X-RAY VISION Vein-imaging technology shows you where to focus your efforts.

The next time you're preparing to start an IV and fail to see a beautiful puffy vein sitting below the skin's surface just waiting to be stuck, take a deep breath, relax and reach for a vein-imaging device. The technology can help you identify suitable IV start sites without sticking and praying. "It's made a huge difference for our staff, especially those members who didn't have the same skill set as others," says Jennifer Blanton, RN, director of nursing at Physicians' Eye Surgery Center in Charleston, S.C. "It's really increased their overall confidence."

Patients are impressed
Ms. Blanton's staff doesn't use the technology for every patient. Like many nurses faced with starting an IV, members of her pre-op team assess patients' veins before deciding how to proceed. Most nurses use the vein-finding technology to identity the best site for a start, not to guide the stick itself, says Ms. Blanton. However, she requires nurses who don't have first-stick success to use the device, "no matter who you are and how much experience you have," she says.

"For nurses who've had trouble starting IVs, it's dramatically increased their performance," says Ms. Blanton. "They're more comfortable now, so they're more successful during first attempts, even without the visual aid."

The feedback from patients has been overwhelmingly positive, says Ms. Blanton. "They see that we invest in the best technology," she says, "and that we go the extra mile for our patients. They're truly impressed we have a device that helps allay one of their biggest fears."

Starting an IV can be stressful for staff and patients, says Lisa Aiken, RN, MSN, a nurse educator for the intensive care unit and emergency department at Emory Johns Creek (Ga.) Hospital, which recently invested in vein-viewing technology for use in the emergency room, neonatal ICU and outpatient surgery department.

The hospital doesn't have a specific stick policy in place, but its nurses are educated about which patients might prove difficult, including those with BMIs greater than 30 and patients who've been stuck often for the treatment of chronic diseases. Ms. Aiken says her staff trialed 2 devices before settling on one that weighs slightly less than 10 ounces and is straightforward to use. It comes with a stand that holds the device in place, freeing nurses to use both hands when starting IVs.

CLINICAL PROOF
Study Backs Vein-viewing Technology

FALSE START Vein-viewing devices can help your staff locate more potential IV start sites, even when faced with challenging cases.

Infrared vein-viewing technology increased the number of potential IV start sites caregivers identified compared with conventional visual methods, according to a study published in the British Journal of Anaesthesia (osmag.net/C2eCsN).

The researchers say the technology identified an average of 9 possible sites compared with 6 possible sites noticed with visual inspection. African Americans or Asians and the obese were associated with decreased vein visibility, according to the study. However, the technology resulted in similar vein-finding success in each subgroup.

Patients are living longer and will therefore undergo more procedures in their lifetimes, a factor that increases the importance of vein preservation, note the researchers. They also say blind attempts to access non-visible veins can frustrate caregivers and hurt patients. Worse, they say, multiple unsuccessful attempts at starting IVs can lead to infection and the need for more invasive techniques that raise infection risks even more.

Although the study involved infrared technology, the researchers suggest other vein-viewing aids would likely achieve similar results.

— Daniel Cook

Avoid excessive puncturing
Lynn Hadaway, MEd, RN-BC, CRNI, president of Hadaway Associates, an infusion consulting firm based in Milner, Ga., says first-stick success rate at the front line is generally "abysmally" low.

The failure to start IVs on the initial attempt does more than erode patient satisfaction, says Ms. Hadaway, who's also an active member of the Infusion Nurses Society. She points to the overall waste of resources in terms of nursing time and used supplies. "The more attempts you make, the more cost you're incurring that you can't recoup," she says.

Should you rely on vein-imaging technology for every IV start? "Not at all," says Ms. Hadaway. "When visible veins are plentiful, the devices aren't needed. On the other hand, if you place a tourniquet and assess the arm, and if you're not confident that you can palpate a significant number of potential sites, then use one of these devices immediately to avoid excessive puncturing of the patient." Her staff will pull out a device if patients say they were difficult sticks during previous care.

Multiple failed puncture attempts can also damage and destroy peripheral veins, limiting their use for subsequent therapies, says Ms. Hadaway, who identifies patients with fluid-volume deficit, chronic diseases such as cancer or diabetes, or a long history of frequent IV catheter placements for delivery of fluids and medications as notoriously difficult sticks.

Ms. Blanton's ophthalmic-only center has 8 pre-op bays where patients for 2 high-volume surgeons are prepped for surgery with only oral Versed. One device is enough for the staff to share when it's needed, although Ms. Blanton says they'd need additional units if they started IVs on every patient.

Experienced nurses are good at assessing a patient's arm and asking for help from a colleague with known IV starting skills if they're not confident they can get the job done on their own, says Ms. Aiken. "A lot of them know to not let pride get in the way of proper patient care," says Ms. Aiken. "When it comes to starting IVs, some days are better than others."

Now they can also reach for the device that gives them added confidence in spotting those difficult-to-locate veins. "It's just another tool in the arsenal to help our nurses," says Ms. Aiken.