Vein Finder in Orthopedic Preoperative Care: First-Attempt Success Rises from 54.7% to 70.5%

Peripheral venous access is a routine part of preoperative preparation in orthopedic surgery. Yet for many orthopedic patients — who are often elderly, obese, or living with diabetes, hypertension, or peripheral vascular disease — achieving first-attempt cannulation can be unexpectedly difficult. Limb edema, non-palpable veins, scarring from prior punctures, and age-related vascular changes all reduce the reliability of the traditional landmark technique.

A prospective, parallel-group, randomized controlled superiority trial conducted in the preoperative holding area of a tertiary-care orthopedic surgery department evaluated whether a vein finder device could improve vascular access outcomes in this population.

The device
A vein finder device using near-infrared (NIR) technology to project a real-time venous map onto the skin surface, guiding clinicians toward optimal cannulation sites.

The study design
190 adult orthopedic patients scheduled for elective or semi-elective surgery were randomized 1:1 to NIR-guided venipuncture or traditional landmark-based venipuncture. Randomization was stratified by anticipated difficulty of venous access and type of orthopedic procedure. Trained nurses performed all attempts, with a maximum of five attempts per patient. The primary endpoint was first-attempt success, defined as successful venous entry, full catheter advancement, and unhindered saline flush.

The results

First-attempt success (primary outcome)

• NIR group: 70.5% (67/95)

• Landmark group: 54.7% (52/95)

Total attempts required

• Success on 1st attempt: 70.5% vs. 54.7%

• Failed after 5 attempts: 1.1% vs. 6.3%

Cannulation time (tourniquet to successful placement)

• NIR group: mean 2.0 ± 0.9 minutes; median 2 minutes (IQR 1–2)

• Landmark group: mean 3.5 ± 1.2 minutes; median 3 minutes (IQR 3–4)

Pain scores (VAS 0–10, conscious patients)

• NIR group: mean 2.4 ± 1.1; median 2 (IQR 2–3)

• Landmark group: mean 4.1 ± 1.5; median 4 (IQR 3–5)

Local complications

• Venitis: 2.1% vs. 7.4%

• Hematoma: 3.2% vs. 10.5%

• Extravasation: 1.1% vs. 6.3%

• Thrombophlebitis: 0.0% vs. 2.1%

• Local inflammation: 3.2% vs. 9.5%

Subgroup: difficult venous access

• Difficult access present: 72.0% success with NIR vs. 48.1% with landmark

• No difficult access: 68.9% vs. 62.8%

Nurse-related factors

• Ease-of-procedure score (1–10): 8.1 ± 1.2 with NIR vs. 6.2 ± 1.4 with landmark

• Benefit was consistent across all nurse experience levels

Workflow metric: time to anesthesia readiness

• NIR group: mean 7.5 ± 2.4 minutes; median 7 minutes (IQR 6–9)

• Landmark group: mean 11.2 ± 3.1 minutes; median 11 minutes (IQR 9–13)

Why it matters
This trial provides some of the most detailed evidence to date on vein finder devices in the orthopedic preoperative setting. The benefits were consistent across every measured outcome: higher first-attempt success, fewer total attempts, shorter cannulation time, lower patient-reported pain, fewer local complications, and faster readiness for anesthesia.

The subgroup analysis is particularly relevant for clinical adoption. Among patients with predictors of difficult venous access — obesity, limb edema, non-palpable veins, advanced age, or venous scarring — the device improved first-attempt success from 48.1% to 72.0%. These are precisely the patients who most often experience repeated punctures, preoperative delays, and avoidable discomfort.

The study also found that nurses reported significantly higher ease-of-procedure scores when using the device, regardless of their experience level. This suggests the technology reduces technical burden and may serve as a useful training aid for less experienced staff.

For orthopedic departments, preoperative units, and surgical centers serving aging and comorbid patient populations, this data supports integrating vein finder devices into routine preoperative vascular access protocols — not as a rescue tool, but as a standard of care.

Limitations to note
Operator blinding was not feasible due to the visible nature of the device. Follow-up was limited to the immediate perioperative period, so longer-term complications such as delayed thrombophlebitis or catheter-related infection were not assessed. The study was conducted in a single orthopedic unit, and results were based on one specific device model.