Infrared augmented reality device versus standard procedure for peripheral venous catheterisation in children less than 3 years old: A quasi-experimental cluster randomised controlled trial

The infrared-assisted peripheral intravenous catheterization in pediatric patients: A systematic review and meta-analysis

BACKGROUND

The peripheral intravenous catheter (PIVC) is an important strategy for the treating the illness of pediatric patients. However, the success rate of traditional PIVC method, such as the landmark technique, might be significantly variable and unstable. The near infrared-assisted PIVC might be another option and the results can be revealed by a systemic review and meta-analysis of randomized clinical trials (RCT).

METHODS

A systematic search and a meta-analysis for the RCT of near infrared-assisted PIVC on pediatric patients. The near infrared-assisted and traditional PIVC was compared to evaluate the first time success rate, number of attempts, and attempt duration. Seven RCT studies and total 1068 pediatric patients were enrolled in this meta-analysis. The subgroup analysis of vessel grade difficulty was also performed.

RESULTS

The near infrared-assisted PIVC showed a significantly higher odds ratio of first time success rate when compared to traditional PIVC. In addition, the number of attempts and attempt duration were significantly reduced in the group of near infrared-assisted PIVC. At last, the subgroup analysis of vessel grade difficultly showed that the first time success rate was borderline significantly increased in the subgroup of difficult vessel grade. In addition, the number of attempts was significantly reduced in the subgroup of difficult vessel grade.

CONCLUSIONS

The near infrared-assisted PIVC might be an option for the PIVC on pediatric patients. The advantages of increased first time success rate and decreased number of attempts and attempt duration should be considered by the clinicians and nurses.

Vein Visualization With a Near Infrared Imaging Device and Its Impact on Students' and Nurses' Skills in an Academic Teaching University Hospital

Venipuncture for blood collection is frequently delegated to medical or nursing students, while their individual skills depend on the quality of teaching. The aim of this study was to evaluate the use of a near infrared imaging (NIR) system on the visualization of veins and its potential benefit for the education of medical personnel. Participants answered a questionnaire following standardized venipuncture for blood sampling with the help of an NIR device. Vein visibility with the NIR device and its ability to facilitate venipuncture were examined. Visibility of veins was significantly better with the NIR, and its direction was clearly delineated. Sixty-nine percent of the participants stated that they felt more secure with venipuncture after using the NIR device. Patients' individual factors limited the visibility of veins. The adjuvant use of an NIR system for venipuncture improves participants' subjective skills through visualization of veins and their direction.

Effectiveness of near-infrared light devices for peripheral intravenous cannulation in children and adolescents: A meta-analysis of randomized controlled trials

OBJECTIVES

To examine the effectiveness of near-infrared light devices (NIR) on procedure time of successful cannulation, success rate at the first attempt, and pain scores among pediatric patients and explore potential covariates on the intervention effect.

BACKGROUND

Pediatric patients have encountered a high failure rate as compared with adult patients using traditional cannulation. NIR devices might help to access veins with an optimum viewing area and eliminate the number of attempts. However, methodological limitations and inconsistent results from previous reviews were found.

METHODS

A three-step comprehensive search was performed in nine databases. Meta-analysis, subgroup, and meta-regression analyses were conducted. Individual quality assessment and certainty of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations, Assessments, Development, and Evaluation criteria, respectively.

RESULTS

We included 18 randomized controlled trials (RCTs) with 5298 children and adolescents across nine countries. NIR light devices significantly reduce -29.43 s of procedure time and -0.47 attempts of peripheral intravenous cannulation compared with traditional methods. Subgroup analysis observed a significantly large effect size on procedure time using AccuVein with pre-procedure training at the clinics. However, NIR light devices do not significantly decrease the procedure time, first attempt success rate, and pain scores. Meta-regression identified sample size as a significant covariate that had an impact on the success rate at the first attempt.

CONCLUSIONS

The near-infrared light device can statistically significantly reduce the procedure time and the number of attempts. Given the low or very low certainty of the evidence, future well-designed RCTs are necessary.

Technological Innovations to Improve Patient Engagement in Nephrology

Technological innovation has accelerated exponentially over the last 2 decades. From the rise of smartphones and social media in the early 2000s to the mainstream accessibility of artificial intelligence (AI) in 2023, digital advancements have transformed the way we live and work. These innovations have permeated health care, covering a spectrum of applications from virtual reality training platforms to AI-powered clinical decision support tools. In this review, we explore fascinating recent innovations that have and can facilitate patient engagement in nephrology. These include integrated care mobile applications, wearable health monitoring tools, virtual/augmented reality consultation and education platforms, AI-powered appointment booking systems, and patient information tools. We also discuss potential pitfalls in implementation and paradigms to adopt that may protect patients from unintended consequences of being cared for in a digitalized health care system.

Efficacy of Infrared Vein Visualization versus Standard Technique for Peripheral Venous Cannulation in Infant and Toddler Populations: A Randomized Study

Establishing intravenous (IV) access in younger patient populations via the traditional cannulation technique for procedures requiring anesthesia is often challenging. Infrared (IR) vein visualization is a modality that aids venous cannulation; however, few reports of this technique exist in the infant and toddler population. The primary aim of this study was to compare the efficacy of IR vein visualization to the standard cannulation technique for obtaining peripheral IV access in infant and toddler populations. Following Institutional Review Board (IRB) approval and written informed consent, children were randomly assigned to either a standard cannulation technique group or an IR vein visualization device group for venous cannulation. The primary outcome variable was the success rate of IV cannulation, and the secondary variables were the total number of attempts and the time to successful cannulation. No difference was noted between either group for first-attempt success rate (standard versus IR: 61.25% vs. 54.4%; p = 0.4) or time to establish IV cannulation (standard versus IR: median [interquartile range], 40 s [24-120] vs. 53 s [26-106]; p = 0.55). The anesthesiologist's grading of the anticipated difficulty of IV cannulation was a significant predictor of cannulation success (p = 0.0016). Our study demonstrated no significant benefit in utilizing the IR vein visualization device in terms of the overall success rate, number of attempts, and time to establish successful IV cannulation when compared to the standard technique. However, in difficult IV access situations, this device proved to be a valuable rescue adjunct.

Non-pharmacological management of infant and young child procedural pain

BACKGROUND

Despite evidence of the long-term implications of unrelieved pain during infancy, it is evident that infant pain is still under-managed and unmanaged. Inadequately managed pain in infancy, a period of exponential development, can have implications across the lifespan. Therefore, a comprehensive and systematic review of pain management strategies is integral to appropriate infant pain management. This is an update of a previously published review update in the Cochrane Database of Systematic Reviews (2015, Issue 12) of the same title.

OBJECTIVES

To assess the efficacy and adverse events of non-pharmacological interventions for infant and child (aged up to three years) acute pain, excluding kangaroo care, sucrose, breastfeeding/breast milk, and music.

SEARCH METHODS

For this update, we searched CENTRAL, MEDLINE-Ovid platform, EMBASE-OVID platform, PsycINFO-OVID platform, CINAHL-EBSCO platform and trial registration websites (ClinicalTrials.gov; International Clinical Trials Registry Platform) (March 2015 to October 2020). An update search was completed in July 2022, but studies identified at this point were added to 'Awaiting classification' for a future update.  We also searched reference lists and contacted researchers via electronic list-serves.  We incorporated 76 new studies into the review.  SELECTION CRITERIA: Participants included infants from birth to three years in randomised controlled trials (RCTs) or cross-over RCTs that had a no-treatment control comparison. Studies were eligible for inclusion in the analysis if they compared a non-pharmacological pain management strategy to a no-treatment control group (15 different strategies). In addition, we also analysed studies when the unique effect of adding a non-pharmacological pain management strategy onto another pain management strategy could be assessed (i.e. additive effects on a sweet solution, non-nutritive sucking, or swaddling) (three strategies). The eligible control groups for these additive studies were sweet solution only, non-nutritive sucking only, or swaddling only, respectively. Finally, we qualitatively described six interventions that met the eligibility criteria for inclusion in the review, but not in the analysis.  DATA COLLECTION AND ANALYSIS: The outcomes assessed in the review were pain response (reactivity and regulation) and adverse events. The level of certainty in the evidence and risk of bias were based on the Cochrane risk of bias tool and the GRADE approach. We analysed the standardised mean difference (SMD) using the generic inverse variance method to determine effect sizes.  MAIN RESULTS: We included total of 138 studies (11,058 participants), which includes an additional 76 new studies for this update. Of these 138 studies, we analysed 115 (9048 participants) and described 23 (2010 participants) qualitatively. We described qualitatively studies that could not be meta-analysed due to being the only studies in their category or statistical reporting issues. We report the results of the 138 included studies here. An SMD effect size of 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. The thresholds for the I2 interpretation were established as follows: not important (0% to 40%); moderate heterogeneity (30% to 60%); substantial heterogeneity (50% to 90%); considerable heterogeneity (75% to 100%). The most commonly studied acute procedures were heel sticks (63 studies) and needlestick procedures for the purposes of vaccines/vitamins (35 studies). We judged most studies to have high risk of bias (103 out of 138), with the most common methodological concerns relating to blinding of personnel and outcome assessors. Pain responses were examined during two separate pain phases: pain reactivity (within the first 30 seconds after the acutely painful stimulus) and immediate pain regulation (after the first 30 seconds following the acutely painful stimulus). We report below the strategies with the strongest evidence base for each age group. In preterm born neonates, non-nutritive sucking may reduce pain reactivity (SMD -0.57, 95% confidence interval (CI) -1.03 to -0.11, moderate effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.61, 95% CI -0.95 to -0.27, moderate effect; I2 = 81%, considerable heterogeneity), based on very low-certainty evidence. Facilitated tucking may also reduce pain reactivity (SMD -1.01, 95% CI -1.44 to -0.58, large effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.59, 95% CI -0.92 to -0.26, moderate effect; I2 = 87%, considerable heterogeneity); however, this is also based on very low-certainty evidence. While swaddling likely does not reduce pain reactivity in preterm neonates (SMD -0.60, 95% CI -1.23 to 0.04, no effect; I2 = 91%, considerable heterogeneity), it has been shown to possibly improve immediate pain regulation (SMD -1.21, 95% CI -2.05 to -0.38, large effect; I2 = 89%, considerable heterogeneity), based on very low-certainty evidence. In full-term born neonates, non-nutritive sucking may reduce pain reactivity (SMD -1.13, 95% CI -1.57 to -0.68, large effect; I2 = 82%, considerable heterogeneity) and improve immediate pain regulation (SMD -1.49, 95% CI -2.20 to -0.78, large effect; I2 = 92%, considerable heterogeneity), based on very low-certainty evidence.  In full-term born older infants, structured parent involvement was the intervention most studied. Results showed that this intervention has little to no effect in reducing pain reactivity (SMD -0.18, 95% CI -0.40 to 0.03, no effect; I2 = 46%, moderate heterogeneity) or improving immediate pain regulation (SMD -0.09, 95% CI -0.40 to 0.21, no effect; I2 = 74%, substantial heterogeneity), based on low- to moderate-certainty evidence. Of these five interventions most studied, only two studies observed adverse events, specifically vomiting (one preterm neonate) and desaturation (one full-term neonate hospitalised in the NICU) following the non-nutritive sucking intervention. The presence of considerable heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of evidence of very low to low certainty based on GRADE judgements.

AUTHORS' CONCLUSIONS

Overall, non-nutritive sucking, facilitated tucking, and swaddling may reduce pain behaviours in preterm born neonates. Non-nutritive sucking may also reduce pain behaviours in full-term neonates. No interventions based on a substantial body of evidence showed promise in reducing pain behaviours in older infants. Most analyses were based on very low- or low-certainty grades of evidence and none were based on high-certainty evidence. Therefore, the lack of confidence in the evidence would require further research before we could draw a definitive conclusion.