Reducing the time to successful intravenous cannulation in anaesthetised children with poor vein visibility using a near-infrared device: A randomised multicentre trial.

ABSTRACT

BACKGROUND: During inhalational induction of anaesthesia for children, severe respiratory events can occur but can be rapidly treated once intravenous access is in place. Reducing the time to successful cannulation during inhalational induction for children with poor vein visibility would improve safety. OBJECTIVE: To study the effectiveness of a near-infrared (NIR) vascular imaging device (Veinviewer) to facilitate intravenous cannulation. DESIGN: A prospective, multicentre, randomised, open clinical trial. SETTING: The operating rooms of three paediatric hospitals in Paris, France, from 1 October 2012 to 31 March 2016. PATIENTS Children up to the age of 7 years, with poor vein visibility requiring general anaesthesia. INTERVENTION Inhalational anaesthesia was initiated and intravenous cannulation was performed with the standard approach or with the Veinviewer Vision. MAIN OUTCOME MEASURES: The primary outcome was the time to successful intravenous cannulation. A secondary outcome was the proportion of successful first attempts. RESULTS: The mean time to successful intravenous cannulation was 200 (95% CI, 143 to 295) seconds in the Veinviewer and 252 (95% CI, 194 to 328) seconds for the control group hazard ratio 1.28 (1.02 to 1.60) (P = 0.03). The adjusted hazard ratio for known predictive factors was 1.25 (0.99 to 1.56) (P = 0.06). Success at the first attempt was 64.6% (102/158) in the 'Veinviewer' group vs. 55.6% (85/153) in the 'control' group (P = 0.10). CONCLUSION: The Veinviewer has limited value in reducing the time to successful intravenous cannulation during inhalational anaesthesia for young children with poor vein visibility. However, there is a strong trend to reducing the delay in some cases and, given its absence of side effects, it could be part of a rescue option for a difficult venous-access strategy. CLINICAL TRIAL REGISTRATION NCT01685866 (http//www.clinicaltrials.gov).