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Difficult IV Access: A Warm Thought

Wong, David H., PharmD, MD

Section Editor(s): Shafer, Steven L.

doi: 10.1213/01.ANE.0000227124.83157.80
Letters to the Editor: Letters & Announcements

Department of Anesthesiology; Long Beach Veterans Affairs Medical Center; University of California at Irvine; Orange, California;

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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.

David H. Wong, PharmD, MD

Department of Anesthesiology

Long Beach Veterans Affairs Medical Center

University of California at Irvine

Orange, California

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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.
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.
© 2006 International Anesthesia Research Society