From the UT Southwestern Medical Center, Children's Medical Center, Dallas, Texas; and Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
Anesth Analg. 2013 May;116(5):1087-1092. doi: 10.1213/ANE.0b013e31828a739e. Epub 2013 Mar 14.
The VeinViewer (Luminetx, Memphis, TN) helps identify veins by projecting an image of subcutaneous vasculature on the skin surface. We tested the primary hypothesis that VeinViewer use improves cannulation success by skilled nurses in pediatric patients with anticipated difficult IV access. A secondary goal was to evaluate the relationship between obesity and cannulation success.
Patients aged 0 to 18 years were included. Anticipated cannulation difficulty was evaluated with the difficult IV access score. All cannulations were performed by members of the Intravenous Access Team. Patients were randomized to: (1) routine IV catheter insertion; or (2) insertion facilitated by the VeinViewer. The primary outcome was first-attempt insertion success. The proportion of successful insertions was evaluated using Cochran-Mantel-Haenszel χ(2) analysis to adjust for any imbalanced baseline variables. The effect of obesity on cannulation success was evaluated with multivariable logistic regression.
Two hundred ninety-nine patients (49%) were randomly assigned to VeinViewer and 301 (51%) to routine cannulation. First-attempt cannulation success was 47% in patients assigned to VeinViewer vs 62% in patients assigned to routine cannulation, with an adjusted relative "risk" (95% confidence interval), of 0.76 (0.63-0.91). The Z-statistic of -3.6 crossed the "harm" boundary (Z < -2.41), with corresponding P value of 0.0003. The trial was stopped on statistical grounds since the harm boundary for the primary outcome was crossed. There was no association between first-attempt success and the 4-level categorization of obesity after adjusted for baseline variables (P = 0.94).
The VeinViewer worsened first-attempt IV insertion success by skilled nurses. Surprisingly, first-attempt success for IV cannulation was not worsened by obesity.
VeinViewer（Luminetx，孟菲斯，田纳西州）通过将皮下血管系统的图像投射到皮肤表面来帮助识别静脉。我们测试了主要假设，即 VeinViewer 的使用是否可以提高熟练护士在预计静脉穿刺困难的儿科患者中的穿刺成功率。次要目标是评估肥胖与穿刺成功率之间的关系。
纳入年龄 0 至 18 岁的患者。通过静脉穿刺困难评分评估预期的穿刺难度。所有的穿刺均由静脉穿刺团队成员进行。患者随机分为：（1）常规静脉导管插入；或（2）通过 VeinViewer 辅助插入。主要结局为首次尝试插入成功。使用 Cochran-Mantel-Haenszel χ(2)分析评估成功插入的比例，以调整任何不平衡的基线变量。使用多变量逻辑回归评估肥胖对穿刺成功率的影响。
299 名患者（49%）被随机分配到 VeinViewer 组，301 名患者（51%）被分配到常规穿刺组。在接受 VeinViewer 治疗的患者中，首次尝试穿刺成功率为 47%，而在接受常规穿刺的患者中，首次尝试穿刺成功率为 62%，调整后的相对“风险”（95%置信区间）为 0.76（0.63-0.91）。Z 统计量为-3.6 超过了“伤害”边界（Z < -2.41），相应的 P 值为 0.0003。由于主要结局的伤害边界已被跨越，该试验因统计学原因而停止。在调整基线变量后，肥胖的 4 级分类与首次尝试成功之间没有关联（P = 0.94）。
VeinViewer 降低了熟练护士首次静脉插入的成功率。令人惊讶的是，肥胖并没有使静脉穿刺的首次尝试成功率恶化。
