A Standardized Training Program in Ultrasound-Guided Intravenous Line Placement: Improving Nurses' Confidence and Success.

BACKGROUND: Ultrasound-guided imagery to obtain peripheral intravenous (USGIV) access is a technique that can be used to increase successful peripheral intravenous catheter insertion rates. Improving rates of USGIV use will subsequently decrease central venous catheter use and thus decrease the time to treatment initiation, reduce costs, and improve patient satisfaction. PURPOSE: Current available programs teach nurses USGIV use for the adult population, mainly with a focus on the emergency department. To address this gap in knowledge, a USGIV program aimed at the specific needs of the neonatal intensive care unit (NICU) nurse was developed and implemented. METHOD: Twelve NICU nurses were trained in USGIV access during a 4-hour combination didactic and simulation-based program. Participants took a pretest survey assessing baseline knowledge and confidence levels related to USGIV access. After didactic lecture, participants worked at stations focused on USGIV access. An 80% benchmark for each participant was set for successful USGIV attempts during simulation. Participants' knowledge and confidence levels were reassessed at the end of the program. RESULTS: Posttest scores increased by an average of 25%, demonstrating increased knowledge. The pre- to posttest confidence scores increased by a minimum of 1.6 points (based on a 5-point Likert scale). All participants (n = 12) successfully demonstrated proficiency by achieving at least 80% of attempted USGIV access on a mannequin. IMPLICATIONS FOR PRACTICE AND RESEARCH: This project demonstrated that USGIV catheter can be employed in neonatal patients by training NICU nurses in USGIV techniques.

Diagnostic challenges with central venous catheter studies.

A central venous catheter is typically made of silicone rubber or polyurethane and inserted into a large central vein to provide prolonged and direct access to central venous circulation. These catheters provide a safe and effective method to administer intravenous medications, nutritional supplements, fluids and blood products. However, a myriad of complications is associated with central venous catheters, including, but not limited to, mechanical malfunction or fracture, kinking, erroneous placement, line infection, fibrin sheath formation and venous thrombosis. Following clinical and radiographic evaluation, contrast-enhanced line studies constitute the next best diagnostic tool to assess the functionality of central venous catheters. However, there is a lack of standardization in the literature outlining how these studies should be performed. In addition, the interpretation of these studies can be problematic for general pediatric radiologists, many of whom are often not familiar with placement or manipulation of these catheters. In this pictorial review, we highlight the challenges associated with performing and interpreting fluoroscopically guided contrast injection studies, using case studies drawn from a large tertiary children's hospital database for illustration. Revealing these challenges and understanding their causative mechanisms can improve the performance of these line studies.

Transvenous phrenic nerve stimulation for central sleep apnea is safe and effective in patients with concomitant cardiac devices.

BACKGROUND: Central sleep apnea is common in heart failure patients. Transvenous phrenic nerve stimulation (TPNS) requires placing a lead to stimulate the phrenic nerve and activate the diaphragm. Data are lacking concerning the safety and efficacy of TPNS in patients with concomitant cardiovascular implantable electronic devices (CIEDs). OBJECTIVE: To report the safety and efficacy of TPNS in patients with concomitant CIEDs. METHODS: In the remede System Pivotal Trial, 151 patients underwent TPNS device implant. This analysis compared patients with concomitant CIEDs to those without with respect to safety, implant metrics, and efficacy of TPNS. Safety was assessed using incidence of adverse events and device-device interactions. A detailed interaction protocol was followed. Implant metrics included overall TPNS implantation success. Efficacy endpoints included changes in the apnea-hypopnea index (AHI) and quality of life. RESULTS: Of 151 patients, 64 (42%) had a concomitant CIED. There were no significant differences between the groups with respect to safety. There were 4 CIED oversensing events in 3 patients leading to 1 inappropriate defibrillator shock and delivery of antitachycardia pacing. There was no difference in efficacy between the CIED and non-CIED subgroups receiving TPNS, with both having similar percentages of patients who achieved ≥50% reduction in AHI and quality-of-life improvement. CONCLUSION: Concomitant CIED and TPNS therapy is safe. The presence of a concomitant CIED did not seem to impact implant metrics, implantation success, and TPNS efficacy. A detailed interaction protocol should be followed to minimize the incidence of device-device interaction.

Comparison of Ultrasound-Guided Vs Traditional Arterial Cannulation by Emergency Medicine Residents.

INTRODUCTION: We sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training. METHODS: We identified 60 patients age 18 years or older at a tertiary care, urban academic emergency department who required radial AC for either continuous blood pressure monitoring or frequent blood draws. Patients were randomized to receive radial AC via either USGAC or traditional AC. If there were three unsuccessful attempts, patients were crossed over to the alternative technique. All EM residents underwent standardized, general ultrasound training. RESULTS: The USGAC group required fewer attempts as compared to the traditional AC group (mean 1.3 and 2.0, respectively; p<0.001); 29 out of 30 (96%) successful radial arterial lines were placed using USGAC, whereas 14 out of 30 (47%) successful lines were placed using traditional AC (p<0.001). There was no significant difference in length of procedure or complication rate between the two groups. There was no difference in provider experience with respect to USGAC vs traditional AC. CONCLUSION: EM residents were more successful and had fewer cannulation attempts with USGAC when compared to traditional AC after standard, intern-level ultrasound training.

Hypnosis and communication reduce pain and anxiety in peripheral intravenous cannulation: Effect of Language and Confusion on Pain During Peripheral Intravenous Catheterization (KTHYPE), a multicentre randomised trial.

BACKGROUND: Clinicians traditionally warn patients of pain before peripheral i.v. cannulation (PIVC). However, using words related to pain or undesirable experiences can result in greater pain and anxiety. The use of positive words can improve pain perception and subjective patient experience. We aimed to compare the effects of three types of communication, including hypnotic communication, on pain, comfort, and anxiety in patients during PIVC. METHODS: The Effect of Language and Confusion on Pain During Peripheral Intravenous Catheterization (KTHYPE) trial is a randomised, parallel, single-blind, multicentre study of patients undergoing PIVC on the dorsal face of the hand before surgery. Patients from three hospitals were randomly allocated to one of three groups: PIVC performed with a hypnosis technique (hypnosis group), negative connotation (nocebo group), and neutral connotation (neutral group). The primary outcome measure was the occurrence of pain measured with a 0-10 numerical rating scale just after PIVC. RESULTS: Of the 272 subjects analysed (hypnosis, n=89; nocebo, n=92; neutral, n=91), pain after PIVC was lower in the hypnosis group (mean [standard deviation]; range) (1.5 [1.9]; 0-5) compared with the neutral (3.5 [2.3]; 0-9; P<0.0001) and nocebo groups (3.8 [2.5]; 0-10; P<0.0001). Whilst anxiety was higher and comfort lower before PIVC in the hypnosis group, anxiety decreased and comfort perception increased after PIVC when hypnosis was used. CONCLUSIONS: This is one of the first well-designed RCTs showing a significant benefit of a hypnosis technique during a routine procedure, such as PIVC. The results could facilitate implementation of hypnosis in daily clinical care. CLINICAL TRIAL REGISTRATION: NCT02662322.

Palmar Warming for Radial Artery Vasodilation to Facilitate Transradial Access: A Randomized Controlled Trial.

PURPOSE: To investigate the efficacy of palmar warming to induce radial artery vasodilation. MATERIALS AND METHODS: After informed consent was obtained, healthy volunteers (n = 45) were randomized 2:1 in palmar warming and control groups, respectively, for this prospective, randomized, single-blind clinical trial (NCT03620383). The palmar warming group was given a warm, commercially available, air-activated heat pack (Kobayashi Consumer Products LLC, Dalton, Georgia) to hold in the left hand for palmar warming. The control group was given a deactivated version of the same heat pack. Left radial artery cross-sectional area (CSA) measurements were obtained at baseline and in 5-minute intervals up to 20 minutes in both groups. Differences in the trends of changes in the radial artery CSA between palmar warming and control groups were examined with the age- and sex-adjusted repeated measure analysis of variance. Propensity score-matched treatment effect analysis was conducted to quantify the effect of heat on radial artery CSA. RESULTS: The palmar warming group and the control group were significantly different in terms of subject sex (males/females: 7/23 and 10/5, respectively; P = .005) and baseline CSA (2.5±0.2 mm2 vs 3.2±0.3 mm2, respectively; P = .014). Radial artery CSA showed an increasing trend over time in the palmar warming group compared to a stable trend over time in the control group (P < .0001). Propensity score-matched comparison showed a 43.9% increase (95% confidence interval: 34.1%-53.8%) in CSA in the palmar warming group compared to the control group (P < .0001). CONCLUSIONS: The palmar warming technique is effective at dilating the radial artery and may be a beneficial technique to facilitate transradial access.

Veinplicity versus heat treatment for vein dilation: A randomised cross-over study.

BACKGROUND: Peripheral intravenous cannulation is one of the most common invasive procedures for hospitalised patients. Patients with difficult venous access require special measures to facilitate cannulation. Veinplicity applies mild electrical stimulation to forearm veins to aid vessel dilation. To assess this new technique, we compared its effect on the veins to that of standard heat treatment. METHODS: In all, 20 volunteers were randomised to receive either application of heat packs to the forearm and later stimulation with Veinplicity or the same two treatments in reverse order. Ultrasound measurements of the basilic, cephalic and brachial veins were taken at intervals during and after treatment and compared with baseline values. RESULTS: The mean maximum vein diameter increase from baseline was significantly higher with Veinplicity than with heat packs (49.94% ± 23.55% vs 36.26% ± 23.09%, p = 0.021). In addition, the mean duration of the dilatory effect was significantly longer with Veinplicity than with heat packs (9.7 ± 3.9°min vs 4.9 ± 2.2°min, p < 0.001). CONCLUSION: Veinplicity dilates forearm veins more effectively and for a longer time than commonly used heat packs. This new treatment option appears to be a valuable addition to the vascular access toolkit, with the potential to improve first-attempt cannulation rates and spare patients from discomfort, pain and iatrogenic vessel trauma.

The peripheral portacath provides safe and convenient venous access in pediatric and adolescent patients.

INTRODUCTION: Adolescent patients with chronic conditions rely on permanent venous access for safe treatment and supportive care. Traditionally this is provided by a central venous access device (CVAD) e.g. Hickmann catheter or totally implanted subcutaneous port or also called Port-a-Cath (PaC). We reviewed the patient experience, safety and feasibility of insertion of peripheral inserted implanted subcutaneous port (peripheral PaC). METHODS: Medical records of patients who underwent insertion of peripheral PaC under ultrasound guidance at our institution since between 2012-2017 were reviewed to ascertain specific details including duration of insertion and complication rate. Short structured questionnaires were used to assess nursing and patient satisfaction. RESULTS: Twenty eight peripheral PaC were inserted at our institution. There were 17 female and 11 male patients aged between 12.3 and 18.7 years (median = 16.1). Six were inserted under local anesthetic (LA) in patients who were not fit for general owing to mediastinal mass or lung disease. At the time of analysis 2 PaCs remained in situ with a median duration of 8 months (range 3-48). Removal of 26 PaCs was under LA in 15 cases and under GA in 11. Complications were observed in 9 cases but only necessitated early removal or replacement in 3 cases (displacement and disconnection) and repositioning in 1 case. Thrombosis was seen in 2 patients who required systemic anticoagulation but had complete resolution. CONCLUSION: This study shows that the use of peripheral PaC is safe. The feedback from patients and nursing staff supports the use of the peripheral PaC. We are exploring additional patient groups that might benefit from this device.

Feasibility of complex transfemoral electrophysiology procedures in patients with inferior vena cava filters.

BACKGROUND: The presence of inferior vena cava filters (IVCFs) has been considered a relative contraindication to electrophysiology (EP) procedures that require transfemoral venous placement of multiple catheters and/or long sheaths. There are inadequate data related to complex EP procedures in this population. OBJECTIVE: The purpose of this study was to describe the experience of a single high-volume center with respect to complex EP procedures in patients with IVCFs. METHODS: Patients with IVCFs undergoing complex EP procedures between 2004 and 2018 were identified. Clinical characteristics, IVCF type, procedural findings, and complications were analyzed. RESULTS: Fifty complex ablation procedures were performed in 40 patients (mean age 63.8 ± 10.9 years; 68% men). The mean IVCF dwell time was 69.1 ± 19.1 months, and 48 patients (96%) were on chronic oral anticoagulation. Procedures included ablation of atrial fibrillation (n = 21), ventricular tachycardia (n = 20), supraventricular tachycardia (n = 3), cavotricuspid isthmus flutter (n = 3), supraventricular tachycardia and cavotricuspid isthmus flutter (n = 1), and transvenous lead extraction (n = 3). Twenty procedures included quadripolar catheters (mean 1.4 ± 0.75), and 33 procedures involved deflectable decapolar catheters (mean 1.7 ± 0.47). Long sheaths were used in 35 cases (mean 1.63 ± 0.49) and intracardiac echocardiography in 38. In 4 cases (involving 3 patients), the IVCF was occluded and could not be crossed. There were no procedural complications related to the IVCF. CONCLUSION: The substantial majority of IVCFs in patients presenting for complex EP procedures were patent and easily crossed under fluoroscopic guidance. The presence of an IVCF should not discourage operators from performing procedures that require transfemoral deployment of multiple catheters and/or sheaths.

The clinical efficacy of EMLA cream for intravenous catheter placement in client-owned dogs.

OBJECTIVE: To assess the reaction of client-owned dogs to intravenous (IV) catheter placement after applying a local anaesthetic (EMLA) or placebo cream for either 30 or 60 minutes. STUDY DESIGN: Prospective, randomized, blinded, placebo-controlled, clinical trial. ANIMALS: A total of 202 client-owned dogs of various breeds. METHODS: With owner consent, dogs were randomly allocated to one of four treatment groups: EMLA 60 minutes, EMLA 30 minutes, Placebo 60 minutes and Placebo 30 minutes. After the cream was applied for the allocated time, an IV catheter was placed and the behavioural reaction of the dog was scored. The reaction score was analysed using a Kruskal-Wallis test followed by Mann-Whitney U tests of the multiple pairwise comparisons, with Bonferroni correction. RESULTS: A large number of dogs, even in the placebo groups, did not react to IV catheter placement. However, the Kruskal-Wallis test showed an overall difference between treatment groups (χ2 = 11.029, df = 3, p = 0.012). The pairwise comparisons showed a lower overall reaction score in the EMLA 60 group than in the EMLA 30 and Placebo 60 groups (adjusted p = 0.018 and adjusted p = 0.044, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: This study shows that EMLA cream applied for 60 minutes reduces the behavioural reaction of dogs to IV catheter placement; therefore, this intervention can be advocated for routine use in veterinary medicine to enhance the welfare of dogs undergoing IV catheter placement.

Ankaferd blood stopper as a new strategy to avoid early complications after transradial procedures: A randomized clinical trial.

BACKGROUND: We planned a three arm randomized study to evaluate the safety and efficacy of a new blood stopper, Ankaferd blood stopper (ABS) along with short-time compression, compared to either short-time compression with conventional sterile gauzes (CSG) or with a TR band after transradial (TRA) procedures. METHODS: The Ankaferd blood stopper as a new strategy to avoid early complications. After transradial procedures (ABS transradial) trial is designed in a prospective, randomized, placebo-controlled fashion and registered with http://clinicaltrials.gov (NCT02982733). Six hundred and thirty patients were randomized into three arms in a 1:1:1 fashion corresponding to three different strategies of patent hemostasis techniques after diagnostic or interventional catheterization. RESULTS: One (0.49%) patient in the CSG group and one patient (0.48%) in the TR Band group developed RAO at the end of the hemostasis, compared with 0 (0%) in the ABS group. At 30 days follow-up none of the groups had any patients with RAO. As a secondary end-points the difference was not statistically significant regarding hematoma among the three groups (P = 0.70). Bleeding during deflation of the TR Band or removal of the elastic bandage occurred in 55 patients (26.96%) in the CSG group and in 56 (27.31%) patients in the TR Band group compared to 19 patients (9.40%) in the ABS group (P < 0.001). CONCLUSION: Ankaferd blood stopper is a promising device for use in patent hemostasis, with no evidence on RAO at short-term or long term and with reduced risk of re-bleeding at the end of hemostasis.

Hypnosis as adjunct therapy to conscious sedation for venous access device implantation in breast cancer: A pilot study.

BACKGROUND: Recent reviews support that hypnosis has great potential for reducing pain and anxiety during mini-invasive surgery. Here, we assessed the feasibility of hypnotic induction session as adjunct therapy in conscious sedation for venous access device implantation. Primary outcomes were safety and patient satisfaction. METHODS: Thirty consecutive women with breast cancer were proposed adjunct of hypnosis before implantation under conscious sedation (midazolam: 0.5 mg ± bolus of Ketamin: 5 mg on demand) indicated for chemotherapy. Self-hypnosis was programmed and guided by one of two trained anesthesiologists. Implantation was performed by one of two experimented surgeons. It consisted of blind subclavian implantation of Braun ST 305 devices using a percutaneous technique adapted from Selinger's procedure. Clinical data were prospectively collected and retrospectively analyzed. A comprehensive custom-made questionnaire recorded patient satisfaction. RESULTS: In all, 30/30 patients consented to the procedure. The median age was 54 years (range: 35-77 years). The primary procedure was successful in 29/30. One case was converted into internal jugular vein access after a first attempt. Median length time of the implantation procedure in the operative room was 20 min (range: 10-60 min). Median length time in the recovery room preceding home discharge was 65 min (range: 15-185 min). None of the patients suffered complications. The satisfaction rate was ≥90%, 27/30 patients would get hypnosis in case of reimplantation if necessary and 27/30 would recommend this procedure to others. CONCLUSION: Hypnosis under conscious sedation appears feasible and safe for port implantation under conscious sedation in cancer patients. Further studies would determine the exact value of hypnosis effectiveness.

Development of pumping emulsification device with glass membrane to form ideal lipiodol emulsion in transarterial chemoembolization.

PURPOSE: To evaluate a pumping emulsification device that can improve the physiochemical properties and stability of lipiodol emulsion for conventional transarterial chemoembolization. MATERIALS AND METHODS: A pumping emulsification device constructed of a glass membrane with a hydrophobic surface with pore size of 50 µm in diameter was placed between two syringe adaptors. Epirubicin solutions were mixed with lipiodol with pumping exchanges using the emulsification device or a three-way cock. The ratios of epirubicin solution to lipiodol were 1:2 or 1:1. A total of 120 emulsions were created. RESULTS: The emulsification device showed significantly higher percentages of water-in-oil when compared with the three-way cock (97.9 % vs. 68.9 % in 1:2 ratio, and 82.1 % vs. 17.8 % in 1:1 ratio, p < .001). Droplet sizes in the emulsification device were more homogenous. Mean droplet sizes and viscosities in the emulsification device did not show any significant changes for 30 min after pumping, whereas in the three-way cock, the droplet sizes significantly enlarged and viscosities significantly decreased (p=.023 and p=.002). CONCLUSION: The emulsification device can form a high percentage of water-in-oil emulsion with stable droplets sizes and viscosities. This developed device is promising to increase therapeutic effects in conventional transarterial chemoembolization. KEY POINTS: • We developed new device for transarterial chemoembolization for liver cancer. • The device can improve the physiochemical properties of lipiodol emulsion. • The device can increase the therapeutic effects in conventional transarterial chemoembolization.

A clinical audit to assess the efficacy of the Coolsense® Pain Numbing Applicator for intravenous cannulation in children.

The Coolsense® device is a topical applicator that is used to anaesthetise the skin before a painful procedure. It is a handheld device with a temperature-controlled head that acts on application, without chemicals, to cool and anaesthetise the site of injection. This prospective observational audit of 100 children and adolescents aged six to 18 years studied the analgesic efficacy and patient and carer satisfaction rating of the device during intravenous cannulation and complications arising from its use. The audit demonstrated effective skin analgesia for intravenous cannulation in children and adolescents. Ninety-four percent of patients rated the pain during cannulation as less than or equal to three on a numerical pain rating scale of zero to ten. Patient and carer satisfaction with the device and cannulation success rates were high; 66% of patients and 82% of carers 'really liked' the device and 28% of patients and 12% of carers 'liked' it. Ninety-five percent of patients were cannulated on the first attempt. The incidence of complications using the device was low. The Coolsense device appears to be a useful tool that provides effective analgesia for intravenous cannulation in children with minimal complications. Comparative studies with topical local anaesthesia creams are warranted.

Mapping for Acute Transvenous Phrenic Nerve Stimulation Study (MAPS Study).

BACKGROUND: Central sleep apnea syndrome, correlated with the occurrence of heart failure, is characterized by periods of insufficient ventilation during sleep. This acute study in 15 patients aims to map the venous system and determine if diaphragmatic movement can be achieved by phrenic nerve stimulation at various locations within the venous system. METHODS: Subjects underwent a scheduled catheter ablation procedure. During the procedural waiting time, one multielectrode electrophysiology catheter was subsequently placed at the superior and inferior vena cava and the junctions of the left jugular and left brachiocephalic vein and right jugular and right brachiocephalic vein, for phrenic nerve stimulation (1-2 seconds ON/2-3 seconds OFF, 40 Hz, pulse width 210 µs). Diaphragmatic movement was assessed manually and by a breathing mask. During a follow-up assessment between 2 and 4 weeks postprocedure, occurrence of adverse events was assessed. RESULTS: In all patients diaphragmatic movement was induced at one or more locations using a median threshold of at least 2 V and maximally 7.5 V (i.e., e 3.3 mA, 14.2 mA). The lowest median current to obtain diaphragmatic stimulation without discomfort was found for the right brachiocephalic vein (4.7 mA). In 12/15 patients diaphragmatic movement could be induced without any discomfort, but in three patients hiccups occurred. CONCLUSION: Diaphragmatic stimulation from the brachiocephalic and caval veins is feasible. Potential side effects should be eliminated by adapting the stimulation pattern. This information could be used to design a catheter, combining cardiac pacing with enhancing diaphragm movement during a sleep apnea episode.

A Retrograde Transvenous Embolization Technique with Balloon-Assisted Arterial Aspiration for a Peripheral Arteriovenous Malformation with a Venous Pouch.

Management of arteriovenous malformations (AVMs) is challenging, and there is no consensus regarding either the ideal approach or the treatment timing. Percutaneous embolization is the most frequent approach currently used and is considered the first-line technique for AVMs. There is an ongoing discussion about the best technical approach to embolize AVMs. AVMs associated with a dominant outflow vein (DOV) are rare. Embolization of both the DOV and the nidus is considered more effective. Herein, we report a novel technique of transvenous embolization of a DOV under negative pressure from an arterial balloon catheter in a case of a peripheral AVM. This technique allows the embolization of the DOV and the nidus retrogradely.

Vascular Complications During Catheter Ablation of Cardiac Arrhythmias: A Comparison Between Vascular Ultrasound Guided Access and Conventional Vascular Access.

INTRODUCTION: Vascular access related complications are the most common complications from catheter based EP procedures and have been reported to occur in 1-13% of cases. We prospectively assessed vascular complications in a large series of consecutive patients undergoing catheter based electrophysiologic (EP) procedures with ultrasound (US) guided vascular access versus conventional access. METHODS AND RESULTS: Consecutive patients undergoing catheter ablation procedures at VCU medical center were included. US guided access was obtained in all cases starting June 2015 (US group) while modified Seldinger technique without US guidance (non-US group) was used in cases prior to this date. All vascular complications were recorded for a 30-day period after the procedure. A total of 689 patients underwent 720 procedures. Ablations for ventricular tachyarrhythmias (ventricular tachycardia: VT, premature ventricular contractions: PVCs) accounted for 89 (12%) cases; atrial fibrillation (AF) ablations accounted for 328 procedures (46%) and other catheter based procedures accounted for 42% of cases. A significantly higher incidence of complications was noted in the non-US group compared with the US group (19 [5.3%] vs. 4 [1.1%], respectively, P = 0.002). Major complications were also higher among the non-US group (9 [2.5%] vs. 2 [0.6%], P = 0.03). Increasing age (P = 0.04) and non-US guided vascular access (P = 0.002) were associated with a higher risk of vascular access complications. CONCLUSION: In a large series of patients undergoing catheter based EP procedures for cardiac arrhythmias, US guided vascular access was associated with a significantly decreased 30-day risk of vascular complications.

Effects of local heat application before intravenous catheter insertion in chemotherapy patients.

AIMS AND OBJECTIVES: To characterise the effects of local heat application on the ease of subsequent intravenous catheter insertion. BACKGROUND: Intravenous catheter insertion is a challenging procedure for both nurses and chemotherapy patients. The local application of heat to the area before intravenous catheter insertion may decrease these difficulties by increasing venous distension and visibility. DESIGN: This study was an open label experimental study involving intervention and control groups. METHODS: Patients receiving chemotherapy were divided into intervention (n = 40) and control (n = 40) groups. For patients in the intervention group, a digital moist heating pad was applied to the arm prepared for catheter insertion for 10 minutes in addition to routine care. No additional preparation procedure beyond routine care was performed for control patients. Data were collected using a data collection form and evaluated using chi square, Fisher's exact chi square, Student's t, Mann-Whitney U, Wilcoxon and Pearson correlation tests. RESULTS: Local application of heat decreased patients' pain (p = 0·011), increased the rate of successful catheter placement at first attempt (p = 0·004), decreased the catheterisation procedure time (p = 0·001) and decreased nurse-perceived difficulty during catheter placement (p = 0·001). CONCLUSIONS: Local application of heat before the catheterisation procedure is suggested for patients receiving chemotherapy, particularly in cases where visibility of the veins is poor and intravenous catheter insertion is difficult. RELEVANCE TO CLINICAL PRACTICE: Local application of heat results in vasodilation, and thus intravenous catheter insertion becomes easier. Our findings have important implications for nurses who care for chemotherapy patients. The inclusion of local heat application before catheterisation as a preparation step is suitable to be implemented by nurses in other hospitals and clinics where chemotherapy is provided.