While it is no doubt one of the most common procedures in the hospital, the insertion and placement of intravenous catheters can still be a tricky process, even for veteran nurses.

Luckily, whether for hydration or medication, there are a whole host of new technologies, medical computers, and hand-held devices that are looking to give nurses a leg-up.

Are IV Insertions That Tough?

First, let’s talk about why IVs can be so difficult and aggravating.

Every nurse has run into a “difficult stick,” or a patient whose vascular system seems either needle-proof or too weak to sustain an IV long term.

Difficult sticks are frustrating for both staff and patient. Failed IV placement can make staff feel inadequate, as evidenced by pages upon pages of nurse forum posts asking for advice or simply blowing off steam about their perceived failures. They also may have to bring in other nurses to attempt the insertion, which lowers staff efficiency and leaves other patients untended. Of course, on the more dangerous end of the spectrum, a failed IV could lead to a host of problems, especially if the patient is dehydrated or desperately in need of a given medication.

Patients, of course, don’t exactly enjoy being stabbed multiple times in failed attempts to insert an IV. And, should all resources fail, the staff may have to revert to a central line IV, which is both uncomfortable for the patient, often overkill for short-term treatment, and increases risk of bloodstream infection.

1. Traditional Ultrasound-Guided IV Insertion

Speaking of ultra-sound guided IVs: they’re a newer technology that still hasn’t fully proliferated in all hospital environments. Even facilities that do have it usually only have one individual on shift at a time certified to operate the machine, creating a backup and slowdown of services.

Ultrasound-guided IVs use ultrasound (surprise) to map the veins of the patient and provide a clear path to the best candidates for catheter insertion. It’s not foolproof, and mistakes can be made (see the personal anecdote above), but it’s generally tried-and-true and a solid choice for many IV placements that would be otherwise quite difficult.

In fact, a study found that the success rate of IV placement improved by 16% because of ultrasound-guided IV placement, from a success rate of 64% using traditional methods all the way up to 80% for ultrasound. They also needed fewer redirections, overall attempts, and took less time to insert.

2. Portable Ultrasound Devices

There are even smaller, more easy-to-handle ultrasound devices on the way. The EchoNous, approved by the FDA in 2018, uses a compact form and cutting edge technology to accurately image veins with just the push of a button.

Other portable systems, like the Philips Lumify or the Butteryfly iQ, actually make use of existing medical tablets and even mobile phones for imaging and display. The Lumify is an ultrasound probe (or transducer) that connects to the medical tablet PC via USB. Once connected, and the application downloaded, the Lumify can be used for many ultrasound purposes. However, its compact design and ubiquitous connectivity with any hospital tablet PC make it an excellent option for ultrasound-guided IV insertion.

3. Making Veins Larger and More Visible

Devices like Veinplicity don’t necessarily improve digital imaging – instead, they use physiological methods to actually increase the size and visibility of the actual veins in the forearm.

Veinplicity uses electrical impulses, sent via a pair of leads, to increase blood flow to the area. One lead is placed on the back of the hand, and the other on the bicep. This increased blood flow causes the veins in the forearm to plump up, not only making them easier to see, but physically easier to stick, with a greater margin of error for inserting a catheter.

Devices like AccuVein, on the other hand, don’t improve the size of the veins themselves. Instead, they use lasers to penetrate the skin of the patient. The skin and muscles reflect light well, but the hemoglobin in blood tends to absorb light. This, in turn, causes the veins to appear as very dark shadows against the illuminated skin of the patient, making it obvious where to insert an IV.

Preliminary studies by the University of Massachusetts Medical School show that the Accuvein laser device increased the two-stick success rate of obese female patients from 50% to a whopping 96%

4. IV Safety Administration Solutions

While IV medications are a critical therapy to improve patients’ conditions, they unfortunately pose the greatest risk of harm to said patients. Of the most serious and life-threatening potential patient adverse drug events (PADEs), 61% are associated with IV medications (Bates DW, Brigham & Women’s Hospital, Boston, MA, personal communication, Oct 2001).

Most hospitals in the US have implemented “smart” infusion pumps with dose error reduction software (DERS) to increase IV safety administration; in fact, the BD Alaris™ System was the first infusion pump to offer this protection, coining the term “Guardrails™.” Like the name suggests, DERS allows infusion pumps to warn users of incorrect medication orders, calculation errors or misprogramming events that would result in a significant under or over-delivery of a drug or fluid – potentially resulting in patient harm or death if not caught by the system.

Additionally, the BD Alaris System can wirelessly connect with the Electronic Medical Record (EMR), seamlessly feeding IV information from the pump back to the EHR. This reduces both the need for manual documentation of that information as well as potential programming errors.

Typically, IV medications are compounded in the pharmacy before arriving to the patient floor. Today’s compounding practice involves several complex processes, many with technology gaps that pose risks for harmful errors such as incorrect drug selection and inaccurate dosage. In fact, studies indicate that manual IV compounding can have error rates as high as 9% (Flynn EA. Am J Health Syst Pharm 1997 May 1;54(9):1110). BD Pyxis™ IV Prep helps pharmacies bridge the gaps in compounding medication safety with functions like barcode scanning, image capture, gravimetric analysis and workflow support. Working in tandem, all of these functions ensure compounding is performed accurately, delivering the right drug and the right dose to the right patient, every time.

Cybernet & BD Pyxis IV Prep work in harmony to help ensure the pharmacy is compounding accurately so that nursing can be confident that what is in the IV medication bag is exactly what the doctor ordered.

5. Real-Time Vascular Projection

Technology like the “Vein Viewer” is something of a combination between the on-the-skin laser imaging of Accuvein with the real-time under-skin imaging of an ultrasound device.

The Vein Viewer uses infrared technology to penetrate the skin, which then creates a solid map of the interior of the arm’s vascular system. The Vein Viewer then gathers this data and projects the map right onto the patient’s skin. The patient and clinician can then see a real-time scan of the patient’s veins, without the bulk or screen of a traditional ultrasound device.

6. Distracting Kids from Painful Procedures

IV insertion is painful and uncomfortable enough for adults — children don’t have the willpower to hide it or the experience to deal with it. Placing an IV in a pediatric patient is also doubly hard, because their arms are smaller, and subsequently, their veins are smaller as well.

A group of doctors (Dr. Jeffrey I. Gold, Seok Hyeon Kim, Alexis J. Kant, Michael H. Joseph, and Albert “Skip” Rizzo) decided to try virtual reality stimulation as a way for the pediatric patient to be distracted during the intravenous catheter placement, in hopes that it would help decrease pain, anxiety, tears, and general discomfort.

The children in the test-run were given a head-mounted VR display to wear and the requisite controllers. They then played the VR game “Street Luge,” while the clinicians performed tests, inserted IVs, and did the other normally painful or uncomfortable procedures that the children required for treatment. Everyone in the study, including parents, the child patients, and all clinicians reported less pain, less discomfort, and less anxiety across the board.

Reducing IV Anxiety

As you can see, the issue of IV anxiety and difficult sticks is fairly universal, otherwise there wouldn’t be so many solution ideas popping out of the weeds.

To learn more about the kind of medical computers and medical grade tablets that can make life in the hospital easier, contact Cybernet today.

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