Efficacy of Near-Infrared Vein Imaging for Difficult IV Placement

Not Applicable

Terminated

Interventions: Other: Conventional IV placement
Device: Near Infrared Vein Imaging

Brief Summary: The objective of this project is to define the effectiveness and therefore the role of NIR vein finders in adult patients with difficult peripheral venous access. The specific objective of the proposed randomized controlled trial is to test the clinical success rate of placing peripheral venous catheters in 'difficult' access patients using traditional peripheral venous catheter placement compared to two established methods utilizing NIR vein imaging. The investigators hypothesize that the capability to successfully place lasting peripheral venous catheters is increased with the adjunct of the imaging technology, reducing the number of failed needle sticks, reducing the number of peripheral venous catheters placed throughout a patient's hospital stay, and reducing the need for more invasive catheters such as PICC lines.

Detailed Description: The efficacy of NIR vein finders beyond the first line approach, particularly in patients that have failed conventional peripheral venous access methods or in patients that are expected to be a "difficult stick", is not established. Conflicting results have been reported in the pediatric literature regarding the subjective benefit of NIR light devices in patients with perceived difficult peripheral intravenous access. In addition, knowledge about the efficacy of these devices in the adult inpatient setting is mostly unknown. The aim of the present study is to address these knowledge gaps.

Recruitment & Eligibility

Inclusion Criteria

non-pediatric in-hospital patients (≥15 years of age, inpatient and outpatient setting)
willing to provide research authorization
scheduled and consented to undergo peripheral venous cannulation of one of the upper extremities to be performed by one of the members of the Vascular Access Team
determined to be a difficult peripheral venous access defined by one of the following criteria in alignment to the A-DIVA scale to be assessed by one of the members of the Vascular Access Team [8]:
failed inspection for more than one visible or palpable suitable vein through conventional methods
failed at least one attempt of peripheral venous cannulation through any methods
history of difficult peripheral venous access
greatest diameter of target vein less than 3mm determined by conventional methods

Exclusion Criteria

clinical contraindication for placement of peripheral venous catheter, including:
severe bilateral upper extremity edema
severe bilateral upper extremity skin burn
severe bilateral upper extremity cellulitis
history of bilateral axillary lymphadenectomy
known severe cardiovascular or pulmonary compromise demanding minimization of procedure time, such as:
severe shock with severe cardiovascular instability
active CPR
major uncontrolled hemorrhage
any condition for which the primary healthcare provider is requesting emergent venous access
scheduled PICC or midline catheter placement
non-English-speaking patients if an interpreter is not available
prisoner and any individual involuntarily confined or detained in a penal institution
impaired capacity to make informed medical decisions

Arm && Interventions

Group	Intervention	Description
Conventional Method	Conventional IV placement	Placement of peripheral venous catheter using conventional methods
VeinViewer Visualization Only	Near Infrared Vein Imaging	Use of a VeinViewer to visualize the most suitable target. Once the target has been identified and marked, the device will be placed aside and the peripheral venous catheter will be placed using conventional methods
VeinViewer Visualization Only	Conventional IV placement	Use of a VeinViewer to visualize the most suitable target. Once the target has been identified and marked, the device will be placed aside and the peripheral venous catheter will be placed using conventional methods
Constant Imaging with VeinViewer	Near Infrared Vein Imaging	Identification of the most suitable target and placement of a peripheral venous catheter under constant imaging with a VeinViewer

Primary Outcome Measures

Name	Time	Method
Number of Participants With Successful Initial IV Placement	up to 30 minutes	Rate of successful initial placement of a peripheral venous catheter (investigators have up to 30 minutes or ONE attempt before the study allows for change of technique to the preference of the Vascular Access Team member)

Secondary Outcome Measures