Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> BACKGROUND A new noninvasive vein imaging device initially developed for phlebotomy has been tested for the first time for vein treatment. This unique device captures a near infrared vein image, processes it, and projects it onto the skin using green light. OBJECTIVE To perform the first clinical tests of the device in phlebology. METHODS AND MATERIALS A pilot study on 23 subjects with varicose veins and telangiectasias was performed. The VeinViewer prototype (V-V-P; Luminetx Corp., Memphis, TN) was tested in five situations: diagnosing feeder veins with the V-V-P, comparison between the V-V-P and ultrasound, marking varicose veins with or without the device, phlebectomy using the V-V-P, and the use of laser and sclerotherapy guided by the V-V-P. RESULTS One hundred percent of subjects had feeder veins identified by the V-V-P. The ultrasound machine detected fewer feeder veins than the V-V-P, and the device identified more veins than the naked eye in all subjects. The V-V-P could help in finding feeder veins during phlebectomy and in guiding laser and sclerotherapy treatments. CONCLUSIONS The device could identify veins that were invisible to the naked eye and too shallow for ultrasound detection. The V-V-P may help find feeder veins and may also help various types of vein treatments. Herbert David Zeman, Gunnar Lovhoiden, and Carlos Vrancken are founders, shareholders, and employees of Luminetx Corp., the manufacturer of the VeinViewer <s> BIB001 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> While many areas of health care are still struggling with the issue of patient safety, laboratory diagnostics has always been a forerunner in pursuing this issue. Significant progress has been made since the release of “To Err is Human.” 1 This article briefly reviews laboratory quality assessment and looks at recent statistics concerning laboratory errors. <s> BIB002 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> Under the different light irradiation, the reflective and scattering intensity of skin image can be applied to evaluate many human health indices, such as oxygen saturation in blood, skin tissue aging or skin lesions (leukoplakia, turmoil cell, and so on). Due to the different absorption and scattering rate of skin illustrated by a variety of LED light source, we can perform the processing and analysis of skin surface images. Since the surface roughness is more sensitive to the shorter wavelength light source (430 nm and 470 nm LED), so the difference of reflective light image can be used to detect the skin roughness. In addition, the oxygenated hemoglobin (HbO2) in blood has a relatively high absorption rate at green (570 nm) and near-infrared (940 nm) light, so it can be used to compute the oxygen saturation. In this study, based on the different light absorption of HbO2 in blood, there are six light sources (deep blue, blue, green, deep red, NIR, white light) would be applied to the inspection of skin characteristics. The processed images provide better reference for the follow-up studies on the oxygen saturation of peripheral blood and skin aging. <s> BIB003 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> Since evidence based medicine (EBM) is now become the main principle guiding clinical practice and is being followed universally the role of laboratory medicine in EBM needs not to be over- emphasized. So it is the need of the hour to ensure that the best evidence on testing is made available through the help of the laboratory to the clinician. This would result in making the best decision based on test results which would lead to increased probability of improved health outcomes. So it is necessary for the laboratory to maintain the strictest quality possible. Here we would see the steps of pre-analytical phase and the various points at which error can arise and how to mitigate them. The present study was carried out in our hospital central laboratory and data were collected and analyzed. Pre-analytical phase is most important in testing process and involves variables that are not under the control of the laboratory. So much care needs to be taken to deeply scrutinize this step of analysis and keep a tab on errors arising in it. <s> BIB004 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> BACKGROUND ::: Peripheral venous (PV) cannulation, one of the most common technical procedures in Emergency Medicine, may prove challenging, even to experienced Emergency Department (ED) staff. Morbid obesity (body mass index [BMI] ≥ 40) has been reported as a risk factor for PV access failure in the operating room. ::: ::: ::: OBJECTIVES ::: We investigated PV access difficulty in the ED, across BMI categories, focusing on patient-related predicting factors. ::: ::: ::: METHODS ::: Prospective, observational study including adult patients requiring PV lines. Operators were skilled nurses and physicians. PV accessibility was clinically evaluated before all cannulation attempts, using vein visibility and palpability. Patient and PV placement characteristics were recorded. Primary outcome was failure at first attempt. Outcome frequency and comparisons between groups were examined. Predictors of difficult cannulation were explored using logistic regression. A p-value <0.05 was considered significant. ::: ::: ::: RESULTS ::: PV lines were placed in 563 consecutive patients (53 ± 23 years, BMI: 26 ± 7 kg/m(2)), with a success rate of 98.6%, and a mean attempt of 1.3 ± 0.7 (range 1-7). Failure at the first attempt was recorded in 21% of patients (95% confidence interval [CI] 17.6-24.4). Independent risk factors were: a BMI ≥ 30 (odds ratio [OR] 1.98, 95% CI 1.09-3.60), a BMI < 18.5 (OR 2.24; 95% CI 1.07-4.66), an unfavorable (OR 1.66, 95% CI 1.02-2.69), and very unfavorable clinical assessment of PV accessibility (OR 2.38, 95% CI 1.15-4.93). ::: ::: ::: CONCLUSION ::: Obesity, underweight, an unfavorable, and a very unfavorable clinical evaluation of PV accessibility are independent risk factors for difficult PV access. Early recognition of patients at risk could help in planning alternative approaches for achieving rapid PV access. <s> BIB005 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> Excessive venipunctures are both time- and resource-consuming events, which cause anxiety, pain, and distress in patients, or can lead to severe harmful injuries. We propose a low-cost mobile health solution for subcutaneous vein detection using near-infrared spectroscopy, along with an assessment of the current state of the art in this field. The first objective of this study was to get a deeper overview of the research topic, through the initial team discussions and a detailed literature review (using both academic and grey literature). The second objective, that is, identifying the commercial systems employing near-infrared spectroscopy, was conducted using the PubMed database. The goal of the third objective was to identify and evaluate (using the IEEE Xplore database) the research efforts in the field of low-cost near-infrared imaging in general, as a basis for the conceptual model of the upcoming prototype. Although the reviewed commercial devices have demonstrated usefulness and value for peripheral veins visualization, other evaluated clinical outcomes are less conclusive. Previous studies regarding low-cost near-infrared systems demonstrated the general feasibility of developing cost-effective vein detection systems; however, their limitations are restricting their applicability to clinical practice. Finally, based on the current findings, we outline the future research direction. <s> BIB006 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> Preanalytical errors have previously been shown to contribute a significant proportion of errors in laboratory processes and contribute to a number of patient safety risks. Accreditation against ISO 15189:2012 requires that laboratory Quality Management Systems consider the impact of preanalytical processes in areas such as the identification and control of non-conformances, continual improvement, internal audit and quality indicators. Previous studies have shown that there is a wide variation in the definition, repertoire and collection methods for preanalytical quality indicators. The International Federation of Clinical Chemistry Working Group on Laboratory Errors and Patient Safety has defined a number of quality indicators for the preanalytical stage, and the adoption of harmonized definitions will support interlaboratory comparisons and continual improvement. There are a variety of data collection methods, including audit, manual recording processes, incident reporting mechanisms and laboratory information systems. Quality management processes such as benchmarking, statistical process control, Pareto analysis and failure mode and effect analysis can be used to review data and should be incorporated into clinical governance mechanisms. In this paper, The Association for Clinical Biochemistry and Laboratory Medicine PreAnalytical Specialist Interest Group review the various data collection methods available. Our recommendation is the use of the laboratory information management systems as a recording mechanism for preanalytical errors as this provides the easiest and most standardized mechanism of data capture. <s> BIB007 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> Background ::: Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical phase includes patient preparation, specimen transportation, specimen collection and storage. In the present study, we report the first comprehensive assessment of the frequency and types of pre-analytical errors at the Sulaimani diagnostic labs in Iraqi Kurdistan. ::: ::: ::: Materials and Methods ::: Over 2 months, 5500 venous blood samples were observed in 10 public diagnostic labs of Sulaimani City. The percentages of rejected samples and types of sample inappropriateness were evaluated. The percentage of each of the following pre-analytical errors were recorded: delay in sample transportation, clotted samples, expired reagents, hemolyzed samples, samples not on ice, incorrect sample identification, insufficient sample, tube broken in centrifuge, request procedure errors, sample mix-ups, communication conflicts, misinterpreted orders, lipemic samples, contaminated samples and missed physician’s request orders. The difference between the relative frequencies of errors observed in the hospitals considered was tested using a proportional Z test. In particular, the survey aimed to discover whether analytical errors were recorded and examine the types of platforms used in the selected diagnostic labs. ::: ::: ::: Results ::: The analysis showed a high prevalence of improper sample handling during the pre-analytical phase. In appropriate samples, the percentage error was as high as 39%. The major reasons for rejection were hemolyzed samples (9%), incorrect sample identification (8%) and clotted samples (6%). Most quality control schemes at Sulaimani hospitals focus only on the analytical phase, and none of the pre-analytical errors were recorded. Interestingly, none of the labs were internationally accredited; therefore, corrective actions are needed at these hospitals to ensure better health outcomes. Internal and External Quality Assessment Schemes (EQAS) for the pre-analytical phase at Sulaimani clinical laboratories should be implemented at public hospitals. Furthermore, lab personnel, particularly phlebotomists, need continuous training on the importance of sample quality to obtain accurate test results. <s> BIB008 </s> Vein Pattern Locating Technology for Cannulation: A Review of the Low-Cost Vein Finder Prototypes Utilizing near Infrared (NIR) Light to Improve Peripheral Subcutaneous Vein Selection for Phlebotomy <s> STUDY (First Author, Year of Publication) PRE-ANALYTICAL ERROR (%) <s> The pre-analytical phase encompasses all the procedures before the start of laboratory testing. This phase of the testing process is responsible for the majority of the laboratory errors, since the related procedures involve many sorts of non-laboratory professionals working outside the laboratory setting, thus without direct supervision by the laboratory staff. Therefore, either correct organization or management of both personnel and procedures that regard blood specimen collection by venipuncture are of fundamental importance, since the various steps for performing blood collection represent per se sources of laboratory variability. The aim of this (non-systematic) review addressed to healthcare professionals is to highlight the importance of blood specimen management (from patient preparation to laboratory analyses), as a tool to prevent laboratory errors, with the concept that laboratory results from inappropriate blood specimens are inconsistent and do not allow proper treatment nor monitoring of the patient. <s> BIB009
[ West J et al., 2017 BIB007 up to 68.20 Najat D, 2017 BIB008 up to 70.00 Salinas M et al., 2015  60.00 to 70.00 Patra S, 2013 BIB004 46.00 to 68.20 Hammerling J, 2012 BIB002 46.00 to 68.20 Lippi G et al., 2011 [17] 60.00 to 70.00 Goswami B et al., 2010 [18] 77. BIB005 In venipuncture, there are means on how to help the phlebotomist view the vein properly, among those were by slightly tapping the site [5] , use of tourniquet, and applying cold vibration close to the site for venipuncture or fist clenching, which are considered and studied to cause physiological disturbance on veins and significant variability in several laboratory test results BIB009 . The procedure for venipuncture cannot be considered as a gold standard yet, since errors are still being detected  with continuous recommendations for improvements were supplemented. The CLSI H03-A6 document which suggested modifications in some of the steps in venipuncture, such as to cleanse the site and to allow drying before applying tourniquet to view and select the vein and finally to release the tourniquet immediately when the filling of the first tube started. It is able to reduce the tourniquet application time, as the result showed in the study by  Oliveira G. et al., in 2013. Moreover, it was mentioned that the transilluminator (vein finder) can make for more accurate visualization of the vein course, unfortunately, it is not widely used mainly due to the cost of the commercially available devices BIB009 . The patient's vein is the main site for blood specimen collection for testing, entry point for medications, and the site for and blood transfusions. Venipuncture should be performed with care and precise considering the limited number of easily accessible veins in the body  . Aside from venipuncture, the near infrared (NIR) transilluminator imaging was used to enhance vein treatment by helping in the identification of veins which were noted to be invisible to the naked eye but too shallow for ultrasound detection BIB001 . It is even used for optical imaging of the skin to guide dermatologist for proper diagnosis of diseases and skin care, specifically in the study by BIB003 Huang K et al., 2012, shows black/white mole skin roughness imaging in epidermis and skin tissue aging or skin lesions. Cannulation is being considered as challenging due to many factors. To mention, the following are the known risk factors that cause difficulties during this procedure: Dehydration, dark skin, obesity, hypotension, peripheral vasoconstriction, poor vein quality, aging, young age including preterm and term neonates, vein site used in drug abuse and chemotherapy, telangiectasia, site with skin rash, including even the low skill of the personnel performing the procedure BIB006 . These challenges necessitate for the improvement of steps in performing cannulation. It includes development and use of a vein finder to assist in locating vein as the site for different procedures, which aim to lessen missed vein during needle insertion on the first trial by medical practitioners.