Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy

Vein segmentation and visualization of upper and lower extremities using convolution neural network

OBJECTIVES

The study focused on developing a reliable real-time venous localization, identification, and visualization framework based upon deep learning (DL) self-parametrized Convolution Neural Network (CNN) algorithm for segmentation of the venous map for both lower and upper limb dataset acquired under unconstrained conditions using near-infrared (NIR) imaging setup, specifically to assist vascular surgeons during venipuncture, vascular surgeries, or Chronic Venous Disease (CVD) treatments.

METHODS

A portable image acquisition setup has been designed to collect venous data (upper and lower extremities) from 72 subjects. A manually annotated image dataset was used to train and compare the performance of existing well-known CNN-based architectures such as ResNet and VGGNet with self-parameterized U-Net, improving automated vein segmentation and visualization.

RESULTS

Experimental results indicated that self-parameterized U-Net performs better at segmenting the unconstrained dataset in comparison with conventional CNN feature-based learning models, with a Dice score of 0.58 and displaying 96.7 % accuracy for real-time vein visualization, making it appropriate to locate veins in real-time under unconstrained conditions.

CONCLUSIONS

Self-parameterized U-Net for vein segmentation and visualization has the potential to reduce risks associated with traditional venipuncture or CVD treatments by outperforming conventional CNN architectures, providing vascular assistance, and improving patient care and treatment outcomes.

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.

HyperVein: A Hyperspectral Image Dataset for Human Vein Detection

HyperSpectral Imaging (HSI) plays a pivotal role in various fields, including medical diagnostics, where precise human vein detection is crucial. HyperSpectral (HS) image data are very large and can cause computational complexities. Dimensionality reduction techniques are often employed to streamline HS image data processing. This paper presents a HS image dataset encompassing left- and right-hand images captured from 100 subjects with varying skin tones. The dataset was annotated using anatomical data to represent vein and non-vein areas within the images. This dataset is utilised to explore the effectiveness of dimensionality reduction techniques, namely: Principal Component Analysis (PCA), Folded PCA (FPCA), and Ward's Linkage Strategy using Mutual Information (WaLuMI) for vein detection. To generate experimental results, the HS image dataset was divided into train and test datasets. Optimum performing parameters for each of the dimensionality reduction techniques in conjunction with the Support Vector Machine (SVM) binary classification were determined using the Training dataset. The performance of the three dimensionality reduction-based vein detection methods was then assessed and compared using the test image dataset. Results show that the FPCA-based method outperforms the other two methods in terms of accuracy. For visualization purposes, the classification prediction image for each technique is post-processed using morphological operators, and results show the significant potential of HS imaging in vein detection.

Visualization of Subcutaneous Blood Vessels Based on Hyperspectral Imaging and Three-Wavelength Index Images

Blood vessel visualization technology allows nursing staff to transition from traditional palpation or touch to locate the subcutaneous blood vessels to visualized localization by providing a clear visual aid for performing various medical procedures accurately and efficiently involving blood vessels; this can further improve the first-attempt puncture success rate for nursing staff and reduce the pain of patients. We propose a novel technique for hyperspectral visualization of blood vessels in human skin. An experiment with six participants with different skin types, race, and nationality backgrounds is described. A mere separation of spectral layers for different skin types is shown to be insufficient. The use of three-wavelength indices in imaging has shown a significant improvement in the quality of results compared to using only two-wavelength indices. This improvement can be attributed to an increase in the contrast ratio, which can be as high as 25%. We propose and implement a technique for finding new index formulae based on an exhaustive search and a binary blood-vessel image obtained through an expert assessment. As a result of the search, a novel index formula was deduced, allowing high-contrast blood vessel images to be generated for any skin type.

A guide to cannulation in adults

This article provides clinical guidance on performing cannulation on an adult. The site, equipment selection and aseptic non-touch technique will be discussed. The clinical procedural technique of cannulation will be explained and the article will also provide an awareness of the dangers and complications of this invasive technique for both the patient and the health professional.

Projection mapping system for laser speckle contrast image: feasibility study for clinical application

Significance

Laser speckle contrast images (LSCIs) have been utilized to monitor blood flow perfusion. However, they have conventionally been observed on monitor screens, resulting in potential spatial mismatching between the imaging region of interest (IROI) and monitor screen.

Aim

This study proposes a projection mapping (PM) system for LSCIs (PMS_LSCI) that projects LSCIs to directly observe the blood flow perfusion in the IROI.

Approach

The PMS_LSCI consists of a camera, imaging optics, a laser projector, and graphic user interface software. The spatial matching in the regions of interest was performed by adjusting the software screen of the LSCI in the IROI and evaluated by conducting in-vitro and in-vivo studies. An additional in-vivo study was performed to investigate the feasibility of real-time PM of the LSCI.

Results

The spatial mismatching in the regions of interest was ranged from 2.74% to 6.47% depending on the surface curvature. The PMS_LSCI could enable real-time PM of LSCI at four different blood flow states depending on blood pressure.

Conclusions

The PMS_LSCI projects the LSCI in the IROI by interacting with a projector instead of the monitor screen. The PMS_LSCI presented clinical feasibility in the in-vitro and in-vivo studies.

A Case of Axillary Web Syndrome Caused by Venous Blood Sampling

Axillary web syndrome (AWS) occurs after breast cancer surgery, sentinel lymph node dissection, or sentinel lymph node biopsy. Here, cord-like structures from the axilla to the forearm limit the range of motion of the shoulder joint and cause pain. Although the etiology is unknown, AWS has been attributed to the blockage of normal lymphatic flow. Here, we report a novel case of AWS after venous blood sampling in a patient. A healthy, 31-year-old male patient experienced pain with a limited range of motion of the shoulder joint the day after venous blood was collected from the left upper extremity for a medical checkup, and he presented to an orthopedic outpatient clinic on the day. Palpation of the axillary region disclosed a cord-like structure in the axillary region of the shoulder joint during abduction, and the patient was diagnosed with AWS. The cord-like structure was noted to be a hypoechogenic luminal structure on ultrasound (US) examination of the axilla, extending from the axilla to below the ulnar cutaneous vein from which the blood was drawn. In patients with pain and a limited range of motion of the shoulder joint, only the shoulder joint is examined during an orthopedic examination. It is important to obtain appropriate physical findings for possible AWS.

Literature review on the efficacy of near-infrared device in improving peripheral venous access time and number of attempts in pediatric patients

INTRODUCTION

The process of peripheral venous access (PVA) in children can be challenging for the patient and the clinician, as failed attempts often exceed the recommended two insertions, which can be painful. To speed up the process and increase success, near-infrared device (NIR) device technology has been introduced. This literature review aimed to investigate and critically evaluate the impact of NIR devices on the number of attempts and the time of the catheterization procedure in pediatric patients from 2015 to 2022.

METHODS

An electronic search was performed to identify studies in PubMed, Web of Science, Cochrane Library, and CINAHL Plus, from 2015 to 2022. After applying eligibility criteria, seven studies were considered for further review and evaluation.

RESULTS

The number of successful venipuncture attempts ranged from 1 to 2.41 in control groups and from 1 to 2 in NIR groups. The procedural time required for success ranged from 37.5 s to 252 s in the control group and from 28.47 s to 200 s in the NIR groups. The NIR assistive device could be successfully used in preterm infants and children with special health care needs.

CONCLUSIONS

While more research is needed to examine the training and application of NIR in preterm infants, some studies have shown improvement in placement success. The number of attempts and time required for a successful PVA may depend on several alternative factors, including general health, age, ethnicity, and knowledge and skills of healthcare providers. Future studies are expected to investigate how the level of experience of a healthcare provider performing venipuncture influences the outcome. More research is needed to explore additional factors that predict the success rate.

Patterns of superficial antecubital veins observed by near-infrared light technique: A community-based study

<b>Background: </b>The area of the cubital fossa contains the main superficial veins, including the basilic, cephalic, median cubital, and median antebrachial veins, and their innominate small tributaries. For this reason, it is the area most preferred by medical practitioners to access the circulatory system for various clinical applications.<br /> <b>Objective:</b> The aim of this study was to address the prevalence of different types of antecubital fossa superficial vein patterns observable among Saudi subjects by applying a tourniquet and using a VeinViewer®.<br /> <b>Materials and methods:</b><b> </b>Over the period from September 2020 to April 2021, a cross-sectional study was carried out in the Eastern Province of Saudi Arabia. The 151 study subjects were randomly chosen from the emergency department of King Fahad University Hospital. A total of 302 venous patterns were obtained; 55 were excluded due to the presence of scar tissues over the antecubital fossa, obesity, or thick subcutaneous tissue. Four classes of cubital venous patterns were established according to other studies, and a VeinViewer® and a tourniquet were used to visualize the venous patterns.<br /> <b>Results: </b>Of the 151 people, 21 were female and 130 were male. Among the included 247 venous patterns, the predominant type was type 2 (52.2%), characterized by a branching off the median cubital vein from the cephalic vein and an upward progression to join the basilic vein.<br /> <b>Conclusion: </b>Type 2 appears to be the dominant pattern, with no significant relation to the origins of the parents, in the Saudi population. Gender does not influence the venous patterns. Further studies are needed outside the restrictions of the COVID-19 pandemic to obtain a larger sample.

Near Infrared Illumination Optimization for Vein Detection: Hardware and Software Approaches

Venepuncture is one of the most crucial processes in many medical procedures. However, finding a real-time and vibrant visualization of the vein structures faces many difficulties. Several devices were introduced to solve this problem, yet, these devices shared common drawbacks, primarily when visualizing deep veins or veins in a thicker tissue of the human body. This study proposes a novel method for visualizing vein structures using a near-infrared (NIR) imaging technique enhanced with Hessian ridge detection. Several factors, including the wavelength of NIR light, square LED and ring LED arrangement and the effect of the diffuser and number of LEDs, were evaluated in the study. This study improves the overall quality of the acquired vein images and highlights the vein-morphological structure through image processing techniques. The study’s main aim is to achieve the highest number of visible veins. Based on the optical window, the maximum absorption range in the NIR spectrum was found from 700 to 950 nm. The NIR light absorption of human deoxygenated blood in the vein was highest at 850 nm peak of wavelength. The image processing further enhances the vein image by highlighting the extracted vein. The study also suggests that the square LED arrangements of NIR illumination are much more robust than the ring LED arrangement in ensuring excellent light penetration. The light diffuser further adds promising effects to the NIR illumination process. In terms of the square LED arrangement, increasing the square LED for enlarging the illumination area did not show any degradation effects in the visualization process. Overall, this paper presents an integrated hardware and software solution for the NIR image acquisition of a vein visualization system to cope with the image visualization of the vein for a thicker part of the human tissue, particularly on the arm and palm area.

Reconstructing a Deblurred 3D Structure in a Turbid Medium from a Single Blurred 2D Image—For Near-Infrared Transillumination Imaging of a Human Body

To provide another modality for three-dimensional (3D) medical imaging, new techniques were developed to reconstruct a 3D structure in a turbid medium from a single blurred 2D image obtained using near-infrared transillumination imaging. One technique uses 1D information of a curvilinear absorber, or the intensity profile across the absorber image. Profiles in different conditions are calculated by convolution with the depth-dependent point spread function (PSF) of the transillumination image. In databanks, profiles are stored as lookup tables to connect the contrast and spread of the profile to the absorber depth. One-to-one correspondence from the contrast and spread to the absorber depth and thickness were newly found. Another technique uses 2D information of the transillumination image of a volumetric absorber. A blurred 2D image is deconvolved with the depth-dependent PSF, thereby producing many images with points of focus on different parts. The depth of the image part can be estimated by searching the deconvolved images for the image part in the best focus. To suppress difficulties of high-spatial-frequency noise, we applied a noise-robust focus stacking method. Experimentation verified the feasibility of the proposed techniques, and suggested their applicability to curvilinear and volumetric absorbers such as blood vessel networks and cancerous lesions in tissues.

Speckle-resolved optical coherence tomography for mesoscopic imaging within scattering media

Light scattering poses a challenge for imaging deep in scattering media as the ballistic light exponentially attenuates with depth. In contrast to the ballistic light, the multiply scattered light penetrates deeper and also contains information about the sample. One technique to image deeper is to selectively detect only a subset of the multiply scattered light, namely the 'snake' photons, which are predominantly forward scattered and retain more direct information than the more strongly scattered light. In this work, we develop a technique, termed speckle-resolved optical coherence tomography (srOCT), for efficiently detecting these 'snake' photons to enable imaging deeper in scattering media. The system couples spatio-angular filtering with speckle-resolved interferometric detection to preferentially and efficiently detect the weakly scattered 'snake' photons. With our proof-of-concept system, we demonstrate depth-resolved imaging beyond the ballistic limit, up to a depth of 90 round-trip MFPs in a scattering phantom and a depth of 4.5 mm of chicken tissue at 0.4 mm axial and lateral resolution.

Feasibility of 830 nm laser imaging for vein localization in dark skin tissue-mimicking phantoms

Accessing blood vessels by medical professionals has been a challenge in healthcare centers worldwide. The main objective of this work is to investigate the localization of blood vessels in dark skin based on near infrared laser imaging. An 830 nm diode laser was used as a light source to irradiate dark skin mimicking optical phantoms. Phantoms were constructed to simulate dark skin with embedded polymer tubes filled with human blood to mimic subcutaneous veins. Appropriate image processing techniques were also used to enhance the detection and depth resolved differentiation of the vein phantoms. Results show that a linear regression model can represent the relation between the grey level in subcutaneous vein images and the depth of vessels down to 3 mm or deeper (n = 15, R² = 0.88, P < 0.001). The effect of laser power on the system performance is also discussed. Analysis of the collected images demonstrates the feasibility of 830 nm laser imaging for differentiating vein depths under dark skin surface. The proposed method would enhance the localization of invisible subcutaneous veins. This, in turn, would further improve the success rate of related medical procedures such as blood sampling, drawing, in the dark skin population.

Implementation of Thermal Camera for Non-Contact Physiological Measurement: A Systematic Review

Non-contact physiological measurements based on image sensors have developed rapidly in recent years. Among them, thermal cameras have the advantage of measuring temperature in the environment without light and have potential to develop physiological measurement applications. Various studies have used thermal camera to measure the physiological signals such as respiratory rate, heart rate, and body temperature. In this paper, we provided a general overview of the existing studies by examining the physiological signals of measurement, the used platforms, the thermal camera models and specifications, the use of camera fusion, the image and signal processing step (including the algorithms and tools used), and the performance evaluation. The advantages and challenges of thermal camera-based physiological measurement were also discussed. Several suggestions and prospects such as healthcare applications, machine learning, multi-parameter, and image fusion, have been proposed to improve the physiological measurement of thermal camera in the future.

Dorsal Hand Vein Image Enhancement Using Fusion of CLAHE and Fuzzy Adaptive Gamma

Enhancement of captured hand vein images is essential for a number of purposes, such as accurate biometric identification and ease of medical intravenous access. This paper presents an improved hand vein image enhancement technique based on weighted average fusion of contrast limited adaptive histogram equalization (CLAHE) and fuzzy adaptive gamma (FAG). The proposed technique is applied using three stages. Firstly, grey level intensities with CLAHE are locally applied to image pixels for contrast enhancement. Secondly, the grey level intensities are then globally transformed into membership planes and modified with FAG operator for the same purposes. Finally, the resultant images from CLAHE and FAG are fused using improved weighted averaging methods for clearer vein patterns. Then, matched filter with first-order derivative Gaussian (MF-FODG) is employed to segment vein patterns. The proposed technique was tested on self-acquired dorsal hand vein images as well as images from the SUAS databases. The performance of the proposed technique is compared with various other image enhancement techniques based on mean square error (MSE), peak signal-to-noise ratio (PSNR), and structural similarity index measurement (SSIM). The proposed enhancement technique’s impact on the segmentation process has also been evaluated using sensitivity, accuracy, and dice coefficient. The experimental results show that the proposed enhancement technique can significantly enhance the hand vein patterns and improve the detection of dorsal hand veins.

Locating Hormone-Releasing Contraceptive Implants Using Near-Infrared Light

BACKGROUND

Long-term hormone-releasing contraceptive (etonogestrel) implants are highly effective in preventing pregnancy. In a minority of patients, implants cannot be located by palpation, increasing the risk of complications related to removal. Ultrasonography can be used to locate migrated or deeply inserted implants, but this requires expertise. Thus, alternative methods to locate contraceptive implants are needed.

METHOD

Near-infrared light is sometimes used to facilitate venipuncture and has been described as a technique to locate implanted glucose sensors. Herein, I describe using near-infrared light to locate contraceptive implants. The near-infrared light was positioned perpendicularly and held 33 cm away from the arm. As soon as it is powered up, a reflection of the contraceptive implant is noticeable on the skin. The location of the implant is then marked before the removal procedure.

EXPERIENCE

This method allowed the easy location of nonpalpable etonogestrel implants in five women.

CONCLUSION

Near-infrared light was successful in locating nonpalpable etonogestrel implants. This novel method can be used as an alternative to ultrasonography.

Three-dimensional imaging through turbid media using deep learning: NIR transillumination imaging of animal bodies

Using near-infrared (NIR) light with 700-1200 nm wavelength, transillumination images of small animals and thin parts of a human body such as a hand or foot can be obtained. They are two-dimensional (2D) images of internal absorbing structures in a turbid medium. A three-dimensional (3D) see-through image is obtainable if one can identify the depth of each part of the structure in the 2D image. Nevertheless, the obtained transillumination images are blurred severely because of the strong scattering in the turbid medium. Moreover, ascertaining the structure depth from a 2D transillumination image is difficult. To overcome these shortcomings, we have developed a new technique using deep learning principles. A fully convolutional network (FCN) was trained with 5,000 training pairs of clear and blurred images. Also, a convolutional neural network (CNN) was trained with 42,000 training pairs of blurred images and corresponding depths in a turbid medium. Numerous training images were provided by the convolution with a point spread function derived from diffusion approximation to the radiative transport equation. The validity of the proposed technique was confirmed through simulation. Experiments demonstrated its applicability. This technique can provide a new tool for the NIR imaging of animal bodies and biometric authentication of a human body.

Competitive Real-Time Near Infrared (NIR) Vein Finder Imaging Device to Improve Peripheral Subcutaneous Vein Selection in Venipuncture for Clinical Laboratory Testing

In this study, near-infrared (NIR) technology was utilized to develop a low-cost real-time near infrared (NIR) guiding device for cannulation. A portable device that can be used by medical practitioners and also by students for their skills development training in performing cannulation. Methods. First, is the development of a reflectance type optical vein finder using three (3) light emitting diode (LED) lights with 960 nm wavelength, complementary metal-oxide-semiconductor-infrared (CMOS-IR) sensor camera with 1920 × 1080 UXGA (1080P), IR filter set for the given wavelength, and an open-source image processing software. Second, is the actual in-vitro human testing in two sites: the arm and dorsal hand of 242 subjects. The following parameters were included, such as gender, age, mass index (BMI), and skin tone. In order to maximize the assessment process towards the device, the researchers included the arm circumference. This augmented subcutaneous vein imaging study using the develop vein finder device compared the difference in the captured vein images through visual and digital imaging approaches. The human testing was performed in accordance with the ethical standards of the Trinity University of Asia—Institutional Ethics Review Committee (TUA—IERC). Results. The NIR imaging system of the developed vein finder in this study showed its capability as an efficient guiding device through real-time vein pattern recognition, for both sites. Improved captured vein images were observed, having 100% visibility of vein patterns on the dorsal hand site. Fourteen (5.79%) out of 242 subjects reported non-visible peripheral subcutaneous veins in the arm sites. Conclusions. The developed vein finder device with the NIR technology and reflected light principle with low-energy consumption was efficient for real-time peripheral subcutaneous vein imaging without the application of a tourniquet. This might be utilized as a guiding device in locating the vein for the purpose of cannulation, at a very low cost as compared to the commercially available vein finders. Moreover, it may be used as an instructional device for student training in performing cannulation.

A Novel and Easy Method to Locate and Remove First Approved Long-Term Implantable Glucose Sensors

Eversense is a long-term implantable continuous glucose monitoring (CGM) system. Difficulty in locating and removing implanted sensors is one of the issues limiting its use. We propose using near-infrared (NIR) light to locate implanted glucose sensors. NIR light was used to locate implanted glucose sensors in 30 patients (age 18-62 years) with type 1 diabetes who use Eversense sensors for CGM. Duration of sensor implantation was 10-40 weeks (median 12 weeks). Out of 30 patients with type 1 diabetes, the NIR light located the implanted sensor in 24 patients (success rate 80%) within 5 s. Sensor implantation at the skin with tattoos and excessive freckles were two main reasons for failure to locate sensors using NIR. We report an innovative method to locate implanted glucose sensors in seconds, which would reduce the time significantly to remove the sensor.

Ultra-broadband near-infrared emission CuInS2/ZnS quantum dots with high power efficiency and stability for the theranostic applications of mini light-emitting diodes

Broadband near-infrared CuInS₂/ZnS quantum with up to 94.8% quantum yield was synthesized with fast precursor decomposition. The better power efficiency and stability of CuInS₂/ZnS mini-LED were performed with penetration tests and vein imaging.