Upload
hue
View
51
Download
0
Embed Size (px)
DESCRIPTION
Evaluation of the Veinviewer ® for IV cannulation in children . Yie Hui Lau, J Tan, SY Lee, VK Ho Department of Paediatrics Anaesthesia KK Women’s and Children’s Hospital Singapore. 15 May 2011. The Veinviewer ®. Christie Medical (formerly Luminetx). - PowerPoint PPT Presentation
Citation preview
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!