Atlas of Procedures in Neonatology, 4th Edition
Dawn M. Walton
Billie Lou Short
- Indications (1,2,3,4, and 5)
- To locate artery or vein for:
- Puncture for sampling
- Vessel cannulation
- See also Chapter 36, for use in diagnosing thoracic air leaks (1,2,3,4 and 5).
- Use fiber-optic light source with appropriate filters to cool light and prevent burns (6,7).
- Place sterile surgical glove over tip of probe to preserve sterile field.
- Transillumination source
- High-intensity fiber-optic light (black soft tube around probe can make light seal)
- Otoscope light may be used in some instances (8).
- Sterile glove
- Clean end of light source with an alcohol swab. Cover with sterile glove.
- Dim light in room. Some residual light is necessary to visualize operating field.
- Set light source at low intensity and increase as needed for visualization.
- Position probe to transilluminate vessel.
- Directly opposite to puncture site, through extremity
- Adjacent to vessel but out of way of procedure
- Identify vessel as dark, linear structure (Fig. 12.1).
- Edges may be indistinct.
- Arteries will be pulsatile.
- Compensate for distortion if light is not directly opposite puncture site.
- Do not maintain contact between light source and extremity for long periods of time.
- Burns from light probe (Fig. 12.2) (7)
- Cross-contamination from breach of sterile technique
FIG. 12.1. Transillumination. A: Arteries and veins on volar aspect of left wrist. B: Venous arch on dorsum of hand. C: Vessels in right antecubital fossa. D: Left posterior tibial artery.
FIG. 12.2. Burn from transilluminator.
- Cole FS, Todres ID, Shannon DC.Technique for percutaneous cannulation of the radial artery in the newborn infant. J Pediatr.1978;92:105.
- Curran JS, Ruge W.A restraint and transillumination device for neonatal arterial/venipuncture: efficacy and thermal safety.Pediatrics. 1980;66:128.
- Mattson D, O'Connor M.Transilluminator assistance in neonatal venipuncture. Neonatal Network. 1986;5:42.
- Schwartz N, Eisenkraft JB.Transillumination aids the percutaneous cannulation of peripheral vessels. J Cardiothorac Anesth.1989;3:675.
- Dinner M.Transillumination to facilitate venipuncture in children. Anesth Analg. 1992;74:467.
- Sajben FP, Gibbs NF, Friedlander SF.Transillumination blisters in a neonate. J Am Acad Dermatol. 1999;41:264.
- Keroack MA, Kotilainen HR, Griffin BE.A cluster of atypical skin lesions in well-baby nurseries and a neonatal intensive care unit. J Perinatol. 1996;16:370.
- Goren A, Laufer J, Yativ N, et al. Transillumination of the palm for venipuncture in infants. Pediatr Emerg Care.2001; 17(2):130.