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> Assessment of the Vein Finder Prototype <s> The contamination rate of phlebotomy tourniquets with meticillin-resistant Staphylococcus aureus (MRSA) was assessed, and it was determined whether this could be reduced by changes in practice or by the use of a physical barrier. Initially, the tourniquets of both preregistration house officers and phlebotomists were investigated, but as phlebotomists reported significantly more venepunctures daily, the trial continued solely with phlebotomists. Each day, the phlebotomists were supplied with a fresh sterile tourniquet, and after use, the tourniquets were swabbed and cultured. The rate of contamination with MRSA was 32 of 131 (25%) tourniquets. An audit of hand hygiene practice was undertaken and revealed that phlebotomists were performing hand decontamination inadequately between patients and wore wristwatches while working. Education comprising standard infection control methods to encourage good practice was given. After this, a polythene strip was used as a barrier by half of the phlebotomists during all venepunctures. Tourniquets were cultured and replaced daily as before. During this stage of the trial, the rates of contamination were 1 of 46 tourniquets (using a polythene strip) and 1 of 42 tourniquets (without using a polythene strip). In conclusion, phlebotomy tourniquets may be potential vectors for transferring bacteria, including MRSA. Contamination rates, and hence potential risk, can be reduced if hand decontamination is performed. This suggests that contamination of tourniquets is via phlebotomists' hands, not directly from patients' skin. Hand hygiene should be regarded as the most important method by which the spread of organisms can be reduced. <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> Assessment of the Vein Finder Prototype <s> Introduction. This study aims to evaluate for the first time the value of visualizing veins by a prototype of a near-infrared (NIR) vascular imaging system for venipuncture in children. Methods. An observational feasibility study of venipunctures in children (0-6 years) attending the clinical laboratory of a pediatric university hospital during a period of 2 months without (n = 80) and subsequently during a period of 1 month with a prototype of an NIR vascular imaging system (n = 45) was conducted. Failure rate (ie, more than 1 puncture) and time of needle manipulation were determined. Results. With the NIR vascular imaging system, failure rate decreased from 10/80 to 1/45 (P = .05) and time decreased from 2 seconds (1-10) to 1 second (1-4, P = .07). Conclusion . This study showed promising results on the value of an NIR vascular imaging system in facilitating venipunctures. <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> Assessment of the Vein Finder Prototype <s> Venipuncture is pivotal to a wide range of clinical interventions and is consequently the leading cause of medical injury in the U.S. Complications associated with venipuncture are exacerbated in difficult settings, where the rate of success depends heavily on the patient's physiology and the practitioner's experience. In this paper, we describe a device that improves the accuracy and safety of the procedure by autonomously establishing a peripheral line for blood draws and IV's. The device combines a near-infrared imaging system, computer vision software, and a robotically driven needle within a portable shell. The device operates by imaging and mapping in real-time the 3D spatial coordinates of subcutaneous veins in order to direct the needle into a designated vein. We demonstrate proof of concept by assessing imaging performance in humans and cannulation accuracy on an advanced phlebotomy training model. <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> Assessment of the Vein Finder Prototype <s> BackgroundSubcutaneous veins localization is usually performed manually by medical staff to find suitable vein to insert catheter for medication delivery or blood sample function. The rule of thumb is to find large and straight enough vein for the medication to flow inside of the selected blood vessel without any obstruction. The problem of peripheral difficult venous access arises when patient’s veins are not visible due to any reason like dark skin tone, presence of hair, high body fat or dehydrated condition, etc.MethodsTo enhance the visibility of veins, near infrared imaging systems is used to assist medical staff in veins localization process. Optimum illumination is crucial to obtain a better image contrast and quality, taking into consideration the limited power and space on portable imaging systems. In this work a hyperspectral image quality assessment is done to get the optimum range of illumination for venous imaging system. A database of hyperspectral images from 80 subjects has been created and subjects were divided in to four different classes on the basis of their skin tone. In this paper the results of hyper spectral image analyses are presented in function of the skin tone of patients. For each patient, four mean images were constructed by taking mean with a spectral span of 50 nm within near infrared range, i.e. 750–950 nm. Statistical quality measures were used to analyse these images.ConclusionIt is concluded that the wavelength range of 800 to 850 nm serve as the optimum illumination range to get best near infrared venous image quality for each type of skin tone. <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> Assessment of the Vein Finder Prototype <s> Background ::: Excessive venipunctures are a significant problem both in emergency rooms and during hospital stays. Near-infrared (NIR) illumination devices improve venipuncture success rate but their usage is limited by their availability and economic cost. The objectives of this study were to develop a low-cost NIR spectroscopy prototype from a standard mobile device, to evaluate its efficacy and acceptance as an educational tool, and in a clinical setting. <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> Assessment of the Vein Finder Prototype <s> OBJECTIVE ::: To compare the performance on the detection of the invisible veins between our modified prototype device and an existing device in elderly hospitalized patients. ::: ::: ::: METHODS ::: A prospective, cross-sectional, and observational study was performed in the invisible veins in elderly patients. The major variables, skin color near the invisible veins, and diameter and depth of the invisible veins were measured. The vein visualization rate was calculated as the ratio of the visualized veins to the invisible veins by the visualization device. ::: ::: ::: RESULTS ::: We analyzed 53 invisible veins in the cubital fossa and 56 invisible veins in the forearm in a total of 72 patients (median age, 73 years). The visualization rate for our prototype device was higher than that for an existing device in the cubital fossa and the forearm sites. The visualized veins of the prototype device had a higher intensity ratio than that of an existing device. No significant differences were observed in the body mass index, vein depth, and vein diameter of the visualized veins at the cubital fossa and forearm sites. ::: ::: ::: CONCLUSION ::: The prototype surpassed the existing device in visualizing the invisible veins. However, the prototype was unable to visualize all the invisible veins. We need to look for ways to reduce noise and to visualize the invisible veins, and the visualization rate of devices needs to be investigated in further association with the percentage of success with actual intravenous access and locating time to vein. <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> Assessment of the Vein Finder Prototype <s> Advance biomedical engineering technologies are continuously changing the medical practices to improve medical care of patients nowadays. In this paper, we describe the concept used to prototype a device for needle insertion navigation during intravenous catheterization process via Near Infrared (NIR) imaging technique. A vein locator prototype using the NIR imaging technique and augmented reality (AR) technology have been developed in this work which is meant to be used in the process of intravenous catheterization. The challenges faced during the development of this prototype included the calibration of composite images in the see-through display. In this prototype, the Vuzix STAR 1200XL eyewear system has been used as the head mounted display and the imaging video is input by IR CCD camera. Additional, We select the optimum illumination by using NIR LED with wavelength of 830nm and 850nm in prototying to obtain the best contrast NIR venous image for different types of skin tone. <s> BIB007
There were 9 out of 21 (42.85%) studies which did not perform human testing with their prototypes that lead to the limitation in the actual evaluation process. For studies with human testing, Cuper, S. et al., 2011 BIB002 has the highest number of subjects with a total of 125 male and female children followed by Chen A et al., 2013 BIB003 with 101 patients/subjects and Shahzad A et al., 2014 BIB004 with 80 subjects/patients, the lowest number of subject was with Dai et al., 2013 [35] . In addition, there is a study that used a synthetic plastic vein model with dog's blood for their prototype testing. Access to the antecubital vein is a big challenge for doctors in case of obese people, pediatrics, elderly and dark skinned people as stated in the study of Dhakshayani, M. et al., 2015 [47] , with this they specifically selected their subjects as to 25 dark skinned people, 25 obese subjects, 25 pediatrics, and 2 elderly people in testing their prototype by viewing the antecubital vein in forearm and cephalic vein of the dorsal hand. The prototype tested with pediatric patients for venipuncture showed a positive result, the failure rate with 1 out of 45 (2%) compared without the use of NIR vascular imaging system 10 out of 80 (13%) was noted. The device used was not rated negatively in any of the cases of the performed venipuncture by the phlebotomist BIB002 . In the testing done by Anupongongarch P et al., in 2015 [37] the prototype was evaluated through actual performance of venipuncture. Results show that the use of the vein finder increased the success of the procedure in the first attempt-15/17 (88.23%) with the device compared to 10/17 (58.82%) by standard of care vein access in pale skin/subject. While, the result from color skin/subjects were 8/13 (61.53%) and 6/13 (46.15%) with and without the use of the device, respectively. Moreover, the study of Juric S and Zalik B, 2014 BIB005 included the participation of 43 trainee clinicians (nursing students) in performing the procedure to evaluate their prototype through a noninvasive, observational study having the highest result of 4.45 (mean value) for the Likert scale item (A) "the prototype is useful" and a 35.2% more successful in visualizing and locating veins (n = 500 attempts) than the nursing students. It is worth mentioning that regarding the device with 15-20 cm distance above the site: The allowable distance was set to ensure the needed space in performing a vein puncture in Kimori et al., 2015 BIB006 and the prototype by Meng, G. et al., 2015 BIB007 with a head wearable model. While, there was direct skin contact noted in some of the developed prototypes, the vein finder was introduced  There were 9 out of 21 (42.85%) studies which did not perform human testing with their prototypes that lead to the limitation in the actual evaluation process. For studies with human testing, Cuper, S. et al., 2011 BIB002 has the highest number of subjects with a total of 125 male and female children followed by Chen A et al., 2013 BIB003 with 101 patients/subjects and Shahzad A et al., 2014 BIB004 with 80 subjects/patients, the lowest number of subject was with Dai et al., 2013 [35] . In addition, there is a study that used a synthetic plastic vein model with dog's blood for their prototype testing. Access to the antecubital vein is a big challenge for doctors in case of obese people, pediatrics, elderly and dark skinned people as stated in the study of Dhakshayani, M. et al., 2015 [47] , with this they specifically selected their subjects as to 25 dark skinned people, 25 obese subjects, 25 pediatrics, and 2 elderly people in testing their prototype by viewing the antecubital vein in forearm and cephalic vein of the dorsal hand. The prototype tested with pediatric patients for venipuncture showed a positive result, the failure rate with 1 out of 45 (2%) compared without the use of NIR vascular imaging system 10 out of 80 (13%) was noted. The device used was not rated negatively in any of the cases of the performed venipuncture by the phlebotomist BIB002 . In the testing done by Anupongongarch P et al., in 2015 [37] the prototype was evaluated through actual performance of venipuncture. Results show that the use of the vein finder increased the success of the procedure in the first attempt-15/17 (88.23%) with the device compared to 10/17 (58.82%) by standard of care vein access in pale skin/subject. While, the result from color skin/subjects were 8/13 (61.53%) and 6/13 (46.15%) with and without the use of the device, respectively. Moreover, the study of Juric S and Zalik B, 2014 BIB005 included the participation of 43 trainee clinicians (nursing students) in performing the procedure to evaluate their prototype through a non-invasive, observational study having the highest result of 4.45 (mean value) for the Likert scale item (A) "the prototype is useful" and a 35.2% more successful in visualizing and locating veins (n = 500 attempts) than the nursing students. It is worth mentioning that regarding the device with 15-20 cm distance above the site: The allowable distance was set to ensure the needed space in performing a vein puncture in Kimori et al., 2015 [46] and the prototype by Meng, G. et al., 2015 [48] with a head wearable model. While, there was direct skin contact noted in some of the developed prototypes, the vein finder was introduced with the same purpose as a tourniquet, which is used to help locate the vein. In medical practice, a vein finder is used as a device for venipuncture from one patient to another. With those models that require direct skin contact, it may cause transmission of infection known as hospital acquired infection (HAI) if not properly disinfected. In the 2006 study by Leitch A et al., BIB001 it was showed that the rate of contamination with Methicillin-resistant Staphylococcus aureus (MRSA) was 32 of 131 (25%) of the tourniquets tested, which leads to the conclusion that the tourniquets being used for phlebotomy may be a potential vectors for transferring bacteria including MRSA. Recently, the Clinical & Laboratory Standards Institute (CLSI) recommended a single-use of tourniquets as a preventive measure in the spread of Methicillin-resistant Staphylococcus aureus (MRSA) and other pathogens, since it is being used with direct contact with patients and might have been contaminated   . With the vein finder device, a disposable type is not feasible in the current situation; instead a non-contact model can address the concern on how to prevent possible transfer of contamination.