A BETTER WAY With practice, we learn how to visualize and palpate veins on the skin's surface, but wouldn't it be better if you could see beneath the skin's surface?

Starting an IV line is not without its challenges. But as you'll see over the next couple pages, a handful of manufacturers have introduced devices that let you visualize the vessels beneath the skin when starting IVs. With these advances, you can gain access to veins that aren't otherwise visible or palpable, without the need for interventional radiology services. This ability to visualize what's beneath the skin when starting IVs can boost your providers' first-stick success, improve your facility's pre-op efficiency — particularly among difficult-access patients — and, perhaps most importantly, reduce your patients' discomfort.

These easy-to-use technologies use infrared light, near-infrared light, LEDs or ultrasound; the principles of absorption and reflection; and real-time computerized analysis to project images of what's inside. Nurses and anesthesia providers can identify pitfalls in and verify the potency of the vascular structure, often up to 1cm deep.

With practice we learn how to visualize and palpate veins on the skin's surface. But sometimes what feels like a vein may be a different structure, wasting time and effort. Or we access a vein and obtain a flash only to see the vein "blow" or infiltrate, since we couldn't detect a bifurcation or valve from the outside. Dehydration, obesity, skin pigmentation or recent chemotherapy can also make peripheral veins difficult to find, raising frustration and anxiety in both patients and providers.

Your patient satisfaction scores are very closely tied to the speed and ease of your patients' IV starts. Fairly or unfairly, this practice is in their minds a measure of their providers' competency. That's why I see this technology as here to stay, and believe that in the coming years it may start to replace the traditional "see-feel-stick-get-lucky?" approach of starting IVs with its "visualize-and-precisely-access" method.

AccuVein
AccuVein AV400
accuvein.com
(816) 997-9400
Pricing: about $6,000
FYI: The easy-to-use AccuVein AV400 is handheld and lightweight, weighing only 9.7 ounces (275 grams), and easily converts to hands-free operation with an optional wheeled or fixed stand. The device's design allows it to be wiped clean easily, and its permanent alignment means it never requires calibration. It can be held in any direction above the vein being viewed. Universal and inverse modes make the AV400 useful on a variety of patient types. With center-line accuracy to the width of a human hair, it can detect veins up to 10mm deep.

Bard Access Systems
Site-Rite Prevue Ultrasound System
bardaccess.com
(801) 522-5000
Pricing: $4,600 to $8,600, depending on model and options
FYI: Bard Access Systems' Site-Rite Prevue is a low-cost, portable ultrasound imaging device that can increase the success rate of your nurses' and anesthesia providers' initial IV catheter placements as compared with traditional blind sticks, particularly among patients with limited venous access. Here's how: The system provides users with an assessment of the vasculature under examination; with real-time navigational guidance; with information on the depth and size of vessels; and with the ability to visualize the vasculature, including identifications of bifurcations, valves and tortuous curves before any attempts at access.

Christie Medical Holdings
VeinViewer
christiemed.com
(877) SEE-VEIN
Pricing: $5,000 to $15,000, depending on model
FYI: Christie Medical's VeinViewer direct-projection vein illuminator, is available in 3 different models: VeinViewer Vision, the flagship mobile cart-based unit; VisionXTND, the semi-permanent, mounted viewer; and the portable, handheld Flex. Each one features the proprietary Assess Imaging Suite and its image customization modes. VeinViewer's pre-, intra- and post-op benefits include visualization of peripheral veins to a depth of 10mm and blood patterns to 15mm; valve and bifurcation detection; refill rate and patency assessment; hematoma detection and potential infiltration avoidance. Studies have shown that VeinViewer significantly increases first-stick success and patient satisfaction.

Futuremed
Astodia
www.futuremed.com
(800) 222-6780
Pricing: $950
FYI: Designed for use with premature and newborn infants, Futuremed's Astodia transilluminator provides clear views of the vascular anatomy in order to improve the chances of first-stick success when drawing blood from or placing an IV or PICC line into the small, fragile veins. High-powered yellow and red LEDs, which illuminate the veins from beneath, feature adjustable brightness for optimum visualization through different vein depths, tissue densities and skin tones and under different lighting conditions. The slim wand, lightweight but durable unit and rechargeable battery make vein location portable and efficient.

TransLite
Veinlite LED
veinlite.com
(281) 240-3111
Pricing: $469
FYI: TransLite's portable Veinlite vein finders are designed to reduce access failure even on high-acuity patient populations, including pediatrics, geriatrics, the overweight and the dehydrated, to save providers time and spare patients the pain and anxiety of multiple sticks. The rechargeable Veinlite LED transilluminator features 24 light-emitting diodes in 2 colors, 12 of them orange for high-contrast imaging and 12 of them red for deeper light for deeper light penetration and increased permeation through darker skin, for use together or separately. Disposable covers make the device easily reusable.

VueTek Scientific
Veinsite
vuetekscientific.com
(207) 657-6565
Pricing: $5,995
FYI: Worn like a bicycle helmet, VueTek Scientific's Veinsite illuminates the patient's skin with near-infrared light to detect and analyze vasculature and puts a liquid crystal display screen in the user's line of sight to deliver a video image of details invisible to the unaided eye. The design allows users an unobstructed view of the patient while simultaneously seeing through their skin to find veins suitable for IV cannulation. The headset feature enables effortless panning of the anatomy and frees up both hands for palpation and practice.