Evaluation of the Veinviewer ® for IV cannulation in children

1. 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

2. The Veinviewer® Christie Medical (formerly Luminetx) -uses near infra red technology to project an image of the superficial vasculature on the patient’s skin -no radiation / heat

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

4. 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

5. Methodology • A single-center, prospective, randomised controlled trial. • Subjects were randomized into the Veinviewer ® group and standard cannulation group using a computer generated number list

6. Methodology THE SUBJECTS Inclusion 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 ASSESSOR Senior anaesthesiologist

7. Methodology Inhalational 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) Cannulation If VeinViewer ® was used, the visibility of the vein was noted.

8. Methodology • During 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.

9. Statistical analysis SPSS for Windows v16.0 Survival analysis, Multivariate Cox regression Chi Square Student’s t- test

10. Randomised N= 124 Standard group N= 63 Veinviewer group N= 61 Excluded from analysis* N=7 Excluded from analysis* N=3 Analysed N=56 Analysed N=58 Results *10 patients were excluded in view of protocol violations(2, Veinviewer) or missing data (1 vein viewer, 7 standard)

11. Baseline characteristics of study subjects and operators Table 1

12. Success rate of first attemptOverall patients (N=114) P = 0.56 Table 2

13. Overall patients (N=114)

14. “event” -defined as a successful IV cannulation attempt Table 3

15. Successful cannulation at 1st attempt“Perceived difficult veins” N=23 P <0.05 Table 4

16. Successful cannulation in patients perceived to have difficult veins* (N=23) Table 5 * Perceived by junior doctors to have a score of >4 on a scale of 1 to 7

17. “event” -defined as a successful IV cannulation attempt Table 6

18. Extent of help rendered by the Veinviewer ® N=54 Table 7

19. Successful cannulation in ≤3 attempts N= 109 (Standard 54/56, Vein viewer 55/58) Table 8 P=0.94 95% CI:-22.5 -24.4

20. Conclusion The Vein Viewer™ is a useful tool to assist junior doctors in IV cannulation in children It may not always be useful in all paediatric patients However, there is a clinically and statistically significant benefit of using it for paediatric patients with difficult veins.

21. Thank you!