Natascha J. Cuper

Predictive factors for difficult intravenous cannulation in pediatric patients at a tertiary pediatric hospital

Background:  It is generally believed that certain patient characteristics (e.g., Body Mass Index and age) predict difficulty of intravenous cannulation in children, but there is not much literature evaluating these risk factors. In this study, we investigated predictive factors for success rate at first attempt and time needed for intravenous cannulation.

The use of near-infrared light for safe and effective visualization of subsurface blood vessels to facilitate blood withdrawal in children

Obtaining access to blood vessels can be difficult, especially in children. Visualization of subsurface blood vessels might be a solution. Ultrasound and visible light have been used to this purpose, but have some drawbacks. Near-infrared light might be a better option since subsurface blood vessels can be visualized in high contrast due to less absorption and scattering in tissue as compared to visible light. Our findings with a multispectral imaging system support this theory. A device, the VascuLuminator, was developed, based on transillumination of the puncture site with near-infrared light. The VascuLuminator was designed to meet the requirements of compact and safe use. A phantom study showed that the maximum depth of visibility (5.5mm for a 3.6mm blood vessel) is sufficient to visualize blood vessels in typical locations for peripheral venous and arterial access. A quantitative comparison of the VascuLuminator and to two other vessel imaging devices, using reflection of near-infrared light instead of transillumination, was conducted. The VascuLuminator is able to decrease failure at first attempt in blood withdrawal in pediatric patients from 10/80 (13%) to 1/45 (2%; P=.05).

Visualizing Veins With Near-Infrared Light to Facilitate Blood Withdrawal in Children

Introduction. This study aims to evaluate for the first time the value of visualizing veins by a prototype of a near-infrared (NIR) vascular imaging system for venipuncture in children. Methods. An observational feasibility study of venipunctures in children (0-6 years) attending the clinical laboratory of a pediatric university hospital during a period of 2 months without (n = 80) and subsequently during a period of 1 month with a prototype of an NIR vascular imaging system (n = 45) was conducted. Failure rate (ie, more than 1 puncture) and time of needle manipulation were determined. Results. With the NIR vascular imaging system, failure rate decreased from 10/80 to 1/45 (P = .05) and time decreased from 2 seconds (1-10) to 1 second (1-4, P = .07). Conclusion . This study showed promising results on the value of an NIR vascular imaging system in facilitating venipunctures.

The effectiveness of a near-infrared vascular imaging device to support intravenous cannulation in children with dark skin color : a cluster randomized clinical trial

BACKGROUND:Poor vein visibility can make IV cannulation challenging in children with dark skin color. In the operating room, we studied the effectiveness of a near-infrared vascular imaging device (VascuLuminator) to facilitate IV cannulation in children with dark skin color. METHODS:In the operating room of a general hospital in Curacao, all consecutive children (0–15 years of age) requiring IV cannulation were included in a pragmatic cluster randomized clinical trial. The VascuLuminator was made available to anesthesiologists at the operating complex in randomized clusters of 1 week. RESULTS:Success at first attempt was 63% (27/43, 95% confidence interval [CI], 47%–77%) in the VascuLuminator group vs 51% (23 of 45 patients, 95% CI, 36%–66%) in the control group (P = 0.27). Median time to successful cannulation was 53 seconds (interquartile range: 34–154) in the VascuLuminator group and 68 seconds (interquartile range: 40–159) in the control group (P = 0.54), and hazard ratio was 1.12 (95% CI, 0.73–1.71). CONCLUSION:The VascuLuminator has limited value in improving success at first attempt of facilitating IV cannulation in children with dark skin color.

Near-Infrared Imaging in Intravenous Cannulation in Children: A Cluster Randomized Clinical Trial

OBJECTIVE: Intravenous cannulation is a widespread medical procedure that can be difficult in children. Visualization of veins with near-infrared (NIR) light might support intravenous cannulation. Therefore, we investigated the effectiveness of an NIR vascular imaging system (VascuLuminator) in facilitating intravenous cannulation in children in the operating room. METHODS: This was a pragmatic, cluster randomized clinical trial in all consecutive children (0–18 years) scheduled for elective surgery and in need of intravenous cannulation at a tertiary pediatric referral hospital. Daily operating rooms (770 patients) were randomized for allocation of the VascuLuminator or control group. The primary outcome was success at first attempt; the secondary outcome was time to successful cannulation. RESULTS: Success at first attempt was 70% (171/246) with and 71% (175/245) without the use of the VascuLuminator (P = .69). Time to successful cannulation was 162 (±14) seconds and 143 (±15) seconds respectively (P = .26). In 83.3%, the vein of first choice was visible with the VascuLuminator. CONCLUSIONS: Although it was possible to visualize veins with NIR in most patients, the VascuLuminator did not improve success rate or time to obtain intravenous cannulation. There are 3 possible explanations for this result: first, it could be that localization of the vein is not the main problem, and therefore visualization is not a solution; second, the type of system used in this study could be less than optimal; and, third, the choice of the patient population in this study could be inappropriate.

Evaluating NIR vascular imaging to support intravenous cannulation in awake children difficult to cannulate; a randomized clinical trial

Recently, various near‐infrared vascular imaging devices aimed at facilitating peripheral intravenous cannulation (PIC) were introduced, all claiming to increase success rate of PIC. We evaluated the clinical utility of a near‐infrared vascular imaging device (VascuLuminator®) in pediatric patients who were referred to the anesthesiologist because of difficult cannulation.

Difficult arterial cannulation in children: is a near-infrared vascular imaging system the answer?

BACKGROUND Arterial cannulation is a common anaesthetic procedure that can be challenging and time-consuming in small children. By visualizing the position of the radial artery, near-infrared vascular imaging systems (NIRVISs) might be of assistance in arterial cannulation. The present study evaluates the effectiveness of an NIRVIS in arterial cannulation in infants. METHODS An observational study was conducted in patients up to 3 yr old, undergoing arterial cannulation before cardiothoracic surgery. Arterial cannulation was performed as usual in 38 patients, and subsequently with the NIRVIS in 39 patients. RESULTS The time to successful cannulation was 547 s (171-1183) without and 464 s (174-996) with the NIRVIS (P=0.76) and the time to first flashback of blood was 171 s (96-522) and 219 s (59-447), respectively (P=0.38). There was a tendency in favour of the NIRVIS in success at first attempt: 12/38 and 7/39, respectively (P=0.29) and in the number of punctures: 6 (2-12) and 3 (1-7), respectively (P=0.10). CONCLUSIONS The present study did not show a significant clinical improvement when NIR light was used during arterial cannulation in small children. There is a large difference between time to first flashback of blood and time to successful cannulation, indicating that inserting the cannula, and not localizing the artery, is the main difficulty in arterial cannulation in children.

Development and clinical trial of a practical vessel imaging system for vessel punctures in children

Venipunctures to draw blood for diagnostics can be cumbersome. Multiple puncture attempts are distressing, painful and traumatic, especially for small children. Drawing blood from babies, in particular, is a problem, due to the cutaneous baby fat, tiny veins and, worst case, a pigmented skin. We developed a practical vein viewing system based on IR translumination that, contrary to commercial systems available, has the advantage of: a) low cost, b) easily implemented in routine practice, c) normal and IR image simultaneously available, d) small add-on, e) child friendly IR illuminator and f) efficient IR light coupling. Before introducing the vessel viewer for clinical application in the childrens department, parameters were measured in 194 patients (age 0-17 yrs): time to draw blood, number of attempts, skin characteristics, discomfort of patient, and experience of nurse. In this control group, time to draw blood increases significantly with decreasing age of the children. The instant feedback from the nurses has been valuable for the improvements of especially the illumination sources. A clinical trial has been performed in 125 patients (age 0-6 yrs) to prove effectivity of the system in the blood withdrawal procedure. There was a significant decrease from 13% to 2% in failure rate. Also time needed to search for a vein was significantly decreased. A practical and accessible vein viewing system has been developed and is being introduced for clinical application. Although the concept of patient friendliness is already accepted, measurements need to show the effectiveness for particular groups of patients.

127 Facilitating Blood Withdrawal in Children by Visualizing Veins with Near-Infrared Light

Background and aims: Intravenous (IV) access for infusion or blood withdrawal may be cumbersome, especially in small children. Multiple puncture attempts for gaining IV access are traumatic and painful for the child. We developed a system (the VascuLuminator), based on infrared transillumination, that is able to visualize vessels underneath the skin. A feasibility study to the clinical use of the prototype in the procedure of blood withdrawal in children was performed. Methods: The usefulness of the Vasculuminator during blood withdrawal in children under 6 years was studied in 45 children and compared to 80 children without the system at the phlebotomy station of the laboratory of a pediatric university hospital. Failure rate (i.e. percentage of procedures where more than one puncture was necessary to gain blood) was measured. The opinion of the laboratory technicians about using the VascuLuminator was evaluated after each procedure. Results: The Vasculuminator enabled visualization of vessels underneath the skin up to a depth of several millimeters even in dark coloured skin. The failure rate of the procedures performed with the Vasculuminator (1/45; 2.2%) was smaller (p =.05) than in the procedures without the Vasculuminator (10/80; 12.5 %). In 26 of the 45 cases, the operators reported to have a benefit of the VascuLuminator. In none of the cases it was found to have a negative influence. Conclusions: The Vasculuminator enabled visualization of relevant veins underneath the skin. This first clinical evaluation showed promising results in facilitating blood withdrawal in children by decreasing the failure rate.

An intuitive vessel viewing system to facilitate blood withdrawal

Venipunctures to draw blood for diagnostics can be cumbersome, especially for small children, due to the cutaneous fat, tiny veins and skin pigments. Multiple puncture attempts are painful and traumatic. A compact and practical system was developed based on IR translumination to visualized blood vessel underneath the skin to provide guidance during vessel puncture procedures. A clinical trial has been performed in 125 young children (age 0-6 yrs) to prove the effectiveness of the system in the blood withdrawal procedure looking at failure to puncture at first attempt and time on needle manipulation in the skin. There was a significant decrease from 13% to 2% in failure rate. The time needed to search for a vein also decreased significantly. The nurses were satisfied with the user friendliness and short learning curve of the vessel viewing system while its use did not interfere with the routine procedure. The system has potential to be use in a large are of applications were vessel punctures are performed also in adults. Although the concept of patient friendliness is already accepted, measurements need to show the effectiveness for particular groups of patients. The vessel viewing system proved to be effective to perform blood withdrawals resulting in less pain and trauma for the patients.