Atlas of Procedures in Neonatology, 4th Edition

Blood Sampling


Vessel Transillumination

Dawn M. Walton

Billie Lou Short

  1. Indications (1,2,3,4, and 5)
  2. To locate artery or vein for:
  3. Puncture for sampling
  4. Vessel cannulation
  5. See also Chapter 36, for use in diagnosing thoracic air leaks (1,2,3,4 and 5).
  6. Contraindications


  1. Precautions
  2. Use fiber-optic light source with appropriate filters to cool light and prevent burns (6,7).
  3. Place sterile surgical glove over tip of probe to preserve sterile field.
  4. Equipment
  5. Transillumination source
  6. High-intensity fiber-optic light (black soft tube around probe can make light seal)
  7. Otoscope light may be used in some instances (8).
  8. Alcohol
  9. Sterile glove
  10. Technique
  11. Clean end of light source with an alcohol swab. Cover with sterile glove.
  12. Dim light in room. Some residual light is necessary to visualize operating field.
  13. Set light source at low intensity and increase as needed for visualization.
  14. Position probe to transilluminate vessel.
  15. Directly opposite to puncture site, through extremity
  16. Adjacent to vessel but out of way of procedure
  17. Identify vessel as dark, linear structure (Fig. 12.1).
  18. Edges may be indistinct.
  19. Arteries will be pulsatile.
  20. Compensate for distortion if light is not directly opposite puncture site.
  21. Do not maintain contact between light source and extremity for long periods of time.
  22. Complications
  23. Burns from light probe (Fig. 12.2) (7)
  24. 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.


  1. Cole FS, Todres ID, Shannon DC.Technique for percutaneous cannulation of the radial artery in the newborn infant. J Pediatr.1978;92:105.
  2. Curran JS, Ruge W.A restraint and transillumination device for neonatal arterial/venipuncture: efficacy and thermal safety.Pediatrics. 1980;66:128.
  3. Mattson D, O'Connor M.Transilluminator assistance in neonatal venipuncture. Neonatal Network. 1986;5:42.
  4. Schwartz N, Eisenkraft JB.Transillumination aids the percutaneous cannulation of peripheral vessels. J Cardiothorac Anesth.1989;3:675.
  5. Dinner M.Transillumination to facilitate venipuncture in children. Anesth Analg. 1992;74:467.
  6. Sajben FP, Gibbs NF, Friedlander SF.Transillumination blisters in a neonate. J Am Acad Dermatol. 1999;41:264.
  7. 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.
  8. Goren A, Laufer J, Yativ N, et al. Transillumination of the palm for venipuncture in infants. Pediatr Emerg Care.2001; 17(2):130.