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Does the Use of a Vein Visualization Device for Peripheral Venous Catheter Placement Increase Success Rate in Pediatric Patients?

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Background: Peripheral intravenous catheterization is one of the most frequently encountered medical procedures for hospitalized children and is one that can often be painful. Pediatric nurses should therefore use techniques that increase the success rate or shorten the duration of peripheral intravenous catheterization. Objectives: This study was performed with the objective of determining the effect of using a vein visualization device on the success of the procedure. Success was determined based on the number of attempts per patient, the duration of the procedure, and the first stick success rate. Methods: This was a randomized, controlled experimental study on 129 children aged 3 to 18 years. Results: The duration of peripheral intravenous catheterization was shorter in the study group (S) than in the control (C) patients (37.24 ± 20.07 vs 172.65 ± 153.21 seconds; P = 0.001), with fewer attempts (S, 1.08 ± 0.28; C, 2.23 ± 1.57; P < 0.01). The first stick success rate was higher in the control group (S, 91.7%; C, 47.4%; P = 0.001). Conclusions: Peripheral intravenous catheterization using vein visualization device support reduces the number of attempts per patient and the operation duration but increases the rate of first stick success. We may therefore state that vein visualization device support improves the success of peripheral intravenous catheterization.
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Does the Use of a Vein Visualization Device for Peripheral
Venous Catheter Placement Increase Success Rate in
Pediatric Patients?
Duygu Demir, MScand Sevil Inal, PhD
Background: Peripheral intravenous catheterization is one of the most
frequently encountered medical procedures for hospitalized children and
is one that can often be painful. Pediatric nurses should therefore use tech-
niques that increase the success rate or shorten the duration of peripheral
intravenous catheterization.
Objectives: This study was performed with the objective of determining
the effect of using a vein visualization device on the success of the proce-
dure. Success was determined based on thenumber of attempts per patient,
the duration of the procedure, and the first stick success rate.
Methods: This was a randomized, controlled experimental study on 129
children aged 3 to 18 years.
Results: The duration of peripheral intravenous catheterization was
shorter in the study group (S) than in the control (C) patients
(37.24 ± 20.07 vs 172.65 ± 153.21 seconds; P= 0.001), with fewer
attempts (S, 1.08 ± 0.28; C, 2.23 ± 1.57; P< 0.01). The first stick success
rate was higher in the control group (S, 91.7%; C, 47.4%; P=0.001).
Conclusions: Peripheral intravenous catheterization using vein visualization
device support reduces the number of attempts per patient and the opera-
tion duration but increases the rate of first stick success. We may therefore
state that vein visualization device support improves the success of periph-
eral intravenous catheterization.
Key Words: peripheral intravenous catheterization,
vein visualization device, nursing
(Pediatr Emer Care 2019;35: 474479)
In pediatric patients, the placement of peripheral venous catheters
is more difficult than in adults due tocausessuch as smaller ves-
sel diameters, difficulty in palpating veins, and reduced visibility
in children.
14
The peripheral venous catheterization operation is
sometimes only successful after several failed attempts because
nurses experience difficulties in determining the vein to target
using inspection and palpation.
2,4,5
Repeated failed catheteri-
zation attempts may cause pain, anxiety, tissue injury, and ves-
sel lesions in children.
3,5,6
Seen from the nurse's viewpoint,
unsuccessful attempts may lead to frustration, anxiety, and loss
of self-confidence and damage the trust in the relationship
between the patient and the nurse.
6
To improve the quality of treatment and patient care, pediatric
nurses must be able to use health care technologies effectively.
7,8
Vein visualization technology is one of the technical fields that
has been rapidly developing in recent years. In addition to reducing
the pediatric patient's pain and anxiety, an increased rate of suc-
cess of peripheral venous catheterization after the use of vein
visualization technology may have other positive results such as
an increase in the nurses' self-confidence and a better use of time
and resources.
A search of published reports yielded only few studies of the
efficacy of different vein visualization technologies. Whereas
some of these publications showed a positive outcome in terms
of the success of the operation,
2,6,912
some others reported
an absence of positive influence on efficacy.
1,3,1318
Another
study reported on the contribution of the AccuVein AV400 vein
visualization technology to the efficacy of peripheral intrave-
nous catheterization. This investigation was based on the
nurses' opinion after using AccuVein AV400 on both pediatric
and adult patients. These data that include only nurses' views are
largely subjective in nature.
Vein visualization technology is rapidly developing and in-
creasing in efficacy. With this in mind and because of the limited
data available, we performed a study to determine the effect of
vein visualization device support on the success of peripheral in-
travenous catheterization. Success of the procedure was evaluated
based on the procedure duration, the speed of a successful first
stick, and the number of attempts.
METHODS
Objective and Type of the Study
This was a controlled, randomized experimental study.
Time and Place of the Study
The study was performed in the pediatric clinic of a teaching
and research hospital in Istanbul, Turkey.
Study Universe and Sample Selection
The study universe consisted of 150 pediatric patients aged 3
to 18 years hospitalized for treatment in pediatric clinics between
April 1 and June 1, 2014; the sample was composed of 129 pedi-
atric patients hospitalized in the pediatrics department of the same
hospital in whom peripheral intravenous catheterization was
needed and who chose to participate in the study.
The sample size was calculated using the G*Power (v3.1.7)
software for power analysis. The number of patients needed in
each of the 2 groups, to be able to detect a 30% difference in the
time to success with an αerror of 0.05 and 90% power, was calcu-
lated as 52 (ie, a minimum of 10 patients in each age group). A
post hoc power analysis was also performed using the study data
on the G*Power (v3.1.7) software. Taking into account the distri-
bution of patients in the 72-patient study group and the 57-patient
control group, the power for an αof 0.05 was 99.9%.
The patient selection criteria for the sample were defined as
follows for the study and control group patients: being treated as
inpatients in the pediatric clinic of the same hospital, being 3 to
18 years old, and having the need for peripheral intravenous
From the *Nursing Department, School of Nursing, Halic University; and
Health Science Faculty, Midwifery Department, Istanbul University, Istanbul,
Tur ke y.
Disclosure: The authors declare no conflict of interest.
Reprints: Duygu Demir, MSc, Nursing Department, School of Nursing, Halic
University, Sütlüce, Beyoğlu, Istanbul, Turkey
(email: duygu.dmr@outlook .com).
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0749-5161
ORIGINAL ARTICLE
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Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
catheterization for treatment procedures, randomized allocation of
treatment for each age group (3-6, 6-19, 9-12, 12-15, and 15-18
y), the peripheral intravenous catheterization procedure performed
by the same nurse, and peripheral intravenous catheterization with
the same brand of catheter.
The exclusion criteria were defined as those who did not
need intravenous (IV) attempt, indwelling catheter already pres-
ent, diseases for which IV insertion would be contraindicated,
and patients who were unwilling to be catheterized. Ten patients
were excluded because there was no need for an IVattempt, and
2 patients were excluded because they were unwilling to
undergo catheterization.
Data Collection Tools
Study data were collected with the help of an interview and ob-
servation formand the AccuVein AV400 vein visualization device.
Interview and Observation Form
This form contained a total of 6 open-ended and 7 closed-
ended questions, for a total of 13 questions, developed based on
the available publications.
1,2,6,7,12,17
The first questions of these
queried demographic characteristics such as race, age, sex, and
body mass index (BMI), whereas the others were about the
operation efficiency, including the operation duration and the
number of attempts, vessel difficulty grate, and previous attempts
at peripheral IV catheterization.
This interview and observation form was applied to 10 chil-
dren before the start of the study. Questions that were not easily
understood were edited to their final form. These 10 children were
kept out of the study.
The AccuVein AV400 Vein Visualization Device
The AccuVein AV400 vein visualization device was used
during peripheral intravenous catheter placement (Fig. 1).The
device detects hemoglobin by reflecting it under infrared light,
showing the location of the vessels.
19
The AccuVein AV400 vein
visualization devicewas held 20 cm from the extremity to be cath-
eterized, at a 90° angle (Figs. 2, 3). More information about the
device can be found on the manufacturer's Web page.
19
Before starting the study, the nurse in charge of performing
the peripheral intravenous catheterization was trained in the use
of the device and performed peripheral intravenous catheterizations
for 3 days; the children who underwent catheterization during these
3 training days were not included in the study.
Data Collection
Subjects were allocated either to the study group for venous
visualization support during peripheral intravenous catheteriza-
tion or to the control group for catheterization with the traditional
(or standard) method. Before allocating them to either group, a
preliminary interview was performed, using the interview and ob-
servation form, with the volunteering children and their parents to
select the subjects responding to the selection criteria. Written
informed consent was obtained from the eligible children and
their parents after informing them of the study procedures.
Randomization Method
Subjects in both the study and control groups were to be
stratified into 5 age groups of 3 to 6, 6 to 9, 9 to 12, 12 to 15,
and 15 to 18 years. Power analysis indicated that the minimum
number of patients in each group has to be 10. Each subject was
only entered once into the study.
Envelopes were prepared for each eligible subject, contain-
ing 1 red chit and 1 yellow chit. The children were asked to pull
1 chit without looking. The group represented by each color had
been determined in advance. Subjects who selected yellow were
allocated to the study group, and those who chose red were
allocated to the control group. The same procedures within the
study or control groups were applied to all eligible children who
required peripheral intravenous catheterization and who had
volunteered to participate in the study. Subjects were randomly al-
located to each of the age groups until the minimum required sam-
ple size for each group was reached.
The AccuVein AV400 vein visualization device was used
during peripheral intravenous catheter placement in the study
group patients, and the standard method was used in controls.
Operation success was determined based on the procedure dura-
tion, the number of attempts, and the presence or absence of first
stick success. The number of attempts was the number of tries
made until catheter placement was successful. The procedure du-
ration was the time from the start to the end of the procedure. It
was defined as the time elapsed from the placement of a venous
tourniquet to the moment a patent's venous access was assured.
This definition was adopted to include the time to search for an
access vein. First stick success was defined as establishing venous
access at the first attempt made. If the first attempt was unsuccess-
ful, another vein was searched, and time was kept until success.
FIGURE 1. AccuVein AV400 vein viewing system (http://www.accuvein.com).
FIGURE 2. Appearance of a vein before the procedure.
Pediatric Emergency Care Volume 35, Number 7, July 2019 Vein Visualization Device for Pediatric Patients
© 2019 Wolters Kluwer Health, Inc. All rights reserved. www.pec-online.com 475
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Successful access was defined as blood egress from the vein in the
absence of any evidence of infiltration.
The study procedure was conducted by 2 pediatric nurses,
with one performing the operation and the other observing. Both
of these nurses had at least 5 years of experience working in this
pediatrics department and volunteered to take part in the study.
To avoid subjective differences, the operation duration was mea-
sured, and first stick success was verified in each case by the same
nurse. In addition, peripheral intravenous catheterization was per-
formed by the same nurse in both the control and study groups.
Both nurses underwent training on the operation before the study.
All venous catheterizations in both groups used catheters of the
same brand, of the caliber appropriate to patient age and vessel di-
ameter. To help ensure data reliability, the investigator did not par-
ticipate in the evaluation process of the venous catheterization.
The presence of parents of both the control and study group chil-
dren during the peripheral intravenous catheterization was ensured.
Before the operation, the performing nurse attributed an esti-
mated venipuncture difficulty grade of easy,”“intermediate,or
difficult.This difficulty grade was estimated by the same perform-
ing nurse on the basis of objective, published criteria.
2,3,5,20,21
The
criteria used for the grading were the presence or absence of dam-
age to the vein, its visibility or not, and its palpability or not. All
three criteria, namely, the presence of vein damage, the absence
of visibility, and the absence of palpation, were classified as dif-
ficult,and1or2ofthe3criteriawereclassifiedasintermedi-
ate,whereas in the absence of all three, the vein was deemed to
be easy.
Statistical Analysis of the Data
The Number Cruncher Statistical System 2007 and Power
Analysis and Sample Size 2008 Statistical Software (NCSS,
Kaysville, UT) was used for statistical data evaluation. Student t,
Mann-Whitney U, Kruskal-Wallis, Pearson χ
2
, and Fisher ex-
act tests and Yates' correction for continuity were used as ap-
propriate for comparative statistics. Significance threshold
was set at a Pvalue of 0.05, and a Pless than 0.01 was considered
highly significant.
Ethical and Legal Considerations Regarding
the Study
Authorization was obtained before the start of the study from
the hospital and the institutional review board (ethics committee).
The aim and method of the study were explained to the pediatric
patients and their families; both their oral and written consent
was obtained.
RESULTS
The study was performed from April to June 2014 on a total
of 129 pediatric patients, with 55.8% (72) of them in the study
group and the remaining 44.2% (57) in the control group.
A comparison between the 2 groups for variables that could
affect the success of the procedure did not detect significant
differences. There are no any correlation between BMI and suc-
cess rate of IV insertion between the experimental and control
groups (Table 1).
When comparing the 2 groups for efficacy, the number of at-
tempts was significantly lower (P= 0.001) in the study group
(1.08 ± 0.28; range, 12) than in the control group (2.23 ± 1.57;
range, 18). The operation duration was similarly shorter in the
study group (37.24 ± 20.07 [range, 1583]vs172.65±153.21
[range, 40700] seconds for the control group, P= 0.001). The
first stick success rate washigher in the study group (91.7%) com-
pared with the control group (47.7%; P=0.001)(Table2).
When comparing the first stick success rate according to the
difficulty grade attributed to the veins, no significant difference
was detected between the study (95.8%) and control (92.3%)
groups among the subjects with easyveins (P> 0.05), whereas
in the intermediate(95% in the study group vs 20% in the con-
trol group) and difficult(85.7% in the study group vs 14.3% in
the control group) groups, the first stick success was significantly
higher (P= 0.001) in the study group (Table 3).
Comparing the number of attempts between the study and
control groups according to the difficulty grade attributed to the
vein was similarly failing to show a significant difference in the
easyvein group (P> 0.05), whereas the number of attempts
in the study group was lower than that in the control group
in the easy(1.05 [0.22] vs 2.27 [0.80]) and difficult
(1.14 [0.36] vs 4.06 [1.61]) groups (P= 0.001) (Table 3).
DISCUSSION
This study was performed with the objective of defining the
effect of the AccuVein AV400 vein visualization device support
on the success of peripheral intravenous catheterization in children
aged 3 to 18 years who were hospitalized in a pediatrics depart-
ment. In this study, we started with children aged 3 years; neonates
and very young children were not included. This age group is a
separate group in terms of IV insertion difficulties. Consequently,
we are planning a separate study for the 0- to 3-year age group.
Success was determined based on the number of peripheral
intravenous catheterization attempts, the duration of the operation,
and the first stick success rate. Comparing the study and control
groups for efficacy of the procedure, it was observed that fewer at-
tempts were needed in the study group compared with the control
group and that the operation was similarly shorter in the study
group, which also had a significantly higher first try success rate
(Table 2). Considering the possibility that the study and control
groups are similar for a number of other factors that may influence
efficacy (Table 1), the study shows that the AV400 vein visual-
ization device support improves the success of peripheral
intravenous catheterization.
Some of the few published studies evaluating the effect of
vein visualization technologies on operational success report a
positive result, whereas some others do not. A detailed discussion
regarding AV400 and AV300, its 1-levellower version, is in-
cluded here because the mentioned studies used visualization
technologies different from that in our study.
A search of available publications yielded 4 reports of studies
examining the efficacy of AccuVein AV300, an earlier version of
the vein visualization device used in our study. Kaddoum et al
(2012) concluded a controlled, randomized study of 146 pediatric
FIGURE 3. Pediatric peripheral intravenous catheter placement.
Demir and Inal Pediatric Emergency Care Volume 35, Number 7, July 2019
476 www.pec-online.com © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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patients aged 0 to 17 years by stating that, although the device in-
creased the visibility of veins, it was not more effective than stan-
dard methods. In a controlled, randomized study of pediatric
patients aged 0 to 18 years comparing the effect on operational
efficacy of 3 different vein visualization devices, namely,
Vasculuminator, VeinViewer, and AccuVein AV300, no differ-
ence in the first try success rate was evidenced among the 3 de-
vices or between each of them and the traditional method by de
Graaff et al (2013). Aulagnier et al (2014), reporting a randomized
study of 272 adult emergency room patients of vein visualization
versus controls, concluded that the use of AccuVein AV300 did
not affect peripheral vein catheterization in adult emergency pa-
tients. These results might derive from a high efficacy rate of
noninstrumented venipuncture as a result of the large, evident
veins of adult patients. Guillon et al (2015) conducted a con-
trolled, randomized study of 450 patients with age from
1.8 months to 90 years, using AccuVein AV300. They con-
cluded that vein visibility was increased in patients with
difficult venous access, a finding consistent with our results,
and that pain was reduced in 39% of the cases.
Our literature survey produced 1 study performed with
AccuVein AV400. In a study performed with 6 nurses, Delvo-
Favre et al (2014) evaluated the efficacy of the vein visualization
device in peripheral intravenous cannulation; a 93% success rate
at the first or second try was reported, with 82% of nurses stating
that the device improved their ability to cannulate. This report,
however, did not address the operation duration or the number
of attempts.
The difficulty of cannulating a vessel is one of the most im-
portant factors affecting the success of the operation and the num-
ber of attempts. The first stick success rate was significantly
higher in the control group (P= 0.001) in our study subgroups
with an intermediateor difficultvein grading, whereas the
number of attempts was similarly low (P= 0.001) in these same
subgroups. No difference with regard to the number of attempts
or operation success was seen (P> 0.05) in the subgroup graded
TABLE 1. Comparison of the Study and Control Groups for Variables That Could Affect Success
Study Group (n = 72) Control Gro up (n = 57)
Z/t/χ
2
PMean (SD) (Median) Mean (SD (Median)
Age, y 8.51 (4.4) (7.0) 9.34 (4.54) (9.5) Z= 0.969 0.333*
BMI, kg/m
2
17.27 (3.08) (16.6) 17.34 (2.53) (17.1) t= 0.140 0.889
n% n %
Sex Female 32 44.4 27 47.4 χ
2
= 0.110 0.741
Male 40 55.6 30 52.6
Age group, y 36 25 34.7 17 29.8 χ
2
= 1.616 0.806
69 17 23.6 10 17.5
912 10 13.9 10 17.5
1215 10 13.9 10 17.5
1518 10 13.9 10 17.5
Vessel difficulty grade Easy 24 33.3 26 45.6 χ
2
= 2.355 0.308
Intermediate 20 27.8 15 26.3
Difficult 28 38.9 16 28.1
Previous attempts at peripheral intravenous catheterization Yes 51 70.8 46 80.7 χ
2
= 1.174 0.279§
No 21 29.2 11 19.3
*Mann-Whitney Utest.
Student ttest.
Pearson χ
2
.
§P<0.01.
TABLE 2. Comparison of the Study and Control Groups for Operation Success
Study Group (n = 72) Control Group (n = 57)
Z/χ
2
PMean (SD) (Median, Range) Mean (SD) (Median, Range)
No. attempts 1.08 (0.28) (1, 12) 2.23 (1.57) (2, 18) Z=5.859 0.001*
Operation duration, s 37.24 (20.07) (32, 1583) 172.65 (153.21) (103, 40700) Z=8.648 0.001*
n%n %
Success at first try Yes 66 91.7 27 47.4 χ
2
= 28.867 0.001
†‡
No 6 8.3 30 52.6
*Mann-Whitney Utest.
Yates' continuity correction test.
P<0.01.
Pediatric Emergency Care Volume 35, Number 7, July 2019 Vein Visualization Device for Pediatric Patients
© 2019 Wolters Kluwer Health, Inc. All rights reserved. www.pec-online.com 477
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
easy(Table 3). These results suggest that the use of AccuVein
AV400 will be more beneficial to children with vein access
of intermediate and high difficulties.
It may be stated that the study results were found to contribute
to increasing procedure success and patient comfort during periph-
eral IV placement procedures. It should be noted that vein visualization
technologies to increase the success of peripheral intravenous catheter-
ization are not being used in Turkey. These are only now starting to be
used in a few cases in only a few private hospitals. We expect the
study results to contribute to a wider use of effective vein visu-
alization technology for peripheral intravenous cannulation.
To conclude, peripheral intravenous catheterization
supported by AccuVein AV400 decreases the number of attempts,
reduces procedure time, and increases the rate of first stick success
in pediatric patients. The efficacy of AccuVein AV400 support for
peripheral intravenous catheterization is greater in children with
veins considered to be of intermediate or high access difficulty.
REFERENCES
1. Szmuk P, Steiner J, Pop RB, et al. The VeinViewer vascular imaging system
worsensf irst-attempt cannulation rate for experienced nurses in infants and
children with anticipated difficult intravenous access. Anesth Analg.2013;
116:10871092.
2. Kim MJ, Park JM, Rhee N, et al. Efficacy of VeinViewer in pediatric
peripheral intravenous access: a randomized controlled trial. Eur J Pediatr.
2012;171:11211125.
3. Chapman LL, Sullivan B, Pacheco AL, et al. VeinViewer-assisted
Intravenous catheter placement in a pediatric emergency department. Acad
Emerg Med. 2011;18:966971.
4. Simhi E, Kachko L, Bruckheimer E, et al. Avein entry indicator device for
facilitating peripheral intravenous cannulation in children: a prospective,
randomized, controlled trial. Anesth Analg. 2008;107:15311535.
5. Jacobson AF, Winslow EH. Variables influencing intravenous catheter
insertion difficulty and failure: an analysis of 339 intravenous catheter
insertions. Heart Lung. 2005;34:345359.
6. Sun CY, Lee KC, Lin I, et al. Near-infrared light device can improve
intravenous cannulation in critically ill children. Pediatr Neonatol.2013;
54:194197.
7. Chiao FB, Resta-Flarer F, Lesser J, et al. Vein visualization: patient
characteristic factors and efficacy of a new infrared vein finder technology.
Br J Anaesth. 2013;110:96 6971.
8. Sánchez-Morago GV, Sánchez Coello MD, Villafranca-Casanoves A, et al.
Viewing veins with AccuVein AV300. Rev Enferm. 2010;33:3338. Available
at: http://www.ncbi.nlm.nih.gov/pubmed?term=Villafranca%20Casanoves%
20A%5BAuthor%5D&cauthor=true&cauthor_uid=20201197.
9. Guillon P, Makhloufi M, Baillie S, et al. Prospective evaluation of venous
access difficulty and a near-infrared vein visualizer at four French
haemophilia treatment centres. Haemophilia.2015;21:2126.
10. Delvo-Favre ED, Daneti G, Gui n P. Implementation of near-infrared
technology (AccuVein AV-400) to facilitate successful PIV cannulation.
The Poster Session at the 2014 Infusion Nurses Society Conference.
Available at: http://download.lww.com/wolterskluwer_vitalstream_com/
PermaLink/JIN/A/JIN_2014_06_10_DELVO_00029_SDC20.pdf.
Accessed July 31, 2014.
11. Cuper NJ, Klaessens J, Jaspers J, et al. The use of near-infrared light
for safe and effective visualization of subsurface blood vessels to
facilitate blood withdrawal in children. Med Eng Phys. 2013;35:
433440.
12. Hess HA. A biomedical device to improve pediatric vascular access
success. Pedi at r Nu rs . 2010;36:259263.
13. Aulagnier J, Hoc C, Mathieu E, et al. Efficacy of AccuVein to facilitate
peripheral intravenous placement in adults presenting to an emergency
department: a randomized clinical trial. Acad Emerg Med.2014;21:
858863.
14. van der Woude OC, Cuper NJ, Getrouw C, et al. The effectiveness
of a near-infrared vascular imaging device to support intravenous
cannulation in children with dark skin color: a cluster randomized
clinical trial. Anesth Analg. 201 3;116:12661271.
15. Cuper NJ, de Graaff JC, Verdaasdonk RM, et al. Near-infrar ed
imaging in intravenous cannulation in children: a cluster
randomized clinical trial. Pedi at ri cs. 2013;131:e1 91e197.
TABLE 3. Comparison of Success in the Study and Control Groups According to Difficulty of Vascular Access
Vessel Difficulty Grade
Success at the First Try of Peripheral
Intravenous Catheterization
Success at the First Try of Peripheral Intravenous
Catheterization
χ
2
P
Study Group (n = 72) Control Group (n = 57)
n%n%
Easy Yes 23 95.8 24 92.3 0.275 1.000*
No 1 4.2 2 7.7
Intermediate Yes 19 95.0 3 20.0 17.564 0.001
†‡
No 1 5.0 12 80.0
Difficult Yes 24 85.7 0 0 26.813 0.001
†‡
No 4 14.3 16 100
No. Attempts
n Mean (SD) (Median) n Mean (SD) (Median) ZP
§
Vessel difficulty grade Easy 24 1.04 (0.20) (1) 26 1.08 (0.27) (1) 0.519 0.604
Intermediate 20 1.05 (0.22) (1) 15 2.27 (0.80) (2) 4.497 0.001
Difficult 28 1.14 (0.36) (1) 16 4.06 (1.61) (4) 5.939 0.001
*Fisher exact test.
Yates' continuity correction test.
P<0.01.
§
Mann-Whitney Utest.
Demir and Inal Pediatric Emergency Care Volume 35, Number 7, July 2019
478 www.pec-online.com © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
16. de Graaff JC, Cuper NJ, Mungra RA, et al. Near-infrared light to aid
peripheral intravenous cannulation in children: a cluster randomised
clinical trial of three devices. Anaesthesia. 2013;68:835845.
17. Kaddoum RN, Anghelescu DL, Parish ME, et al. A randomi zed controlled
trial comparing the AccuVein AV300device to standardinsertion technique
for intravenous cannulation of anesthetized children. Pediat r Anes th .2012;
22:884889.
18. Perry AM, Caviness AC, Hsu DC. Efficacy of a near-infrared light device
in pediatric intravenous cannulation: a randomized controlled trial. Ped iat r
Emerg Care.2011;27:510.
19. AccuVein. AccuVein Web site. Available at: http://www.accuvein.com.
Accessed July 5, 2013.
20. Riker MW, Kennedy C, Winfrey BS, et al.Validation and refinement of the
difficult intravenous access score: a clinical prediction rule for identifying
children with difficult intravenous access. Acad Emerg Med.2011;18:
11291134.
21. Yen K, Riegert A, Gorelick M. Derivation of the DIVA score:
a clinical prediction rul e for the ident ification o f children with
difficult intravenous access. Pedi at r Em er g Ca re.2008;24:
143147.
Pediatric Emergency Care Volume 35, Number 7, July 2019 Vein Visualization Device for Pediatric Patients
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... Table 1 outlines characteristics of included studies. Most trials were single center and conducted in an acute inpatient pediatric-specific setting 4,[27][28][29][30][31][32][33][34][36][37][38][39][40][41][44][45][46] or dedicated pediatric unit in a large public hospital 35,43,44 ; one study was a multicenter trial. 36 All trials described evidence of ethical review board approval and participant consent for trial participation. ...
... Table 1 outlines characteristics of included studies. Most trials were single center and conducted in an acute inpatient pediatric-specific setting 4,[27][28][29][30][31][32][33][34][36][37][38][39][40][41][44][45][46] or dedicated pediatric unit in a large public hospital 35,43,44 ; one study was a multicenter trial. 36 All trials described evidence of ethical review board approval and participant consent for trial participation. ...
... First-time insertion success (AppendixFigure 3.1) was reported in five studies37,[41][42][43][44] and 778 patients with no evidence of effect (RR, 1.21; 95% CI, 0.91-1.59). Subgroup analysis by DIVA 41-44 demonstrated first-time insertion success more than doubled with near-infrared technology compared with landmark (RR, 2.72; 95% CI, 1.02-7.24). ...
Article
Objective: Insertion and function of pediatric peripheral intravenous catheters (PIVCs) present challenges. We systematically reviewed techniques and technologies to improve PIVC outcomes (first-time insertion success, overall insertion success, time to insertion, dwell time, failure, and complications). Data sources: Cochrane Central Register of Controlled Trials (CONTROL), Cumulative Index to Nursing and Allied Health (CINAHL), US National Library of Medicine, and Embase. Study selection: English-language pediatric trials published post 2010 reporting PIVC outcomes. Data extraction: Following Cochrane standards, two authors screened, extracted, and critiqued study quality (Grading of Recommendations Assessment, Development and Evaluation approach) data, random effects analysis, results expressed as risk ratios (RR), mean differences (MD) and 95% CIs. Results: Twenty-one studies (3237 children; 3098 PIVCs) were included. First-time insertion success significantly increased with ultrasound guidance (compared with landmark insertion; RR, 1.60; 95% CI, 1.02-2.50). Use of ultrasound guidance (compared with landmark insertion) did not improve overall PIVC insertion success (RR, 1.10; 95% CI, 0.94-1.28). There was no evidence of an effect of near-infrared (compared with landmark) on first-time insertion success (RR, 1.21; 95% CI, 0.91-1.59) or number of attempts (MD, -0.65; 95% CI, -1.59 to 0.29); however, it significantly reduced PIVC insertion time (MD, -132.47; 95% CI, -166.68 to -98.26) and increased first-time insertion success in subgroup analysis of patients with difficult intravenous access (RR, 2.72; 95% CI, 1.02-7.24). Limitations: Few studies per intervention, small sample sizes, and inconsistent outcome measures precluded definitive conclusions. Conclusions: Ultrasound and near-infrared appear to improve pediatric PIVC insertion. High-quality studies examining the full extent of techniques and technologies are needed. Registration: CRD42020175314.
... Table 1 outlines characteristics of included studies. Most trials were single center and conducted in an acute inpatient pediatric-specific setting 4,[27][28][29][30][31][32][33][34][36][37][38][39][40][41][44][45][46] or dedicated pediatric unit in a large public hospital 35,43,44 ; one study was a multicenter trial. 36 All trials described evidence of ethical review board approval and participant consent for trial participation. ...
... Table 1 outlines characteristics of included studies. Most trials were single center and conducted in an acute inpatient pediatric-specific setting 4,[27][28][29][30][31][32][33][34][36][37][38][39][40][41][44][45][46] or dedicated pediatric unit in a large public hospital 35,43,44 ; one study was a multicenter trial. 36 All trials described evidence of ethical review board approval and participant consent for trial participation. ...
... First-time insertion success (AppendixFigure 3.1) was reported in five studies37,[41][42][43][44] and 778 patients with no evidence of effect (RR, 1.21; 95% CI, 0.91-1.59). Subgroup analysis by DIVA 41-44 demonstrated first-time insertion success more than doubled with near-infrared technology compared with landmark (RR, 2.72; 95% CI, 1.02-7.24). ...
... Supporting our study results, Fukuroku et al. (2016) found in a study with second-year nursing students using infrared light in the PIVC procedure that the students' mean age was 24.9 ± 5.5 years. In the literature, studies examining the use of infrared light in implementing PIVC relate to the skill of PIVC in nurses in pediatric patients (Çaglar et al., 2019;Demir and ˙I nal, 2019;Hess, 2010;İ nal and Demir, 2021;Lee et al., 2020;Lininger, 2003;Ramer et al., 2016;Wang and Wang, 2021), hemophiliac patients (Guillon et al., 2015), patients receiving chemotherapy treatment (Eren and Çalışkan, 2021), patients in the emergency service (Aulagnier et al., 2014), and in dermatology (AlZahrani et al., 2019), where finding a vein is much more difficult (Delvo-Favre et al., 2014). Examining the distribution of the students participating in the study according to gender, no difference was found according to gender between the experimental and control groups when a comparison was made between the two groups, both of which were mostly made up of females. ...
... In a study with 165 patients diagnosed with hemophilia, Guillon et al. (2015) found that the technique of vein visualization increased success in in patients whose veins were difficult to access (Guillon et al., 2015). In a study to determine the effect on procedure success of PIVC location supported by a vein visualization device in pediatric patients, Demir and İ nal (2019) found that procedure success increased, procedure duration was shortened, and pain felt during the procedure was reduced (Demir and ˙I nal, 2019). In another study, Demir and ˙I nal stated that the use of infrared light in pediatric patients aged 0-3 years (n = 54) reduced the number of attempts per patient and the duration of the procedure, and that it increased the rate of success at the first attempt (İnal and Demir, 2021). ...
... In a study with 165 patients diagnosed with hemophilia, Guillon et al. (2015) found that the technique of vein visualization increased success in in patients whose veins were difficult to access (Guillon et al., 2015). In a study to determine the effect on procedure success of PIVC location supported by a vein visualization device in pediatric patients, Demir and İ nal (2019) found that procedure success increased, procedure duration was shortened, and pain felt during the procedure was reduced (Demir and ˙I nal, 2019). In another study, Demir and ˙I nal stated that the use of infrared light in pediatric patients aged 0-3 years (n = 54) reduced the number of attempts per patient and the duration of the procedure, and that it increased the rate of success at the first attempt (İnal and Demir, 2021). ...
Article
Background PIVC is one of the essential procedures of modern medicine, and is one of the most widely used and important treatments in the clinical setting. Nevertheless, it is one of the most difficult skills to teach in nursing education, and it is the skill which causes the most anxiety in nursing students. Objectives The aim of the study was to examine the effect of the teaching method using infrared technology on PIVC success, duration, and the level of psychomotor skills and knowledge in the acquisition of PIVC skills in nursing students. Methods This was a pre-test post-test randomized experimental study with a control group. The research was conducted in the Skills and Simulation Laboratory of a Nursing Faculty of a university between December 2019 and February 2020 to examine the effects of teaching PIVC measurement via infrared light on students' success rate. A theory lesson on PIVC followed 15 days later by laboratory practical was carried out with all of the students included in the study. The PIVC Knowledge Evaluation Form as a pre-test. The researchers completed the PIVC Skills Performance Test from observation during the application of the checklist. Immediately after the procedure, the PIVC Knowledge Evaluation Form was applied as a post-test. Results The procedure success rate of the experimental group was 90%, and that of the control group was 46%. Comparing PIVC skill scores between the groups, the difference was found to be statistically significant (Z = −2.741; p < 0.05). The groups' PIVC knowledge levels increased in a similar way. Conclusion Teaching with infrared technology contributes more to students' success in PIVC skills than does standard teaching. Both methods were effective in developing knowledge of PIVC.
... Additionally, our results, in line with the previous studies [20], found that the overall puncture time and the first attempt time of the ultrasound-assisted group were shorter than that of the conventional approach group, and less numbers of redirection of the first attempt were needed in the ultrasound-assisted group. Considering the potential toxicity of general anesthesia in small children, all of these reductions are probably advantageous. ...
Article
Full-text available
Background The study investigated the success rate of the great saphenous venous catheter placement performed by ultrasound-assisted technique compared with the conventional puncture method in infants and toddlers with congenital heart disease and aimed to assess the efficiency and feasibility of this method within the context of pediatric peripheral venous access. Methods We selected infants and toddlers who underwent congenital cardiac surgery in our medical center from June 1, 2020, to September 7, 2020, by convenience sampling. Children were stratified by the presence of the manifesting cardiac types (cyanotic or acyanotic heart disease). They were assigned to the conventional puncture method group or the ultrasound-assisted group through randomly blocked randomization. The primary outcome was the success rate of the first attempt. The second outcomes included the time to cannulation at the first attempt, the redirections of the first attempt, overall puncture time, and overall redirections of efforts. Besides, a binary logistic regression model was implemented to identify the possible variables related to the success rate of the first attempt. Results A total of 144 children in our medical center were recruited in the study. The success rate of the first attempt in the ultrasound-assisted group was higher than that of the conventional puncture method group in the stratification of cyanotic children (66.7% vs. 33.3%, P = 0.035). Among children of acyanotic kind, the difference in the success rate of the first attempt between the two groups was not significant (57.6% vs. 42.4%, P = 0.194). Overall puncture time (45.5 s vs. 94 s, P = 0.00) and the time to cannulation at the first attempt (41.0 s vs. 60 s, P = 0.00) in the ultrasound-assisted group was less than the conventional puncture method group. The ultrasound-assisted group also required fewer redirections of the first attempt (three attempts vs. seven attempts, P = 0.002) and fewer total redirections of efforts (two attempts vs. three attempts, P = 0.027) than the conventional puncture method group. The result of binary Logistic regression showed that the success rate of the first attempt was related to age (OR:1.141; 95% CI = 1.010–1.290, P = 0.034), the redirections of the first attempt (OR:0.698; 95% CI = 0.528–0.923, P = 0.012) and the saphenous venous width (OR:1.181; 95% CI = 1.023–1.364, P = 0.023). Conclusions The ultrasound-assisted technique improves the saphenous venous cannulation sufficiently in children with difficult peripheral veins. The younger age is associated with a higher likelihood of peripheral venous difficulty. The ultrasound-assisted methods can effectively screen peripheral veins, e.g., selecting thicker diameter peripheral veins, making puncture less uncomfortable, and improving success rates. This method can be used as one of the effective and practical ways of peripheral venipuncture in children, especially in difficult situations. It should be widely applied as one of the alternative ultrasound techniques in the operating room. Trial registration ChiCTR.org.cn (ChiCTR-2,000,033,368). Prospectively registered May 29, 2020.
... Most of these RCTs (Conversano et al. [17], McNeely et al. [18], Curtis et al. [23], de Graaff et al. [25], Szmuk et al. [27], Woude et al. [30], Kaddoum et al. [33], Cuper et al. [34], and Perry et al. [36]) did not find a vein-finder device worthwhile for paediatric peripheral intravenous cannulation. However, 4 RCTs (Demir et al. [20], Inal et al. [29], Sun et al. [31], and Kim et al. [32]) led to the conclusion that these tools increase the success of intravenous cannulation in paediatric patients. Ramer et al. [22], in their cohort study on 53 patients in a paediatric haemato-oncology clinic, noted that in the VeinViewer group it took less time to get into a vein than when using the standard method. ...
Article
Full-text available
Peripheral intravenous placement can be difficult in children. Vein finder devices are vascular access devices that delineate veins lying in the subcutaneous tissues to identify potential venipuncture sites. In this narrative review, we highlight the currently available literature on this device to analyse the hope that this device has to offer vs. the unnecessary hype. The search of the databases (Cochrane Library, Google Scholar, and PubMed) was limited to studies on the paediatric population and in English language between 2011 and 2019. Twenty-three relevant articles were found. Most of the articles did not demonstrate a major impact of these modalities in the general paediatric population. However, they may be beneficial in children with difficult intravenous access. Appro-priate simulator mannequins should be utilised to train healthcare providers in using these vein finder devices.
... Additionally, our results, in line with the previous studies [20], found that the overall puncture time and the rst attempt time of the ultrasound-assisted group were shorter than that of the traditional landmark group, and less numbers of redirection of the rst attempt were needed in the ultrasound-assisted group. ...
Preprint
Full-text available
Background: The study investigated the success rate of the great saphenous venous catheter placement performed by ultrasound-assisted technique compared with the anatomical landmark approach in infants and toddlers with congenital heart disease and aimed to assess the efficiency and feasibility of this ultrasound-assisted method within the scope of pediatric peripheral intravenous access. Methods: We selected infants and toddlers who underwent congenital cardiac surgery in our medical center from June 1, 2020, to September 7, 2020, by convenience sampling. Children were stratified by the presence of the manifesting cardiac types (cyanotic or acyanotic heart disease). They were assigned to the traditional anatomical landmark group and the ultrasound-assisted group through randomly blocked randomization. The primary outcome was the success rate of the first attempt. The second outcomes included the time to cannulation at the first attempt, the redirections of the first attempt, overall puncture time, and overall redirections of efforts. Besides, a binary logistic regression model was implemented to identify the possible variables related to the success rate of the first attempt. Results: A total of 144 children in our medical center were recruited in the study. The success rate of the first attempt in the ultrasound-assisted group was higher than that of the traditional anatomic landmark group in the stratification of cyanotic children(66.7% vs. 33.3%, P=0.035). Among children of acyanotic kind, the difference in the success rate of the first attempt between the two groups was not significant(57.6% vs. 42.4%, P= 0.194). Overall puncture time (45.5 s vs. 94 s, P= 0.00)and the time to cannulation at the first attempt (41.0 s vs. 60 s, P= 0.00)in the ultrasound-assisted group was less than the traditional landmark group. The ultrasound-assisted group also required fewer redirections of the first attempt (three attempts vs. seven attempts, P=0.002) and fewer total redirections of efforts (two attempts vs. three attempts, P=0.027) than the traditional landmark group. The result of binary Logistic regression showed that the success rate of the first attempt was related to age(OR:1.141; 95% CI=1.010-1.290, P=0.034), the redirections of the first attempt (OR:0.698; 95% CI=0.528 -0.923, P=0.012)and the saphenous venous width(OR:1.181; 95% CI=1.023 -1.364, P=0.023). Conclusions: The ultrasound-assisted technique improves the saphenous venous cannulation sufficiently in children with difficult peripheral veins. The younger age is associated with a higher likelihood of peripheral venous difficulty. The ultrasound-assisted method could effectively screen peripheral veins, such as selecting peripheral veins with a thicker diameter, less puncture discomfort, and a better success rate. This method can be used as a useful and practical way for peripheral venipuncture in children, especially in a difficult situation. It should be widely applied in the operating room. Trial registration: ChiCTR.org.cn(ChiCTR-2000033368). Prospectively registered May 29, 2020.
Article
Peripheral venous catheter placement (PVCP) is difficult for children due to the small diameter of their veins in adipose tissue. The transilluminator device (TD) is proposed as the effective method for PVCP. Therefore, this meta-analysis aimed to assess the effect of TD on first attempt success rate (FASR), mean the number of attempts (MNA), and mean duration of successful PVC placement (MDSPP) in children. In a systematic review and meta-analysis, an extensive search of online databases including PubMed, Scopus, Science Direct, Web of sciences, Cochrane, Clinical trial.gov, ProQuest, and Google scholar search engine was conducted. Keywords were combined and searched from the earliest records up to December 2021. The current meta-analysis was performed using STATA V.14.0 software. Six studies (four RCTs and two non-RCTs design) were included in the present meta-analysis. Analysis showed using of TD significantly led to FASR to 34% in studies with RCTs design (RR = 1.34; CI = 1.18–1.53) although, non-RCT studies did not indicate it (RR: 0.95; CI = 0.50–1.79). Also, one RCT (WMD = −0.24; CI = −0.4 −0.08) and two non-RCTs 0.05 (WMD = −0.05; 95% CI = −0.46–0.37) reported the MNA. Two RCTs (WMD: −24.30; CI = −53.50–4.89) and one non-RCT (WMD: −295.20; CI = −359.34 to −231.06) found TD decreased MDSSP. RCTs and non-RCTs studies showed different results in terms of some outcomes. Based on the results of four RCTs studies, the use of TD significantly increased the FASR of PVCP. The results of two non-RCTs also showed TD insignificantly decreased the FASR of PVCP. More evidence (RCT design) is required for decision-making about the effectiveness of TD on successful PVCP.
Article
Background The application of peripheral intravenous catheter has been an effective guarantee for the success of pediatric therapy. We aimed to investigate the correlative factors that impacting the duration of pediatric peripheral intravenous catheter. Methods From January 2017 to October 2017, 370 cases of pediatric patients in the First Hospital of Hunan University of Chinese Medicine were collected as the research object. Based on the indwelling time, the collected cases were divided into two groups, namely long time group (>72 h) and short time group (<72 h). The general data and laboratory test results of two groups were collected, and the correlation factors of indwelling time were analyzed by single factor and Logistic multiple factors. Results As the results revealed that compared with short time group, patients in long time group had statistically significant differences in puncture site, phlebitis, extravasation of blood vessels, hemoglobin, white blood cells, platelets, and 75% ethanol sterilization ( p < 0.05). Logistic multivariate analysis indicated that scalp puncture was the independent protective factors that affecting the duration of pediatric peripheral intravenous catheter. Moreover, phlebitis represented the independent risk factor that influencing the indwelling time of pediatric peripheral intravenous catheter. And the differences were statistically significant ( p < 0.05). Conclusions Analyze factors influencing indwelling time of pediatric peripheral intravenous catheter and enhance the management of relevant factors are of great significance to prolong the indwelling time, reduce the pain of pediatric patients, and facilitate the clinical medication.
Chapter
Difficult vascular access (DVA) is a potentially life-threatening condition that can prevent the delivery of efficient and effective medical care for at-risk patients. Under emergent conditions, DVA can delay the resuscitation of unstable patients by complicating providers’ efforts to administer life-saving fluids and medications. Improved awareness of the causes of DVA, including strategies to overcome these factors, may help to minimize the sequelae of DVA. This chapter proposes four main factors influencing the development of DVA, as well as solutions for DVA management in the emergent setting, based upon established techniques and evidence-based guidelines.
Article
Full-text available
Intravenous cannulation can be difficult in children. Recently, new devices using near-infrared light to make blood vessels visible have become available. We aimed to evaluate the effectiveness of three such devices in facilitating peripheral intravenous cannulation in children. In this cluster randomised clinical trial, daily operating rooms at a tertiary childrens' hospital were randomised to the use of the VeinViewer(®) , AccuVein(®) AV300, VascuLuminator Vision(®) or to a control group. We included 1913 children between birth and 18 years scheduled for elective surgery. Suitable veins for cannulation were more easily visible with the VeinViewer (307/322 (95.3%)) and AccuVein (239/254 (94.1%)) devices than with VascuLuminator (229/257 (89.1%)) (p = 0.03). However, success at the first attempt was not significantly different among groups, ranging from 73.1% to 75.3% (p = 0.93). We conclude that although vein visibility is enhanced, near-infrared devices do not improve cannulation.
Article
Full-text available
Background: Poor vein visibility can make IV cannulation challenging in children with dark skin color. In the operating room, we studied the effectiveness of a near-infrared vascular imaging device (VascuLuminator) to facilitate IV cannulation in children with dark skin color. Methods: In the operating room of a general hospital in Curacao, all consecutive children (0-15 years of age) requiring IV cannulation were included in a pragmatic cluster randomized clinical trial. The VascuLuminator was made available to anesthesiologists at the operating complex in randomized clusters of 1 week. Results: Success at first attempt was 63% (27/43, 95% confidence interval [CI], 47%-77%) in the VascuLuminator group vs 51% (23 of 45 patients, 95% CI, 36%-66%) in the control group (P = 0.27). Median time to successful cannulation was 53 seconds (interquartile range: 34-154) in the VascuLuminator group and 68 seconds (interquartile range: 40-159) in the control group (P = 0.54), and hazard ratio was 1.12 (95% CI, 0.73-1.71). Conclusion: The VascuLuminator has limited value in improving success at first attempt of facilitating IV cannulation in children with dark skin color.
Article
Full-text available
Background: Vascular access in critically ill children can be a real challenge for medical staff. Methods: To evaluate the effectiveness of a near-infrared light vein-viewing device for critically ill children, 60 pediatric inpatients were enrolled in a randomized prospective observation trial for intravenous cannulation. The patients' demographic data, mean time required to find the first available vessel, first-attempt success rate, mean number of attempts per patient, and the total time taken on the attempts per patient were compared. Results: Less time was required to find the first available vessel in the near-infrared light device group compared with the control group (126.37 vs. 383.61 seconds; p = 0.027). In addition, the near-infrared light device group had a fewer number of attempts compared with the control group (median 1 vs. 2; p = 0.004), and also a shorter total time of attempts per patient compared with the control group (186.16 vs. 497.23 seconds; p = 0.014). Conclusion: The use of a near-infrared light vein-viewing device for vascular access in critically ill children can decrease the total medical time and cost.
Article
Full-text available
Objective: Intravenous cannulation is a widespread medical procedure that can be difficult in children. Visualization of veins with near-infrared (NIR) light might support intravenous cannulation. Therefore, we investigated the effectiveness of an NIR vascular imaging system (VascuLuminator) in facilitating intravenous cannulation in children in the operating room. Methods: This was a pragmatic, cluster randomized clinical trial in all consecutive children (0-18 years) scheduled for elective surgery and in need of intravenous cannulation at a tertiary pediatric referral hospital. Daily operating rooms (770 patients) were randomized for allocation of the VascuLuminator or control group. The primary outcome was success at first attempt; the secondary outcome was time to successful cannulation. Results: Success at first attempt was 70% (171/246) with and 71% (175/245) without the use of the VascuLuminator (P = .69). Time to successful cannulation was 162 (± 14) seconds and 143 (± 15) seconds respectively (P = .26). In 83.3%, the vein of first choice was visible with the VascuLuminator. Conclusions: Although it was possible to visualize veins with NIR in most patients, the VascuLuminator did not improve success rate or time to obtain intravenous cannulation. There are 3 possible explanations for this result: first, it could be that localization of the vein is not the main problem, and therefore visualization is not a solution; second, the type of system used in this study could be less than optimal; and, third, the choice of the patient population in this study could be inappropriate.
Article
Full-text available
Obtaining access to blood vessels can be difficult, especially in children. Visualization of subsurface blood vessels might be a solution. Ultrasound and visible light have been used to this purpose, but have some drawbacks. Near-infrared light might be a better option since subsurface blood vessels can be visualized in high contrast due to less absorption and scattering in tissue as compared to visible light. Our findings with a multispectral imaging system support this theory. A device, the VascuLuminator, was developed, based on transillumination of the puncture site with near-infrared light. The VascuLuminator was designed to meet the requirements of compact and safe use. A phantom study showed that the maximum depth of visibility (5.5mm for a 3.6mm blood vessel) is sufficient to visualize blood vessels in typical locations for peripheral venous and arterial access. A quantitative comparison of the VascuLuminator and to two other vessel imaging devices, using reflection of near-infrared light instead of transillumination, was conducted. The VascuLuminator is able to decrease failure at first attempt in blood withdrawal in pediatric patients from 10/80 (13%) to 1/45 (2%; P=.05).
Article
Although a serious impediment in haemo-philia patients, difficulty accessing peripheral veins has received little attention in clinical studies. New peripheral vein visualization devices could potentially ameliorate difficult venous access (DVA), but their utility remains unproved. The study aim was to survey the frequency, causes and clinical manifestations of DVA and evaluate the clinical utility of a near-infrared (NIR) vein visualizer. In this multicentre prospective study, methods, difficulties and outcomes of venous access were assessed for a single venipuncture in consecutive patients. The impact of an NIR vein visualizer on vein localization, the number of venipuncture attempts and patient stress and pain was determined. Among 450 total patients enrolled, venous access was judged to be difficult in 165 (36.7%), most often because of poor vein condition, young patient age, overweight and difficulty in finding veins. Of the patients with DVA, difficulty in locating veins was encountered in 82.4%, and more than one venipuncture attempt was required in 24.8%. Veins were difficult to locate in significantly fewer DVA patients (P = 0.002) when the NIR vein visualizer was used (76.0%) than not used (92.3%). Pain during venipuncture in DVA patients was also significantly less common (P = 0.019) with use of the NIR vein visualizer (34.0% vs. 55.4%). No effect was observed on venipuncture attempts. DVA affects more than one-third of patients at haemophilia treatment centres. An NIR vein visualizer showed significant promise for facilitating vein location and mitigating patient pain in those patients.
Article
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-values of <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, 98 seconds, 95% CI = 85 to 113 seconds; and AccuVein, 119 seconds, 95% CI = 93 to 154 seconds) 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.
Article
Background: The VeinViewer (Luminetx, Memphis, TN) helps identify veins by projecting an image of subcutaneous vasculature on the skin surface. We tested the primary hypothesis that VeinViewer use improves cannulation success by skilled nurses in pediatric patients with anticipated difficult IV access. A secondary goal was to evaluate the relationship between obesity and cannulation success. Methods: Patients aged 0 to 18 years were included. Anticipated cannulation difficulty was evaluated with the difficult IV access score. All cannulations were performed by members of the Intravenous Access Team. Patients were randomized to: (1) routine IV catheter insertion; or (2) insertion facilitated by the VeinViewer. The primary outcome was first-attempt insertion success. The proportion of successful insertions was evaluated using Cochran-Mantel-Haenszel χ(2) analysis to adjust for any imbalanced baseline variables. The effect of obesity on cannulation success was evaluated with multivariable logistic regression. Results: Two hundred ninety-nine patients (49%) were randomly assigned to VeinViewer and 301 (51%) to routine cannulation. First-attempt cannulation success was 47% in patients assigned to VeinViewer vs 62% in patients assigned to routine cannulation, with an adjusted relative "risk" (95% confidence interval), of 0.76 (0.63-0.91). The Z-statistic of -3.6 crossed the "harm" boundary (Z < -2.41), with corresponding P value of 0.0003. The trial was stopped on statistical grounds since the harm boundary for the primary outcome was crossed. There was no association between first-attempt success and the 4-level categorization of obesity after adjusted for baseline variables (P = 0.94). Conclusions: The VeinViewer worsened first-attempt IV insertion success by skilled nurses. Surprisingly, first-attempt success for IV cannulation was not worsened by obesity.
Article
Background: We investigated the patient characteristic factors that correlate with identification of i.v. cannulation sites with normal eyesight. We evaluated a new infrared vein finding (VF) technology device in identifying i.v. cannulation sites. Methods: Each subject underwent two observations: one using the conventional method (CM) of normal, unassisted eyesight and the other with the infrared VF device, VueTek's Veinsite™ (VF). A power analysis for moderate effect size (β=0.95) required 54 samples for within-subject differences. Results: Patient characteristic profiles were obtained from 384 subjects (768 observations). Our sample population exhibited an overall average of 5.8 [95% confidence interval (CI) 5.4-6.2] veins using CM. As a whole, CM vein visualization were less effective among obese [4.5 (95% CI 3.8-5.3)], African-American [4.6 (95% CI 3.6-5.5 veins)], and Asian [5.1 (95% CI 4.1-6.0)] subjects. Next, the VF technology identified an average of 9.1 (95% CI 8.6-9.5) possible cannulation sites compared with CM [average of 5.8 (95% CI 5.4-6.2)]. Seventy-six obese subjects had an average of 4.5 (95% CI 3.8-5.3) and 8.2 (95% CI 7.4-9.1) veins viewable by CM and VF, respectively. In dark skin subjects, 9.1 (95% CI 8.3-9.9) veins were visible by VF compared with 5.4 (95% CI 4.8-6.0) with CM. Conclusions: African-American or Asian ethnicity, and obesity were associated with decreased vein visibility. The visibility of veins eligible for cannulation increased for all subgroups using a new infrared device.