1. Examining Therapeutic Interventions for the Perioperative Area: A Comparison Trial using Veinlite® LED vs. Standard Methods for Peripheral Intravenous Access
Noelle Radcliffe CCRN, BSN, SRNA
Danica Webster MBA, RNC, SRNA
University of North Florida-Nurse Anesthetist Program

2. Patrick Monaghan Ph.D., CLS, SBB Kathaleen Bloom Ph.D., CNM
Committee members
Patrick Monaghan Ph.D., CLS, SBB
Kathaleen Bloom Ph.D., CNM
Danica Webster SRNA
Noelle Radcliffe SRNA

3. Will it help or Hinder?
Will the use of the Veinlite® LED increase first time success rate of obtaining intravenous access?
Research question

4. Overview IV route is preferred route of medication administration.
IV access can often become a difficult task
Failure rate ranging from 10 to 40%. (Leidel)
Average time requirement for peripheral IV cannulation is reported at 2.5 to 13 minutes, with difficult IV access requiring as much as 30 minutes (Leidel)
Improvements have been made with use of ultrasound
1. IV Route: providing the most reliable control for dosing and the resulting pharmacodynamic and pharmacokinetic properties of pharmacologic agents (Stoelting & Hillier, 2006).
Obtaining intravenous access can often become a difficult task especially in patients with co-morbities such as obesity, dehydration, anemia, drug abusers, dialysis patients, and patients receiving chemotherapy.
Another study: Katsogridakis, Seshadri, Sullivan, and Waltzman (2008) identifies success rates in multiple attempts for admitted patients at a children’s hospital ranges from 23% for physicians, 44% for nurses to 98% for IV nurse clinicians.
3. This can lead to dissatisfaction of patients, delay in treatment and loss of productivity for the healthcare team. There are many techniques used by healthcare providers to assist in visualizing and obtaining intravenous access such as identifying anatomical landmarks and simple palpation, using warm compresses to aid in vasodilation, manual B/P cuff inflation or tourniquets, or ultrasound guidance
4. Ultrasonographic-guided peripheral intravenous access is more successful than traditional “blind” techniques, requires less time, decreases the number of percutaneous punctures, and improves patient satisfaction in the subgroup of patients who have difficult intravenous access. (Constantino)

5. demographics
2008 there were 37.5 million hospital admissions in the US
Every hospital patient gets at least one blood draw on admission, 7 out of 10 get an IV, and 3 out of 10 get an injection of contrast
This totals 263 million vein access procedures in hospitals alone
4 out of every 10 sticks fail, averaging 174 million vein access failures divided between the IV, the blood draw, and the injection of contrast.
Stotler, 2012
In spite of advances in the tools that have been made over the last 200 yrs, like the hypodermic needle, the vacutainer system (1949), and other advances in tool technology, the actual procedure of locating and accessing the vein has not changed much….we still smack, slap, flick, and tap the vein, and they still use the tourniquet. And the failure rates are 40%. That is pretty significant.

6. Clinical Relevance
Use of an interventional technique could potentially:
Decrease potential rates of infection from multiple IV attempts
Decrease costs by using less materials
Decrease rate of central venous cannulation and ensuing co-morbities
Decrease delays in treatment
*Improve Patient Satisfaction and Quality of Care*
CVC co-morbities-venous thrombosis, arterial puncture, catheter associated bloodstream infection, and pneumothorax

7. Veinlite® LED Product of TransLite LLC
Hand held, battery powered transillumination device for visualizing veins and superficial vessels
Uses patented “side-transillumination”, enables Veinlite® to uniformly illuminate small regions of skin and subcutaneous tissue
Applications:
Visualizing and mapping of varicose veins
venous access-especially in patients with history of difficult access
easier visualization in patients with dark pigmentation
transillumination in pediatric and neonatal patients
Side transillimination: Light shines into the skin from outside the area of interest. A ring of bright light is focused below the skin surface and directed towards rings center…this focused light creates a volume of illumination with the central focus acting as a virtual light source under the skin.
---Has 24 LED’s (light emitting diodes) mounted in a circular pattern and pointed towards center of circle.
--12 orange emitting lights for viewing superficial veins
--12 red emitting lights for viewing deeper veins and better penetration thru darker pigmented skin
We found that using both orange and red lighting worked best for all pigments

8. Veinlite® LED Hand held portable device
Disposable sleeves to minimize contamination and spread of infection from patient to patient

9. Methods
N=50, Sample included SRNAs, CRNAs, RNs, nursing students and other advanced practice nurses representing a large range of experience.
After being instructed in the use of the Veinlite LED device, health care professionals were asked to assess vein access on a human arm with and without the use of the device. A self-developed survey was then administered, asking the participant’s opinion of the device and it’s usefulness.
Standard method: included simple palpation and visualization techniques.
Interventional method: included the standard methods in addition to the Veinlite® LED

10. Results
From the questionnaire that was answered, the majority of people surveyed stated that the veinlite was helpful, though they would not necessarily change their choice of cannulation site. Most also said they would use the veinlite in practice, however, almost all participants (sidebar) asked about the cost of the device and they would use it if provided for them, not if they had to buy it.

11. Survey
Here is a copy of our survey. Thanks to Dr. Bloom for helping us with the wording of the survey, and making sure the appropriate questions were asked.

12. Results
-Fifty participants including nursing students, Registered Nurses, Certified Registered Nurse Anesthetists, and Student Nurse Anesthetists; were surveyed after instruction and demonstration on use of Veinlite. Participants’ intravenous access experience ranged from 1-35 years. 89% (42) of participants agreed that the Veinlite is a useful device in the identification of intravenous cannulation sites. Of the participants, 45% (21) stated the Veinlite actually changed the location of choice of intravenous access of the human arm, and 79% (37) of participants would use the Veinlite in practice if it were available to them. The majority of participants, 68%,(32) agreed that the Veinlite was very easy to use.

13. Results No one felt that the veinlite was difficult to use.
Very easy was 68% of the partcipants
Easy 21%
Somewhat easy 11%

14. conclusions
Many anesthetists are faced with difficulties obtaining intravenous access due to many factors and different patient comorbidities. According to the results, the Veinlite would be a useful device in assisting to identify venous access sites in these patients. The device was proven to be easy to use and most people would use the Veinlite if it were available for their use. The Veinlite may be a useful alternative to ultrasound and traditional intravenous identification techniques in the operative area.

15. Recommendations Start early The clock is not on your side
Choose a topic that is both measurable and finite.
Stay in constant contact with your faculty and heed what they say
Submit to IRB early, because you may have to revise several times.
Your faculty really are invaluable in this process because they have been through the IRB process many times and are very familiar with wording, documentation, and requirements.

16. Proposed Timeline 1. Obtain IRB Approval --- by November 2012
2. Gather materials---by November 2012
3. Collect Data—November thru Feb 2013
4. Analyze Data---March 2013
5. Prepare Research Paper---Mar/Apr 2013

17. What we would have changed
Incorporated Veinlite into the hospital setting
Use of Model Arm specifically designed for Veinlite use
Special thank you to Dr. Monaghan and Dr. Bloom for their guidance and expertise in our research project
Limitation of study-fake arm, providers may do better with VeinLite with increased familiarity of device, not testing for things such as obesity, dehydration, dialysis pts, anemics, drug abusers
---testing people with all skill levels---
Time constraints and IRB approval limited ability to take to hospital setting-maybe class under us could do—most studies have been in the pediatric setting up to date.

18. References
Constantino, T., Parikh, A., Satz, W., & Fojtik, J. (2005). Ultrasound-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Annals of Emergency Medicine, 46(5),
Katsogridakis, Y. L., Seshadri, R., Sullivan, C., & Waltzman, M. L. (2008). Veinlite transillumination in the pediatric emergency department: a therapeutic interventional trial. Pediatric Emergency Care, 24(2
Leidel, B. A., Kirchhoff, C., Bogner, V., Stegmaier, J., Mutschler, W., Kanz, KG., & Braunstein, V. (2009). Is the intraosseous route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Safety in Surgery, 3(1), doi: /
Stoelting, R., & Hillier, S. (2008). Pharmacology and physiology in anesthetic practice. 4th ed. Lippincott Williams & Wilkins, Philadelphia, PA.
Stotler, G.M. (2012). A scientific explantion for why there are so many IV, blood draw and injection of contrast failures. ASCLS Today, 26(5), 4-12.
Translite LLC. Veinlite LED Instructional Packet