Objective To evaluate the efficacy of an optimized lighting environment combined with a vein visualization device for intravenous puncture in oncology patients undergoing nuclear medicine procedures， thereby providing evidence-based support for venipuncture practices in this specific clinical setting. Methods A prospective randomized controlled study was conducted involving 240 oncology patients undergoing whole-body bone scintigraphy at the Department of Nuclear Medicine， Anyang Tumor Hospital， between January and December 2025. Patients were randomized into four groups （n = 60 per group） using a random number table： Group A underwent conventional puncture under standard lighting （300 - 500 lx， 4 000 K）； Group B underwent conventional puncture under optimized lighting （650 - 750 lx， 5 000 - 75 500 K， with the light source positioned at a 30° - 45° angle to the vein）； Group C underwent vein visualization device-guided puncture under standard lighting； and Group D underwent vein visualization device-guided puncture under optimized lighting. The outcomes compared among the four groups included the first-pass success rate， puncture duration， Visual Analogue Scale （VAS） pain score， operator satisfaction， and complication rates. Results Group D achieved the highest first-pass success rate （98.3%）， which was significantly higher than that of Group A （83.3%， P = 0.004） and Group B （88.3%， P = 0.028）， with no significant difference compared to Group C （96.7%， P = 0.559）. Group D exhibited the shortest puncture duration （median： 78.50 s）， which was significantly shorter than that of the other three groups （all P < 0.001）. The VAS pain score was lowest in Group D （2.00 ± 0.80）， significantly lower than those in Groups A， B， and C （all P < 0.05）. Operator satisfaction was highest in Group D （4.37 ± 0.82）， significantly exceeding that in Groups A and B （both P < 0.001） and Group C （P = 0.030）. Furthermore， Group D demonstrated the lowest overall complication rate （5.0%）， significantly lower than that of Group A （21.7%， P = 0.007） and Group B （18.3%， P = 0.023）， but comparable to Group C （10.0%， P = 0.298）. Conclusion The combination of an optimized lighting environment and a vein visualization device significantly improves the first-pass success rate， shortens puncture duration， alleviates patient pain， reduces the overall complication rate， and enhances operator satisfaction during intravenous puncture in oncology patients undergoing nuclear medicine procedures. This combined strategy is particularly advantageous in nuclear medicine， where the short half-life of radiopharmaceuticals necessitates a successful first-pass puncture to minimize radioactive decay and ensure optimal imaging quality.