Christie Medical Holdings

The Impact of VeinViewer in an

Emergency Environment

The ED patient population changes every day. Patients may be seriously injured or ill. Disease
states vary; many patients are dehydrated and/or difficult venous access. Time is critical and
delays may be detrimental to patient outcomes.

VeinViewer by Christie is a vein visualization device that can help the clinician find the optimal
venipuncture site and avoid potential complications. The device is proven to improve first-stick
success rates, leading to improved (shorter) overall time to start peripheral IVs.

A study conducted in a pediatric ward of the Yonsei University College of Medicine, Seoul,
Korea looked at whether use of VeinViewer facilitated peripheral venous access. Authors
randomized 111 pediatric patients between the ages of 1 month and 16 years into either the
VeinViewer (n=54) group or the standard group (n=57). Nurses with at least 3 years of pediatric
experience were recruited to perform the study on PIV access. The study revealed a significant
improvement of first attempt success rates and a significant trend toward improvement of overall
procedural time during peripheral venous access.

% Conclusion: “The VeinViewer®

Outcome VeinViewer Control Improvement
Measure Group Group (p-value) facilitated peripheral venous
access for pediatric patients with
First
difficult veins, which enhanced
attempt 58.3% 25.0% 133%
success (14/24) (5/20) (0.026) first-attempt success rates.” –Kim,
Results

rate MJ et al. Efficacy of VeinViewer in

pediatric peripheral intravenous
access: a randomized controlled
Overall
procedural 54 92 41% trial. European J. Pediatrics (2012)
time per (44,106) (75,156) (0.056)
patient (s)
VeinViewer is in use in hospitals, clinics, ambulatory surgery centers and vein treatment
centers across the US, including Hendrick Medical Center in Abilene, Texas. The first
unit was built in 1924. Today Hendrick Medical Center is a 522-bed facility that includes:
a Retirement Village, Cancer Center, Day Surgery Center, Wound Center and Trauma
Center.

Hendrick Medical Center adopted VeinViewer technology in 2008. The device allows a
clinician to visualize peripheral veins up to 10mm deep and blood patterns up to 15mm
beneath the surface of the skin. VeinViewer is effective regardless of a patient’s size,
age, skin tone or disease state.

“I am a coordinator in the Trauma Center where we see not only a large pediatric
population, but a great number of geriatric and just plain dehydrated patients. I
have had great success in using the VeinViewer…I used the VeinViewer on an
elderly gentleman last week who had been stuck a total of 27 times at another
facility prior to being transferred to us. I used the VeinViewer and was able to
start an 18 gauge with only one stick.” –Judy Gilbreath, RN, CEN Coordinator,
Hendrick Medical Center, Abilene, TX

The imaging is accurate as well. Analysis of 3,000 data points showed VeinViewer has
an overall vein width imaging accuracy of +/- 0.5mm when compared to ultrasound. For
veins that are most commonly accessed for peripheral IVs, those that are 3.0 – 7.0mm
wide, VeinViewer imaging accuracy increases to +/- 0.06mm. The vein width accuracy of
VeinViewer was analyzed as a function of depth as well and results demonstrated near-
perfect image projection in veins up to 10mm deep.

How it Works:

VeinViewer is a vein visualization device. It works simply by illuminating the area of interest with
near-infrared (NIR) light, and because it is known that NIR light is absorbed by blood, an image
of where the veins are and are not located can be displayed on the surface of the skin. First the
skin is flooded with harmless NIR light (figure 1). The light not absorbed by the blood reflects
back to the NIR detector (figure 2). The VeinViewer projector then projects the pattern of where
the NIR light was and was not absorbed, with an image digitally enhanced for clarity (figure 3).

Figure 1 Figure 2 Figure 3

The resulting image is projected in high-definition and in real-time on the surface of the
skin. It is this digital full-field projection that allows for assessment pre, during and post
(PDP) vascular access. These capabilities set VeinViewer apart from other vein
visualization devices and puts it in line with INS recommendations for patient safety.

VeinViewer® Vision2 projected image, Caucasian pediatric patient

Recommendations from the Infusion Nurses Society:

In 2014 the Infusion Nurses Society published a position paper with recommendations on
improving patient safety practices. The group recommends the use of:

“vein visualization technology as a routine strategy for difficult or poor venous

access. Visualization technology can improve success rates, decrease
unsuccessful insertion attempts, and improve patient satisfaction.”

The group also recommends assessment of the patient during “preinsertion, insertion
and postinsertion” to avoid the potential for complications.

All three of the studies cited regarding the recommendation of vein visualization were
studies done using VeinViewer.
Clinical Evidence:

Christie Medical Holdings conducts its own clinical trials using VeinViewer. But there are also a
number of peer-reviewed articles that detail the benefits of using VeinViewer. Below are results
from four studies that show the significant impact VeinViewer has had in first-stick success.

Near-Infrared Light Device Can Improve Intravenous Cannulation in Critically Ill Children
Conclusion: VeinViewer improved the rate of first-stick success and improved the total time of attempt per
patient.
PICU patients (3 mos. –
Achieved with VeinViewer Standard Improvement
17 years)
1st attempt stick-rate
56% 33.3% 70.2%
success
Time of attempts per
3.10 min 8.28 min 62.5%
patient

Efficacy of VeinViewer in Pediatric Peripheral Intravenous Access: A Randomized Controlled Trial

Conclusion: VeinViewer facilitated peripheral venous access for pediatric patients with difficult veins, which
enhanced first-attempt success rates.
First Attempt Success VeinViewer Standard Technique
Patient with DIVA (Difficult Intravenous
58% 25%
Access) Score > 4
Overall Success 72% 67%

VeinViewer-assisted Intravenous Catheter Placement in a Pediatric Emergency Department

Conclusion: While no results were statistically significant for the overall study group, subgroup analysis of
children age 0 to 2 years suggests that VeinViewer may decrease the time of PIV placement.
Geometric mean time to VeinViewer Standard Improvement
place PIV, seconds n=163 n=160 in Time
0-17 years old 2.20 min 2.42 min 10%
0-2 years old 2.02 min 2.78 min 38%

A Biomedical Device to Improve Pediatric Vascular Access Success

Conclusion: The use of vein viewing device significantly improved the first attempt venipuncture success
rate, decreased the number of attempts per patient, and decreased procedure time for the study population.
The device was well received by patients, families and staff.
PIV Placement VeinViewer Traditional Method
First Attempt Success Rate 80% 49%
Mean # of Attempts 1.29 1.97
*All clinical evidence referenced is available at the Christie website; www.ChristieMed.com

Conclusion:

VeinViewer provides quick assessment and accurate imaging. It is proven to increase first-stick
success rates and can be beneficial in urgent care situations when quick assessment and fast
access to a patient’s vasculature is a necessity.