 800-345-6443 281-240-3111
16 LEDs (eight orange and eight red). Ac- http://weesight.respironics.com www.veinlite.com
cording to the manufacturer, it provides a
[In order of appearance in this article]
lower-cost option for venous access and is
well suited to emergency response teams.
It uses two AA alkaline batteries and has “It seems to me that the motto of our profession as always been ‘YES, WE CAN!’
a single switch to illuminate both orange It continually astonishes me how much we accomplish under the most chal-
and red LEDs. The Veinlite PEDI the lenging of circumstances. Not just doing business as usual or more with less,
smallest vein transilluminator and is de- but the intelligence, resourcefulness, creativity, and tenacity characteristic of
signed for babies and neonates. It has 12 laboratory professionals. We are still largely unknown by name to the general
LEDs (eight orange and four red) and one public but the passion and commitment to excellence that typify our contribu-
CR2 lithium battery. Two switches allow tion to healthcare are reward enough. We are professionals in every sense of
for selection of either or both colors for the word!”—Sharon M. Miller, PhC, MT(ASCP), CLS(NCA), Professor Emerita,
optimum vein imaging. A snap-on neona- Clinical Laboratory Sciences, College of Health & Human Sciences, Northern
tal adapter is designed to shine six closely Illinois University, DeKalb, IN.
packed LEDs through a small opening for
safe through-the-body transillumination
of small limbs in neonates.
The magic of veinfinders
Whether you use supernatural powers,
the technologies of Planet Earth, or the
good old-fashioned fingertip, locating
the best vein for venipuncture is critical
to patient satisfaction, specimen integ-
rity, staff productivity, and compliance
with the standards. Arthur Clarke, author
of 2001: A Space Odyssey, once wrote,
“Any sufficiently advanced technology
is indistinguishable from magic.” Some
of these devices may seem to be employ
magic, but healthcare professionals
should use them as supplements to
their keenly developed senses of vision,
palpation, and instinct, not substitutes
for them.
Vein finders may not enable a labora-
tory’s staff to leap tall buildings in a single
bound or make them more powerful than
a locomotive. But if they can draw on the
first stick, they might just become super
heroes to difficult patients.

Dennis J. Ernst, MT(ASCP), is the director of the Center

for Phlebotomy Education in Corydon, IN. The author
of several books on phlebotomy, Ernst also chairs the
revisions of several CLSI specimen-collection standards
and serves as the editor of the Phlebotomy Today family
of e-newsletters. As an industry consultant, Ernst con-
sults with companies serving the preanalytical market,
including Accuvein.

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