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Received January 1, 2025, accepted May 27, 2025, date of publication June 21, 2025.

Original Research Article

Quantitative Evaluation of Venipuncture Training Models: A 
Study Using a Puncture Force Testing Device

Naofumi Nakaya1,*, Kunio Horiuchi2, and Kazuo Aoki3

1 Department of Clinical Engineering, Faculty of Medical Science, Juntendo University, Urayasu-shi, Chiba, Japan.
2 Department of Mechanical Science and Engineering, School of Advanced Engineering, Kogakuin University, Hachioji-shi, Tokyo, Japan.
3 College of Science and Technology, Nihon University, Chiyoda-ku, Tokyo, Japan.

* Corresponding Author Email: n.nakaya.ac@juntendo.ac.jp

ABSTRACT

Background/Objectives: This study introduces a quantitative assessment of venipuncture training models using a custom-
ized puncture force testing device. The device, engineered to quantify the force and torque exerted during a puncture under 
regulated speed and angle conditions, aims to augment the authenticity and efficiency of medical training models. In Japan, a 
diverse group of medical professionals receive training in venipuncture, utilizing models in a variety of educational environ-
ments. However, the existing models often fall short of replicating the physiological realism of human tissue, which limits the 
effectiveness of the training. 

Methods: To address this issue, the study employed a puncture force testing device that includes a needle, syringe, load 
test stand, and digital force gauge, among other components. This arrangement facilitated the precise control and recording of 
puncture force at varying speeds and angles. Three distinct venipuncture models (Models A, B, and C), filled with water to mimic 
venous blood, were tested under these regulated conditions. 

Results: The findings revealed notable differences in puncture force among the models, with Model C closely resembling 
human tissue because of its lower maximum puncture force.

Conclusion: The study also observed a variation in the force required at different puncture speeds, thereby enhancing our 
understanding of model behavior under diverse conditions. Moreover, the use of a mechanically controlled puncture device 
eliminated the variability associated with individual technique, allowing for a more quantitative and reproducible evaluation. 
In conclusion, the study proposes a more quantitative and objective approach for evaluating venipuncture models. This prog-
ress is vital for refining these models to more accurately simulate human tissue, consequently improving the quality of medical 
training in venipuncture procedures.

Keywords—Clinical skills, Intravenous injection, Nursing students, Public health nurses, Venipuncture.     

Copyright © 2025. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - 
Attribution 4.0 International - CC BY 4.0. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright 
owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduc-
tion is permitted which does not comply with these terms.

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Nakaya, Horiuchi, Aoki: Quantitative Evaluation of Venipuncture Training Models: A Study Using a Puncture Force Testing Device

J Global Clinical Engineering Vol.7 Issue 2: 2025 66

INTRODUCTION

In Japan, a broad spectrum of medical professionals, 
including physicians, dentists, public health nurses, mid-
wives, nurses, licensed practical nurses, clinical laboratory 
technicians, radiology technicians, and clinical engineers, 
are trained in intravenous injection and blood sampling. 
These professionals acquire venipuncture skills through 
various training schools and clinical practice. Simulation 
education, exemplified by skills laboratories, is actively 
conducted primarily in medical schools. Ishikawa et al. 
reported that at least 74 out of 80 faculties in Japan had 
a skills laboratory at the time of their survey.1 Suzuki 
et al. reported that an intravenous blood collection and 
injection model was used in 53 faculties, with more than 
300 sets available.2

These models are utilized not only in training schools 
but also in postgraduate education to enhance clinical skills 
across various professions. Training facilities for medical 
professionals in Japan comprise 81 medical schools,3 1 
medical doctor training programs at a ministerial univer-
sity, 828 three- or four-year training schools for nurses, 
and 180 training schools for licensed practical nurses.4 
In addition, there are 103 clinical technologist training 
schools,5 55 training schools for radiology technologists,6 
and 88 training schools for clinical engineers who are 
members of educational associations nationwide.7

A comparative study of cannulation training for veins 
in nursing students observed no statistically significant 
differences in performance between groups of students 
trained with each other and with a rubber mannequin.8 
Jones et al. suggested that student-to-student and man-
nequin training are equally effective. They also noted 
that the use of mannequins can reduce risk.8 Despite the 
widespread use of these models, it has been noted that the 
skills acquired from training on a mannequin are limited 
because of their unique characteristics that differ from 
those of the human body.9–11 To address this issue, we 
attempted to measure the force and torque applied when 
puncturing a model to establish a quantitative evaluation 
method to improve the quality of these models.12,13 How-
ever, the methods used in previous studies are dependent 
on the human technique, which remains a challenge.

In this study, we developed a puncture force testing 
device capable of testing puncture speed and angle under 
specific conditions. We conducted tests on a product simi-
lar to the model used in the previous study to compare it 
with conventional methods.

METHODS

Puncture Force Testing Device

We constructed a puncture force testing device, which 
incorporates a force gauge and a load test stand, to as-
sess the venous blood collection and injection model. 
This device allows for the evaluation of the model under 
consistent puncture speed and angle (Figure 1). 

FIGURE 1. Puncture force testing apparatus utilizing a load 
test stand.



67 J Global Clinical Engineering Vol.7 Issue 2: 2025

Nakaya, Horiuchi, Aoki: Quantitative Evaluation of Venipuncture Training Models: A Study Using a Puncture Force Testing Device

In contrast to our previous study,12 which employed 
a syringe-type force sensor operated manually by par-
ticipants—potentially introducing variability associated 
with individual technique—the device developed in the 
present study enables puncture under controlled condi-
tions with a fixed speed and angle.

This system offers improved reproducibility and 
eliminates inter-operator variability, thereby enhanc-
ing the reliability and objectivity of the puncture force 
measurements.

The apparatus comprises a needle (NN-2232S: Terumo), 
a Luer–Lock adapter (PS6608: ISIS), a three-way stopcock 
(394900: BD), a syringe (SS-05SZ: Terumo), a force test 
stand (FGS-100VC: Nidec-Sympo), a digital force gauge 
(FGP-1: Nidec-Sympo), a personal computer (ideapad 
Z500: Lenovo), and a jig made of acrylonitrile-butadiene-
styrene (ABS) resin produced by a 3D printer for securing 
the model.

The puncture force tester can move a digital force gauge 
up and down at a variable speed (10–400 mm/min) by 
either automatic or manual operation. When a puncture 
is performed with the load test stand, the puncture force 
is transmitted to the measurement axis of the digital force 
gauge via the needle. The measured data can be continu-
ously recorded by a personal computer connected to the 
digital force gauge. The force waveform obtained by the 
digital force gauge is smoothed by an integrated measure-
ment filter. In the experiments, the 90% response time to 
step input was set to 3 ms, and the sampling frequency 
was 100 times per second.

A three-way stopcock was attached to verify whether 
the needle tip was inserted into the model’s blood vessel 
after puncture with the load test stand. If the puncture 
was successful, water filled in the model’s blood vessel 
could be aspirated from the port of the three-way stopcock 
by a syringe. The puncture needle is a sterile disposable 
needle commonly used for blood collection in adults 
(22G, short bevel type). The Luer–Lock adapter, made 
of polyetheretherketone (PEEK) resin, is used to screw 
the puncture needle into the device. The tool adheres to 

the same standard as the method used to secure needles 
in actual clinical practice, allowing the puncture needle 
to be changed according to the application. The jig for 
securing the model, made of ABS resin, is used to punc-
ture the model at an angle suitable for blood collection 
and puncture. The jig was fabricated using a 3D printer 
(Replicator2X: Makerbot).12

Figure 2 provides an example of a puncture force wave-
form measurement and the items measured. In Figure 2, 
“Fmax” represents the maximum puncture force.

Subjects and Methods of Experiments

We prepared three models, designated as Model A, 
Model B, and Model C, similar to those used in the previ-
ous study (Figure 3).9,10 Models A and B are designed to 
be worn on the arm of the training collaborator, while 
Model C is shaped like an arm. The simulated vessels of 
the models were filled with tap water to mimic blood, and 
a drop pressure was applied to simulate venous blood 
pressure, as per the models’ instruction manual.

FIGURE 2. Puncture force waveform measurement and the 
corresponding measured item (The puncture force waveform 
was smoothed using a low-pass filter built into the force gauge. 
The filter parameters were set such that the 90% response time 
to a step input was 3 ms).



Nakaya, Horiuchi, Aoki: Quantitative Evaluation of Venipuncture Training Models: A Study Using a Puncture Force Testing Device

J Global Clinical Engineering Vol.7 Issue 2: 2025 68

comparisons using Fisher’s protected least significant 
difference (PLSD) indicated significant differences in all 
combinations, except between Model A and Model B in 
the group with a puncture speed of 200 mm/min (p < 
0.05). Notably, Model C exhibited a significantly lower 
maximum puncture force than the other models at all 
puncture speeds (p < 0.05). The puncture speed depen-
dence test results showed that only Model B exhibited a 
dependence on puncture speed (p < 0.05).

Compared to the results of multiple comparisons in a 
previous study by the authors, the current study demon-
strated significant differences in all pairs at a puncture 
speed of 400 mm/min. This suggests that the differences 
in model characteristics are equally or more detectable.12 

In the previous study, 12 using the same models, punc-
ture experiments were conducted by 12 participants with 
a syringe-type force sensor. While that study found statisti-
cally significant differences between most model pairs, no 
significant difference was observed between Model A and 
Model C. In contrast, the present study, which employed 
mechanically controlled puncture conditions and the same 
number of trials (n = 12), revealed significant differences 
among all models at a puncture speed of 400 mm/min. 

During the puncture test, the puncture angle was 
mechanically fixed at 25° using a jig, in accordance with 
the standards specified in the blood collection method 
guidelines.14 We also set the puncture speed at 200 mm/
min and 400 mm/min. We used two different puncture 
speeds to examine the model’s dependence on speed, 
as it has been reported that the puncture reaction force 
decreases as the speed increases when puncturing the 
biological tissue.15

We conducted 12 tests for each model at a sampling 
frequency of 100 Hz. The needle was manually advanced 
into the model’s simulated blood vessel using the stand, 
and the stand was stopped when the needle reached the 
vessel. We replaced the needle used for the puncture 
after each test. A puncture was deemed successful when 
water could be aspirated from the three-way stopcock 
by a syringe. The number of tests was set to 12 to allow 
for comparison with our previous study,12,13 in which the 
same model was used and experiments were conducted 
with 12 participants.

RESULTS AND DISCUSSION

The average of the maximum puncture force is pre-
sented in Figure 4. An analysis of variance revealed a 
significant difference (p < 0.05) between the groups 
with a puncture speed of 200 mm/min and those with a 
puncture speed of 400 mm/min. Furthermore, multiple 

FIGURE 3. Intravenous blood sampling practice model.12,13

FIGURE 4. Average maximum puncture force (mean ± standard 
error, n = 12)



69 J Global Clinical Engineering Vol.7 Issue 2: 2025

Nakaya, Horiuchi, Aoki: Quantitative Evaluation of Venipuncture Training Models: A Study Using a Puncture Force Testing Device

These findings suggest that the method developed in this 
study enables more sensitive and consistent detection of 
differences in model characteristics.

Okuno et al. reported that the puncture force for the 
median cubital vein on a volunteer was 0.64 ± 0.23 N (21 
G, regular bevel).16 Consequently, all models were deemed 
stiffer compared to the human body, aligning with the 
observations in the authors’ previous studies.12,13 In a 
subjective evaluation, Model C was assessed to be the 
most similar to the human body, although there were 
opinions that the skin and blood vessels were slightly 
stiff.12 In the experimental results of this study, Model C 
was the closest to the human body among the three mod-
els. Therefore, the subjective evaluations of the models 
by previous studies12 and the quantitative evaluation by 
the current method are in agreement, and the results are 
considered to be reasonable.

Several factors could account for the variation in results, 
even when punctures are performed under specific condi-
tions. Given that blood vessels have a cylindrical shape, 
their thickness can vary depending on the position of the 
puncture. Moreover, the blood vessels themselves are not 
uniformly manufactured. Consequently, the large standard 
error in Model B might be because of the nonuniform 
thickness of the blood vessel compared to other models 
or the blood vessel being stiffer than in other models. 
These tendencies are more pronounced.

However, when compared to the experimental results 
using the syringe-type puncture force waveform measuring 
device, the smaller standard error and the independence 
of this experimental system from human techniques sug-
gest the possibility of a more quantitative evaluation.12,13

Since the number of trials in both the previous study12 
and the present study was the same (n = 12), the compari-
son based on standard error is considered appropriate. 
Therefore, the smaller standard error observed in this 
study reflects reduced variability and supports the po-
tential for more consistent and quantitative evaluation.

In addition, an investigation of puncture speed dependence 
by Naemura et al. reported that the higher the puncture 
speed, the higher the peak value, up to a region of 600 

mm/min or less. The trend became more pronounced with 
increasing needle diameter, and differences in the needle 
tip shape were considered to contribute to variations in 
its magnitude.17 Lorenzo et al. demonstrated that during 
needle insertion, the cutting force at the needle tip changes 
markedly when penetrating tissue, while the shaft friction 
force increases proportionally with insertion depth but 
does not change abruptly at penetration.18 These reports 
suggest that the maximum puncture force increases when 
the incision force of the needle is insufficient relative to 
the puncture velocity. Since Model B was considered the 
stiffest model in previous studies, it is possible that this 
tendency was significantly observed.12,13

CONCLUSION

In this study, we sought to evaluate the model using a 
puncture force test device that allows for puncture under 
specific conditions. Multiple comparisons of the average 
maximum puncture force indicated that the model was 
capable of detecting differences in model characteristics 
to an equal or greater extent than the method using a 
syringe-type puncture force waveform measuring device. 
Furthermore, the results, which had a small standard 
error, and the device that enabled puncture force mea-
surement under certain conditions eliminated the need 
to consider the effects of individual differences among 
experiment participants. This facilitated a more quanti-
tative evaluation of the model. However, the maximum 
puncture force of the model was higher than the results 
of puncture experiments on the human body reported 
in previous studies, including a study by the authors.12,13 
Therefore, it is necessary to innovate materials for the 
skin and blood vessels by developing synthetic materi-
als with lower elasticity in order to enhance the model’s 
resemblance to the human body.

AUTHOR CONTRIBUTIONS

Conceptualization, N.N., K.H. and K.A.; Methodology, 
N.N.; Validation, N.N.; Formal Analysis, N.N.; Data Curation, 
N.N.; Writing–Original Draft Preparation, N.N.; Writing–
Review & Editing, N.N., K.H. and K.A.



Nakaya, Horiuchi, Aoki: Quantitative Evaluation of Venipuncture Training Models: A Study Using a Puncture Force Testing Device

J Global Clinical Engineering Vol.7 Issue 2: 2025 70

ACKNOWLEDGMENTS

Not applicable.

FUNDING

The authors did not receive support from any organi-
zation for the submitted work.

DATA AVAILABILITY STATEMENT

The raw data supporting the conclusions of this article 
will be made available by the authors on request.

CONFLICTS OF INTEREST

The authors declare they have no competing interests.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE 

Not applicable.

CONSENT FOR PUBLICATION

Not applicable.

FURTHER DISCLOSURE

Part of the findings were presented at the 27th Annual 
Conference of Biomedical Fuzzy Systems Association 
(Japan), 2014.

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