I am giving a presentation at INS in June on vascular visualization technology. There are 2 types - visible light such as regular flashlights, Venoscope, etc and infrared light devices such as Vascular Viewer from IRIS and VeinViewer from Luninetx.
Visible light devices are cheap but they require the other lights to be out so they will work better. Some require extra hands to hold or may be in the way of the venipuncture procesure. Some people really have good success and others hate them - very personal issue.
Infrared light devices are capital equipment purchases and each has positives and negatives. The 2 devices use different infrared technology. You can call or email me privately to discuss. Lynn
Our hospital puchased three VeinViewers recently. We have been using them a month or so. From an IV therapist standpoint the device is helpful for those chronic patients that no longer have visible or palpable veins, especially in my field of pediatrics. Although, some of the time it just proves that there was nothing there to "stick" all along just like your initial assessment would have been without the technology. The Vein Viewers are available to all the staff as we are not a 24 hour IV therapy team. We have tried to stess that the device will not teach you how to "stick". So an experienced nurse needs to be using the device. We should have more feedback from staff later as we are following them with process improvement flowsheets.
I am not familiar with the IRIS but we have a Vein Viewer and will get another one later this year. I find it is most helpful to nurses with less IV experience, or who struggle with IV skills. It provides another tool to make vascular access more successful with fewer tries, which is our goal, especially in peds. The comment stating "it doesn't teach you how to stick" is very true...we say, it provides a roadmap, you still have to drive the car. You may e-mail me directly if you would like more in depth discussion. Holly
I am in look out for more vein finder manufacturers. I know about Accuvein & Vein Viewer (earlier Luminetx). To the best of my information, there are around 6-7 manufacturers. I would like to contact them for promoting their product in Indian market. if any body knows, kindly contact me at [email protected] or leave message here.
Basing on the principle that hemoglobin in the blood vessel has stronger absorption of near-infrared light than other tissues and through a series of digital image processing, Projection Vein Finder projects the outline of the vein to the skin surface, so that medical personnel can clearly observe the tiny blood vessels 8mm to 10mm under the skin.
1. Adjustable Brightness: Through the operation panel, the brightness of projection images can be adjusted for different light sensitivities of personnel.
2. Adult& Child Mode: Projection image area is different according to different groups, It is user-friendly.
3. Portable and Easy to Adjust: B500 has a size of 227mm*65mm*63mm (length * width * height) and weight about 500g, It is portable in the pocket.
4.Clamp Support turns around in 360°, and adjusts up and down.
Results of trialing the new vein finders disappointing.
I trialed both the vein viewer and the acuvein in my facility. I had high hopes for the devices because we do not have an IV team or phlebotomy services and we have a lot of need for IVs and lab sticks by the nurses. Some of the nurses have little to no experience. The problem I found was that the devices were so good at finding veins that they would light up ones that no one should consider cannulating due to the capillary-size of them. A larger appropriate vein would look much dimmer and not bright and big. To test this for yourself, find a vein that you can see and that you would never consider sticking. Then look at how well the device makes it appear. Check the palm of your hand. The acuvein did not show the tiny ones quite as bad as the vein vision but it was enough of a problem for both that I decided they were not the right thing to have in our facility and especially should not be used by nurses with little experience. And for someone who did have experience, I found that they did not show any vein that was worth sticking that I could not already see or feel. There was a great wow factor, but that was all. I was very dissapointed. I do teach my nurses to use ultrasound to locate veins, and even though it is a higher skill, many of them do will with it. I have them locate the vein and then mark it in two places with the end of the plunger of the 10 ml saline flush they will be using. The dent is made by pressing gently for 5 seconds on the skin. (Other variations are a card edge for marking but we kept loosing it). (A surgical marking pen would be nice but the all seem to scrub off with the scrub). Maybe there is a type that is really permanent that I could use. After making the marks, they should check once again to assure that the marks are in the middle of the vein. Then they just set the ultrasound down, try to palpate the vein and scrub and poke just like normal. If the want to do it more advanced, they would actually hold the probe during insertion and do ultrasound-guided insertion but only 2 of my nurses do that and lots of them use the finding method. I have them look for veins that are not more than 1 cm down, so that they will have enough catheter to thread after canulating.
In my opinion, this is a large group of devices known generically as vascular visualization devices. I think "vein finder" may actually be a trade name of a visible light device and does not include near infrared light devices. This group also includes ultrasound.
Re near infrared light - first let me disclose that I have worked for several of these companies in the past, but am not actively working with any of them now.
The studies on nIR devices have used the metric of first stick success as their primary measurement. But these studies have been a mixed bag of results with some showing improvement in 1st stick success and others not showing this improved success. These devices are excellent at identifying the veins and their pathway. But the fact remains that there still must be a high level of skill by the operator to make the venipuncture and successfully cannulate the vein. I do strongly believe that these devices have a place in our practice. US is great for deep veins but nIR is better for superficial veins. Being able to see the venous pathway is a great improvement over blind techniques based on palpation. I would also hasten to add that not every patient requires the use of nIR.
The whole decision should be in this process, in my opinion, for patients with difficult peripheral access:
traditional visualization and palpation in most patients
no veins seen or felt, then nIR should be used to identify them
if this fails, then a USGPIV is indicated
if this fails, then a USG midline or PICC or some other type of CVAD
There is evidence in the research that use of nIR prevents many unnecessary CVAD insertions. So I think we need to use a better metric for measuring success with nIR. And I agree, that this should not be put in the hands of the novice inserter.
I am giving a presentation at INS in June on vascular visualization technology. There are 2 types - visible light such as regular flashlights, Venoscope, etc and infrared light devices such as Vascular Viewer from IRIS and VeinViewer from Luninetx.
Visible light devices are cheap but they require the other lights to be out so they will work better. Some require extra hands to hold or may be in the way of the venipuncture procesure. Some people really have good success and others hate them - very personal issue.
Infrared light devices are capital equipment purchases and each has positives and negatives. The 2 devices use different infrared technology. You can call or email me privately to discuss. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Our hospital puchased three VeinViewers recently. We have been using them a month or so. From an IV therapist standpoint the device is helpful for those chronic patients that no longer have visible or palpable veins, especially in my field of pediatrics. Although, some of the time it just proves that there was nothing there to "stick" all along just like your initial assessment would have been without the technology. The Vein Viewers are available to all the staff as we are not a 24 hour IV therapy team. We have tried to stess that the device will not teach you how to "stick". So an experienced nurse needs to be using the device. We should have more feedback from staff later as we are following them with process improvement flowsheets.
Parrish Nored, RN , Vascular Access Nurse
Children's Hospital of Alabama
I am in look out for more vein finder manufacturers. I know about Accuvein & Vein Viewer (earlier Luminetx). To the best of my information, there are around 6-7 manufacturers. I would like to contact them for promoting their product in Indian market. if any body knows, kindly contact me at [email protected] or leave message here.
Rahul Dev
Basing on the principle that hemoglobin in the blood vessel has stronger absorption of near-infrared light than other tissues and through a series of digital image processing, Projection Vein Finder projects the outline of the vein to the skin surface, so that medical personnel can clearly observe the tiny blood vessels 8mm to 10mm under the skin.
1. Adjustable Brightness: Through the operation panel, the brightness of projection images can be adjusted for different light sensitivities of personnel.
2. Adult& Child Mode: Projection image area is different according to different groups, It is user-friendly.
3. Portable and Easy to Adjust: B500 has a size of 227mm*65mm*63mm (length * width * height) and weight about 500g, It is portable in the pocket.
4.Clamp Support turns around in 360°, and adjusts up and down.
www.bright-med.com
www.bright-med.com
I trialed both the vein viewer and the acuvein in my facility. I had high hopes for the devices because we do not have an IV team or phlebotomy services and we have a lot of need for IVs and lab sticks by the nurses. Some of the nurses have little to no experience. The problem I found was that the devices were so good at finding veins that they would light up ones that no one should consider cannulating due to the capillary-size of them. A larger appropriate vein would look much dimmer and not bright and big. To test this for yourself, find a vein that you can see and that you would never consider sticking. Then look at how well the device makes it appear. Check the palm of your hand. The acuvein did not show the tiny ones quite as bad as the vein vision but it was enough of a problem for both that I decided they were not the right thing to have in our facility and especially should not be used by nurses with little experience. And for someone who did have experience, I found that they did not show any vein that was worth sticking that I could not already see or feel. There was a great wow factor, but that was all. I was very dissapointed. I do teach my nurses to use ultrasound to locate veins, and even though it is a higher skill, many of them do will with it. I have them locate the vein and then mark it in two places with the end of the plunger of the 10 ml saline flush they will be using. The dent is made by pressing gently for 5 seconds on the skin. (Other variations are a card edge for marking but we kept loosing it). (A surgical marking pen would be nice but the all seem to scrub off with the scrub). Maybe there is a type that is really permanent that I could use. After making the marks, they should check once again to assure that the marks are in the middle of the vein. Then they just set the ultrasound down, try to palpate the vein and scrub and poke just like normal. If the want to do it more advanced, they would actually hold the probe during insertion and do ultrasound-guided insertion but only 2 of my nurses do that and lots of them use the finding method. I have them look for veins that are not more than 1 cm down, so that they will have enough catheter to thread after canulating.
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]
In my opinion, this is a large group of devices known generically as vascular visualization devices. I think "vein finder" may actually be a trade name of a visible light device and does not include near infrared light devices. This group also includes ultrasound.
Re near infrared light - first let me disclose that I have worked for several of these companies in the past, but am not actively working with any of them now.
The studies on nIR devices have used the metric of first stick success as their primary measurement. But these studies have been a mixed bag of results with some showing improvement in 1st stick success and others not showing this improved success. These devices are excellent at identifying the veins and their pathway. But the fact remains that there still must be a high level of skill by the operator to make the venipuncture and successfully cannulate the vein. I do strongly believe that these devices have a place in our practice. US is great for deep veins but nIR is better for superficial veins. Being able to see the venous pathway is a great improvement over blind techniques based on palpation. I would also hasten to add that not every patient requires the use of nIR.
The whole decision should be in this process, in my opinion, for patients with difficult peripheral access:
traditional visualization and palpation in most patients
no veins seen or felt, then nIR should be used to identify them
if this fails, then a USGPIV is indicated
if this fails, then a USG midline or PICC or some other type of CVAD
There is evidence in the research that use of nIR prevents many unnecessary CVAD insertions. So I think we need to use a better metric for measuring success with nIR. And I agree, that this should not be put in the hands of the novice inserter.
Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861