Ms. Whiteley et al., USE OF HAND-HELD DOPPLER TO IDENTIFY DIFFICULT FOREARM VEINS FOR CANNULATION, Annals of the Royal College of Surgeons of England, 77(3), 1995, pp. 224-226
Intravenous cannulation is a necessary procedure in many hospital pati
ents. Some patients are regarded as having 'impossible' veins that are
invisible and impalpable despite venous tourniquet. We investigated t
he use of a hand-held Doppler to identify veins suitable for percutane
ous cannulation in such patients. A total of 24 arms in 12 patient vol
unteers with invisible and impalpable forearm veins was studied by squ
eezing the ipsilateral hand and using a hand-held 8 MHz Doppler probe
on the forearm. Each venous signal was noted and the loudest chosen. C
lassification as 'good' or 'poor' was made on signal strength. The bes
t signal was then mapped and the direction was indicated by a line on
the skin. Each forearm was examined using a colour-flow Duplex. All ve
ins were noted and diameters measured with and without tourniquet. The
se results were compared with the best veins found by hand-held Dopple
r. In all, 23 (96%) arms had the largest vein correctly identified by
the hand-held Doppler. All 19 (100%) described as 'good' on signal had
a diameter of 2.0-4.2 mm (mean 3.2 mm). All 4 (100%) described as 'po
or' on Doppler signal had diameters of 1.4-1.7 mm (mean 1.6 mm). Hand-
held Doppler, used as described, can accurately identify forearm veins
larger than 2.0 mm in diameter in patients with invisible and impalpa
ble veins with venous tourinquet. These veins should be amenable to pe
rcutaneous cannulation.