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January 31, 2012 > Nurse's vein technique gets recognized

Nurse's vein technique gets recognized

By Jill Moon, The (Alton) Telegraph
Submitted By AP Wire Service

ALTON, Ill. (AP), Jan 14 - A local registered nurse is gaining worldwide recognition for pioneering a phlebotomy technique that makes getting stuck with a needle less painful and troublesome for patients.

Working from her own business at The Nurses' Station in East Alton, M. Gail Stotler is training others in her technique, which calls for accessing veins through gentle touch, rather than tourniquet or slapping and flicking. She has been involved in the practice for years, but became recognized only recently for her vein access technique based on science.

Vein access basically means entering a vein with a needle either to draw blood or inject fluid, such as an IV.

The American Society for Clinical Pathology and the World Association of Societies of Pathology and Laboratory Medicine, at its World Congress, last fall recognized Stotler's scientific explanation for better vein access. A committee of the society selected Stotler's abstract, ``A Scientific Explanation for Why There are So Many IV, Blood Draw and Injection of Contrast Failures,'' for presentation Oct. 21 at the World Congress meeting in Las Vegas.

``It's hard to get one concept accepted at this thing,'' said Stotler, who has been in the medical field for more than 30 years. ``But, it's not about me; it's a credit to all the science before I took it and applied it.''

Besides recognition at the international society's World Congress, The National Phlebotomy Association posted Stotler's article on its website, and Stotler declined a consulting offer from BD Diagnostics Preanalytical Systems of New Jersey because she wants to maintain her independence in teaching her technique and avoid conflicts of interest.

Stotler has two bachelor's degrees from Saint Louis University in biology and in nursing, as well as graduate hours from SLU in anatomy, physiology and math. She wrote that even though advances in tools have been made over the last 200 years, such as the hypodermic needle and the vacutainer system in 1949 that sucks blood into a tube for diagnostic blood draws, the actual procedure of locating and accessing a vein has not changed that much. Smacking, slapping, flicking and tapping the vein, as well as the tourniquet, still are used.

At least four out of 10 sticks to a vein fail, and not just once, according to Stotler's documented research. By her calculations, she estimated that in 2008 there were 174 million vein access failures divided among the IV, the blood draw and the injection of contrast.

But when vein access began 2,000 years ago, the medical community did not have the knowledge about anatomy and physiology, or the tool technology that it has now.

Stotler said she simply uses gentle touch for vein dilatation; even though some previous research cited in other sources mentions heat, she adamantly does not advocate heat.

``We have the simple, gentle sense of touch in our fingers,'' said Stotler, of Holiday Shores, who has taught her vein access technique for years but just published her technique in 2006 with ``The Science Behind the Skill of Vein Access,'' a seven-book series. ``Simply touch the vein; the very act of feeling for a vein causes it to dilate. The good Lord said, `Put this thing in writing,' and I drew the diagrams of what I taught, and that's where the book came from.''

Alton Memorial Hospital, Alton Multispecialists, Riverbend Physicians and Surgeons and Christian Hospital Northeast regularly request Stotler to train or retrain technicians and nurses in the skill of vein access, she said.

``The vein access procedure of today was built on fifth- to 19th-century non-scientific foundation,'' Stotler, who was born and raised in Bethalto, wrote in her abstract.

Furthermore, she said that the people who teach vein access and the people who use this skill have a minimal science education through no fault of their own. The information for the skill taught at the allied health level is minimal compared to graduate and medical school levels. She contends that physics, chemistry and math also are missing from the allied health level of education.

In coming up with her technique of vein dilatation, she considered several facts, some of them contained in past research:

- ``Gray's Anatomy'' says that the vein wall is innervated and has a middle layer of smooth muscle; ``Guyton's Physiology'' says that negative stimuli to the nerve tells that muscle to contract.

Thus, Stotler said the problem with smacking, slapping, flicking or tapping the vein, techniques to ``raise the vein'' in an effort to locate it, is that these methods cause vaso-constriction.

- A natural dilatation, with heat or gentle touch, of the adult vein results in an average 2-millimeter-diameter dilation of that vein, as cited in the Journal of Vascular Surgery, Volume 42, Issue 5, pg. 957-962 (November 2005).

``An artificial dilatation, from applying a tight tourniquet, causes an over-distention of that vein greater than 2 millimeters,'' Stotler writes. ``There is an anatomical limit to how much the vein wall nerves and smooth muscle can be stretched before injury occurs to those tissues and that segment of vein wall.''

- A less than or equal to 30-degree angle of entry of the needle through the vein wall results in a vein wall injury four to five times the size that a greater than or equal to 45-degree angle of entry causes.

``Injury size is extended. Pain is maximized. Clotting time will be extended. Healing time will be extended. The likelihood of bruising is greater,'' Stotler wrote.

``My real mission for this is to let the world know there's a better way to do these vein access procedures,'' she said. ``Science does evolve and has advanced, and this is one of the advancements that is coming along in this century.''

She said this is not her idea, but that science made this technique possible, although she has come up with singular ideas for which she takes credit.

``This level of science and the application of the science to the skill is what is missing from the current training programs and teaching manuals,'' she said. ``The science is out there that I use; it already exists.''

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Information from: The Telegraph, http://www.thetelegraph.com

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