I had to get an arterial blood gas draw done earlier this year. Despite having an ultrasound which would make it easy to find the right spot in my wrist, the resident decided to “learn” on me by digging her large needle into my wrist and fishing around. After she failed her 5th or 6th attempt and my dilaudid couldn’t help me forget what was happening, the tech decided to “show” her how to do it and repeated the same experiment while tears rolled down my face. Finally the ICU NP brought in the ultrasound and got it done in one shot. Long story to say — we have lots of technology, but using it appropriately is the key!
A 27 or 30G insulin needle with some lidocaine (still often called lignocaine here in Australia ) is a nice addition to this procedure. I rarely omit it unless the patient is unconscious. If you inject the local anaesthetic under real time ultrasound, it can also serve as a seeker so you see if you’re off target with the 30G needle and adjust based on that information, which improves your success with the larger (commonly 22G) needle used to take the gas. Not unreasonable to request local anaesthetic, really - it is known to be a painful procedure.
This is how I became needle phobic and hospital phobic till I was an adult and I overcame it. I remember just the smell of hospitals would send me into severe anxiety.
VeinViewer was invented in 1995 by Herb Zeman, a professor at The University of Tennessee Health Sciences Center. [ Disclosure: Herb’s a friend, but I wasn’t involved and only know most details second hand. ]. Commercialization of the device has a contorted history. Search for Luminetx if you want to read more backstory….
RN here who’s used a VeinViewer in practice. Technology is neat, but intimidating to a lot of staff who are the “influencers” of a nursing unit.
It was useful to sight deeper veins you couldn’t normally find using your usual techniques.
However, the projected image had a bit of lag to be annoying, and you had to position your hands a certain way to be out of view of the camera as you worked.
The version of the VeinViewer I used had a bright green projected image, which made too much of a contrast and made it tricky to work with the projected image. Newer versions have a white projection which is less annoying.
After a few uses, I adapted my technique to use the VeinViewer to sight a vein, mark the vessel with a pen, and then, with the VeinViewer out of the way, proceed with my usual technique.
If a patient requires a lot of bloodwork, they will usually be referred to have a PICC inserted anyway which takes away the muss and fuss of peripheral IV draws.
That would have been useful back when my son was a few days old and they needed to find a vein. They had to bring down an ultrasound machine, and had to keep looking for usable vein. There were multiple failed attempts, each one painful.
For really small kids we tend to use a transilluminator rather than ultrasound for peripheral IVs (though it doesn’t tell you the depth like ultrasound does). For CVCs or bigger people, ultrasound is often very useful. Like all things, experience makes a big difference! In my opinion, for known tricky veins (in adults at least) it’s best to use local anaesthetic from the outset - it does make it slightly harder but if (when?) you miss it’s easier to keep the patient on side for the next attempt.
Edit: YouTube link to a transilluminator being used - beware the video does have an unhappy child in it
I am sorry for your experience, but in a newborn this will also probably be of limited use.
Note that the signal to noise ratio will be very low in a newborn, smaller humans means smaller vessels and less blood pressure. If it was my child I would much rather have an ultrasound guided cannulation then to trust this device.
The reality is that although it looks very flashy it will have limited use other than maybe training very junior nurses/doctors.
Phlebotomy is a respectable job in my opinion, and not everyone has the hand skill for hitting veins. I’ve stopped bad nurses from chopping me up before. They can get uppity but I’ve got 10,000 more punctures and counting to my name and I’ll be damned if I let pride get in the way of competence when it comes to medicine. I’m not a know it all but there’s some real hagiography around power dynamics and treating illnesses versus coming up with a health plan.
All this to note that it is a genuine skill and if this helps, great, but don’t go helping the lowest common denominator that doesn’t deserve it. Can’t hit a vein? Give it to someone who can, immediately.
My high school had a phlebotomy track after you took anatomy physiology and I was able to get good enough to get my first job at Scott & White here in Texas. I then used those skills to work 30 hours a weekend (Friday - Sunday) to pay for college. The hardest part was the field work, nursing homes, if you could not get the blood there was no backup like at the hospital so it typically forced bad techs to go hunting for a different job. I would go home and practice on various speaker cable to get the feel for hard veins. This job was filled with pride, challenges, character building traits, and it paid the bills. $17.5/hr back in years 98->20, was far better than most of my friends jobs. No complaints here and a lot of respect for the craft.
Without this job I likely would not have been able to start my software company 22 years ago.
Holy smokes almost $20 an hour around 2000 is a good way to go, thanks for sharing and I really appreciate the story. Never heard the speaker cable thing! When I get together with my community I’ll share it with parents and the thought leaders because it’s hard to take that job forced on you. Ports are everywhere now, which for the elderly must be good.
Fascinating story and I’m sad to think 22 years later it’s probably about the same pay rate. Honorable gig. Nice to hear how it can be a steeping stone for use of talent as well!
Ps - I heard Chuck kind of came up with Fight Club while driving cancer patients and other terminal patients to appointments when not working as a diesel mechanic.
Strongly disagree; this is a really useful tool, even for experienced phlebotomists.
They recently got one of these at a clinic someone very close to me attends regularly. Even skilled nurses can struggle to find usable veins when treating folks who’ve had many needles put in over the years; in those cases using this saves a great deal of time and pain for everyone involved.
Would anyone know where to look to aquire that sort of monochrome projector?
And in general how to implement a camera->projector loop with that low latency / high frame rate?
I've been looking into a similar idea and have bodged together something like:
USB camera -> laptop (opencv) -> consumer LED projector (via Hdmi).
Probably unsurprisingly, latency is a problem.
Wow this is neat, and I am wondering how to get licensed equips and is it possible to be another country's wholesaler? I mean, does hospitals desperate for such things or even have better alternatives?
