A Biomedical Device to Improve Pediatric Vascular Access success

Published in: PEDIATRIC NURSING/September-October 2010/Vol. 36/ No. 5

This study was done “To evaluate the effectiveness of a vein-viewing device on the success of venipuncture’s performed by staff nurses on a pediatric surgical unit.” The VeinViewer uses near-infrared light which is reflected off a patient’s skin. The infra-red light is absorbed by the hemoglobin and therefore less infra-red light is detected where bloods (or veins) are.  This information is then used to create a real-time image/video which is projected back onto the skin or a map of your veins up to 10 mm deep.

The evaluation attempted to measure the following parameters
1) Percent of first-attempt success
2) number of attempts Per Patient,
3) time needed to complete the procedure.

My Take: this device has the potential to decrease the average time required to start an IV in pediatric patients with a huge potential for financial savings. My personal experiences make me wonder how come healthcare is so reluctant to investigate and adopt technologies which save money.  This like smoking prevention is an area where a small amount of up-front money can save a lot of downstream spending.  I am also sorry to say that this device is not appropriate for visualizing arteries.  I hope that day will come, and then it will even be more fun to talk about this device.

Declaration: I sell the VeinViewer by Christie Medical.
Quotes I liked:

Though a cornerstone of medical treatment, venipuncture remains one of the most common and severe sources of pain and anxiety experienced by hospitalized children (Crowley, 2003; Cummings, Reid, Finley, McGrath, & Ritchie, 1996;  Goodenough et al., 1999; Gupta et al., 2006; Wong & Baker, 1988).
Nurses with more experience and those with specialty training and certification, such as intravenous (IV) teams, will be more successful in starting IVs (Jacobsen & Winslow, 2005). However, many Facilities do not employ IV teams, and nursing unit staff typically have a variety of skill and experience levels. Many patient-related factors can also contribute to the challenges of pediatric vascular access. Small vein diameter and lack of cooperation are among the most common factors, resulting in multiple attempts (Alexander & Corrigan, 2004). Dark skin and obesity make visualizing veins more difficult. Lengthy or frequent hospitalization multiple medications, successful venipuncture. Improving vascular access success by reducing multiple attempts reduces labor and supply costs, and creates a better experience for the child, family, and staff. , multiple medications, and disease processes (such as dehydration or sepsis) may further complicate vascular access. In addition, multiple unsuccessful attempts make future attempts more difficult by damaging veins and causing vessel and tissue bruising. Although many of these injuries are minor and self-limiting, for children who require multiple IVs and/or lab draws during a hospitalization, vascular access will be made more difficult simply by the reduction of viable sites until tissue damage and vessel injury have resolved.

Conversely, improving the experience of the child has a positive impact on both the family and health care providers. In a recent study, nurses who helped improve the vascular access experience in children reported improved job performance and job satisfaction (Papa, Morgan, & Zempsky, 2008).

Thirty-two extemporaneous comments from the nurses, patients, and families were recorded. Themes that emerged included a) increased ease of venipuncture with the device in those patients who had prior venipuncture experiences without an assistive device, b) increased ability to visualize veins, and c) overall appreciation of the technology. Eighty-three percent of nursing comments were positive, such as, “Unable to see veins without VeinViewer,” and “[I] found veins [I] couldn’t see otherwise.” One hundred percent of patient/family comments were positive and included “It took eight sticks last admit, this time it took one,” and “He’s usually a very hard stick.” Children tended to express appreciation of the technology of the device with comments such as, “This thing is great,” and ‘Pretty awesome.”

The first-attempt success rate increased from 49% in the control group to 80% in the experimental group, (X2[l] = 22.71, p < 0.001). The mean number of attempts per patient decreased from 1.97 to 1.29, (t[227.8] = 5.198, p < 0.001). The percentage of procedures completed within 15 minutes increased from 52.8% in the control group to 86.7% in the experimental group (X2[l] = 28.107, p < 0.001).

Using Frey’s (1998) model increasing the success rate from 50% to 80% would result in a cost savings of $720 per 100 IVs. For a facility that places 1000 1Vs per month, the annual net savings would amount to $86,400.

A biomedical device, such as the VeinViewer, is not intended to replace the expertise of skilled clinicians, but rather, to maximize the probability of successful venipuncture. Improving vascular access success by reducing multiple attempts reduces labor and supply costs, and creates a better experience for the child, family, and staff.