®
the Veinviewer
Evaluation of
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)
-uses near infra red technology to
project an image of the superficial
vasculature on the patient’s skin
-no radiation / heat
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
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
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
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.
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.
Statistical analysis
 SPSS for Windows v16.0
 Survival analysis, Multivariate Cox regression
 Chi Square
 Student’s t- test
Results
Randomised N= 124
Standard group
N= 63
Excluded from analysis*
N=7
Analysed
N=56
Veinviewer group
N= 61
Excluded from analysis*
N=3
Analysed
N=58
*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 operators
Standard
(N=56)
VeinViewer®
(N=58)
P value
Age
Mean (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 53
Did not have
EMLA 5
Had EMLA 50
Did 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 5
No 53
Yes 6
No 50
0.70
Years after
medical school
4.14 ±0.11
3.77 ±0.11
0.02
Table 1
Success rate of first attempt
Overall patients (N=114)
P = 0.56
Table 2
Overall patients (N=114)
95.0% CI for Exp(B)
VeinViewer®
group
Exp(B)
(Hazard
Ratio)
Lower
Upper
1.303
.870
1.950
“event”
-defined as a
successful
IV cannulation
attempt
Table 3
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)
95.0% CI for Exp(B)
Exp(B)
Lower
Upper
Vein Viewer group
6.078
1.368
27.007
Yrs_after_Med_school
2.191
1.009
4.757
Table 5
* Perceived by junior doctors to have a score of >4 on a scale of 1 to 7
“event”
-defined as a
successful
IV cannulation
attempt
Table 6
Extent of help rendered by the Veinviewer ®
N=54
Table 7
Successful cannulation in ≤3 attempts
N= 109 (Standard 54/56, Vein viewer 55/58)
Time to
successful
cannulation
Standard
Vein Viewer®
70.7 ± 62.6s
71.6 ± 60.9s
Table 8
P=0.94
95% CI:-22.5 -24.4
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.
Thank you!