A doctor preparing to give a nervous young woman an injection

    Needling a vein can be torture for the doctor, too — this ‘magic torch’ is the answer

    5 May 2017

    It has always troubled me as a doctor that, before I can help a patient, I first have to hurt them. I am referring to the necessary needling of a vein somewhere on their body surface through which I can give life-saving or anaesthetic drugs, or draw blood samples.

    Burned into memory is the vision of my toddler daughter’s face as a cruel paediatrics doctor stuck a needle into the back of her hand while she lay in my arms, breathlessly dying from heart failure. Only I, not she, could understand the reason for her pain.

    By the next morning, after her debilitating symptoms had been salved by the medications she had received through that needle, she had forgotten the assault and was bouncing around the children’s ward as if nothing was wrong. My daughter’s experience could have been much worse, but that young doctor was good at his job, and her veins were big and bouncy and highly visible (because of the heart failure).

    I contrast that success story with my own bad personal experience. As a junior anaesthetist I was summoned to the children’s ward at 3am to help gain venous access for a nine-year-old patient who suffered from haemophilia and was bleeding internally. Over his few years, this poor youngster had already had multiple intravenous infusions of blood-clotting factors for similar episodes. As a result, all of the veins in his arms and legs were wrecked.

    It is a sad fact of life that every time a vein is punctured and used for medication, it rarely becomes easily usable again. All his veins had already been used up. I tried and tried and tried to find a vein, but failed every time.

    His father was in the room and became belligerent as he watched his son suffering and dying in front of him, and my continuous failure to succeed. ‘What kind of bloody doctor are you!’ he yelled. I was extremely fatigued, and had never faced such professional difficulty before. I teared up and had to leave the room, no longer able to function. A grown man driven to tears by his own uselessness! I called for help. Seniors arrived. Even they had difficulty, but they found a vein eventually, and the therapy was administered. I remained shaken and demoralised. That incident haunts me to this day.

    Veins can be difficult to find for many reasons. They may have been wrecked by previous interventions, especially chemotherapy. The patient might be anxious, dehydrated, or may have lost blood — all of these cause veins to shrink. There may be difficulties caused by skin colour or tattoos, or their veins might be buried beneath a thick layer of pudginess. One thing is certain: veins always exist, even if hidden. How else would blood return to the heart? The problem is finding them.

    The other day, I was shown a new piece of technology purchased by the children’s ward at my hospital by charitable funds. Despite yearly exposure to professional meetings and trade fairs, I had never seen or heard of it before. It is really ingenious. It uses two lasers and a camera to project a rectangle of light upon any area of skin. The infra-red laser illuminates any structure in the skin, up to 1cm deep, that is rich in red blood cells, such as a vein.

    The camera sees that infra-red image and then instructs the visible laser to draw on the skin what it sees. This all happens so fast that all the user perceives is as if the skin is being illuminated by a ‘magic torch’, revealing all the blood vessels within the beam of the instrument.

    All I can say is that it must be seen to be believed. I used it on a nervous victim of many previous needlings. I was successful on the first go. I alerted colleagues and friends directly and via social media. Their interest was immediate and strong. This piece of kit doesn’t require lengthy clinical trials: its immediate deployment to all clinical areas is a no brainer.

    The unit I used was an AccuVein AV400. It projects a red image. It has been available in Britain since 2012 — its marketing department has wasted five years of potential profits, if you ask me. I have found an identical competitor that projects a green image. Let them fight to bring the price down and roll them out to all areas.

    The AccuVein currently costs £3,300 plus VAT. To put that in perspective, that is about one half of the cost of a single joint replacement. Each AccuVein has an estimated life of five years.

    Even if the lumbering bureaucracy of the NHS cannot see the obvious value of this technology, charitable bodies will. Lobby them! Get these machines into your hospital’s theatres, chemotherapy and phlebotomy departments and children’s wards. You know it makes sense.

    You can see AccuVein in action on YouTube. Be prepared for your jaw to drop. Mine did.