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Heated-Hand Boxes for Obtaining "Arterialized"-Venous Blood

heated hand box

A heated-hand box (HHB) shown in use during a euglycemic hyperinsulinemic clamp

These boxes are for sale (see below) to institutions and investigators performing clinical research requiring arterialized-venous blood.


A list of peer-reviewed publications concerning the technique is provided below. Details for the technique of warming the hand to obtain "arterialized"-venous blood are also shown. As can be seen from these publications, the technique has been used for a number of years.

The standard method of obtaining serial arterial blood samples is via catheter placement into an artery. For most routine clinical research studies, placement of an arterial catheter in the radial or femoral artery provides an unnecessary risk and unnecessary discomfort to the volunteer. The purpose of obtaining arterial blood is to obtain either (i) blood coming directly from the heart and lungs to measure oxygenation or (ii) to measure metabolite concentrations in the whole body. The former technique is still best done via direct arterial sampling, but the latter may be performed in other ways.

When blood passes through an organ bed (e.g. the liver or muscle), the organ will both extract and add metabolites to the blood. A common example is the removal of glucose and oxygen and addition of end-products of metabolism, lactate, CO2, alanine, ..., as blood passes through muscle beds. Thus, the venous concentration of glucose will almost always be lower in the antecubital vein compared to the brachial artery. Hormones, such as epinephrine, are also extracted passing through tissues. For example, antecubital venous blood will have an epinephrine concentration of almost 1/2 that of arterial blood due to extraction of catecholamines across muscle. To obtain a measure of metabolite and hormone concentration in the whole body, blood coming directly out of the heart needs to be obtained.

Although we sweat to reduce our body temperature through evaporative loss of heat, we also have a physiological mechanism to open up capillaries to increase blood flow through the skin and remove heat directly through conduction and radiation. The hand is designed to cool itself primarily through opening up capillary beds. This mechanism also cools the hand by providing cooler blood when the hand temperature rises above 37°C -- thus, the principal of heating the hand to obtain "arterialized" blood. We say "arterialized" instead of "arterial" to differentiate that the venous effluent from a hand that has been warmed is not true arterial blood--only a good representation of it. The key element to obtaining "arterialized" blood from the vein of the hand is to get the skin temperature of the hand well above 37°C. The hand can be warmed in a variety of ways: placing in warm water, wrapping with a heating blanket, or warming by a gentle stream of heated air. We have chosen the latter approach as being the simplest, cleanest, and easiest way to warm the hand, sample blood from the hand, and see the hand during the process.

Dr. Matthews has been using the boxes that generate warm air to heat hands for clinical research studies since the early 1980's. The earliest boxes were simple and made from plywood and economical parts found in cheap space-heaters used to warm feet under the desk in an office. In the early 1990's Dr. Matthews designed the first box to meet (and exceed) the requirements for the Biomedical Engineering Dept at the New York Hospital (now the New York-Presbyterian Hospital). The box that was devised is shown in the photo above. Since that time, many copies of this box have been built and shipped around the country and world for use by other clinical investigators and in clinical research centers.


Operating Conditions:

Ordering Instructions:

Technical Points:

Measurement of the skin temperature of two people as a function of time after the hand was placed in the heated-hand box:

hand temperature graph

Each graph represents the time course of hand-skin temperature in one subject. A thermistor was placed directly on the back of the hand with a piece of tape, and the hand inserted into a box pre-heated to 60°C. The skin temperature immediately rose with heating. Opening of capillaries within the hand is seen by the rapid slowing of the rate of heating at about 2-3 minutes. Once "arterialized", the temperature of the skin remained relatively constant at ~45°C. From these data we recommend the lower 50°C setting for extended heating periods, as it allows a smaller gradient of temperature to keep the hand warm and arterialized.

Measurement of oxygen content of "arterialized-venous" blood taken as a function of time after the hand was placed in the eated-hand box:

PO2 graph

The values on the left and symbols in red on the graph are pO2; the values on the right and symbols in blue are % O2 saturation.

Measurement of arterial, venous and "arterialized-venous" plasma epinephrine concentration during infusion of epinephrine in human subject:

Epi graph

This graph appears in the 1990 Matthews et al. paper and shows data from that work and data taken from the literature. The graph shows the large drop in plasma epinephrine concentration going from arterial to venous sampling (Best & Halter).


  1. WE Clutter, DM Bier , SD Shah & PE Cryer: Epinephrine plasma metabolic clearance rates and physiologic thresholds for metabolic and hemodynamic actions in man. J. Clin. Invest. 66: 94-101, 1980.
  2. JD Best & JB Halter: Release and clearance rates of epinephrine in man: Importance of arterial measurements. J. Clin. Endocrinol. Metab. 55: 263-268, 1982.
  3. DE Matthews, G Pesola & RG Campbell: Effect of epinephrine upon amino acid and energy metabolism in humans. Am. J. Physiol. Endocrinol. Metab. 258: E948-E956, 1990.

List of Locations Where Our Heated-Hand Boxes Are Used:

References from the Literature about "Arterialized"-Venous Blood Sampling:

  1. EAH McGuire, JH Helderman, JD Tobin, R Andres & M Berman: Effects of arterial versus venous sampling on analysis of glucose kinetics in man. J. Appl. Physiol. 41: 565-573, 1976.
  2. NN Abumrad, D Rabin , MP Diamond & WW Lacy: Use of a heated superficial hand vein as an alternative site for the measurement of amino acid concentrations and for the study of glucose and alanine kinetics in man. Metabolism 30: 936-940, 1981.
  3. GE Sonnenberg & U Keller: Sampling of arterilized heated-handvenous blood as a nonivasive technique for the study of ketone body kinetics in man. Metabolism 31: 1-5, 1982.
  4. A Astrup, L Simonsen, J Bülow & NJ Christensen: Measurement of forearm oxygen consumption: Role of heating the contralateral hand. Am. J. Physiol. Endocrinol. Metab. 255: E572-E578, 1988.
  5. DC Brooks, PR Black , MA Arcangeli, TT Aoki & DW Wilmore: The heated dorsal hand vein: An alternative arterial sampling site. JPEN J. Parenter. Enteral Nutr. 13: 102-105, 1989.
  6. IW Gallen & IA Macdonald: Effect of two methods of hand heating on body temperature, forearm blood flow, and deep venous oxygen saturation. Am. J. Physiol. Endocrinol. Metab. 259: E639-E643, 1990.
  7. JH Green, FR Ellis, TM Shallcross & PN Bramley: Invalidity of hand heating as a method to arterialize venous blood. Clin. Chem. 36: 719-722, 1990.
  8. GA Zello, JM Smith, PB Pencharz & RO Ball: Development of a heating device for sampling arterialized venous blood from a hand vein. Ann. Clin. Biochem. 27: 366-372, 1990.
  9. PN Bramley, RW Heighton & JH Green: Methodological considerations in arterialization of venous blood. Clin. Chem. 37: 1139-1140, 1991.
  10. MD Jensen & VJ Heiling: Heated hand vein blood is satisfactory for measurements during free fatty acid kinetic studies. Metabolism 40: 406-409, 1991.
  11. KC Copeland, FA Kenney & KS Nair: Heated dorsal hand vein sampling for metabolic studies: A reappraisal. Am. J. Physiol. Endocrinol. Metab. 263: E1010-E1014, 1992.
  12. KN Frayn & IA Macdonald: Methodological considerations in arterialization of venous blood. Clin. Chem. 38: 316-317, 1992.
  13. JC Marker, PE Cryer & WE Clutter: Simplified measurement of norepinephrine kinetics: Application to studies of aging and exercise training. Am. J. Physiol. Endocrinol. Metab. 267: E380-E387, 1994.
  14. A Kurpad & M Elia: Effect of repeated hand warming in metabolic studies. Med. Sci. Res. 23: 51-52, 1995.