86 Section III ■ Blood Sampling

Fig. 13.1. Fiberoptic transilluminator placed on the palmar

surface to visualize veins on the dorsum of hand.

Fig. 13.2. LED transilluminator positioned to visualize a scalp

vein. (Courtesy of Veinlite by Translite, Sugar Land, Texas.)

Fig. 13.3. Otoscope placed on the palmar surface to visualize

cephalic vein.

Fig. 13.4. Transilluminator placed on the palmar surface to

visualize the veins on the dorsum during IV insertion.

Fig. 13.5. Transilluminator placed posteriorly to visualize the

posterior tibial artery.

F. Technique

1. Place a sterile cover over the probe, and use sterile

lubricant on the probe

2. Use your nondominant hand to hold and position the

US probe (Fig. 13.8)

Chapter 13 ■ Vessel Localization 87

Fig. 13.8. US probe positioned perpendicular to vein to access

Fig. 13.6. Burn from transilluminator. for PICC placement.

Fig. 13.7. Superficial burn after prolonged transillumination.

3. Optimize probe orientation, placing the target vessel in

the center of the screen.

a. Short-axis or transverse view: Probe is placed transverse to the direction of the vessel, which is seen in

cross-section (Fig. 13.9).

b. Long-axis or sagittal view: Probe follows the direction

of the vessel, which is seen in its length. Following the

vein’s path, identify valves, stenosis, or thrombosis.

Fig. 13.9. Transverse view with cross-section of the vessel visualized.

c. Out-of-plane where the needle crosses the US beam

perpendicularly

d. In-plane where the needle stays in the US beam

4. Position the handheld transducer probe perpendicular

to a vein.

5. The needle tip should always be in the field of view

during the procedure.

88 Section III ■ Blood Sampling

G. Complications

None

Near-Infrared Visualization

A. Background

The infrared light source emits a harmless, near-infrared

light, which is absorbed by the blood. Tissues surrounding

the blood reflect the light and this image is captured by a

digital video camera and processed. A green LED adds contrast to the image, which is then directly projected onto the

surface of the skin in real time. This device requires no

patient contact and has no heat, radiation or laser–eye safety

issues (15,16).

B. Indication

1. To locate an accessible artery or vein for

a. Phlebotomy

b. Vessel cannulation

C. Contraindications