Mastering the maze: Expert tips for cannulating tortuous veins

Tortuous veins, characterized by their enlarged and twisted, winding, or convoluted structure, deviate from the usual relatively straight path by forming multiple curves or loops.

Examples of tortuous veins. A) Normal, lesser saphenous vein. B) Tortuous, varicose lesser saphenous veins.

This unique anatomy presents considerable challenges during procedures like IV cannulation or venipuncture. Attempting to access these irregular pathways often leads to multiple unsuccessful attempts, causing patient discomfort and increasing the risk of complications such as bruising or hematoma formation.

Despite their apparent visibility and palpability, tortuous veins can be deceptively tricky due to their reduced elasticity. This reduced elasticity makes them prone to rolling when approached with a needle, necessitating a careful and precise technique during these procedures.

Here are some strategies for when a tortuous vein is the only option:

• Select a tortuous vein with visible branches (tributaries) for better needle stabilization, or choose a relatively straight vein. 
• Keep the needle at a low angle during insertion to minimize the risk of vein rolling. 
• Use a swift-entry method by rapidly pushing the needle in, which prevents the vein from rolling. This is called the “snake bite” technique. 
• Apply the counter traction method: Place a finger below the intended insertion point and gently pull the skin downward to create tension and stabilize the vein.

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