evidence & practice / CPD / intravenous therapy
VASCULAR ACCESS
Locating difficult veins for
venepuncture and cannulation
NS881 Shaw SJ (2017) Locating difficult veins for venepuncture and cannulation. Nursing Standard. 31, 25, 62-69.
Date of submission: 29 November 2016; date of acceptance: 8 December 2016. doi: 10.7748/ns.2017.e10778
Sally Jane Shaw
Clinical skills trainer,
VIP Venepuncture and
Cannulation Training,
Warwickshire, England
Correspondence
sally.shaw88@yahoo.
co.uk
Conflict of interest
The author undertook
some consultancy work
for Novarix Ltd for four
months in 2015. She
provided training for
Olberon on the Vacuderm
to staff at the Royal Derby
Hospital in January 2017
Peer review
This article has been
subject to external
double-blind peer
review and checked
for plagiarism using
automated software
Revalidation
Prepare for revalidation:
read this CPD article,
answer the questionnaire
and write a reflective
account: nursingstandard.
com/revalidation
62 / 15 February 2017 / volume 31 number 25
Abstract
Vein location and assessment are essential to improve the success rates for vascular access.
However, problems remain with first attempt success rates for peripheral cannulation and
locating difficult veins. Practitioners may not be aware of developments in technology and aids
to assist in the location and assessment of veins to achieve vascular access. This article provides
an overview of two vein location aids that can be used to locate difficult veins: the IV-eye vein
imager and the Vacuderm tourniquet. It discusses the patient factors that can increase the
difficulty of vein assessment and location, and emphasises the importance of vessel health
and preservation, and vein palpation. Practitioners should be experienced and skilled in the
assessment of veins, and they are encouraged to revisit how they locate and assess veins.
Keywords
cannulation, IV-eye vein imager, Vacuderm tourniquet, vascular access, vein assessment, vein
preservation, venepuncture, vessel health and preservation, VHP framework
Aims and intended learning Outline the VHP framework
outcomes (Hallam et al 2016) and consider how it
This article aims to increase the could be implemented in your practice to
practitioners knowledge of veins that are improve vein assessment and location.
difficult to locate for venepuncture and
peripheral intravenous (IV) cannulation. Relevance to The Code
It focuses on the use of two vein location Nurses are encouraged to apply the
aids: the IV-eye vein imager and the four themes of The Code: Professional
Vacuderm tourniquet. It also discusses Standards of Practice and Behaviour for
the importance of vessel health and Nurses and Midwives to their professional
preservation (VHP), and the use of an practice (Nursing and Midwifery Council
assessment tool to enhance this. After (NMC) 2015). The themes are: Prioritise
reading this article and completing the time people, Practise effectively, Preserve safety,
out activities you should be able to: and Promote professionalism and trust.
Consider aspects of your practice that This article relates to The Code in the
could be developed to improve vein following ways:
assessment and location. Developments in technology in relation
Identify the factors that may increase the to vein location and assessment are
difficulty of vein location and peripheral discussed, which assists nurses to ensure
IV cannulation. their knowledge and skills up-to-date,
Understand the appropriate actions and to practise in line with the best
to take to reduce the risk of failed available evidence.
cannulation attempts. The use of vein location aids may
Describe the different vein location improve successful vascular access rates,
devices available and outline their use. reducing the adverse effects for patients
nursingstandard.com
 associated with several failed attempts.
This relates to the theme of prioritising
people, since it can enhance patient care.
The Code emphasises the importance
of working within the limits of your
competence. The article states that
when attempting cannulation, nurses
should consider their level of skill and
experience, and recognise when to
refer the patient to a more experienced
practitioner or the IV therapy team.
It can help nurses to preserve safety
by reducing potential harm associated
with venepuncture and cannulation
procedures.
Introduction
Vein location for venepuncture and
cannulation is a common procedure in
healthcare. However, the high incidence
of failed venous access attempts is well
documented (Asrar et al 2015). First
attempt cannula insertion success rates in
emergency departments have been found to
range from 18% to 79% (Carr et al 2016),
while a first attempt success rate of 86%
was found in one emergency department
(Carr et al 2016). This demonstrates that
there is significant variation in first cannula
attempt insertion success rates. Hallam et al
(2016) stated that the implications for
patients of failed cannulation include
suboptimal patient experience, pain,
and delays to IV treatments such as the
administration of antibiotics and IV fluids.
Practitioners often become aware of
the patient factors that may increase the
difficulty of locating an appropriate vein
for cannulation through their experience
of vein location and vascular access. These
factors include: deep vein location in obese
patients; suboptimal visualisation and
palpation of the vein because of factors
such as oedema, skin pigmentation or
tattoos; a history of chemotherapy, which
may have caused intimal damage; and
altered subcutaneous fat distribution,
which reduces the visualisation of
peripheral veins (Carr et al 2016).
Chiao et al (2013) found that patient
characteristics, such as dark skin colour
and obesity, reduce vein visibility, affecting
the location of veins for cannulation.
nursingstandard.com
The age of the patient may also affect the Online
difficulty of cannulation. For example, older For related articles visit
patients have a weaker vein structure and the archive and search
endothelium of the vein (Dougherty 2013), using the keywords.
increasing the difficulty of cannulation, Guidelines on writing for
while Lamperti and Pittiruti (2013) publication are available
suggested that the small vein diameter at: journals.rcni.com/r/
in infants may increase the difficulty of author-guidelines
peripheral IV cannulation. Carr et al (2016)
found a significantly increased risk of To write a CPD article
peripheral IV cannulae insertion failure in Please email gwen.
patients aged over 80 years, compared to clarke@rcni.com.
those aged under 40 years. It is important to Guidelines on writing for
note that there is no specific patient group publication are available
whose veins will always be more difficult to at: journals.rcni.com/r/
locate. For example, one older patient may author-guidelines
not have veins that are difficult to locate,
while another might.
Where veins are not visible and are difficult
to palpate, aids may be used to assist in
vein location. There are many different vein
location aids available, including ultrasound,
near-infrared vein imagers and various types
of tourniquets. Assessment tools, such as the
VHP framework (Hallam et al 2016), may
also be used.
This article discusses two vein location
aids that the author has used during
venepuncture and cannulation training:
the IV-eye vein imager and the Vacuderm
tourniquet. It is important to note that
the author is not suggesting that these
specific aids are preferable to others; this
article aims to provide information about
the use of these two aids to enhance the
readers knowledge and encourage them
to undertake further research in this area.
Practitioners should be mindful of The
Code (NMC 2015), which states that
nurses must ensure their knowledge and
skills are up to date and practise in line
with the best available evidence.
TIME OUT 1
List any patient factors that could increase the difficulty
of vein location. What could you do to manage each of
these factors and how could you apply this knowledge to
your practice to improve patient outcomes?
Benefits of using vein location aids
and assessment tools
An important benefit of using vein location
aids is their potential to preserve veins.
volume 31 number 25 / 15 February 2017 / 63
evidence & practice / CPD / intravenous therapy

KEY POINT
Using an assessment tool,
such as the VHP framework
(Hallam et al 2016), can
assist the practitioner
to assess difficult veins
and identify appropriate
actions. The VHP framework
provides flow charts that
guide the practitioner
through the process of vein
assessment, decision-
making regarding the use of
vein location aids, vascular
access device selection and
re-evaluation of a vascular
access device
Since patients are living longer, they
may undergo an increasing number of
medical procedures, and it is vital that
vein preservation is considered a long-
term goal (Chiao et al 2013). Chiao et al
(2013) suggested that, to achieve vein
preservation, practitioners should locate all
visible veins and map them before choosing
the most suitable cannulation site. Using
an assessment tool, such as the VHP
framework (Hallam et al 2016), can assist
the practitioner to assess difficult veins
and identify appropriate actions. The VHP
framework provides flow charts that guide
the practitioner through the process of vein
assessment, decision-making regarding the
use of vein location aids, vascular access
device selection and re-evaluation of a
vascular access device. Figure 1 shows
an excerpt from the VHP framework
(Hallam et al 2016), which practitioners
can use to assist in decisions regarding IV
therapy. The VHP framework also prompts
practitioners to refer to local guidance
about how to obtain support from more
experienced practitioners (Hallam et al
2016). The Royal College of Nursing
(RCN) (2016) Standards for Infusion
Therapy state that use of an organisation-
wide Vessel Health and Preservation
framework should be considered to
support staff in assessing and selecting the
best vascular access device to meet each
patients needs and preserve patent blood
vessels.
TIME OUT 2
Read your local policies for cannulation and vascular
access device selection. Look at the VHP framework
(Hallam et al 2016), available at: www.3mlearning.co.uk/
media/1155/vhp-poster.pdf, and consider if it could be
implemented in your clinical area. Make a list of the
factors you would need to consider before implementing
the VHP framework.
IV-eye vein imager
The IV-eye vein imager uses near-
infrared light to illuminate the skin and
subcutaneous layer. The near-infrared light
is absorbed by the haemoglobin in the
blood and the resulting real-time image is
captured by a camera on the underside of
the IV-eye and displayed on an LCD (liquid
crystal display) screen on the top of the
device (Novarix Ltd 2016).
Before using the IV-eye, the practitioner
should ensure that they have knowledge of
the patients medical and vascular access
history, as well as local vascular access and
venepuncture policies. When considering
the use of the IV-eye, the practitioner
should assess whether they require an aid
to locate a vein, taking into account their
level of experience and skill in vascular
access or vein location, and any patient
factors that may increase the difficulty of
vein location.
The following procedure should be
followed to locate veins using the IV-eye:
1. Gather the equipment required for this
procedure, including cleansing wipes,
as per local policy; a tourniquet; and an
IV-eye disposable cover.
2. Introduce yourself to the patient and
discuss the procedure with them.
Obtain the patients consent for
the procedure and ensure they are
comfortable.
3. Identify patient factors that may
indicate possible difficulty in locating
veins, such as the age, medical
conditions and a history of difficult
vascular access.
4. Wash your hands.
5. Use the peripheral vein assessment tool
(Figure 2) (Hallam et al 2016) to assess
the quality of the patients veins. If the
vein quality is fair (Grade 3) or poor
(Grade 4), this is an indicator to use an
infrared vein imager.
6. Cleanse the IV-eye using a cleansing
wipe and apply a disposable cover to
the IV-eye under the device so that it
does not come into direct contact with
the patients skin, in accordance with
local policy.
7. Apply a tourniquet and check for a
radial pulse.
8. Turn on the IV-eye using the single
button on the top of the device.
9. Anchor the patients skin and place
the IV-eye on the area of vein location,
ensuring that the red light is pointing
down the patients limb (Figure 3).
10. Apply slight pressure while slowly
sliding the IV-eye over the patients

64 / 15 February 2017 / volume 31 number 25 nursingstandard.com

 skin to locate a vein. Vein location is
indicated by an image of a defined dark
solid line on the screen of the IV-eye
Figure 1. Right line decision tool
Genuine need for intravenous therapy?
Yes
MUST therapy be administered
centrally?
(see example drugs list)
Yes
(Figure 4a). If the vein is deeper, the
image will become a grey defined line
(Figure 4b) (Novarix Ltd 2016).
of the patients medical and
No
Continue via alternative route
Consider: oral, sublingual, inhaled,
subcutaneous, nasal, transdermal,
topical etc
the difficulty of vein location
Peripheral vein
No
Assessment grade
KEY POINT
Before using the IV-eye, the
practitioner should ensure
that they have knowledge
vascular access history,
as well as local vascular
access and venepuncture
policies. When considering
the use of the IV-eye, the
practitioner should assess
whether they require an
aid to locate a vein, taking
into account their level
of experience and skill in
vascular access or vein
location, and any patient
factors that may increase

Peripheral vein assessment

5
1 2 3 4
None
Excellent Good Fair Poor
Identifiable

Ok for 4-6
<6 months <4 months
Outpatient / weeks One-off
intermittent intermittent
long term intermittent cannulation
therapy therapy Not suitable for
therapy
cannulation
Inpatient / One-off
Less than 10 days therapy
Acute cannulation

If peripheral vein grade not compatible with intended treatment

duration, consider other type of vascular device

Duration of anticipated therapy?

<10 days1 >10 days <4 weeks1 >4 weeks - <6 months1 >4 months - <6 years1

Non-tunnelled PICC / Midline2 PICC / Tunnelled CVC

CVC / PICC or Tunnelled CVC / TIVAD
or TIVAD
Midline2
1
Epic 3: National evidence-based guidelines for preventing healthcare-associated infections in hospitals in England
2
Midlines are not a suitable option for drugs that must be given centrally
CVC: central venous catheter; PICC: peripherally inserted central venous catheter; TIVAD: totally inserted venous access device
(Hallam et al 2016)

nursingstandard.com volume 31 number 25 / 15 February 2017 / 65

evidence & practice / CPD / intravenous therapy
11. Locate the red line in the centre of the
display screen and align it with the
centre of the vein (Novarix Ltd 2016).
12. Observe the suitable insertion point.
This is indicated by the red laser index
light projected onto the patients skin
(Novarix Ltd 2016).
13. Confirm vein location by palpation,
visual inspection and the use of the
IV-eye.
From experience of using the IV-eye
in training, the author has found that,
following palpation and location of veins,
practitioners were able to use the IV-eye to
confirm vein location. Being able to visualise
the veins following palpation improved
practitioners confidence and learning in this
area. One advanced nurse practitioner in
vascular and IV therapy at Frimley Health
NHS Foundation Trust carried out a small
clinical trial to evaluate the IV-eye, finding
that vein visualisation was achieved in
95% (58/61) of patients (Barton 2016). Of
the patients where vein visualisation was
achieved, 52% (32/61) had difficult-to-access
veins (Barton 2016), and the IV-eye was
able to locate veins that previously could
only be found using an ultrasound scanner
(Barton 2016). For patients with non-visible
veins, the use of an infrared vein imager or
Figure 2. Peripheral vein assessment tool
Peripheral Vein Assessment
Grade Vein quality Definition of vein quality
4-5 palpable/visible veins suitable to cannulate
1 Excellent
2-3 palpable/visible veins suitable to cannulate
2 Good
1-2 palpable/visible veins suitable to cannulate.
3 Fair (Veins may be small, scarred or difficult to find
and require heat packs to aid vasodilation)
Veins not palpated/visible (requires ultrasound
4 Poor assistance or infrared viewer)
5 None identifiable No visible (naked eye or aids) or palpable veins
Note: the number of cannulation attempts permitted before escalation should be reflected in local policy
(Hallam et al 2016)
66 / 15 February 2017 / volume 31 number 25
ultrasound scanner is recommended because
it avoids the use of blind venepuncture
(Infusion Nurses Society 2016a) and
supports the preservation of veins.
Using vein imagers to improve vascular
access increases the success rate of
peripheral cannulation and reduces the
use of a central vascular access device
when there are no other factors to indicate
its use (Infusion Nurses Society 2016a).
Chiao et al (2013) found that infrared vein
imagers increased the visibility of veins of
patients with dark skin colour and those
who are obese. Standard 22 of the Infusion
Therapy Standards of Practice (Infusion
Nurses Society 2016b) recommends that
practitioners consider the use of near-
infrared light technology for venous access,
since it enables them to make informed
decisions about vein selection. For example,
it displays palpable but non-visible veins,
and shows the tortuosity of veins. The RCN
(2016) Standards for Infusion Therapy also
state that practitioners should consider the
use of infrared imagers.
TIME OUT 3
Read the Infusion Therapy Standards of Practice (Infusion
Nurses Society 2016b) and list the reasons given for
considering the use of infrared vein imagers. Discuss with
Insertion management
Cannula may be inserted by trained/authorised
practitioners
Cannula may be inserted by trained/authorised
practitioners
Cannula may be inserted by trained/authorised
practitioners but infrared viewer or ultrasound
may be required to help locate the vein
Cannula may be inserted by practitioners
experienced in cannulation (to be determined
locally)
Peripheral cannulation should not be performed
nursingstandard.com
a colleague the circumstances in which an infrared vein KEY POINT
Figure 3. Locating a vein using the IV-eye vein
imager could be used in your clinical area. imager The Vacuderm and IV-eye
vein imager can be used
The Infusion Nurses Society (2016b) states together to assist with vein
that two studies identified improvement location. As with the IV-eye,
in first attempt success rates for peripheral practitioners should have
cannulation, although other studies have knowledge of the patients
not shown the same outcome. Additional medical and vascular
research is required to address the reasons access history, as well as
why some studies do not demonstrate local vascular access and
improved first attempt success rates, which venepuncture policies
may include differences in vein imagers, before using the Vacuderm
patient-related factors and skill level of tourniquet
the practitioners using the vein imagers
(Infusion Nurses Society 2016b). Lamperti
and Pittiruti (2013) identified that there
have not been enough studies that consider
the use of different vein imagers and the
different outcomes for different patient
groups. They found that the majority of
studies had been limited to the paediatric
setting, and that studies did not consider
what training had been provided for use of (Novarix Ltd)
the vein imagers.

Vacuderm tourniquet Figure 4a. Cephalic vein antecubital fossa

The Vacuderm tourniquet is a single- (depth 2.3mm)
use tourniquet that, when the dome
is pumped several times, enhances the
tourniquet effect by producing a negative
pressure. This causes the veins to fill and
become pronounced (Olberon Ltd 2016),
potentially improving vein location. While
using the Vacuderm in a training setting,
the author was able to locate veins that
could not be located using a standard
tourniquet on some individuals. The
Vacuderm and IV-eye vein imager can be (Novarix Ltd)
used together to assist with vein location.
As with the IV-eye, practitioners should
have knowledge of the patients medical Figure 4b. Cephalic vein forearm
(depth 6.3mm)
and vascular access history, as well as local
vascular access and venepuncture policies
before using the Vacuderm tourniquet.
The procedure for using the Vacuderm
tourniquet is as follows:
1. Introduce yourself to the patient and
discuss the procedure with them.
Obtain the patients consent to
undertake the procedure and ensure
they are comfortable.
2. Check that the packaging is intact and
that the Vacuderm is not damaged. (Novarix Ltd)

nursingstandard.com volume 31 number 25 / 15 February 2017 / 67

evidence & practice / CPD / intravenous therapy
KEY POINT
While different aids can
be used to assist in vein
location, it is important for
practitioners to be aware
that their use does not
replace the requirement
for a full assessment of the
patients veins. The National
Institute for Health and Care
Excellence (2014) states
that visual inspection may
be part of the process of
identifying a suitable vein; it
is the palpation of that vein
that is essential for deciding
if cannulation should be
attempted
68 / 15 February 2017 / volume 31 number 25
3. Wash your hands.
4. Open the packaging of the Vacuderm.
5. Use both hands to put the Vacuderm
on the patients arm, 7-8cm above the
insertion site (Brooks 2014).
6. Ensure that the Vacuderm is applied
with the hand indicator pointing down
towards the patients hand and, using
both hands, place the Vacuderm around
the patients arm and thread the tip of
the strap through the attachment lock
(Olberon Ltd 2016).
7. Ensure that the attachment lock is
pulled away from the patients limb to
prevent pinching of the skin (Figure 5).
8. Pull the strap to tighten and lock the
device and ensure that the patients
limb is supported.
9. Press down on the dome of the
Vacuderm using a pumping action
(Figure 6). This should be repeated
eight to ten times. This creates a
negative pressure to distend the vein
(Olberon Ltd 2016).
Figure 5. Pulling the attachment lock of
the Vacuderm tourniquet away from the
patients limb
(Olberon Ltd)
Figure 6. Pumping the Vacuderm tourniquet
(Olberon Ltd)
10. Palpate the veins and release the
Vacuderm by pulling the lock upwards
(Figure 7) (Olberon Ltd 2016).
TIME OUT 4
Speak to a member of the IV therapy team or practice
development team to find out what vein location aids are
available. Access @wenurses on Twitter and ask: What
aids and technologies for vein location for venepuncture
and cannulation do you use or know about, and what are
their benefits or limitations? Write down the responses
and consider how this may affect your practice.
TIME OUT 5
Reflect on and list the reasons why vein palpation and
assessment are required.
Importance of vein palpation and
assessment
While different aids can be used to
assist in vein location, it is important
for practitioners to be aware that their
use does not replace the requirement for
a full assessment of the patients veins.
The National Institute for Health and
Care Excellence (2014) states that visual
inspection may be part of the process of
identifying a suitable vein; it is the palpation
of that vein that is essential for deciding
if cannulation should be attempted.
Vein location aids enable assessment of
veins that are difficult to locate and assist
practitioners in deciding whether they
should attempt cannulation, or refer the
patient to the IV therapy team or a more
experienced practitioner. The mapping and
preservation of veins is paramount when
gaining vascular access, and visualising
and mapping the veins will enable the
Figure 7. Releasing the Vacuderm tourniquet
(Olberon Ltd)
nursingstandard.com
 For related CPD articles visit
evidenceandpractice.nursingstandard.com

practitioner to identify which vascular access to specialist IV therapy teams.

access device will be most suitable for each
patient, as advised by the VHP framework
(Hallam et al 2016). The author considers
vein imagers and specialist tourniquets to
have an important role in vein preservation
and optimal vascular access placement. It
may be beneficial for practitioners to have
a variety of aids available when assessing
veins that are difficult to locate, since
different vein location aids may work
differently depending on patient factors. The
area of difficult vein location and the use
of aids, such as vein imagers and specialist
tourniquets, require further study.
Clinical areas should consider using the
VHP framework (Hallam et al 2016), since
this tool can enable practitioners to assess
veins and select appropriate vascular access
devices. The framework also provides
guidance on relevant local policies and on
how to access appropriate support from
the IV therapy team or more experienced
practitioners. This will enable effective vein
assessment and location of the right vein,
for the right vascular access device, at the
right time, thus preserving patients veins,
improving vascular access and enabling IV
therapy to be administered.

Conclusion TIME OUT 6

The use of the IV-eye vein imager and Nurses are encouraged to apply the four themes of The
the Vacuderm tourniquet may assist the Code (NMC 2015) to their professional practice. Consider
assessment and location of veins for how knowledge of the aids available to assist in difficult
vascular access and venepuncture. Since vein location relates to the themes of The Code.
these aids are only part of addressing
the issue of difficult vein location, it is TIME OUT 7
important that practitioners have a range Now that you have completed the article, you might like
of technologies available to them and to write a reflective account as part of your revalidation.

References

Asrar M, Al-Habaibeh A, Houda MR (2015)
A Comparative Study Between Visual,
Near Infrared and Infrared Images for
the Detection of Veins for Intravenous
Cannulation. http://irep.ntu.ac.uk/26755/1/
PubSub4070_Al-Habaibeh.pdf (Last
accessed: 30 January 2017.)
Barton A (2016) The Use of Near Infrared
Vein Location Technology in Improving
Outcomes in Peripheral Vascular Access and
Assessment. http://novarix.com/wp-content/
uploads/2016/09/MKG201626-AB-abstract-
poster.pdf (Last accessed: 30 January 2017.)
Brooks N (2014) Venepuncture and
Cannulation: A Practical Guide. M&K
Publishing, Keswick.
Carr PJ, Rippey JCR, Budgeon CA et al
(2016) Insertion of peripheral intravenous
cannulae in the emergency department:
factors associated with first-time insertion
success. Journal of Vascular Access. 17, 2,
182-190.
Chiao FB, Resta-Flarer F, Lesser J et al (2013)
Vein visualization: patient characteristic
factors and efficacy of a new infrared
vein finder technology. British Journal of
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Dougherty L (2013) Intravenous therapy in
older patients. Nursing Standard. 28, 6, 50-58.
Hallam C, Weston V, Denton A et al (2016)
Development of the UK vessel health and
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organisational collaborative. Journal of
Infection Prevention. 17, 2, 65-72.
Infusion Nurses Society (2016a) Policies and
Procedures for Infusion Therapy. Fifth edition.
Infusion Nurses Society, Norwood MA.
Infusion Nurses Society (2016b) Infusion
Therapy Standards of Practice. Journal of
Infusion Nursing. 39, 1S.
Lamperti M, Pittiruti M (2013) II. Difficult
peripheral veins: turn on the lights. British
Journal of Anaesthesia. 110, 6, 888-891.
National Institute for Health and Care
Excellence (2014) AccuVein AV400 for
Vein Visualisation: Medtech Innovation
Briefing. www.nice.org.uk/guidance/
mib6/resources/accuveinav400-for-vein-
visualisation-1763868852421 (Last accessed:
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Novarix Ltd (2016) IV-eye: Portable Near
Infrared Vein Imager. novarix.com/iv-eye
(Last accessed: 30 January 2016.)
Nursing and Midwifery Council (2015) The
Code: Professional Standards of Practice
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NMC, London.
Olberon Ltd (2016) Optimising Venous Access.
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Royal College of Nursing (2016) Standards
for Infusion Therapy. Fourth edition. RCN,
London.

nursingstandard.com volume 31 number 25 / 15 February 2017 / 69

evidence & practice / self-assessment questionnaire

Locating difficult veins

TEST YOUR KNOWLEDGE BY COMPLETING SELF-ASSESSMENT QUESTIONNAIRE 881

1. A patient factor that may reduce vein visibility is: 7. When using the Vacuderm tourniquet, How to complete
a) Obesity c practitioners should: thisassessment
b) Skin pigmentation c a) Ensure the hand indicator on the Vacuderm
This self-assessment
c) History of chemotherapy c points up, away from the patients hand c
questionnaire will help you
d) All of the above c b) Press down on the dome of the Vacuderm to test your knowledge.
eight to ten times using a pumping action c
It comprises ten multiple choice
2. Increased risk of peripheral cannulation failure c) Ensure the attachment lock is pulled towards questions that are broadly
has been found in patients aged: the patients limb c linked to the article starting on
a) Under 40 years c
d) Pull the attachment lock downwards to release page 62. There is one correct
b) Under 60 years c the Vacuderm c answer to each question.
c) Over 60 years c Youcan test your subject
8. VHP in the VHP framework stands for: knowledge by attempting
d) Over 80 years c
a) Vessel health and protection c the questions before reading
3. Which of the following is not used to assist in b) Vessel health and preservation c the article, and then go
locating difficult veins? c) Vein health and protection c back over themto see ifyou
a) Tourniquet c wouldanswer any differently.
d) Vein health and preservation c
You might like to read the
b) Near infrared vein imager c
c) X-ray c 9. The VHP framework provides guidance for article before trying the
practitioners on: questions. Thecorrect
d) Ultrasound c
answers will be published in
a) The process of vein assessment c
4. Which statement is false? Nursing Standard on 1 March.
b) Vascular access device selection c
a) Vein location is always indicated by an image c) The use of vein location aids c Subscribers making use
of a defined dark solid line c
d) All of the above c of their RCNi Portfolio can
b) Deeper veins are indicated by a grey defined line c complete this and other
10. Which statement is true? questionnaires online and save
c) The IV-eye vein imager projects a red laser index
light on to the skin to indicate a suitable insertion a) Palpation of the vein is not essential when the resultautomatically.
deciding if cannulation should be attempted c Alternatively, you can cut
point c
b) The preservation of veins is not important c out this page and add it to your
d) It is important to have knowledge of the patients professional portfolio. Don't
medical history before using a vein location aid c c) The Vacuderm and the IV-eye vein imager can
forget to record the amount
be used together c
oftime taken tocomplete it.
5. The IV-eye vein imager should be used for veins
d) All vein location aids work in the same way,
that are of: You may want to write
regardless of patient factors c
a) Fair or poor quality c areflective account based
b) Poor quality only c on what you have learned.
Visitjournals.rcni.com/r/
c) Fair quality only c reflective-account
d) Good, fair or poor quality c

6. The Vacuderm tourniquet improves vein

location by:
a) Visualising and mapping the veins c This self-assessment questionnaire was compiled by Henrietta Cole
b) Producing a negative pressure, which causes the The answers to this questionnaire will be published on 1 March
veins to fill and become pronounced c
c) Using near infrared light to illuminate the skin and
subcutaneous layer c The answers to SAQ 879 on adult resuscitation equipment, which
appeared in the 1 February issue, are:
d) Producing a positive pressure, which causes the
veins to fill and become pronounced c 1. c 2. d 3. b 4. c 5. d 6. a 7. b 8. b 9. a 10. d

nursingstandard.com volume 31 number 25 / 15 February 2017 / 71