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新生儿静脉置管中静脉透照法与标准方法的比较:一项随机试验

Vein Transillumination Versus the Standard Method in Neonatal Venous Cannulation: A Randomized Trial.

作者信息

Zainudin Zurina, Nunis Melissa Anne, Lim Zi Han

机构信息

Department of Pediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, MYS.

出版信息

Cureus. 2025 Aug 24;17(8):e90891. doi: 10.7759/cureus.90891. eCollection 2025 Aug.

Abstract

INTRODUCTION

Peripheral venous cannulation is an essential procedure in neonatal intensive care units (NICUs) but is often associated with high failure rates. Near-infrared vein visualization devices may enhance vein identification and reduce the number of attempts; however, evidence in neonatal populations remains limited. This study aimed to compare the first-attempt success rates of peripheral venous cannulation using a vein transillumination device versus the standard method in neonates with prior punctures. Secondary analyses explored patient- and performer-related factors associated with successful cannulation.  Methodology: This study conducted a prospective, randomized controlled trial from October 2022 to January 2024 in the NICU at Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. Only neonates of ≥ 35 weeks of gestation requiring venous access with at least one prior venipuncture were enrolled. The participants were randomized into standard (control) and AccuVein AV500-assisted (intervention) cannulation groups. All procedures were performed by 14 trained medical officers. First-attempt success was documented as the primary outcome, while secondary outcomes included associations with patient, performer, and procedural factors.

RESULTS

A total of 120 neonates were enrolled (60 per group). The overall first-attempt peripheral venous cannulation success rate was 47 (39.2%). No significant differences were observed between the control (21, 35%) and the intervention (26, 43.3%) groups ( > 0.05). Vein palpability was notably associated with cannulation success (odds ratio (OR) 7.86, 95% confidence interval (CI): 2.22-27.85, = 0.001). Right-sided cannulation was also linked to improved cannulation success (OR 3.44; 95% CI: 1.15-10.32, = 0.028). Conversely, four or more previous punctures reduced the likelihood of successful peripheral venous cannulation (OR 0.30; 95% CI: 0.09-0.99, = 0.048).

CONCLUSIONS

Vein transillumination did not significantly improve the first-attempt peripheral venous cannulation success rate. However, vein palpability, fewer prior punctures, and right-sided cannulation were associated with superior outcomes.

摘要

引言

外周静脉置管是新生儿重症监护病房(NICUs)的一项基本操作,但失败率往往较高。近红外静脉可视化设备可能会提高静脉识别率并减少穿刺次数;然而,新生儿群体中的相关证据仍然有限。本研究旨在比较在有过穿刺史的新生儿中,使用静脉透照设备与标准方法进行外周静脉置管的首次尝试成功率。次要分析探讨了与置管成功相关的患者和操作者相关因素。

方法

本研究于2022年10月至2024年1月在马来西亚博特拉大学苏丹阿卜杜勒·阿齐兹·沙阿医院的新生儿重症监护病房进行了一项前瞻性随机对照试验。仅纳入孕周≥35周、需要静脉通路且至少有过一次静脉穿刺史的新生儿。参与者被随机分为标准(对照)组和AccuVein AV500辅助(干预)置管组。所有操作均由14名经过培训的医务人员进行。首次尝试成功被记录为主要结局,而次要结局包括与患者、操作者和操作因素的关联。

结果

共纳入120名新生儿(每组60名)。外周静脉置管首次尝试的总体成功率为47例(39.2%)。对照组(21例,35%)和干预组(26例,43.3%)之间未观察到显著差异(>0.05)。静脉可触及性与置管成功显著相关(优势比(OR)7.86,95%置信区间(CI):2.22 - 27.85,=0.001)。右侧置管也与更高的置管成功率相关(OR 3.44;95% CI:1.15 - 10.32,=0.028)。相反,既往有四次或更多次穿刺会降低外周静脉置管成功的可能性(OR 0.30;95% CI:0.09 - 0.99,=0.048)。

结论

静脉透照并未显著提高外周静脉置管首次尝试的成功率。然而,静脉可触及性、较少的既往穿刺次数和右侧置管与更好的结局相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ab6/12456672/4235872e412d/cureus-0017-00000090891-i01.jpg

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