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Vein Visualisation Technology for Peripheral Intravenous Access in Paediatric Patients: A Clinical Decision-Making
Elizabeth Weathers1, Mary Cazzell2, Julie A Thompson3
1School of Nursing, Midwifery, and Health Sciences, University College Dublin, Belfield, Ireland.
Insights
This study developed a clinical decision tool for vein visualization technologies to improve peripheral intravenous catheter (PIVC) insertion success. The tool recommends specific devices like NIR or transilluminators based on patient age and BMI, enhancing patient care.
Area of Science:
- Medical Devices
- Clinical Decision Support
- Vascular Access
Background:
- Vein visualization technologies (VVT) are recommended to improve peripheral intravenous catheter (PIVC) insertion.
- Adoption and optimal utilization of VVT for PIVC insertion remain limited in clinical practice.
- A need exists for a structured approach to guide VVT selection and application.
Purpose of the Study:
- To develop a clinical decision-making tool for guiding the utilization of vein visualization technologies.
- To enhance the success rate of peripheral intravenous catheter (PIVC) insertion.
- To leverage data from a pediatric medical center's vascular access team.
Main Methods:
- Quantitative, two-phase study design.
- Phase 1: Retrospective chart review of clinician utilization and preferences for VVT.
- Phase 2: Prospective study with post-discharge chart review to confirm VVT use and influencing factors.
Main Results:
- Cluster analysis identified 16 distinct patient groups.
- Near-infrared (NIR) devices demonstrated higher first-attempt success rates for patients over 2 years old, irrespective of BMI or access site.
- Transilluminators were most effective for underweight patients under 2 years old.
Conclusions:
- The developed tool provides evidence-based recommendations for VVT selection in PIVC insertion.
- This is the first study to create a clinical decision-making tool specifically for VVT in PIVC procedures.
- Implementation of this tool can improve PIVC insertion outcomes and efficiency of care.
Aim:
The aim of this study is to develop a clinical decision-making tool to guide utilisation of vein visualisation technologies and enhance chances of successful peripheral intravenous catheter (PIVC) insertion, using data collected from a vascular access team in a large paediatric medical centre in the United States.
Design:
Quantitative two-phase, cluster analysis design.
Methods:
The study consisted of the following two phases: (1) a quantitative retrospective chart review to evaluate clinician utilisation and preference for vein visualisation technologies and (2) a quantitative prospective design, including a post-discharge retrospective chart review, to confirm utilisation of vein visualisation technologies and factors influencing clinician decision-making.
Results:
A total of 16 groups were created based on the cluster analysis and expert clinician input. The results of first-attempt success analyses identified optimal device recommendations for each of the 16 patient groups. For patients older than 2 years old, the NIR device was more likely to result in first-attempt success regardless of BMI or access site and the NIR device was most optimal for almost all categories of paediatric patients regardless of BMI or access site. The transilluminator was found to be the most optimal device to use with younger patients (< 2 years old) who are underweight.
Conclusion:
Vein visualisation technology is recommended by professional nursing organisations to improve PIV access. Yet, adoption of this useful technology to aid selection of an optimal vein for insertion and visualisation during insertion is limited. This is the first study to develop a clinical decision-making tool for vein visualisation technology in PIVC insertion.
Implications For The Profession And Patient Care:
Vein visualisation technology allows for a rapid, thorough assessment of patients' vasculature to determine an optimal site for PIVC placement beyond what is visible to the naked eye or achievable using traditional methods. The tool was designed to guide healthcare professionals towards successful first attempt PIVC insertions, thereby improving patient outcomes and efficiency of care.
Patient Or Public Contribution:
None.
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