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> Errors in the Pre-Analytical Phase in Clinical Laboratory Testing <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> 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> Errors in the Pre-Analytical Phase in Clinical Laboratory Testing <s> Abstract Background Peripheral intravenous catheterization (PIVC) is commonly performed on emergency departments and inpatient units. Unsuccessful PIVC first attempts increase pain, and lead to treatment and diagnostic delays. Objective To determine strategies associated with PIVC first attempt success in adult emergency department patients and inpatients. Methods We searched MEDLINE, EMBASE, CINAHL, TRIP, Cochrane Central Register of Controlled Trials (OVID), and grey literatures databases such as Proquest Dissertation and Theses Global, and Open Grey databases between November and December, 2014. The search was updated on January 28, 2016. We included full text reports of randomized controlled trials testing PIVC interventions versus standard of care. Risk of bias was assessed using the Cochrane Collaboration's tool. Results We included 14 randomized controlled trials involving 3201 participants. Interventions included the AccuVein™, AccuCath™ catheter system, ultrasound, safety catheters, and topical anesthetics. Three studies compared AutoGuard and Insyte catheters and were suitable for meta-analysis. There was no difference in first attempt success with a relative risk of 0.0 (95% CI, −0.04, 0.04). There was limited evidence to support the use of ultrasound to increase first attempt success. Conclusions Well-designed and reported randomized controlled trials examining the effectiveness of ultrasound compared to standard of care are warranted. Registration PROSPERO registration: CRD42014015428. <s> BIB002
Cannulation using the vein is the most common site for blood extraction, also known as phlebotomy, gaining venous blood as a specimen of choice for many clinical laboratory testing for the diagnosis of diseases. Moreover, cannulation is being used in performing technical procedures in emergency medicine BIB001 . It includes peripheral intravenous catherization (PIVC) that remains challenging for many clinicians to complete successfully on the first attempt BIB002 . This procedure is considered as one of the pre-analytical steps that can be a possible source of variability in the laboratory results affecting proper diagnosis and treatment process (see Table 1} . Table 1 shows that pre-analytical phase in clinical laboratory testing in various studies has the highest percentage error as compared to the analytical and post analytical phases from 46.00% up to 77.10% with the average of 61.55%. 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  Cannulation using the vein is the most common site for blood extraction, also known as phlebotomy, gaining venous blood as a specimen of choice for many clinical laboratory testing for the diagnosis of diseases. Moreover, cannulation is being used in performing technical procedures in emergency medicine BIB001 . It includes peripheral intravenous catherization (PIVC) that remains challenging for many clinicians to complete successfully on the first attempt BIB002 . This procedure is considered as one of the pre-analytical steps that can be a possible source of variability in the laboratory results affecting proper diagnosis and treatment process (see Table 1 ). Table 1 shows that pre-analytical phase in clinical laboratory testing in various studies has the highest percentage error as compared to the analytical and post analytical phases from 46.00% up to 77.10% with the average of 61.55%. Table 1 . Statistical report on pre-analytical errors (2010) (2011) (2012) (2013) (2014) (2015) (2016) (2017) .