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Three Part Question

In [a pediatric population requiring venous access], are [near-infrared vein illuminating devices more effective than existing palpation-visualization techniques] in [securing better patient outcomes]?

Clinical Scenario

A 12-month old child is admitted into the pediatric ward requiring peripheral venous access for the administration of fluids and medications. The parents are fretful of the procedure and has refused further attempts as multiple junior medical staff have failed on previous occasions. How do you minimize the number of attempts and time required, thereby improving patient confidence and satisfaction.

Search Strategy

vein AND illumination
Search Engine: PubMed
Search Criteria: vein AND illumination
Filtered for: human studies, 10 years, English

Search Outcome

Total Hits: 880 Hits

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Chapman LL, Sullivan B, Pacheco AL, Draleau CP, Becker BM 2011 USA	323 children aged 0 to 17 years requiring peripheral intravenous catheter (PIV). Standard SC group (n=165), VeinViewer VV group (n=171).	Prospective, randomized sample measuring time to PIV placement, number of PIV attempts, pain scores as reported by the child, parent or guardian, and nurse using a 100-mm visual analog scale (VAS).	Mean time (s) / Median Number of Attempts (0 - 2 years)	VV 121 / 1, SC 167 / 1	Limited PIV placements (7.5%) rated as very difficult, hence small sample size is to interpret helpfulness of the VeinViewer for difficult PIV placement.
			Mean time (s) / Median Number of Attempts (0 - 17 years)	VV 132 / 1, SC 145 / 1
			Nurse pain (age 0-2)	VV 34, SC 46
Cuper NJ, Verdaasdonk RM, de Roode R, de Vooght KM, Viergever MA, Kalkman CJ, de Graaff JC. 2011 Netherlands	125 children (0-6 years): 80 without use of NIR imaging system, 45 with use.	Observational feasibility study of venepunctures with and without use of NIR vascular imaging system. measuring failure rate (more than 1 puncture) and time of needle manipulation.	Failure Rate	Without NIR 12.5%, With NIR 2.2% (P Value 0.052)	Small sample size. Potential conflict of interest - authors co-inventors in filed patent for named imaging system.
			Manipulation Time (median)	Without NIR 2s, With NIR 1s (P Value 0.068)
Perry AM, Caviness AC, Hsu DC. 2011 USA	123 patients (0 - 20 years old). Median age is 3. Standard group (n=62), Device group (n=61).	Prospective, randomized trial measuring success rate at first attempt for IV catheter placement, and a qualitative assessment of the near-infrared device by study nurses via questionnaire.	First attempt success	Standard 79%, Device 72.1%
			Patients with difficult vein access	90% found device helpful
			Non-dehydrated patients w/o chronic conditions	70% neutral or unfavorable assessment of device
Hosokawa K, Kato H, Kishi C, Kato Y, Shime N. 2010 Japan	136 children weighing <15 kg undergoing anaesthesia. Transillumination (n=67), Usual Method (n=69). Median score of estimated cannulation difficulty before attempted puncture was similar in both groups.	Prospective, randomized trial measuring success rate at first attempt and time to successful venous access. Random assignment of patients into the 2 study groups via a sealed envelope method. Procedures were performed by interns or junior residents with little experience.	First attempt success rates	Transillumination 75%, Usual Method 61%	Number of patients enrolled did not reach planned sample size. Sample population was under general anesthesia, in whom unintentional movements were prevented and insertion of cannulas could be expedited.
			First attempt success (<2 years old)	Transillumination 73%, Usual Method 49%
			Mean time for success	Transillumination 47s, Usual Method 66s
Hess HA. 2010 USA	241 pediatric inpatients (0-17 years old) requiring vascular access. Device group (n=91), control group (n=150).	Prospective, non-randomized study measuring first-attempt success rate, the number of attempts per patient, and the time to procedure completion.	First-attempt success rate	Control 49.3%. Device 80.2%	Self-reported data collection - potential for under- or over-reporting of attempts as a result of perceived institutional, investigator or peer expectations.
			Number of attempts per patient	Control 1.97, Device 1.29
			Procedures < 15 mins	Control 52.8%, Device 86.7%
Strehle EM. 2010 United Kingdom	50 children <16 years of age requiring venous blood sampling or peripheral venous catheterization as part of standard clinical care.	Observational feasibility study, measuring pediatric doctors, nurses and patients rating of the vein viewer device, via a 10-questions survey.	General effectiveness	Useful 72%, Neutral 20%, Not Useful (8%)
			Visibility of peripheral veins (doctors & nurses)	Useful 76%, Neutral 240%, Not Useful (0%)
			Acceptance by family	Useful 100%, Neutral 0%, Not Useful 0%

Comment(s)

The standard palpation and visualization technique is universally employed to secure peripheral venous access. However, success or failure is often dependent on patient-related factors (e.g. poor vein quality, dark skin, physiologic peripheral vasoconstriction) as well as clinican-related factors (e.g. years of experience, number of IVs inserted per week etc). Today, there are technological advances in equipment design and imaging techniques to aid the success of obtaining vascular access. The use of such equipment and techniques by junior medical and nursing personnel may achieve desirable outcomes, including reduced patient discomfort, shortened time to secure vascular access, as well as minimal needle phobia. Transilluminating devices facilitating the visualization of peripheral veins are increasingly marketed and developed for such purposes.

Clinical Bottom Line

Transilluminating devices may not offer a significant advantage over the traditional technique if used in the general population. However, these devices are likely to improve outcomes in particular groups such as pediatric patients between 0 - 2 years old and patients with difficult vascular access. These devices are well accepted by medical pediatric doctors, nurses, and highly accepted by patient\'s families.

References

1. Chapman LL, Sullivan B, Pacheco AL, Draleau CP, Becker BM VeinViewer-assisted Intravenous catheter placement in a pediatric emergency department Acad Emerg Med. 2011 Sep;18(9):966-71. doi: 10.1111/j.1553-2712.2011.01155.x. Epub 2011 Aug 19.
2. Visualizing veins with near-infrared light to facilitate blood withdrawal in children. Visualizing veins with near-infrared light to facilitate blood withdrawal in children. Clin Pediatr (Phila). 2011 Jun;50(6):508-12. Epub 2011 Feb 27.
3. Perry AM, Caviness AC, Hsu DC. Efficacy of a near-infrared light device in pediatric intravenous cannulation: a randomized controlled trial. Pediatr Emerg Care. 2011 Jan;27(1):5-10.
4. Hosokawa K, Kato H, Kishi C, Kato Y, Shime N. Transillumination by light-emitting diode facilitates peripheral venous cannulations in infants and small children. Acta Anaesthesiol Scand. 2010 Sep;54(8):957-61. Epub 2010 Jul 12.
5. Hess HA. A biomedical device to improve pediatric vascular access success. Pediatr Nurs. 2010 Sep-Oct;36(5):259-63.
6. Strehle EM. Making the invisible visible: near-infrared spectroscopy and phlebotomy in children. Telemed J E Health. 2010 Oct;16(8):889-93. Epub 2010 Oct 6.