What is a blown vein
VeinViewer-Assisted Intravenous Catheter Placement in the Pediatric Emergency Room
Needle pricks are part of many standard treatments in the pediatric emergency room (ED). and are often a source of pain and anxiety for children. Intravenous Catheters (IVs) have been shown to be among the leading causes of pain in hospitalized children 1 and Venipuncture is widely considered to be one of the most painful and most commonly performed invasive disease procedures by nurses. 2 (Jacobson et al.) In children who record pain scores in response to VAS IV catheter placement in the emergency room rated pain 3.23 / 5.0 and their parents rated their children's pain 3.4 / 5.0.3 (Skarbek et al.) Catheters would be more efficient and less stressful if the clinician had a clear roadmap or picture that highlights the location of the vein. A lack of clear visual guidance for IV placement often leads to multiple painful attempts at catheter placement, as well as urgent delays in treatment (IV fluid and drug administration) and increased use of human resources. The current average number of catheter punctures required to be successful Catheter placement is 2.4 with a range of 1 to 14.4 (Larue, GD). The VeinViewer from Luminetx ™ enables the clinician to clearly see the child's accessible vasculature or lack thereof in real time, right on the skin surface. The clinician can be trained to operate the VeinViewer in minutes and use does not require additional job or skills certification. The VeinViewer is free-standing and hands-free so the clinician can freely use both hands to perform the work of placing the catheter (as opposed to ultrasound, which requires one hand to hold the probe and the other hand to place the catheter unless two people are available and able to coordinate their work efforts, which doubles the resources required for this IVplacement.The VeinViewer is non-invasive and does not cause tissue damage, patient contact with the device and therefore no risk of contamination with infectious diseases with blood products. The Vein Viewer uses near infrared light to locate subcutaneous veins and project their position onto the surface of the skin, creating a visible roadmap for IV catheter placement. This protocol describes a prospective, randomized study of the effectiveness of VeinViewer in increasing the ease t of intravenous cannulation in children received intravenous cannulation in the pediatric emergency room. The investigators hypothesized that cannulation with VeinViewerâ required fewer sticks and resulted in fewer missed or repeated IV starts, fewer extravasating ("blown vein") IV placements, increased perceived ease of placement by the operator, and decreased pain-related pain the IV placement as perceived by the child, parent and operator.
2. Background Intravenous cannulation is a routine and common part of pediatric care treatment in the pediatric emergency room. Intravenous cannulation is painful and often challenging in children. Peripheral IVs are generally placed visually and / or tactile cues. These can be minimal or deceptive in children who often have small peripheral veins and increased subcutaneous fat with opaque, resilient skin struggling to place these IVs that successfully multi-stick and subcutaneously infiltrate tissues that require extensive operator time and most importantly A number of approaches have been tried to relieve the pain, most of which involve the cutaneous application of lidocaine in an attempt to numb the skin and relieve the pain of the stick.
EMLA and more recently LMX (lidocaine in liposomal delivery system) are topically effective agents, but there is a 30 minute dwell time - inappropriate in the emergency medicine setting. A number of devices have been tested that lower the stratum corneum barrier in this way, allowing the lidocaine to numb the skin in 3-5 minutes. This includes a hand laser (effective, burns and pigmented the skin), a small ultrasound (effective but bulky and difficult to use), and gas pressure powered lidocaine powder (effective but not approved by the FDA yet for general distribution) Devices depend on identifying the vein and then successfully cannulating the identified vein through the anesthetized skin. Missing sticks force the operator to start the anesthesia process again in a other side. This process is time consuming and ineffective in the ED setting.
Other centers have begun using ultrasound to identify the veins for the periphery, cannulation to cannulation with indirect visualization. This process is for small difficultly mobile pediatric veins and requires extensive operator training and exercise, requiring an additional set of operator hands when children are, often less than cooperative, it is unclear whether this approach will be effective in pediatric ED.
Vein Viewerâ is a hands-off device that projects a map of the subcutaneous veins onto the vein surface of the skin. It enables the operator to insert the IV catheter directly from visualization. It can be used by an operator who can insert the catheter and hold the catheter in place in the child's arm while using the device. The direct visualization is accurate and reduces blindness on sticks, missed & quot; fishing expeditions & quot; and extravasations of IV fluid and medication (often not benign) that can occur with intravenous cannulation, especially in children. Reducing the number of sticks and the time to successful catheterization will improve the child and the Parents perceived the pain of the procedure and the operator's time to catheterize effectively This increases operator efficiency and ED in general, and speeds the onset of therapy ( intravenous hydration or medication). The vein viewer has no side effects and is visually interesting for children and parents. It has the potential to revolutionize the effectiveness and efficiency of IV cannulation in the pediatric emergency room and to greatly reduce the child and parent's perceived pain and fear of the procedure from the procedure. .
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