The best vein to be accessed based on descriptive study of dorsal metacarpal vein

Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial

BACKGROUND

Peripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if needed in a deteriorating patient; however, it is also perceived that larger-gauge cannula placement is associated with increased pain and procedural difficulty.

OBJECTIVE

This study aimed to compare the pain and procedural difficulty experienced during insertion between 18-gauge (18G) and 20-gauge (20G) cannulas.

METHODS

We conducted a single-blinded, randomized controlled trial on adult patients who required peripheral IV cannulation within a tertiary hospital emergency department between April and October 2018. Patients were randomized to either the 18G or 20G cannula group. The primary outcomes of the study-pain experienced by patients and procedural difficulties experienced by clinical staff-were recorded on two separate 10-cm visual analog scales. Other outcomes include first-attempt success rate, operator designation, complications, and the intent and actual use of the IV cannula were documented on preformatted questionnaires.

RESULTS

Data from 178 patients were included in the analysis. Eighty-nine patients were allocated to each cannula group. There were no statistically or clinically significant differences between mean pain score (0.23; 95% CI 0.56-1.02; p = 0.5662) and mean procedural difficulty score (0.12; 95% CI 0.66-0.93; p = 0.7396). between the two groups. There was no difference in first-attempt success rate (73 of 89 vs. 75 of 89; p = 0.1288), complications (2 of 89 vs. 1 of 89) between the 20G group and 18G group, respectively.

CONCLUSIONS

There was no significant difference between the 18G or 20G cannula for either pain experienced by patients or procedural difficulty experienced by clinicians.

Visualization of superficial vein dynamics in dorsal hand by near-infrared imaging in response to elevated local temperature

SIGNIFICANCE

Dry or moist skin-contact thermal stimulation for vein puncture (VP) and vein cannulation (VC) may not be feasible for sensitive skin. For a damaged, burned, or dark skin, near-infrared (NIR) imaging is preferred to visualize a vein. Postprocessing of NIR images is always required because the skin is a reflective material and veins need segmentation for quantitative analysis.

AIM

Our pilot study aims to observe the effect of noncontact local heating on the superficial metacarpal veins in the dorsal surface of the hand and to visualize vein dynamics using an NIR imaging system.

APPROACH

Our experiment consists of studies A and B at two ambient temperatures, 19°C and 25°C. A simple reflection-based NIR imaging system was installed to acquire sequential vein images for 5 min before and after applying 10 min of radiant thermal stimulation. To measure the vein diameter (VD), we trained a convolutional neural network (CNN) on sequential raw images to predict vein-segmentation masks as output images. Later these masked images were postprocessed for the VD measurements.

RESULTS

The average VD was significantly increased after thermal stimulation in study A. The maximum increments in VD were 39.3% and 9.19%, 1 min after thermal stimulation in studies A and B, respectively. Both the VD and skin temperature (Tskin) follow negative exponentials in time, and the VD is proportional to Tskin. A multiple linear-regression model was made to predict the final VD. A significant difference was observed in the change of the VD.

CONCLUSIONS

NIR imaging with CNN can be used for quantitative analyses of vein dynamics. This finding can be further extended to develop real-time, image-guided medical devices by integrating them with a radiant heater and to assist medical practitioners in achieving high success rates for VP or VC.