Prospective evaluation of venous access difficulty and a near-infrared vein visualizer at four French haemophilia treatment centres

Near-infrared technology for improved PIVC placement: a clinical technology implementation model

AIMS

To share lessons learned from an evidence-based practice (EBP) initiative that implemented near-infrared (NIR) technology in a large US hospital system. A Clinical Technology Implementation Model (CTIM©) that can be adapted for use in other health institutions is presented.

BACKGROUND

EBP implementation, including the adoption of new cutting-edge technologies, is crucial to improving patient care. Yet there are significant delays in changes to clinical practice, often due to organisational challenges that stifle the implementation process. The evidence-practice gap is increasingly evident in peripheral intravenous access (PIV). Implementation science offers new insights into the challenges of updating clinical practice, which can support EBP implementation.

EVALUATION

Recent literature on implementation science, change theory, PIV access, NIR technology, and patient outcomes were reviewed. A model that can help nurse managers implement technology that aligns with EBP is presented, drawing on experience from the adoption of NIR vein visualisation to enhance PIV access in a large US hospital system.

KEY ISSUE

A pervasive hesitancy in healthcare to embrace technology, coupled with the challenges of implementing a change to practice, has led to limited application of EBP PIV access guidelines and a stagnant standard of care.

CONCLUSION

This article provides nurse managers with the tools necessary to successfully implement EBP, drawing on the experience from implementing NIR in a large US hospital. Nurse managers are uniquely positioned to lead the way in embracing technology to improve care and reduce the evidence-practice gap.

An Improved Definition and SAFE Rule for Predicting Difficult Intravascular Access (DIVA) in Hospitalized Adults

Patients with difficult intravascular access (DIVA) are common, yet the condition is often ignored or poorly managed, leading to patient dissatisfaction and misuse of health care resources. This study sought to assess all published risk factors associated with DIVA in order to promote prospective identification and improved management of patients with DIVA. A systematic literature review on risk factors associated with DIVA was conducted. Risk factors published in ≥4 eligible studies underwent a multivariate meta-analysis of multiple factors (MVMA-MF) using the Bayesian framework. Of 2535 unique publications identified, 20 studies were eligible for review. In total, 82 unique DIVA risk factors were identified, with the 10 factors found in ≥4 studies undergoing MVMA-MF. Significant predictors of DIVA included vein visibility, vein palpability, history of DIVA, obesity (body mass index [BMI] >30), and history of intravenous (IV) drug abuse, which were combined to create the mnemonic guideline, SAFE: See, Ask (about a history of DIVA or IV drug abuse), Feel, and Evaluate BMI. By recognizing patients with DIVA before the first insertion attempt and treating them from the outset with advanced vein visualization techniques, patients with DIVA could be subject to less frequent painful venipunctures, fewer delays in treatment, and a reduction in other DIVA-associated burdens.

The economic burden of difficult intravenous access in the emergency department from a United States' provider perspective

Background

Peripheral intravenous catheter placement is one of the most common invasive procedures that nurses will perform, especially in emergency departments.

Aims

This early analysis aimed to quantify the economic burden associated with intravenous therapy in patients presenting in emergency departments with difficult intravenous access, receiving traditional peripheral intravenous catheters. This may inform the opportunity for improvement for investment in nursing tools and services regarding difficult venous access burden reduction.

Methods

Model parameter data were obtained from published literature where possible via a targeted literature review for the terms including relative variations of 'Difficult Venous Access', 'burden', and 'costs', or elicited from expert clinical opinion. A simple decision tree model was developed in Microsoft® Excel 2016. Results included number of insertion attempts, number of patients requiring escalation, catheter failures due to complications, healthcare professional (e.g. nurse) time, and total costs (including/excluding health care professional time). Sensitivity analyses were performed.

Results

The model considers 64,000 individuals presenting in the emergency department annually, of which 75% (48,000) require a peripheral intravenous catheter; of these 22% (10,560) are estimated to have difficult venous access. The total cost burden of difficult venous access is estimated to be $890,095 per year/$84.29 per patient with difficult venous access, including the cost of clinician time. Key total cost drivers include the population size treated in the emergency department annually, the proportion of midlines placed by a specialist IV (intravenous access) nurse and the percentage of patients with difficult venous access.

Conclusion

This is the first formal analysis estimating the significant economic burden of difficult venous access in emergency departments via peripheral intravenous catheter placement, a task frequently performed by nurses. Further studies are needed to evaluate nursing-centric strategies for reducing this burden. Additionally, adoption of a concise definition is needed, as is routine use of reliable assessment tools so that future cost analyses can be better contextualised.

Safety, pharmacokinetics and efficacy of a subcutaneous recombinant FVIII (OCTA101) in adult patients with severe haemophilia A

INTRODUCTION

Regular, prophylactic intravenous (i.v.) FVIII can be challenging for some patients with haemophilia A. Subcutaneous (s.c.) FVIII administration could provide an alternative treatment option with greater convenience and without the complications associated with venous access.

AIM

To assess the safety, pharmacokinetics (PK), bioavailability and efficacy of s.c. OCTA101, a recombinant FVIII with a recombinant von Willebrand factor fragment dimer.

METHODS

This was a single-centre, prospective, open-label, phase I/II study (NCT04046848). Previously treated male patients (≥18 years) with severe haemophilia A were eligible for the study. The primary objective of the study was to assess the safety (including immunogenicity) of OCTA101. Secondary objectives included assessments of PK, bioavailability, and the efficacy of prophylaxis.

RESULTS

Thirty patients were treated with OCTA101. FVIII inhibitors developed in five (16.7%) patients during daily prophylaxis with 40-60 IU/kg (three cases) and 12.5 IU/kg (two cases) OCTA101. The trial was therefore terminated. OCTA101 had a 2.5-fold longer terminal half-life compared with i.v. rFVIII, and bioavailability was 16.6%. Efficacy data at study termination indicated that daily prophylaxis with 40-60 IU/kg OCTA101 was efficacious in the absence of FVIII inhibitors.

CONCLUSIONS

Despite promising PK and efficacy results, the trial was terminated due to the incidence of FVIII inhibitors. The occurrence of inhibitors at two dose levels suggests that their development may be related to the subcutaneous route of administration.

Incorporating Near Infrared Light Vein Visualization Technology Into Peripheral Intravenous Access Protocols

Placement of peripheral intravenous catheters (PIVCs) is a frequent occurrence. Yet, PIVCs consistently require multiple attempts for successful cannulation, leading to an increased use of resources and risk of complications. Even though hospitals have established vascular access teams to improve outcomes and increase longevity of PIVCs, not every facility has one, and some struggle to meet demand. In these cases, PIVC placement depends on the confidence and skills of bedside nurses. Difficult access risk identification tools, as well as vein visualization technologies, like near infrared (nIR), have been developed to assist nurses with cannulation. This study sought to explore how hospitals are using vein visualization technology in nurse-driven protocols and to evaluate whether the technology is being meaningfully integrated into venous assessment and PIVC access protocols. In a survey sent to facilities utilizing nIR technology, 48% of respondents incorporated nIR in nurse-driven protocols. Of these respondents, 88% reported improvement in patient satisfaction, 92% saw a reduction in escalations, and 79% reported a reduction in hospital-acquired infections associated with PIVC placement. Integrating vein visualization technology into nurse-driven PIVC placement protocols has the potential to make a positive impact but requires future research to reproduce these findings in clinical studies.

Comparison of Clinical, Economic, and Humanistic Outcomes Between Blood Collection Approaches: A Systematic Literature Review

BACKGROUND

A systematic literature review was performed to understand the prevalence, advantages, and disadvantages of blood collection using different approaches (direct venipuncture or vascular access devices), and interventions used to mitigate the disadvantages.

METHODS

The review included a broad range of study designs and outcomes. Database searches (Embase, MEDLINE, Cochrane library, and Centre for Reviews and Dissemination) were conducted in March 2021 and supplemented by hand searching.

RESULTS

One hundred forty-one publications were included. The data indicate that blood sampling from vascular access devices is common in emergency departments, trauma centers, and intensive care units. Studies showed that hemolysis and sample contamination place a considerable economic burden on hospitals. Significant cost savings could be made through enforcing strict aseptic technique, or using the initial specimen diversion technique.

CONCLUSIONS

Hemolysis and sample contamination are far from inevitable in vascular access device-collected or venipuncture samples; both can be reduced through adherence to strict blood sampling protocols and utilization of the initial specimen diversion technique. Needle-free blood collection devices offer further hope for reducing hemolysis. No publication focused on the difficult venous access population; insertion success rates are likely to be lower (and the benefits of vascular access devices higher) in these patients.

Watching me … watching you: Training and assessment in a virtual world

Virtual education isn't new. Teaching has been delivered remotely for many years, although it came to prominence with the enforced move to online learning during the COVID-19 pandemic. Technologies provide tools that are integral to our everyday lives, and training and assessment are no different. Stepping back from the obligatory remote delivery of practical skills training, now we have the opportunity to review and evaluate our own learning (as educators) about the value of resources for training delivery. Combining sound educational principles with the available technologies, we can use remotely delivered learning to enhance our teaching and to increase access to learning, without hindrance because of distance or the type of facility. Remote connections allow expertise and best practice to become suddenly available to a wider cohort of researchers, rapidly spreading new ideas about refinement of in vivo procedures and supporting colleagues to learn and develop. We currently use only a few of the technological tools available, and there is much to learn from other disciplines where virtual and augmented reality are assisting surgeons, aircraft pilots and others daily. By harnessing remote and assisted technologies in teaching, we can also develop the mindset and ability of the biomedical community to use them to augment, or even to replace, animal studies in future and to democratise training globally.

European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project

Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.

The Effect of a New Ligation and Venipuncture Method on Vena Basilica Vessel

Objective

This study evaluated the impact of a novel venipuncture method on vascular parameters of vena basilica to provide a new technical option for the clinical management of difficult venipuncture.

Methods

32 volunteers examined by ultrasound at the Medical Imaging Center of The First People's Hospital of Nantong, Jiangsu province, from February 2020 to April 2020 were randomly selected. One hand of each patient was ligated with the traditional single tourniquet and the new ligation method for 20 seconds. Then, the distance between the left or right vena basilica and the skin and the diameter of blood vessels were measured by ultrasound. 98 patients with peripheral venipuncture difficulty who were examined by ultrasound of a third-grade hospital from April 2019 to March 2020 were selected and randomly divided into control group (n = 49) and experimental group (n = 49). The traditional method was used in the control group, and the new peripheral venipuncture was used in the experimental group. The success rate of single puncture, preparation time before puncture, time required for puncture operation, pain reaction during puncture, intravascular congestion after puncture, subcutaneous tissue injury, and vascular reuse rate after puncture were compared between the two methods.

Results

The new ligation and puncture method increased the diameter of peripheral superficial vein vessels by 0.51 ± 0.04 mm, and the change of vena basilica diameter was not significantly associated with gender and age of patient. The success rate of single puncture and the vascular reuse rate were significantly higher in the experimental group than in the control group, while the preparation time and venipuncture time, as well as the patient's pain response, were significantly lower in the experimental group compared to the control group, and the intravascular congestion and subcutaneous tissue injury were lower. In addition, the mean satisfaction score of patients in the experimental group was higher than that of the control group.

Conclusion

The new ligation and puncture method was an effective vena basilica dilation technique for filling the peripheral superficial veins, improving puncture success rate of peripheral difficult vein, and reducing patient pain, which was worth popularizing and applying in clinic.

Does the use of infrared technology (AccuVein AV-500®) for Peripheral Intravenous Cannulation (PIVC) increase the success rate in nursing students? A randomized controlled trial

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.

Augmented reality in anesthesia, pain medicine and critical care: a narrative review

Augmented reality (AR) is the integration of computer-generated information with the user's environment in real time. AR is used in many industries, including healthcare, where it has gained significant popularity. Recent strides in hardware and software engineering have reduced the cost of AR, while significantly improving the experience for users and developers. One of the first applications of AR technology in perioperative medicine has been in the identification of anatomical structures for regional blocks and peripheral or central vascular access. AR has also been implemented in pediatric care to reduce periprocedural anxiety. In this narrative review, we summarize the current role of AR in anesthesiology, pain medicine, and critical care.

Construction and validation of a family guidance manual on complications of intravenous therapy in children

OBJECTIVES

to build and validate the content of an educational manual for the inclusion of family members of hospitalized children in the prevention and early identification of complications associated with IVT through the peripheral route.

METHODS

it was a methodological study of construction and validation of the content of an instructional material. The validation process took place using the Delphi Technique, adopting a content validation index equal to or greater than 0.80 as a desirable consensus.

RESULTS

the handbook was validated in the second assessment round in all categories: content, language, illustration, layout, motivation, culture, and applicability. The Global Content Validation Index was 0.98.

CONCLUSIONS

because of the high values obtained (> 0.8), after the second evaluation, the handbook is considered validated in terms of content, by expert judges.

Impact of Peripheral Venous Catheter Placement With Vein Visualization Device Support on Success Rate and Pain Levels in Pediatric Patients Aged 0 to 3 Years

BACKGROUND

Pediatric nurses should be able to use techniques that increase the success rate or shorten the procedural duration of peripheral intravenous catheterization (PIVC).

OBJECTIVES

This study was performed to define the effect of the infrared vein visualization device support on the success of PIVC in pediatric patients aged 0 to 3 years. Success was determined based on the number of attempts per patient, the duration of the procedure, the success rate of first attempts, and the pain levels of the children.

METHODS

The study was a randomized, controlled experimental study on 54 children aged 0 to 3 years.

RESULTS

Peripheral intravenous catheterization in the study group was performed with fewer attempts (study group: 1.44 ± 0.85 [median, 1]; control group: 2.41 ± 1.99 [median, 2]; P = 0.016) and in a shorter period (study group: 44.37 ± 32.22 [median, 40 seconds]; control group: 168.89 ± 171.54 [median, 112 seconds; P = 0.001), and the first attempt success rate in the study group (74.1%) was higher than in the control group (40.7%; P = 0.028). Also, the pain level of the children in the study group was significantly lower than that in the control group (P < 0.05).

CONCLUSIONS

In conclusion, PIVC supported by the infrared vein visualization device reduces the number of attempts per patient, reduces the duration of the procedure, and increases the success rate of first attempts, and there is procedural pain; therefore, vein visualization improves the success of PIVC.

Effect of a Vein Imaging Device and of Fist Clenching on Determination of an Appropriate Vein and on Catheter Placement Time in Patients Receiving Chemotherapy: A Randomized Controlled Trial

BACKGROUND

As the vein structure gets damaged in patients receiving chemotherapy treatment, placement of peripheral intravenous catheter becomes difficult. To increase the success of peripheral intravenous catheter placement, a vein imaging device and fist clenching can be used.

OBJECTIVE

The aim of this study was to determine the effect of using a vein imaging device or fist clenching on the determination of an appropriate vein and successful catheter placement time in adult patients receiving chemotherapy.

METHODS

One hundred thirty-five patients receiving chemotherapy were randomly assigned to either the vascular imaging device group (n = 45), the fist clenching group (n = 45), or the control group (n = 45). In the vascular imaging group, a vascular imaging device was used to determine the appropriate vein; in the fist clenching group, the patients were asked to open and close their palms to determine the appropriate vein; and in the control group, no interventions except for the process steps were applied and the same nurse carried out the catheter insertion.

RESULTS

The durations of determining the appropriate vein and successful peripheral intravenous catheter insertion were shorter in the device group at a significant level (P < .05) compared with the control group. The satisfaction levels of the patients and the nurse were higher in the device group at a significant level (P < .05) compared with the control group.

CONCLUSION

The vascular imaging device was effective in determining the proper vein and in successful intravenous catheter insertion time in patients who were receiving chemotherapy.

IMPLICATIONS FOR PRACTICE

The use of vein imaging device will have positive results for patients and nurses.

Peripheral vascular access for therapeutic plasma exchange: A practical approach to increased utilization and selecting the most appropriate vascular access

BACKGROUND

Therapeutic plasma exchange (TPE) is used in the treatment of many diseases. At present, peripheral vascular access (PVA) is an underutilized method of vascular access in TPE. It should be considered more frequently due its relatively low risk for adverse events, particularly infections.

METHODS

The Advancing Vascular Access in Apheresis Working Group met in December 2017 for an extensive review and discussion of vascular access for TPE and developed a "road map" providing detailed information regarding clinical situations in which PVA-based TPE would and would not be appropriate.

RESULTS

The road map is consistent with current recommendations that PVA should be used in combination with TPE whenever possible. PVA should be considered for patients who do not have existing central lines and who are stable. The patient should have peripheral veins that will allow for adequate treatment and must be able to comply with the process of achieving and maintaining peripheral access. There should be expert clinical assessment of veins, and this evaluation may include ultrasound and/or near infrared evaluation. Conditions that would prompt a switch from PVA to an alternate method of venous access include loss of venous access, patient preference, or development of a requirement for very frequent treatment over a long period of time.

CONCLUSIONS

While PVA is not suitable for all patients requiring TPE, it has significant safety advantages over other approaches and should be employed whenever possible.

Elaboración y validación del contenido y apariencia de la cartilla “punción venosa periférica para la familia”

Introducción: Durante la hospitalización del niño, en algunas situaciones clínicas, se necesita utilizar la Terapia Intravenosa por vía periférica, a través de la instalación de dispositivos intravenosos. Este procedimiento puede causar sentimientos negativos en la crianza, los cuales se pueden amenizar a través del uso de tecnologías didácticas e Instruccionales. De esta forma, el objetivo del estudio consiste en elaborar y validar el contenido y la apariencia de la cartilla titulada “Punción venosa periférica para la familia” con jurados especialistas en el área pediátrica. Materiales y Métodos: Se trata de una investigación metodológica del tipo elaboración y validación de cartilla educativa, realizada con siete jurados a través de la técnica Delphi. Para recolectar los datos se utilizó un instrumento estructurado que contenía variables categorizadas de la siguiente forma: contenido, lenguaje, ilustración, layout, motivación, cultura y aplicabilidad. Se adoptó como valor deseable el Índice de Validación de Contenido igual o superior a 0,80 para cada criterio evaluado. Resultados: En el estudio participaron siete jurados especialistas, todos del sexo femenino, enfermeras, de las cuales cinco son magister, una doctora y una especialista, que se desempeñaban en el campo de la educación, asistencia, investigación y extensión en el área pediátrica. La cartilla fue validada en la primera ronda de evaluación, obteniendo un Índice Global de Validación de Contenido de 0,98. Discusión y Conclusiones: Los jueces consideraron válida la cartilla propuesta en términos de contenido y apariencia, sugiriendo que este recurso educativo tiene potencial para ayudar en la educación en salud sobre la Cateterización Intravenosa Periférica impartida en niños. Cómo citar este artículo: Silva C, Lisboa S, Santos L, Carvalho S, Passos S, Santos S. Elaboração e validação de conteúdo e aparência da cartilha “Punção venosa periférica para a família”. Rev Cuid. 2019; 10(3): e830. http://dx.doi.org/10.15649/cuidarte.v10i3.830

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

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 than [corrected] 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.

Risk factors for a difficult intravenous access: A multicentre study comparing nurses' beliefs to evidence

AIMS AND OBJECTIVES

To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence.

BACKGROUND

Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence.

DESIGN

The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses.

METHODS

The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed.

RESULTS

Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research.

CONCLUSIONS

An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research.

RELEVANCE TO CLINICAL PRACTICE

Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Impact of near infrared light in pediatric blood drawing Centre on rate of first attempt success and time of procedure

Background

Peripheral blood access and venipuncture are a stressful and painful experience in pediatric patients; moreover, it is estimated that more than one attempt is required to achieve the procedure in about one third of children. For this reason, we investigated if Near-infrared light technology routinely used, could give an advantage to venipuncture in a pediatric blood center setting.

Methods

We conducted an open, pseudo-randomized controlled trial with two parallel arms, in the blood-drawing center, with enrolment of 115 patients between 0 and 18 years, in 14 consecutive working days. Fifty-three subjects were enrolled in group 1 (VeinViewer®) and 62 in group 2 (control group). We divided patients into three subgroups considering their age (< 5 years, 6–10 years, > 10 years). The primary study outcome was to assess if the use of VeinViewer® was associated with a reduction of time to perform blood sampling. The secondary outcome was to analyze VienViewer®‘s impact on first attempt success rate in blood sampling.

Results

No difference was found regarding the duration of blood sampling between the two groups, even after stratifying the patients into the three age subgroups. There was no difference between the two groups in the success at the first attempt in blood sampling.

Conclusions

Routine use of VeinViewer® is not useful to reduce time of the procedure during venipuncture.

Trial registration

The study was registered with ClinicalTrials.gov, with number NCT03277092, on September 8, 2017.

Near-Infrared Vein Visualization in Index Finger Pollicization

Near-infrared vein visualization devices allow for noninvasive identification of superficial veins. During index finger pollicization, preservation of the dorsal veins is important for protecting blood outflow from the digit. Near-infrared vein visualization devices can be used to identify the location of the dorsal veins prior to skin incision, allowing increased confidence during dissection. We describe the use of this device to identify veins during index finger pollicization.

Use of cutting-edge biomedical devices for intravenous cannulation in the health care of a patient: literature review

Introduction: Biomedical devices are tools used for locating invisible and impalpable peripheral veins. The purpose of this article is to give a systematic review and analysis of existing studies on the available biomedical devices used for locating peripheral veins and on their effectiveness in clinical practice. Methods: Databases CINAHL, Medline and ScienceDirect were used for the literature review and analysis. The search was performed with the following key words in English: devices, visualization, technology, cannulation, vein, nursing care, with Boolean operators 'AND' and 'OR'. The analysis included randomized and experimental clinical studies published in the English language in the period from 2000 to August 2016. From a total of 1,020 retrieved studies, 17 were included in the detailed analysis. Results: The results of the analysis have shown that the success rate of the first attempt of intravenous cannulation using biomedical devices in more than half of the studies was not significantly higher than when the process was performed using the conventional method. The success of the first attempt of intravenous cannulation mostly depends on the experience and skills of nurses. Biomedical devices are more helpful for novice nurses who do not perform cannulation on a daily basis, for beginners and nursing students. Discussion and conclusions: Based on research, we cannot affirm that biomedical devices significantly contribute to easier peripheral venous cannulation. Further research is required to validate the advantages of such an approach. However, this is limited due to the affordability issues of such biomedical devices.

Vascular Access in the Pediatric Population

Vascular access procedures are an important and frequent component of the day-to-day practice of the pediatric surgeon. Most access procedures can be performed percutaneously via Seldinger or modified Seldinger technique and are aided by technology, such as ultrasound and fluoroscopy. Complications, such as infection, do occur, and the pediatric surgeon should be able to diagnose and treat these when they arise. The indications, techniques, and complications of vascular access are covered in this article.

Development of the A-DIVA Scale: A Clinical Predictive Scale to Identify Difficult Intravenous Access in Adult Patients Based on Clinical Observations

Placement of a peripheral intravenous catheter is a routine procedure in clinical practice, but failure of intravenous cannulation regularly occurs. An accurate and reliable predictive scale for difficult venous access creates the possibility to use other techniques in an earlier time frame. We aimed to develop a predictive scale to identify adult patients with a difficult intravenous access prospectively: the A-DIVA scale. This prospective, observational, cross-sectional cohort study was conducted between January 2014 and January 2015, and performed at the department of anesthesiology of the Catharina Hospital (Eindhoven, The Netherlands). Patients 18 years or older were eligible if scheduled for any surgical procedure, regardless ASA classification, demographics, and medical history. Experienced and certified anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access. Cannulation was performed regarding standards for care. A failed peripheral intravenous cannulation on the first attempt was the outcome of interest. A population-based sample of 1063 patients was included. Failure of intravenous cannulation was observed in 182/1063 patients (17%). Five variables were associated with a failed first attempt of peripheral intravenous cannulation: palpability of the target vein (OR = 4.94, 95% CI [2.85-8.56]; P < 0.001), visibility of the target vein (OR = 3.63, 95% CI [2.09-6.32]; P < 0.001), a history of difficult peripheral intravenous cannulation (OR = 3.86, 95% CI [2.39-6.25]; P < 0.001), an unplanned indication for surgery (OR = 4.86, 95% CI [2.92-8.07]; P < 0.001), and the vein diameter of at most 2 millimeters (OR = 3.37, 95% CI [2.12-5.36]; P < 0.001). The scoring system was applied in 3 risk groups: 36/788 patients (5%) suffered from a failed first attempt in the low-risk group (A-DIVA score 0 or 1), whereas the medium (A-DIVA score 2 or 3) and high-risk group (A-DIVA score 4 plus), included 72/195 (37%) and 74/80 (93%) patients with a failed first attempt of inserting a peripheral intravenous catheter, respectively. The additive 5-variable A-DIVA scale is a reliable predictive rule that implies the probability to identify patients with a difficult intravenous access prospectively. Dutch Trial Register (ref: 4595).