Investigative study of hemodilution ratio: 4Vs for vein diameter, valve, velocity, and volumetric blood flow as factors for optimal forearm vein selection for intravenous infusion

Abstract

Background: Multimodal research and guidelines recognize veins in the forearm used for peripheral intravenous catheter (PIVC) insertion can optimize dwell time. Yet, many PIVCs are still placed in areas of flexion or suboptimal locations such as the back of the hand causing premature failure of >50%. This study identified characteristics of the forearm cephalic vein that make the anatomical location highly successful for PIVC insertion. The goal was to increase the understanding of the human vasculature in association with fluid mechanics in veins above the wrist and below the antecubital fossa. Methodology: A prospective in-vivo study with 10 consented healthy human volunteers (HHVs) was performed with Color Pulse Wave Doppler Ultrasound that captured high-resolution video and images of vein diameter, velocity of blood flow, and location of venous valves in the forearm. Results: Forearm vein diameter was not directly correlated with higher or lower Velocity of Blood Flow (0.58 cm = 3.0 cm/s). However, Volumetric Blood Flow rates tended to be lower (2.51–8.28 mL/min) with Vein Diameters smaller than 0.29 cm. Ultrasound assessments and Volumetric Blood Flow calculations confirmed natural turbulence in blood and retrograde blood reflux correlated with venous valves opening and closing. Areas of turbulence, with pulse flushing, created backflow with retrograde blood flow around and into the catheter. Conclusions: Placement of long PIVCs in the cephalic veins of the upper forearm yield adequate flow and hemodilution capacity for veins with at least a 3 to 1 hemodilution ratio. The data from this study, along with previous research, suggest that PIVC placement in the cephalic vein, based on selection criteria, may help to reduce or eliminate intravenous complications such as chemical or mechanical thrombophlebitis causing premature catheter failure. Application of these investigational principles may result in better outcomes and catheter longevity for patients who require intravenous infusions.

Verification study on the catheterization of an upper arm vein using the new long peripheral intravenous catheter to reduce catheter failure incidence: A randomized controlled trial

“…Recently, the PIV5RightsTMBundle was proposed to prevent complications associated with catheter placement and to preserve vessels (18). Although there have been reports of high puncture success rates, long indwelling periods, and decreased complications with the PIV5RightsTMBundle, it has been highlighted that vessel selection in terms of blood flow (hemodilution ratio) was not considered (19). Blood vessels are probably repeatedly exposed to chemical stimuli, particularly when irritant or vesicant agents are used in chemotherapy.…”

Incorporating Near Infrared Light Vein Visualization Technology Into Peripheral Intravenous Access Protocols

“…Furthermore, nIR technology allows for identification of valves, which are important to consider in optimal positioning of PIVCs. 27 Avoidance of valves is another important factor to consider in reducing IV complications that can lead to premature catheter failure. 27 The integration of nIR into PIVC protocols could be as simple as adding a statement to a policy encouraging the use of vein visualization (Figure 2).…”

“…27 Avoidance of valves is another important factor to consider in reducing IV complications that can lead to premature catheter failure. 27 The integration of nIR into PIVC protocols could be as simple as adding a statement to a policy encouraging the use of vein visualization (Figure 2). Targeted education and training for nurses on vein visualization devices, along with nurse-driven protocols that recommend the use of vein visualization technology for PIVC through assessment and placement could help bridge the gap when vascular access teams are unavailable and ultimately improve care for patients.…”

“…Successful utilization of visualization technologies in DIVA patients could lead to a decrease in time to cannulation, number of attempts, unnecessary resource use, escalations, and overall improvement in patient care. Furthermore, nIR technology allows for identification of valves, which are important to consider in optimal positioning of PIVCs 27. Avoidance of valves is another important factor to consider in reducing IV complications that can lead to premature catheter failure 27…”

“…Furthermore, nIR technology allows for identification of valves, which are important to consider in optimal positioning of PIVCs 27. Avoidance of valves is another important factor to consider in reducing IV complications that can lead to premature catheter failure 27…”