Evaluation of the Veinviewer ®

for IV cannulation in children Yie Hui Lau, J Tan, SY Lee, VK Ho

Department of Paediatrics AnaesthesiaKK Women’s and Children’s Hospital

Singapore

15 May 2011

The Veinviewer®

-uses near infra red technology to project an image of the superficial vasculature on the patient’s skin

-no radiation / heat

Christie Medical (formerly Luminetx)

Intravenous cannulation in young children is a common yet challenging procedure for the junior doctor.

Objective: to evaluate the VeinViewer ® as a tool for junior doctors to improve ease of IV cannulation in children

-? increase in first attempt success rate-? reduction in time taken for successful IV cannulation

MethodologyA single-center, prospective, randomised

controlled trial.

Subjects were randomized into the Veinviewer ® group and standard cannulation group using a computer generated number list

MethodologyTHE SUBJECTSInclusion criteria: all children aged 1 to 10

presenting for elective surgery at a tertiary children’s hospital

Exclusion criteria: contra-indications to

inhalational induction, IV cannulas in situ and parental refusal

THE OPERATOR:Junior doctor (3-6 years post medical school)

THE ASSESSORSenior anaesthesiologist

MethodologyInhalational induction Prior to cannulation:

The junior doctor performing the IV cannulation will evaluate the quality of the vein and anticipated ease of IV cannulation by grading it on a scale of 1 to 7 (1= very easy, 4=neutral, 7=very difficult)

CannulationIf VeinViewer ® was used, the visibility of

the vein was noted.

MethodologyDuring cannulation: • timing of cannulation was noted by the assessor

= time from the first application of tourniquet to confirming patency of the cannula by flushing heparinised saline. -A failed attempt = at the end of 3 unsuccessful attempts after which the timing will be stopped.

Statistical analysisSPSS for Windows v16.0Survival analysis, Multivariate Cox

regressionChi Square Student’s t- test

Results

*10 patients were excluded in view of protocol violations(2, Veinviewer) or missing data (1 vein viewer, 7 standard)

Baseline characteristics of study subjects and operatorsStandard (N=56)

VeinViewer®

(N=58)P value

AgeMean (sd)

6.95 ± 0.32 7.58 ± 0.305 0.16

Height (cm)Mean

121.68± 2.12 123.01 0.63

Weight (kg)Mean

24.79 ±1.53 24.80±1.14 0.10

Presence of EMLA

Had EMLA 53Did not have EMLA 5

Had EMLA 50Did not have EMLA 6

0.14

EMLA duration (min)

61.84 ±5.67(N= 53)

81.70± 71.55(N=50)

0.05

History of prematurity

Yes 5No 53

Yes 6No 50

0.70

Years after medical school

4.14 ±0.11 3.77 ±0.11 0.02Table 1

Success rate of first attemptOverall patients (N=114)

P = 0.56

Table 2

Overall patients (N=114)

Exp(B)(Hazard

Ratio)

95.0% CI for Exp(B)

Lower UpperVeinViewer®

group1.303 .870 1.950

Table 3

“event”-defined as a successfulIV cannulation attempt

Successful cannulation at 1st attempt

“Perceived difficult veins” N=23

P <0.05

Table 4

Successful cannulation in patients perceived to have difficult veins*

(N=23)

Exp(B)

95.0% CI for Exp(B)

Lower UpperVein Viewer group 6.078 1.368 27.007

Yrs_after_Med_school 2.191 1.009 4.757

* Perceived by junior doctors to have a score of >4 on a scale of 1 to 7

Table 5

Table 6

“event”-defined as a successfulIV cannulation attempt

Extent of help rendered by the Veinviewer ®

N=54

Table 7

Successful cannulation in ≤3 attemptsN= 109 (Standard 54/56, Vein viewer 55/58)

Standard Vein Viewer®

Time to successful cannulation

70.7 ± 62.6s 71.6 ± 60.9s

P=0.9495% CI:-22.5 -24.4

Table 8

ConclusionThe Vein Viewer™ is a useful tool to assist

junior doctors in IV cannulation in childrenIt may not always be useful in all

paediatric patientsHowever, there is a clinically and

statistically significant benefit of using it for paediatric patients with difficult veins.

Thank you!