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Clinical Trial to Assess the Effectiveness of Applying Dry Local Heat and/ or High Tourniquet Pressure for Venipuncture.

Cross-over Clinical Trial to Assess the Effectiveness of Applying Dry Local Heat and/ or High Tourniquet Pressure With Current Clinical Practice for Venipuncture, and Blinded for Evaluating Their Impact on Hemolysis

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04027218
Acronym
ECYPVEN-H/17
Enrollment
62
Registered
2019-07-19
Start date
2017-07-09
Completion date
2018-04-03
Last updated
2019-11-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Venipuncture, Healthy Adult

Keywords

venipuncture, hemolysis, heat, pressure, safety

Brief summary

Low level intervention health products clinical trial, fourth phase, non-commercial research. Dissertation of COMPLUTENSE UNIVERSITY of Madrid. Principal Investigator of this clinical trial: Ms. LETICIA CARMEN SIMÓN LÓPEZ Collaborative investigators: Dr. DOLORES OCHOA-MAZARRO (principal investigator of bioequivalence clinical trial), and Sir. SERGIO LUQUERO-BUENO (collaborative researcher) The setting is Clinical trials Unit of Clinical Pharmacology Department. LA PRINCESA HOSPITAL of Madrid. Research Ethical Committee of LA PRINCESA HOSPITAL of Madrid. Any person will monitor this clinical trial because the sponsor and principal researcher are the same person. Nevertheless, an adherence to this protocol will ensure by principal researcher and co-researchers. The three interventions are: 1. To Apply local dry heat. 2. To apply high tourniquet pressure. 3. To apply both of them. (Dry heat and high pressure) The common comparator: Current Clinical practice for peripheral venous catheterization. The main hypothesis: The number of attempts of success venipuncture at first time are influenced by any of the interventions applied before. The main goal: To identify the most effective intervention of applying dry local heat and/or high tourniquet pressure in relation of number success venipuncture attempts, compared to current clinical practice. Design: An experimental, randomized study which is controlled with current clinical practice to insert a peripheral vein catheter. It is an incomplete cross-over clinical trial, with three arms which are involved interventions and a common comparator. Population: Adult healthy subjects. Sample size: It is required to enroll 54 subjects with a 95% of level of confidence and 80% level of power. Main variable: Succeed peripheral vein catheter insertion at first attempt. Effectiveness assessment: The optimal effectiveness is considered when vein cannulation success at first attempt exceeds 95% applying any of the interventions. Planned date to address: It is planned to carry out around June and/or July of 2017 for the main variable.

Detailed description

The study is considered a low level intervention clinical trial to evaluate the use and safety of a sanitary product marketed and accredited for a different aim, but according to their rules of using. It is experimental, randomized and controlled study with the usual technique of inserting a venipuncture catheter until now. Incomplete clinical trial, blind to third parties, in healthy volunteers, which consists of three arms, in which they are intervened and the comparator is applied. The volunteers comes from a bioequivalence clinical trial for testing a new drug, and a venous catheter is required in two period between a wash-out period of one week, approximately. For each volunteer one of intervention is applied in one period, and in other period the comparator is applied. Thus, one intervention and the sequence of one intervention application and comparator is assigned by randomization using sealed envelopes. Randomization is only performed in first period, in second period one intervention or comparator assigned in applied. Thus, each one volunteer is her/his own comparator . Before assigned intervention or comparator is applied, a Venous International Assessment is carried out using Venous International Assessment (VIA) validated scale by nurse perception and palpation. After assigned intervention, another VIA is performed. Then, when peripheral venous catheterization is achieved, a blood sample is withdrawn in order to examine hemolysis. Afterwards, pain is registered by Visual Analogue Scale (VAS) validated scale within no more than two hours from vein catheterization, and skin perception is evaluated by Fitzpatrick's scale (only in first period) in order to analyze a possible relationship with adverse events on skin. Subjects are followed-up for 72h in order to monitor adverse events if applicable. According to hemolysis, an ethylene diamine tetra acetate (EDTA) blood sample is processing at 3400 revolutions per minute at 4 Celsius grades for 10 minutes, and plasma samples are frosted for 24-48h. Afterwards, they are defrosted, and analyzed by absorbance using NANODROP SPECTROPHOTOMETER. The analysis by spectrophotometer is blinded of intervention or comparator used to withdrawn.

Interventions

DEVICEDry heat

The application is made with two sacks of carob seeds during 7 minutes. The sacks are placed on antebrachial anatomical zone, together, and previously heated in the microwave for 0.30 seconds at 850 W of power.

It will be carried out with the use of the manual aneroid sphygmomanometer fixed at 100 millimeters of mercury. Brand (QUIRUMED) with European Conformity (CE) marking 0197. A pressure lower than the systolic blood pressure, and in each subject will be monitored the radial pulse.

DEVICECombination of dry heat and high pressure

The application is made with two sacks of carob seeds during 7 minutes. The sacks may be placed on antebrachial anatomical zone, together, and previously heated in the microwave for 0.30 seconds at 850 W of power; according to instructions for use. After 7 minutes, the pressure is applied with the use of the manual aneroid sphygmomanometer fixed at 100 millimeters of mercury. Brand QUIRUMED with CE Marking 0197. A pressure lower than the systolic blood pressure, and in each subject will be monitored the radial pulse.

Sponsors

Fundación de Investigación Biomédica - Hospital Universitario de La Princesa
CollaboratorOTHER
Universidad Complutense de Madrid
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Investigator)

Masking description

For hemolysis analysis in blood samples, the responsible of analysis by spectrophotometry is blinded from the intervention or comparator used for blood sample performed, using two different departments: one for interventions and comparator applications and other for spectrophotometer.

Intervention model description

Experimental, randomized and controlled study with the usual technique of inserting a venipuncture catheter until now. Incomplete clinical trial, blind to third parties, in healthy volunteers, which consists of three arms, in which they are intervened and the comparator is applied.

Eligibility

Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
Yes

Inclusion criteria

* Signed the informed consent form for bioequivalence study * Signed the informed consent form for this clinical trial * Fluid intake of participants was limited to a volume equal to or less than 500 ml * Participants fasted 6-8 hours before venous cannulation * Body mass index (BMI) between 18.5-29.9 * Vein perception by Venous International Assessment (VIA) scale between 5 to 2 grade.

Exclusion criteria

* Grade one in VIA scale * Smokers * BMI lower than 18.5 or equivalent or higher than 30 * Subjects who had any disease, * Blood test, urinalysis, physical examination or electrocardiogram showing disorders with clinical relevance * Subjects receiving treatment for anything apart from contraceptives. * Gluten, lactose intolerance, vegetarian or vegan subjects for bioequivalence subjects.

Design outcomes

Primary

MeasureTime frameDescription
Number of Participants With Successful Venous Catheterization at the First AttemptFrom 1-5 minutesNumber of participants with successful venous catheterization at the first attempt (effectiveness)

Secondary

MeasureTime frameDescription
Number of the Grade of Venous International Assessment (VIA) Scale After Application of Interventionup to ten minutes after application of interventionVein perception in VIA scale was considered as the self-reported visual observation or palpation of a venous pathway. Subjects were graded using the current clinical practice vein stagnation with an elastic compressor application (Unidix®). Five grades considering the numbers of points of optimal puncture visible and tangible, in one of the dorsal veins of the hand, forearm cephalic and/or basilic. Grade I: At least six. Grade II: At least four. Grade III: At least three. Grade IV: At least one. Grade V: None. Therefore, the best grade is I, and the worst grade is V. Higher scores mean a worse outcome.
Number of the Grade in Visual Analogue Scale (VAS) for Pain After Interventionup to 2 hours after application of interventionVisual Analogue Scale (VAS) in pain was measured by integer number. Pain was self-expressed by participants, in a range from 0 to 10. 10: was considered the worst pain experienced 0: no pain perceived. The entire range was 0, 1, 2, 3, 4, 5 , 6, 7, 8, 9, 10. Therefore, higher scores mean a worse outcome.
Number of Participants in Each Type of Skin Standardized According to Fitzpatrick Scaleup to 2 hours after application of interventionNumber of participants in each type of skin standardized according to Fitzpatrick scale. Fitzpatrick scale is the UNABBREVIATED scale that indicates different types of skin described as phototypes. The individuals were graded clinically by sel-expressed by participants in the area of the forearm not exposed to the sun. In a range of six phototypes, where phototype I corresponds with the minimum and phototype VI the maximum. Phototype I: Ivory white, burns easily, never tans. Phototype II: White, burns easily, tans minimally with difficulty. Phototype III: White, burns moderately, tans moderately and uniformly Phototype IV: Beige-olive, lightly tanned, burns minimally, tans moderately and easily. Phototype V: Rarely burns, tans profusely. Phototype VI: Dark brown or black, never burns, tans profusely. Phototype I was considered more risky outcome for expected adverse events in skin. None was considered better or worse outcome.
Level of Hemolysis in Absorbance Unitsup to 9 days after first intervention completionDetection level of absorbance values of hemolysis in plasma samples. The units of absorbance are dimensionless. The hemolysis in plasma is analyzed by spectrophotometry method, using a NanoDrop® 2000 Spectrophotometer device (Thermo Fisher Scientific Inc., Wilmington, United States of America). The following equation was used to correct lipemia: (A414-A385) +0.16xA385. Additionally, a baseline correction factor at 750 nanometer wavelength was applied. Therefore, absorbance were measured at 414 nanometer, 385 nanometer and 750 nanometer. Higher values represent a worse outcome: higher value mean higher hemolysis in a blood sample. Therefore, lower values, near to zero are better outcomes that mean low hemolysis in blood sample.
Number of Participants With Adverse EventsDuring the study completion,. an average of 30 days.Number of adverse events by visual inspection.

Countries

Spain

Participant flow

Pre-assignment details

63 individuals signed informed consent form, but one of them did not meet all the inclusion criteria. Then 62 participants were included in the study.

Participants by arm

ArmCount
Current Clinical Practice First, Washout, Then Dry Heat
First (day 1):The standardized and approved Clinical and Laboratory Standards Institute (CLSI) GP41-A6 venipuncture guide has been established for clinical current practice so far. According to vein cannulation procedure CLSI GP41-A6, an elastic compressor will be applied (Synthetic rubber-latex compressor tape, UNIDIX®, Madrid, Spain) provided by the hospital. Washout (1 week) Second (1 day). Dry heat: The application is made with two sacks of carob seeds during 7 minutes. The sacks are placed on antebrachial anatomical zone, together, and previously heated in the microwave for 0.30 seconds at 850 W of power.
10
Current Clinical Practice First, Washout, Then High Pressure
First (1 day): The standardized and approved CLSI GP41-A6 venipuncture guide has been established for clinical current practice so far. According to vein cannulation procedure CLSI GP41-A6, an elastic compressor will be applied (Synthetic rubber-latex compressor tape, UNIDIX®, Madrid, Spain) provided by the hospital. Washout (1 week) . Second (1 day): High pressure: It will be carried out with the use of the manual aneroid sphygmomanometer fixed at 100 millimeters of mercury. Brand (QUIRUMED) with European Conformity (CE) marking 0197. A pressure lower than the systolic blood pressure, and in each subject will be monitored the radial pulse.
8
Current Clinical Practice First, Washout, Then Combination
First (day 1):The standardized and approved CLSI GP41-A6 venipuncture guide has been established for clinical current practice so far. According to vein cannulation procedure CLSI GP41-A6, an elastic compressor will be applied (Synthetic rubber-latex compressor tape, UNIDIX®, Madrid, Spain) provided by the hospital. Washout (1 week) Second (1 day): Combination of dry heat and high pressure: as described in dry heat application, and after 7 minutes, high pressure was applied as described for high pressure intervention.
9
Dry Heat First, Washout, Then Current Clinical Practice
First (1 day). Dry heat: The application is made with two sacks of carob seeds during 7 minutes. The sacks are placed on antebrachial anatomical zone, together, and previously heated in the microwave for 0.30 seconds at 850 W of power. Washout (1 week) Second (day 1):The standardized and approved Clinical and Laboratory Standards Institute (CLSI) GP41-A6 venipuncture guide has been established for clinical current practice so far. According to vein cannulation procedure CLSI GP41-A6, an elastic compressor will be applied (Synthetic rubber-latex compressor tape, UNIDIX®, Madrid, Spain) provided by the hospital.
11
High Pressure First, Washout, Then Current Clinical Practice
First (1 day): High pressure: It will be carried out with the use of the manual aneroid sphygmomanometer fixed at 100 millimeters of mercury. Brand (QUIRUMED) with European Conformity (CE) marking 0197. A pressure lower than the systolic blood pressure, and in each subject will be monitored the radial pulse. Washout (1 week) First (1 day): The standardized and approved CLSI GP41-A6 venipuncture guide has been established for clinical current practice so far. According to vein cannulation procedure CLSI GP41-A6, an elastic compressor will be applied (Synthetic rubber-latex compressor tape, UNIDIX®, Madrid, Spain) provided by the hospital.
10
Combination First, Washout, Then Current Clinical Practice
First (1 day): Combination of dry heat and high pressure: as described in dry heat application, and after 7 minutes, high pressure was applied as described for high pressure intervention. Washout (1 week) Second (day 1):The standardized and approved CLSI GP41-A6 venipuncture guide has been established for clinical current practice so far. According to vein cannulation procedure CLSI GP41-A6, an elastic compressor will be applied (Synthetic rubber-latex compressor tape, UNIDIX®, Madrid, Spain) provided by the hospital.
11
Total59

Baseline characteristics

CharacteristicDry Heat First, Washout, Then Current Clinical PracticeCurrent Clinical Practice First, Washout, Then CombinationCurrent Clinical Practice First, Washout, Then High PressureTotalHigh Pressure First, Washout, Then Current Clinical PracticeCombination First, Washout, Then Current Clinical PracticeCurrent Clinical Practice First, Washout, Then Dry Heat
Age, Continuous27.36 years
STANDARD_DEVIATION 3.8
26.78 years
STANDARD_DEVIATION 7.8
30.00 years
STANDARD_DEVIATION 8.22
26.72 years
STANDARD_DEVIATION 5.881
26.30 years
STANDARD_DEVIATION 4.71
25.45 years
STANDARD_DEVIATION 6.91
25.33 years
STANDARD_DEVIATION 3.72
Grade of Venous International Assessment (VIA) scale
Grade II
2 Participants4 Participants3 Participants15 Participants1 Participants3 Participants2 Participants
Grade of Venous International Assessment (VIA) scale
Grade III
4 Participants4 Participants3 Participants20 Participants1 Participants6 Participants2 Participants
Grade of Venous International Assessment (VIA) scale
Grade IV
4 Participants1 Participants2 Participants23 Participants8 Participants2 Participants6 Participants
Grade of Venous International Assessment (VIA) scale
Grade V
1 Participants0 Participants0 Participants1 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
4 Participants2 Participants3 Participants21 Participants3 Participants5 Participants4 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants1 Participants0 Participants0 Participants1 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
7 Participants7 Participants5 Participants37 Participants7 Participants6 Participants5 Participants
Sex: Female, Male
Female
9 Participants4 Participants4 Participants39 Participants7 Participants7 Participants8 Participants
Sex: Female, Male
Male
2 Participants5 Participants4 Participants20 Participants3 Participants4 Participants2 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
0 / 210 / 180 / 200 / 59
other
Total, other adverse events
7 / 211 / 216 / 200 / 59
serious
Total, serious adverse events
0 / 210 / 180 / 200 / 59

Outcome results

Primary

Number of Participants With Successful Venous Catheterization at the First Attempt

Number of participants with successful venous catheterization at the first attempt (effectiveness)

Time frame: From 1-5 minutes

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Dry HeatNumber of Participants With Successful Venous Catheterization at the First Attempt21 Participants
High PressureNumber of Participants With Successful Venous Catheterization at the First Attempt18 Participants
CombinationNumber of Participants With Successful Venous Catheterization at the First Attempt19 Participants
Current Clinical PracticeNumber of Participants With Successful Venous Catheterization at the First Attempt28 Participants
p-value: 0.00195% CI: [2.34, 2.79]McNemar
p-value: 0.00295% CI: [1.7, 2.13]McNemar
p-value: 0.00495% CI: [1.87, 1.92]McNemar
Secondary

Level of Hemolysis in Absorbance Units

Detection level of absorbance values of hemolysis in plasma samples. The units of absorbance are dimensionless. The hemolysis in plasma is analyzed by spectrophotometry method, using a NanoDrop® 2000 Spectrophotometer device (Thermo Fisher Scientific Inc., Wilmington, United States of America). The following equation was used to correct lipemia: (A414-A385) +0.16xA385. Additionally, a baseline correction factor at 750 nanometer wavelength was applied. Therefore, absorbance were measured at 414 nanometer, 385 nanometer and 750 nanometer. Higher values represent a worse outcome: higher value mean higher hemolysis in a blood sample. Therefore, lower values, near to zero are better outcomes that mean low hemolysis in blood sample.

Time frame: up to 9 days after first intervention completion

ArmMeasureValue (MEDIAN)
Dry HeatLevel of Hemolysis in Absorbance Units0.08 Absorbance units
High PressureLevel of Hemolysis in Absorbance Units0.08 Absorbance units
CombinationLevel of Hemolysis in Absorbance Units0.14 Absorbance units
Current Clinical PracticeLevel of Hemolysis in Absorbance Units0.07 Absorbance units
p-value: 0.502Wilcoxon (Mann-Whitney)
p-value: 0.744Wilcoxon (Mann-Whitney)
p-value: 0.059Wilcoxon (Mann-Whitney)
Secondary

Number of Participants in Each Type of Skin Standardized According to Fitzpatrick Scale

Number of participants in each type of skin standardized according to Fitzpatrick scale. Fitzpatrick scale is the UNABBREVIATED scale that indicates different types of skin described as phototypes. The individuals were graded clinically by sel-expressed by participants in the area of the forearm not exposed to the sun. In a range of six phototypes, where phototype I corresponds with the minimum and phototype VI the maximum. Phototype I: Ivory white, burns easily, never tans. Phototype II: White, burns easily, tans minimally with difficulty. Phototype III: White, burns moderately, tans moderately and uniformly Phototype IV: Beige-olive, lightly tanned, burns minimally, tans moderately and easily. Phototype V: Rarely burns, tans profusely. Phototype VI: Dark brown or black, never burns, tans profusely. Phototype I was considered more risky outcome for expected adverse events in skin. None was considered better or worse outcome.

Time frame: up to 2 hours after application of intervention

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Dry HeatNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype IV7 Participants
Dry HeatNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype III9 Participants
Dry HeatNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype VI1 Participants
Dry HeatNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype V1 Participants
Dry HeatNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype II2 Participants
Dry HeatNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype I1 Participants
High PressureNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype I1 Participants
High PressureNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype II2 Participants
High PressureNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype III6 Participants
High PressureNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype IV8 Participants
High PressureNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype V1 Participants
High PressureNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype VI0 Participants
CombinationNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype II1 Participants
CombinationNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype IV8 Participants
CombinationNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype VI0 Participants
CombinationNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype V3 Participants
CombinationNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype I0 Participants
CombinationNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype III8 Participants
Current Clinical PracticeNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype III23 Participants
Current Clinical PracticeNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype VI1 Participants
Current Clinical PracticeNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype V5 Participants
Current Clinical PracticeNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype IV23 Participants
Current Clinical PracticeNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype I2 Participants
Current Clinical PracticeNumber of Participants in Each Type of Skin Standardized According to Fitzpatrick ScalePhototype II5 Participants
Secondary

Number of Participants With Adverse Events

Number of adverse events by visual inspection.

Time frame: During the study completion,. an average of 30 days.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Dry HeatNumber of Participants With Adverse Events7 Participants
High PressureNumber of Participants With Adverse Events1 Participants
CombinationNumber of Participants With Adverse Events6 Participants
Current Clinical PracticeNumber of Participants With Adverse Events0 Participants
Secondary

Number of the Grade in Visual Analogue Scale (VAS) for Pain After Intervention

Visual Analogue Scale (VAS) in pain was measured by integer number. Pain was self-expressed by participants, in a range from 0 to 10. 10: was considered the worst pain experienced 0: no pain perceived. The entire range was 0, 1, 2, 3, 4, 5 , 6, 7, 8, 9, 10. Therefore, higher scores mean a worse outcome.

Time frame: up to 2 hours after application of intervention

ArmMeasureValue (MEAN)
Dry HeatNumber of the Grade in Visual Analogue Scale (VAS) for Pain After Intervention3 units on a scale
High PressureNumber of the Grade in Visual Analogue Scale (VAS) for Pain After Intervention2 units on a scale
CombinationNumber of the Grade in Visual Analogue Scale (VAS) for Pain After Intervention2.5 units on a scale
Current Clinical PracticeNumber of the Grade in Visual Analogue Scale (VAS) for Pain After Intervention3 units on a scale
p-value: 0.863Wilcoxon (Mann-Whitney)
p-value: 0.205Wilcoxon (Mann-Whitney)
p-value: 0.391Wilcoxon (Mann-Whitney)
Secondary

Number of the Grade of Venous International Assessment (VIA) Scale After Application of Intervention

Vein perception in VIA scale was considered as the self-reported visual observation or palpation of a venous pathway. Subjects were graded using the current clinical practice vein stagnation with an elastic compressor application (Unidix®). Five grades considering the numbers of points of optimal puncture visible and tangible, in one of the dorsal veins of the hand, forearm cephalic and/or basilic. Grade I: At least six. Grade II: At least four. Grade III: At least three. Grade IV: At least one. Grade V: None. Therefore, the best grade is I, and the worst grade is V. Higher scores mean a worse outcome.

Time frame: up to ten minutes after application of intervention

ArmMeasureValue (MEDIAN)
Dry HeatNumber of the Grade of Venous International Assessment (VIA) Scale After Application of Intervention2 units on a scale
High PressureNumber of the Grade of Venous International Assessment (VIA) Scale After Application of Intervention2 units on a scale
CombinationNumber of the Grade of Venous International Assessment (VIA) Scale After Application of Intervention1 units on a scale
Current Clinical PracticeNumber of the Grade of Venous International Assessment (VIA) Scale After Application of Intervention3 units on a scale
p-value: 0Wilcoxon (Mann-Whitney)
p-value: 0Wilcoxon (Mann-Whitney)
p-value: 0Wilcoxon (Mann-Whitney)

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026