Vein Viewer-assisted Intravenous Catheter Placement in a Pediatric Emergency Department
ABSTRACT Peripheral intravenous catheter (PIV) placement is a common, painful, and frequently difficult procedure in children. The VeinViewer is a device that delineates subcutaneous veins using near-infrared light and video technology. To the best of our knowledge, the benefit of this device for PIV placement in children in the emergency department (ED) has not been studied.
The authors enrolled a prospective, randomized sample of children aged 0 to 17 years who required a nonemergent PIV in a tertiary care pediatric ED. Participants were randomized to standard PIV cannulation (SC) or PIV cannulation with the VeinViewer (VV). The primary outcome measure was time to PIV placement. Secondary outcome measures included number of PIV attempts and pain scores as reported by the child, parent or guardian, and nurse using a 100-mm visual analog scale (VAS).
A total of 323 patients completed the study: 174 boys and 149 girls. Age, sex, and body mass index (BMI) were not different between groups. There were no differences in time to PIV placement, number of PIV attempts, or pain scores for the overall study group. However, a planned subgroup analysis of children age 0 to 2 years (n = 107) did yield significant results for the geometric mean time to place the PIV (121 seconds [VV] vs. 167 seconds [SC], p = 0.047) and for nurses' perception of pain (median VAS 34 [VV] vs. 46 [SC], p = 0.01).
While no results were significant for the overall study group, subgroup analysis of children age 0 to 2 years suggests that the VeinViewer may decrease the time to PIV placement.
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ABSTRACT: Background Recently, various near-infrared vascular imaging devices aimed at facilitating peripheral intravenous cannulation (PIC) were introduced, all claiming to increase success rate of PIC. We evaluated the clinical utility of a near-infrared vascular imaging device (VascuLuminator®) in pediatric patients who were referred to the anesthesiologist because of difficult cannulation.Methods There were 226 consecutive children referred to pediatric anesthesiologists by the treating pediatrician of the in- and outpatient clinic, because of difficulties with intravenous cannulation, were included in this cluster randomized clinical trial. The presence and use of the near-infrared vascular imaging device for PIC was randomized in clusters of 1 week. Success at first attempt (Fisher exact test) and time to successful cannulation (Log-rank test) were assessed to evaluate differences between groups.ResultsSuccess at first attempt in the group with the VascuLuminator® (59%) was not significantly different from the control group (54%, P = 0.41), neither was the median time to successful cannulation: 246 s and 300 s, respectively (P = 0.54).Conclusions Visualization of blood vessels with near-infrared light and with near-infrared vascular imaging device did not improve success of PIC in pediatric patients who are known difficult to cannulate.Pediatric Anesthesia 08/2014; DOI:10.1111/pan.12501 · 1.74 Impact Factor
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ABSTRACT: Background Excessive venipunctures are a significant problem both in emergency rooms and during hospital stays. Near-infrared (NIR) illumination devices improve venipuncture success rate but their usage is limited by their availability and economic cost. The objectives of this study were to develop a low-cost NIR spectroscopy prototype from a standard mobile device, to evaluate its efficacy and acceptance as an educational tool, and in a clinical setting.Methods Through a user-centric design process a prototype device was developed. Its educational efficacy was evaluated through a non-invasive, observational study (20 student clinicians, 25 subjects) and its acceptance was assessed using quantitative and qualitative analysis. A smaller clinical trial was performed by a group of 4 medical professionals over a period of 6 weeks that involved 64 patients.ResultsThe prototype enables real-time visualization of peripheral veins on a variety of Android-based devices. The prototype was 35.2% more successful in visualizing and locating veins (n¿=¿500 attempts) than the nursing students. The acceptance assessment revealed high perception of usefulness, satisfaction, and ease of use. In the clinical trial, 1.6 (SD 1.3) additional veins per patient were identified compared with the traditional visualization methods.Conclusions To the best of our knowledge this is the first study that describes the design, feasibility and application of an NIR spectroscopy prototype developed on a standard mobile device.BMC Medical Informatics and Decision Making 11/2014; 14(1):100. DOI:10.1186/s12911-014-0100-z · 1.50 Impact Factor
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ABSTRACT: Objectives In the emergency department (ED), intravenous (IV) catheter placement is one of the most frequent interventions and may be a real challenge in some conditions. Improvement of the success rate with new technology represents a great opportunity. This randomized controlled trial aimed to show the superiority of AccuVein to cannulate veins in adults compared to routine care. Methods After giving written consent, patients were randomized into two groups: routine IV catheter insertion or insertion guided by the AccuVein, which is a hand-held instrument displaying laser light to optimize visualization of veins. The primary outcome was the time to successful placement of catheters. Secondary outcomes included the number of attempts, the rate of failure, technique-related pain, occurrence of movements, and efficiency of IV cannulation as perceived by the operator when using the AccuVein device. Results are given as mean and bootstrapped 95% confidence interval (CI) and percentages. p-valuesof <0.05 were considered significant. Results A total of 266 six patients were included, with 157 randomized to routine cannulation and 115 to AccuVein. Patient characteristics were similar. Time to successful placement of IV catheter (routine, 98seconds, 95% CI=85 to 113seconds; and AccuVein, 119seconds, 95% CI=93 to 154seconds) was not different between groups (p=0.24). Secondary outcomes (failure and pain) did not significantly differ, except for movements, which were more frequent when using the AccuVein device (19.1% vs. 10.2%, p=0.05). Evaluation of the AccuVein by operators was more often negative than positive. Conclusions Use of the AccuVein did not improve IV cannulation in nonselected ED patients.Academic Emergency Medicine 08/2014; 21(8). DOI:10.1111/acem.12437 · 2.20 Impact Factor