Transillumination of the palm for venipuncture in infants

Goren, Avner; Laufer, J; Yativ, Nir; Kuint, Jacob; Ackon, Michael Ben; Rubinshtein, Marina; Paret, Gideon; Augarten, Arie

doi:10.1097/00006565-200104000-00013

Cited by 56 publications

(34 citation statements)

References 2 publications

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“…15,[18][19][20] Yen and colleagues prospectively evaluated characteristics that predict peripheral IV insertion success or failure in a sample of 615 children, to help identify those who will be difficult to cannulate. They then used these factors to develop the Difficult Intravenous Access (DIVA) scoring tool 21 …”

Section: Definition and Scope Of The Problemmentioning

confidence: 99%

“…Good pain management and the use of advanced technologies to enhance visualization of veins during cannulation have been shown to improve peripheral IV insertion success rates. 2,14,15,20 In one study, transillumination enhanced the visualization of veins in 40% of children <3 years of age who had DVA, and venous access was achieved on the first attempt in 97.5%. 15 Similarly, the use of a near infrared light source that permits hands-free viewing of both superficial and deep veins was shown to significantly decrease the number of needle sticks required to achieve venous access by 40% and to reduce the supplies needed and the time required for cannulation when compared with traditional methods of IV insertion.…”

Section: Physician Concernsmentioning

confidence: 99%

“…Special interventions are defined as the use of any technique or hospital resource with the potential to improve peripheral IV insertion success rates. These include traditional methods of enhancing the visibility and palpability of peripheral veins (eg, warming the catheter site to induce vasodilation) [10][11][12] ; advanced visualization technologies such as ultrasound, transillumination, and nearinfrared lighting 2,[13][14][15] ; and enlisting designated IV specialists and/or hospital staff with extensive experience in starting pediatric IVs.16 Some children may need more invasive interventions such as intraosseous (IO) infusion, a peripherally inserted central catheter, or a central venous catheter (CVC) to achieve parenteral access.There is a dearth of clinical evidence on the incidence of DVA in pediatric patients. Studies of IV insertion success rates indicate that 5% to 33% of children require more than 2 needle sticks to achieve IV access.…”

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confidence: 99%

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Peripheral Difficult Venous Access in Children

Rauch

Dowd

Eldridge

et al. 2009

Clin Pediatr (Phila)

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discuss management strategies. This article summarizes the recommendations of the consensus panel for physicians. The recommendations for nurses will be published separately. Definition and Scope of the ProblemEarly identification of DVA is the first step in optimizing patient care. The consensus panel described DVA as a clinical condition in which multiple attempts and/or special interventions are anticipated or required to achieve and maintain peripheral venous access. Special interventions are defined as the use of any technique or hospital resource with the potential to improve peripheral IV insertion success rates. These include traditional methods of enhancing the visibility and palpability of peripheral veins (eg, warming the catheter site to induce vasodilation) [10][11][12] ; advanced visualization technologies such as ultrasound, transillumination, and nearinfrared lighting 2,[13][14][15] ; and enlisting designated IV specialists and/or hospital staff with extensive experience in starting pediatric IVs.16 Some children may need more invasive interventions such as intraosseous (IO) infusion, a peripherally inserted central catheter, or a central venous catheter (CVC) to achieve parenteral access.There is a dearth of clinical evidence on the incidence of DVA in pediatric patients. Studies of IV insertion success rates indicate that 5% to 33% of children require more than 2 needle sticks to achieve IV access. [1][2][3][4] Even when interventions such as transillumination and ultrasound are used, up to 15% of children still require more than 2 attempts to establish venous access.2 A recent prospective analysis of 593 insertion attempts in centers with pediatric hospitalist services showed that successful placement E stablishing peripheral intravenous (IV) access in pediatric patients can be challenging. Clinical studies show that only 53% to 76% of children are successfully cannulated on the first attempt.1-4 Multiple failed attempts are painful and upsetting for the child and distressing for family members and caregivers, 5-9 yet there are no guidelines or consensus statements on the recognition and management of this problem.In January 2008, a panel of physicians and nurses specializing in emergency medicine, anesthesia, critical care, and hospital medicine convened to discuss peripheral difficult venous access (DVA) in children. Daniel Rauch, MD, FAAP, and Laura L. Kuensting, MSN(R), RN, CPNP, cochaired the roundtable discussion, which was made possible by a grant from Baxter Healthcare, Inc. The main objectives of the meeting were to estimate the frequency of DVA in pediatric patients; describe its clinical and emotional impact on the patient, the patient's family, and clinicians; develop terminology that accurately describes the condition; review the factors that help identify children with DVA; and

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Section: Definition and Scope Of The Problemmentioning

confidence: 99%

Section: Physician Concernsmentioning

confidence: 99%

mentioning

confidence: 99%

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Peripheral Difficult Venous Access in Children

Rauch

Dowd

Eldridge

et al. 2009

Clin Pediatr (Phila)

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“…Identifying the potentially difficult venous access cases at an early stage is important for nurses to adjust their approach and staff, which can contribute to improving the success rate. There are many methods to manage peripheral IV insertion, such as anesthetizing the peripheral IV site to reduce patient pain and discomfort (19)(20)(21) using an assistive device to improve vein visualization to achieve a higher success rate (22)(23)(24)(25)(26) applying diagnostic tests to confirm correct intravascular placement (27) and local warming (28). Considering the fact that each registered nurse can establish peripheral IV access for pediatric patients, we proposed grades to measure the venipuncture skills of pediatric nurses (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Grade Management in Establishing Pediatric Peripheral Venous Access

Yan

Gong

et al. 2016

Iran J Pediatr

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Background: Establishing venous access is a challenging job for pediatric nurses, especially in the emergency department. Measures to ensure higher success rates on the first attempt are important to provide quality nursing care. Objectives: To explore the effect of grade management on the success of establishing peripheral venous access in the child population of China and to analyze the factors influencing failed IV access on the first attempt. Methods: This is an observational study on children aged 0 -16 years old undergoing peripheral venous catheterization in a children's hospital. Patient information was collected before attempting each puncture. Logistic regression was used to identify independent factors for success prediction. Results: A total of 1,016 subjects enrolled. The success rate of intravenous puncture on the first attempt was 86.02%. This can be influenced by several factors, such as patient age, department, venous condition, and nurse experience. The success rate within two attempts was 96.85%; the number of catheters used per IV attempt was 1.21. Conclusions: To date, only a few studies have explored the success rate of peripheral IV catheterization in the pediatric population of China. Grade management of peripheral veins and pediatric nurses facilitated higher first-attempt success than in previously published reports. Failures of catheterization were multifactorial. The success rate of peripheral intravenous insertion in children can be improved through applying assistance devices or enhancing the venipuncture skills of pediatric nurses.

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“…4 Ultrasound allows visualization without exposure to radiation but specialized training is needed which has limited its use. 5,6 A transilluminator 7,8 allows visualization of veins; its efficacy may be limited by the size of the infant. New to the list of choices to improve successful PICC placement is the Vein Viewer a Food and Drug Administration (2005) approved device ( Figure 1).…”

Section: Introductionmentioning

confidence: 99%