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LETTER TO THE EDITOR

Difficult IV Access: A Warm Thought

Department of Anesthesiology; Long Beach Veterans Affairs Medical Center; University of California at Irvine; Orange, California; david.wong{at}med.va.gov

To the Editor:

IV cannulation is a routine part of anesthetic practice. We wish to report a technique that may improve the success of IV cannulation in patients with difficult peripheral venous access.

In patients with expected or actual difficult IV access, place a tourniquet on the desired extremity, and then place a clean, clear plastic bag over the extremity. Insert the hose of a forced-air warming unit at least 3 in into the bag, hold the bag and hose together, and turn the unit on at 44°C. The bag should inflate. Allow air to escape from the bag's opening. After approximately 5 min, remove the bag and look for potential IV cannulation sites. This "warm air" technique has helped secure IV access in patients after multiple unsuccessful IV cannulation attempts.

Peripheral vein vasodilation can improve the success rate of IV cannulation (1). Unlike the technique of applying warm moist towels, the warm air technique continuously warms the extremity. Unlike applying nitroglycerin ointment (2), the warm air technique can dilate the multiple extremity veins, not just individual veins. Unlike applying a commercial warming mitt (1), the warm air technique uses equipment and supplies commonly available in the operating room area.

REFERENCES

1. Lenhardt R, Seybold T, Kimberger O, et al. Local warming and insertion of peripheral venous cannulas: single blinded prospective randomized control trial and single blinded randomized crossover trial. BMJ 2002;325:409–12.[Abstract/Free Full Text]
2. Roberge RJ, Kelly M, Evans TC, et al. Facilitated intravenous access through local application of nitroglycerine ointment. Ann Emerg Med 1987;16:546–9.[Web of Science][Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Wong, D. H. Search for Related Content PubMed PubMed Citation Articles by Wong, D. H.