Aim: To assess the efficacy of transillumination of the palm of the hand in establishing venous access in small infants. Methods: One hundred infants aged 2 to 36 months were considered for venipuncture under transillumination following failure to find an accessible vein or a failed venipuncture attempt. Results: In 40 of the 100 infants, a vein was visible with transillumination. In 22 of these children, previous attempts to achieve a venous line failed (mean number of failed venipunctures 2.11 ± 0.6) and in 18 infants, no vein could be identified. Using transillumination, venous access was established with just one venipuncture in 39 of the 40 patients. Conclusions: Transillumination of the palm can aid in establishing venous access in infants. This can be easily carried out using a common otoscope.