Superficial venous morphometry in the antecubital fossa: An autonomous robotic ultrasound-based analysis

Abstract

Background:

The antecubital fossa is an important site for venepuncture and intravenous procedures. The size and location of a vein can affect the success of venepuncture and intravenous access. Several studies have investigated the superficial vein morphometry, but they had small sample sizes or focused on specific populations or groups. Therefore, we conducted a prospective study with large participants in general population to analyse the morphology of the antecubital superficial vein and identify the association of sex, age and body mass index (BMI) with the size and location of the vein.

Methods:

This study collected images of superficial veins prospectively using autonomous robotic ultrasound on the antecubital area between October and November 2020. We measured the superficial vein depth, vertical diameter and horizontal diameter at the antecubital area, extracted population characteristics (sex, age and BMI), and analysed a relationship between the vein dimensions and the characteristics.

Results:

In this study, data from 461 participants (201 males and 260 females) with mean age of 41.1 years were produced. The mean vein depth, mean vertical diameter and mean horizontal diameter (±standard deviation) were 4.81 (±2.17), 3.01 (±1.10) and 4.46 (±1.60) mm, respectively. We found significant differences in vein dimensions between males and females, with males having larger vertical and horizontal diameters than females (p < 0.001). The study also revealed significant differences in vein depth and dimensions among age groups and BMI subgroups (p < 0.001).

Conclusions:

These findings revealed that the superficial vein in the antecubital area was oval, with a larger horizontal diameter than vertical diameter. Morphometry revealed differences in sex, age and BMI. Understanding variations in vein dimensions among different subgroups can help medical professionals improve success rate of venous access and patient safety.

Keywords

Veins morphology ultrasonography robotics phlebotomy intravenous infusions

Get full access to this article

View all access options for this article.

References

Bains

KNS

Lappin

. Anatomy, shoulder and upper limb, elbow cubital fossa. In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC., 2022.

Sheen

Khan

. Anatomy, shoulder and upper limb, cubital fossa. In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC., 2022.

Kato

. [Peripheral nerve injury in venipuncture]. Masui 2010; 59: 1357–1363.

Mikuni

Chiba

Tonosaki

. Topographical anatomy of superficial veins, cutaneous nerves, and arteries at venipuncture sites in the cubital fossa. Anat Sci Int 2013; 88: 46–57.

Cairns

Kang

. National Hospital Ambulatory Medical Care Survey: 2020 emergency department summary tables. 2022.

Alexandrou

Ray-Barruel

Carr

, et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med 2015; 10: 530–533.

Drugeon

Guenezan

Pichon

, et al. Incidence, complications, and costs of peripheral venous catheter-related bacteraemia: a retrospective, single-centre study. J Hosp Infect 2023; 135: 67–73.

Ellis

Feldman

Harrup-Griffiths

. The clinical anatomy of the antecubital fossa. Br J Hosp Med 2010; 71: M4–M5.

Newman

Waxman

. Blood donation-related neurologic needle injury: evaluation of 2 years’ worth of data from a large blood center. Transfusion 1996; 36: 213–215.

10.

Brannam

Blaivas

Lyon

, et al. Emergency nurses’ utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Acad Emerg Med 2004; 11: 1361–1363.

11.

Chiricolo

Balk

Raio

, et al. Higher success rates and satisfaction in difficult venous access patients with a guide wire-associated peripheral venous catheter. Am J Emerg Med 2015; 33: 1742–1744.

12.

Pittiruti

Van Boxtel

Scoppettuolo

, et al. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): a WoCoVA project. J Vasc Access 2023; 24: 165–182.

13.

Lamperti

Bodenham

Pittiruti

, et al. International evidence-based recommendations on ultrasound-guided vascular access. Intensive Care Med 2012; 38: 1105–1117.

14.

Munshey

Parra

McDonnell

, et al. Ultrasound-guided techniques for peripheral intravenous placement in children with difficult venous access. Paediatr Anaesth 2020; 30: 108–115.

15.

Duran-Gehring

Bryant

Reynolds

, et al. Ultrasound-guided peripheral intravenous catheter training results in physician-level success for Emergency Department Technicians. J Ultrasound Med 2016; 35: 2343–2352.

16.

Bahl

Pandurangadu

Tucker

, et al. A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients. Am J Emerg Med 2016; 34: 1950–1954.

17.

Rodríguez-Calero

Blanco-Mavillard

Morales-Asencio

, et al. Defining risk factors associated with difficult peripheral venous cannulation: a systematic review and meta-analysis. Heart Lung 2020; 49: 273–286.

18.

Kimori

Sugama

. Investigation of vasculature characteristics to improve venepuncture techniques in hospitalized elderly patients. Int J Nurs Pract 2016; 22: 300–306.

19.

Witting

Schenkel

Lawner

, et al. Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. J Emerg Med 2010; 39: 70–75.

20.

Mukai

Nakajima

Nakano

, et al. Safety of venipuncture sites at the cubital fossa as assessed by ultrasonography. J Patient Saf 2020; 16: 98–105.

21.

Brandt

Jepsen

Hendriksen

, et al. The use of ultrasound to identify veins for peripheral venous access in morbidly obese patients. Dan Med J 2016; 63: A5191.

22.

Mukai

Fujii

Nakajima

, et al. Factors affecting superficial vein visibility at the upper limb in healthy young adults: a cross-sectional observational study. J Vasc Access 2020; 21: 900–907.

23.

Popli

Dittman

Amendola

, et al. Anatomic suitability for commercially available percutaneous arteriovenous fistula creation systems. J Vasc Surg 2021; 73: 999–1004.

24.

Lockhart

Robbin

Fineberg

, et al. Cephalic vein measurement before forearm fistula creation: does use of a tourniquet to meet the venous diameter threshold increase the number of usable fistulas? J Ultrasound Med 2006; 25: 1541–1545.

25.

Planken

Keuter

Hoeks

, et al. Diameter measurements of the forearm cephalic vein prior to vascular access creation in end-stage renal disease patients: graduated pressure cuff versus tourniquet vessel dilatation. Nephrol Dial Transplant 2006; 21: 802–806.

26.

Kordzadeh

Chung

Panayiotopoulos

. Cephalic vein and radial artery diameter in formation of radiocephalic arteriovenous fistula: a systematic review. J Vasc Access 2015; 16: 506–511.

27.

von Haxthausen

Böttger

Wulff

, et al. Medical robotics for ultrasound imaging: current systems and future trends. Curr Rob Rep 2021; 2: 55–71.

28.

Sharp

Cummings

Childs

, et al. Measurement of vein diameter for peripherally inserted central catheter (PICC) insertion: an observational study. J Infus Nurs 2015; 38: 351–357.

29.

Herring

Oskui

Hale

, et al. Testosterone and the cardiovascular system: a comprehensive review of the basic science literature. J Am Heart Am 2013; 2: e000271.

30.

Janssen

Heymsfield

Wang

, et al. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol 2000; 89: 81–88.

31.

Green

Spence

Rowley

, et al. Vascular adaptation in athletes: is there an ‘athlete’s artery’? Exp Physiol 2012; 97: 295–304.

32.

Greenwald

. Ageing of the conduit arteries. J Pathol 2007; 211: 157–172.

33.

Prakash

Arora

Rani

. Peripheral venous access in the obese patient. Indian J Anaesth 2015; 59: 692–693.

34.

Miharu

Nobuko

Hiromitsu

. Short- and long-term reproducibility of peripheral superficial vein depth and diameter measurements using ultrasound imaging. BMC Med Imaging 2022; 22: 212.

35.

Khan

Muise

Iyengar

, et al. Metabolic dysregulation and adipose tissue fibrosis: role of collagen VI. Mol Cell Biol 2009; 29: 1575–1591.

36.

Brass

Hellmich

Kolodziej

, et al. Ultrasound guidance versus anatomical landmarks for subclavian or femoral vein catheterization. Cochrane Database Syst Rev 2015; 1: CD011447.

37.

Maecken

Grau

. Ultrasound imaging in vascular access. Crit Care Med 2007; 35: S178–S185.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.21 MB