15 Arterial Puncture

16 Capillary Blood Sampling

III Blood Sampling

85

Suna Seo

13 Vessel Localization

Transillumination

A. Indication

 Failure to locate an accessible artery or vein under normal lighting conditions for

1. Puncture for sampling (1–3)

2. Vessel cannulation (4,5)

B. Contraindications

None

C. Precautions

Verify that the light source equipment has an intact heatabsorbing glass and infrared and UV filters (6).

D. Equipment

1. Transillumination source

a. High-intensity cold source with a fiberoptic cable

(Fig. 13.1)

b. Light-emitting diode (LED) (Fig. 13.2) (4,5)

c. Otoscope light may be used in some instances (Fig.

13.3) (1)

2. Alcohol swab

3. Sterile glove or disposable plastic covers

E. Technique

1. Clean end of light source with an alcohol swab. Cover

with sterile glove or disposable plastic cover.

2. Dim light in room. Some residual light is necessary to

visualize operating field.

3. Set light source at low intensity and increase as needed

for visualization.

4. Position probe to transilluminate vessel.

5. Identify vessel as a dark, linear structure (Figs. 13.4 and

13.5).

6. Compensate for distortion if light is not directly opposite the puncture site.

7. Do not maintain contact between light source and

extremity for long periods of time.

F. Complications

1. Thermal burns from light probe (Figs. 13.6 and 13.7)

(6–10)

2. Contamination from breach of sterile technique

Ultrasonography

A. Background

The use of portable ultrasound (US) as an adjunct tool for

neonatal percutaneously inserted central catheter (PICC)

placement has increased with the advent of smaller neonatal

probes, and growing knowledge and experience of US (11).

B. Indication

To locate artery or vein for vessel cannulation (11–13)

C. Contraindications

None

D. Precautions

The difference between veins and arteries can be subtle in

neonates. Veins are usually collapsible and arteries are pulsatile (12).

E. Equipment

1. High-frequency (>10 MHz) small (<30 mm width) linear US probe

2. Doppler function (screening for thrombosis and occlusion)

3. Zoom function

4. Sterile gel

5. Sterile probe cover