Patient Position Affects Venodilation for Peripheral Intravenous Cannulation

Abstract

Background:

Larger veins are associated with a higher rate of success of peripheral intravenous cannulation. Although patient position affects venodilation during central venous cannulation, the association between patient position and vein size for peripheral intravenous cannulation remains unclear.

Purpose:

We examined the effect of seated versus supine positioning on vein size during peripheral intravenous cannulation before and after tourniquet application.

Methods:

In the present study, we recruited 81 participants (20–64 years) and included 80 in the analysis. We measured outcomes before and after tourniquet application in the seated and supine positions. The primary outcome was the cross-sectional area of the target forearm vein (ultrasonography by a blinded assessor). Subgroup analysis was used to test the effects of positioning combined with difficult peripheral intravenous cannulation (DPIVC) defined as poor visibility and/or palpability of the target vein.

Results:

Results of paired t tests demonstrated that the venous cross-sectional area significantly increased in the supine position with tourniquet application compared with the seated position with tourniquet application. Subgroup analysis with two-way repeated measures analysis of variance revealed that the venous cross-sectional area was significantly larger in the supine position than in the seated position despite DPIVC.

Conclusion:

Vein size during tourniquet application was greater in the supine than in the seated position even in cases of DPIVC. We thus recommend the supine position over the seated position for peripheral intravenous cannulation.

Keywords

position vasodilation catheterization injection evidence-based practice

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References

Akselrod

Gordon

Madwed

J. B.

Snidman

N. C.

Shannon

D. C.

Cohen

R. J.

(1985). Hemodynamic regulation: Investigation by spectral analysis. American Journal of Physiology-Heart and Circulatory Physiology, 249, H867–H875. doi:10.1152/ajpheart.1985.249.4.H867

Bellazzini

M. A.

Rankin

P. M.

Gangnon

R. E.

Bjoernsen

L. P.

(2009). Ultrasound validation of maneuvers to increase internal jugular vein cross-sectional area and decrease compressibility. The American Journal of Emergency Medicine, 27, 454–459.

Benkhadra

Collignon

Fournel

Oeuvrard

Rollin

Perrin

… Girard

(2012). Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: A prospective randomized study. Paediatric Anaesthesia, 22, 449–454. doi:10.1111/j.1460-9592.2012.03830.x

Ciuti

Righi

Forzoni

Fabbri

Pignone

A. M.

(2013). Differences between internal jugular vein and vertebral vein flow examined in real time with the use of multigate ultrasound color Doppler. American Journal of Neuroradiology, 34, 2000–2004.

Cohen

(1977). CHAPTER 1 – The Concepts of Power Analysis. In Statistical Power Analysis for the Behavioral Sciences (pp. 1–17). https://doi.org/10.1016/B978-0-12-179060-8.50006-2

Fortune

J. B.

Feustel

(2003). Effect of patient position on size and location of the subclavian vein for percutaneous puncture. Archives of Surgery, 138, 996.

Hadaway

(2012). Short Peripheral Intravenous Catheters and Infections. Journal of Infusion Nursing, 35, 230–240.

Hayama

Inoue

(2012). The effects of deep breathing on “tension–anxiety” and fatigue in cancer patients undergoing adjuvant chemotherapy. Complementary Therapies in Clinical Practice, 18, 94–98. doi:10.1016/j.ctcp 2011.10.001

Higgins

J. P. T.

Altman

D. G.

Gotzsche

P. C.

Juni

Moher

Oxman

A. D.

… Sterne

J. A. C.

(2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. British Medical Journal, 343, d5928. doi:10.1136/bmj.d5928

10.

Ingram

Lavery

(2007). Peripheral intravenous cannulation: Safe insertion and removal technique. Nursing Standard, 22, 44–48.

11.

Jacobson

A. F.

Winslow

E. H.

(2005). Variables influencing intravenous catheter insertion difficulty and failure: An analysis of 339 intravenous catheter insertions. Heart & Lung: The Journal of Critical Care, 34, 345–359. doi:10.1016/j.hrtlng.2005.04.002

12.

Juvin

Blarel

Bruno

Desmonts

JM.

(2003). Is peripheral line placement more difficult in obese than in lean patients? Anesthesia & Analgesia, 96, 1218.

13.

Kato

Mori

(2009). The effect of pressure of tourniquet for venipuncture on overswelling of the vein: Fasten ratio of tourniquet to upper arm circumference (in Japanese). Japanese Journal of Nursing Art and Science, 8, 10–15. Retrieved from http://ci.nii.ac.jp/naid/40016927506

14.

Kiger

Knudsen

É. A.

Curran

Hunter

Schaub

Williams

M. J.

… Kwekkeboom

(2014). Survey of heat use during peripheral IV insertion by health care workers. Journal of Infusion Nursing, 37, 433–440. doi:10.1097/NAN.0000000000000074

15.

Kim

H. Y.

Choi

J. M.

Lee

Y. H.

Lee

Yoo

Gwak

(2016). Effects of the Trendelenburg position and positive end-expiratory pressure on the internal jugular vein cross-sectional area in children with simple congenital heart defects. Medicine, 95, e3525. doi:10.1097/MD.0000000000003525

16.

Kimori

Sugama

Nakatani

(2011). Investigation of invisible peripheral veins for certain and safe venipuncture in catheter placement: Non-invasive measurement of width, depth, and skin color (in Japanese). Japanese Journal of Nursing Art and Science, 10, 103–110. Retrieved from https://www.jstage.jst.go.jp/article/jsnas/10/1/10_103/_article/-char/en

17.

Kwon

M. Y.

Lee

E. K.

Kang

H. J.

Kil

Jang

K. H.

Koo

M. S.

… Kim

T. Y.

(2013). The effects of the Trendelenburg position and intrathoracic pressure on the subclavian cross-sectional area and distance from the subclavian vein to pleura in anesthetized patients. Anesthesia & Analgesia, 117, 114–118. doi:10.1213/ANE.0b013e3182860e3c

18.

Landis

J. R.

Koch

G. G.

(1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174. doi:10.2307/2529310

19.

Lapostolle

Catineau

Garrigue

Monmarteau

Houssaye

Vecci

… Adnet

(2007). Prospective evaluation of peripheral venous access difficulty in emergency care. Intensive Care Medicine, 33, 1452–1457. doi:10.1007/s00134-007-0634-y

20.

Lewin

M. R.

Stein

Wang

Lee

M. M.

Kernberg

Boukhman

… Lewiss

R. E.

(2007). Humming is as effective as Valsalva’s maneuver and Trendelenburg’s position for ultrasonographic visualization of the jugular venous system and common femoral veins. Annals of Emergency Medicine, 50, 73–77. doi:10.1016/j.annemergmed.2007.01.024

21.

Lukish

(2002). Classical positioning decreases subclavian vein cross-sectional area in children. The Journal of Trauma, 53, 272–275.

22.

Martin-Du Pan

R. C.

Benoit

Girardier

(2004). The role of body position and gravity in the symptoms and treatment of various medical diseases. Swiss Medical Weekly, 134, 543–551. doi:2004/37/smw-09765

23.

Modeliar

S. S.

Sevestre

M. A.

de Cagny

Slama

(2008). Ultrasound evaluation of central veinsin the intensive care unit: Effects of dynamic manoeuvres. Intensive Care Medicine, 34, 333–338. doi:10.1007/s00134-007-0875-9

24.

Mori

Ichimura

Matsumura

Sasaki

Murakami

Kawasaki

Hirano

(2011). New tourniquet with markers for applying with appropriate strength (in Japanese). Bulletin of Faculty of Health and Welfare Science, Okayama Prefectural University, 18, 29–33. Retrieved from http://ci.nii.ac.jp/naid/110009391641

25.

Moureau

N. L.

(2008). Tips for inserting an I.V. device in an older adult. Nursing, 38, 12.

26.

Ortega

Sekhar

Song

Hansen

C. J.

Peterson

(2008). Peripheral intravenous cannulation. New England Journal of Medicine, 359, e26.

27.

Panebianco

N. L.

Fredette

J. M.

Szyld

Sagalyn

E. B.

Pines

J. M.

Dean

A. J.

(2009). What you see (sonographically) is what you get: Vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Academic Emergency Medicine, 16, 1298–1303. doi:10.1111/j.1553-2712.2009.00520.x

28.

Piredda

Biagioli

Barrella

Carpisassi

Ghinelli

Giannarelli

De Marinis

M. G.

(2017). Factors affecting difficult peripheral intravenous cannulation in adults: A prospective observational study. Journal of Clinical Nursing, 26, 1074–1084. doi:10.1111/jocn.13444

29.

Rippey

J. C. R.

Pascu

Jacobs

(2008). Abdominal compression effectively increases the size of the common femoral vein, as measured by ultrasonography. Annals of Emergency Medicine, 52, 446–452. doi:10.1016/j.annemergmed.2008.04.022

30.

Roberge

R. J.

(2004). Venodilatation techniques to enhance venepuncture and intravenous cannulation. The Journal of Emergency Medicine, 27, 69–73. doi:10.1016/j.jemermed.2004.02.011

31.

Rosenthal

(2005). Tailor your I.V. insertion techniques special populations. Nursing, 35, 36–41.

32.

Rothman

R. L.

Malone

Bryant

Shintani

A. K.

Crigler

Dewalt

D. A.

… Pignone

M. P.

(2005). A randomized trial of a primary care-based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. The American Journal of Medicine, 118, 276–284. doi:10.1016/j.amjmed.2004.09.017

33.

R Development Core Team 2017. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria, 2017.

34.

Sasaki

Murakami

Matsumura

Ichimura

Mori

(2012). Relationship between tourniquet pressure and a cross-section area of superficial vein of forearm (in Japanese). Acta Medica Okayama, 66, 67–71. Retrieved from http://jairo.nii.ac.jp/0017/00047465

35.

Sayers

B. M.

(1973). Analysis of heart rate variability. Ergonomics, 16, 17–32. doi:10.1080/00140137308924479

36.

Scales

(2005). Vascular access: A guide to peripheral venous cannulation. Nursing Standard, 19, 48–52.

37.

Schnadower

Lin

Perera

Smerling

Dayan

(2007). A pilot study of ultrasound analysis before pediatric peripheral vein cannulation attempt. Academic Emergency Medicine, 14, 483–485. doi:10.1197/j.aem.2006.12.016

38.

Terai

Anada

Matsushima

Shimizu

Okada

(1995). Effects of mild Trendelenburg on central hemodynamics and internal jugular vein velocity, cross-sectional area, and flow. The American Journal of Emergency Medicine, 13, 255–258. doi:10.1016/0735-6757(95)90194-9

39.

Valdueza

von Münster

Hoffman

Schreiber

Max Einhäupl

(2000). Postural dependency of the cerebral venous outflow. The Lancet, 355, 200–201. doi:10.1016/S0140-6736(99)04804-7

40.

van Bemmelen

P. S.

Kelly

Blebea

(2005). Improvement in the visualization of superficial arm veins being evaluated for access and bypass. Journal of Vascular Surgery, 42, 957–962. doi:10.1016/j.jvs.2005.06.021

41.

Witting

M. D.

Schenkel

S. M.

Lawner

B. J.

Euerle

B. D.

(2010). Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. The Journal of Emergency Medicine, 39, 70–75. doi:10.1016/j.jemermed.2009.01.003

42.

H. L.

Ting

C. K.

Chen

C. Y.

Cheng

H. W.

Chan

K. H.

Chang

W. K.

Chen

P. T.

(2013). No enlargement of the right internal jugular vein of the dialysis patients in the Trendelenburg position. Journal of the Chinese Medical Association, 76, 401–406. doi:10.1016/j.jcma.2013.03.014

43.

Yamagami

Tomita

Tsujimoto

Inoue

(2017). Tourniquet application after local forearm warming to improve venodilation for peripheral intravenous cannulation in young and middle-aged adults: A single-blind prospective randomized controlled trial. International Journal of Nursing Studies, 72, 1–7. doi:10.1016/j.ijnurstu.2017.03.009

44.

Yamagami

Tsujimoto

Inoue

(2018). How long should local warming for venodilation be used for peripheral intravenous cannulation? A prospective observational study. International Journal of Nursing Studies, 79, 52–57. doi:10.1016/j.ijnurstu.2017.11.004

45.

Yamagami

Ueki

Matoba

Makimoto

(2018). Effectiveness of ultrasound-guided peripheral intravenous cannulation in pediatric patients aged under three years: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 16, 35–38. doi:10.11124/JBISRIR-2017-003395

46.

Yeragani

V. K.

Pohl

Berger

Balon

Srinivasan

K. V. K.

(1994). Relationship between age and heart rate variability in supine and standing postures: A study of spectral analysis of heart rate. Pediatric Cardiology, 15, 14–20. doi:10.1007/BF0079700