Luminetx

The words most of us fear when requiring medical care are “We need to draw blood” and/or “We need to start an IV.” Immediately, the apprehension associated with having a clinician stick a needle into our vein begins to build. For many patients, the apprehension is intensified knowing they generally have to be stuck multiple times before venous access is properly obtained.

“The VeinViewer is truly having a positive impact on patient care. The device makes our patients' veins visible to the naked eye”
-Sonia Dent., RN / MSN / Clinical Informatics Director, King's Daughters Medical Center

Some 1 billion venipunctures are performed each year in the United States. Among inpatients, 25 percent need central venous access, and 90 percent of patients who enter the doors of a hospital require peripheral intravenous access. Unfortunately, far too often the initial efforts to find veins and insert lines are unsuccessful, leading to multiple needlesticks and insertion attempts and the “IV Domino Effect.”

The far-reaching consequences include a host of mounting costs, lost staff time, serious infections from higher acuity procedures and accidental needlesticks, and increased pain and trauma for patients. It’s no wonder that venipuncture services have suffered the most consistent and dramatic declines in patient satisfaction ratings of care.

The Challenge
Venipuncture can be challenging for numerous reasons, many of them patient-related. The veins may be too small or too difficult to find, and as a result, almost impossible to access.

Factors that can contribute to a problematic procedure include:

• Frequent (or lengthy) infusion therapies
• Multiple disease states
• Dehydration
• Hypertension
• Size and fragility of vessels
• Skin tone
• Edema or fatty tissue

One in four patients requires three or more insertion attempts before an IV line is successfully placed, and reported times to achieve a successful IV start average at 23 minutes. During that time, medications and key fluids are delayed and “throughput” of the institution is affected.

Studies show that vascular access needs are not routinely assessed on admission and at regular intervals. The “IV Domino Effect” direct financial impact is staggering, but can be summarized into the three “Rs” of ROI, Risk, and Patient Referral and Satisfaction. These include inappropriate resource utilization and increases in the following:

• Length of stay
• Use of supplies and equipment
• General and higher acuity staff and room time
• Number of procedures
• Liability

Inability to obtain peripheral vascular access leaves few options. More highly trained staff may make additional attempts to gain access, or the decision may be taken to use a Peripherally Inserted Central Catheter (PICC) or Central Venous Catheter (CVC). These options involve additional costs and increased risk of complications.

VeinViewer delivers an identifiable ROI. The costs associated with missed attempts are a major concern to health care facilities. Currently, the average cost of a single peripheral intravenous insertion attempt is approximately $32 (includes materials and labor). If one were to multiply this figure by the number of missed attempts in any given health care setting, the figures would be staggering. Recent studies have demonstrated that if one figured in the average cost of unsuccessful peripheral intravenous attempts for a 200-bed hospital, it would result in a total of more than $350,000 in annual revenue lost. Larger hospitals would, of course, experience an exponential increase in that figure. Needless to say, missed peripheral intravenous attempts, from a cost standpoint, are a significant concern.

VeinViewer reduces the need for higher risk procedures, such as insertions of central lines, due to the lack of PIV. Increased costs that arise from poor venous access can be associated with the need for central line placement and maintenance. In some instances, particularly in critical care areas, central venous catheters are placed in patients because of the inability to access a peripheral vein. The cost of a central line can range anywhere from $110 to $1,500, but is negligible when compared to the potential complication costs associated with the placement of a central line. One of the most costly events in the hospital setting is a Catheter-Related Bloodstream Infection (CRBSI).

• Central Venous Catheters (CVCs) are associated with 90 percent of all catheter-related bloodstream infections (CRBSIs), or 250,000 cases per year.
• CRBSIs can add between $30,000 and $70,000 in costs per patient, and increase length of stay by up to 22 days.
• The mortality associated with CRBSIs is even more significant; national data infer that more than 14,000 patients die each year as a result of acquiring a CRBSI.
• CMS-1533-FC, a key ruling beginning in October of 2008, the Centers for Medicare & Medicaid Services will not reimburse facilities for monies spent on two conditions directly correlated to vascular access:
  • Vascular Catheter – Associated Infection
  • Serious Preventable Event – Air Embolism

The Solution
VeinViewer drives patient referrals and may be the deciding factor for a patient when choosing a health care institution for care. The VeinViewer® provided by Luminetx® uses patented technologies to identify and locate subcutaneous vasculature and project its location directly onto the surface of the skin. The device is effective for all patients regardless of age, body type or skin tone. VeinViewer illuminates the vasculature of the desired access area with the exception of the eyes, reducing the “guess-work” when locating a vessel.

Consider the above challenges associated with venipuncture, limited or difficult access points, not to mention managing the anxiety of patients and their families. Now, consider the value of a system that allows the clinician to clearly see the presence or absence of the patient’s accessible vasculature in real time, directly on the surface of the skin. The ability for a clinician to not just find a vein, but locate the optimal vein based on their enhanced visualization. The VeinViewer is a tool to be used for locating veins, but does not replace the special skill required for vascular access.

Any clinician may operate the VeinViewer system without additional certification. The clinicians’ hands are free to do their work. The system is non-invasive, with no risk of tissue damage from the image. There is no risk of cross contamination because there is no patient contact with the device. From the neonate to geriatric patient, VeinViewer delivers dramatic increased first stick success.

A non-randomized study of pediatric patients requiring vascular access for lab tests or intravenous therapy was conducted at Wolfson Children’s Hospital in Jacksonville, Fla. Self-reported control data were collected in a retrospective manner on the same surgical unit prior to the utilization of the VeinViewer, while the VeinViewer data were collected prospectively. The study results were significant.

The traditional method for intravenous cannulation resulted in a first stick success rate of 49.3 percent, and a mean number of attempts per IV of 1.97. The VeinViewer method for intravenous cannulation resulted in a first stick success rate of 80 percent, and a mean number of attempts per IV of 1.28. Additionally, the VeinViewer method provided a decrease in the time needed for IV cannulation by approximately 65 percent. The VeinViewer demonstrated a dramatic enhancement with regard to first stick success, number of attempts and the time needed for cannulation. Through these study results, the VeinViewer by Luminetx has proven to be a truly cost-effective way to enhance patient care and satisfaction.

Results

*Traditional method data was self-reported and collected retrospectively.

Luminetx in cooperation with Lifeblood Biological Services conducted a non-randomized clinical trial to determine whether the VeinViewer is useful in locating viable superficial veins for venous access for blood donations.

Thirty patients, previously pre-screened and rejected as donors by Lifeblood Biological Services due to the inability of the lab to achieve successful venous access, were chosen by Luminetx for clinical evaluation to determine the effectiveness of the VeinViewer to locate veins in these individuals with known difficult-to-find and difficult-to-access veins for blood collection. Over a 20-day period, each patient was invited back to Lifeblood Biological Services, re-screened and imaged with the VeinViewer device to:

1. Locate a viable vein for venous access
2. Attempt venous access of that vein for blood collection with one successful needlestick

The VeinViewer was 100 percent successful in locating a viable vein for venous access in each patient, which provided the Lifeblood Biological staff with a 100 percent success rate when accessing the vein for blood collection. In addition, the VeinViewer was successful in aiding staff members in accessing those difficult patients on the very first attempt.

It’s been shown that complications can be reduced if the vein is carefully assessed, selected and prepared. In addition, Infusion Nursing Standards of Practice recommends using vascular visualization technologies that aid in vein identification and selection. The results for health care facilities are increased efficiencies, improved clinical results, higher patient satisfaction ratings and significant savings.

VeinViewer clinically demonstrates effective ROI with respect to material costs, labor time, decreased potential for infections and sharps-related injuries. In a recent study, the VeinViewer demonstrated an enhancement in patient care and satisfaction realized by a 62 percent increase in first stick success.

Cardinal Glennon hospital is a pediatric hospital based in St. Louis, Mo. This particular hospital is a 190-bed, non-for-profit medical center that was founded in 1956. The hospital treats children that live predominantly in the Midwest region of the country, but also serves to treat children from around the world. Cardinal Glennon has a long tradition of providing “firsts” in health care and subsequently using those accomplishments to market its facility. The hospital purchased seven VeinViewer imaging systems in the summer of 2007. Realizing the benefits associated with VeinViewer as a symbol of providing better patient care Cardinal Glennon rolled out a community awareness marketing campaign focusing on the facility offering VeinViewer technology. The public relations department ran 800 television spots and distributed 1,900 informational pieces to community physicians touting the VeinViewer as the newest in technologies that would give clinicians more confidence. The brochure also claimed that Cardinal Glennon was the first pediatric hospital in the St. Louis area to have such a technology that would assist in lowering the number of needlesticks needed in order to gain intravenous access in their children. Additionally noted was that the VeinViewer purchases could result in a financial return of $175,000 with a 50 percent decrease in unsuccessful peripheral IV attempts.

The VeinViewer gives us another assessment tool to rely on… It gives us more confidence.

By reducing needle sticks, the patient’s pain level is substantially decreased and the risk of infection is minimized…

The VeinViewer by Luminetx is an innovative technology that has demonstrated the ability to provide quantifiable and un-quantifiable benefits to hospitals, clinics, health care workers and patients. When health care facilities introduce the VeinViewer into their daily practice, they find that the device is an extremely valuable visualization tool with regard to achieving successful venipuncture. In addition, VeinViewer clearly delivers on the three “Rs” of ROI, Risk, and Patient Referral and Satisfaction. With the VeinViewer moving toward becoming the standard of care in medicine, the device will continue to demonstrate that it can be utilized to positively enhance the patient experience and thus the appeal of health care facilities that embrace the technology.

And maybe one day, the words “We need to draw blood” or “We need to start an IV” won’t carry with them the dark cloud of worry or anxiety they now provoke. Our goal is to provide technologies that deliver clear benefits to the patient and healthcare community at large. That is our company’s hope.

For more information, please contact Luminetx at 877-733-8346 or visit our website at www.veinviewer.com.

References:

1. “…one billion…” Grable HO, Gill GW. Phlebotomy puncture juncture: preventing phlebotomy errors – potential for harming patients. Laboratory Medicine. 2005; 36(7): 420-433.
2. “…25%…90%…” Horattas MC, Trupiano J, Hopkins S, et al. Changing concepts in long-term central venous access: Catheter selection and cost savings.
   American Journal of Infection Control. 2001; 29:32-40.
3. “…23 minutes…” Schears GJ. Summary of Product Trials for 10,164 Patients: Comparing an Intravenous Stabilizing Device to Tape. Journal of Infusion Nursing. 2006; 29(4): 225-31.
4. “…insertion attempt is approximately $32…” Jamie Bowen Santolucito, RN, CRNI, OCN. A retrospective Evaluation of the Timeliness of Physician Initiated PICC Referrals. Oregon Health Sciences University Hospital, JVAD, Fall 2001.
5. “…dramatic declines…” Kaldenberg D. Better or Worse? Patients’ perceptions of hospital services. The Satisfaction Report. August 2000; 1-7.
6. “…The cost of a central line can range anywhere from $110 to $1,500, but is negligible…)” Taylor, RW, Palagiri,AV, Central venous catherization, Crit Care Med 2007; 35,1390-96 Schears, Gregory J MD. Summary of Product Trials for 10,164 Patients: Comparing an Intravenous Stabilizing Device to Tape.
   Journal of Infusion Nursing 2006:29(4)225-31.
7. “…Standards of Practice…” Infusion Nurses Standards of Practice, 2006, Site Selection and Device Placement Standard #37.
   
   Chart data: “…$30,000 - $70,000…” Central-Line Associated
   Bloodstream Infection Collaborative. United Hospital Fund of New York.
   
   All other chart data cited in or derived from Santolucito J. A Retrospective Evaluation of the Timeliness of Physician Initiated PICC Referrals: A Continuous Quality Assurance/Performance Improvement Study. Journal of Vascular Access Devices. 2001; 6(3):20-26(7). The given costs of Advanced Vascular Access Devices in the chart excludes physician fees.
8. “…200-bed hospital…” Conclusions based on combined data from two studies: Frey AM. Success Rates…and Schears GJ. Summary of Product Trials for 10,164 Patients: Comparing an Intravenous Stabilizing Device to Tape. Journal of Infusion Nursing.
   2006; 29(4): 225-231.
9. “…250,000 cases…” Reduction in Central Line-Associated Bloodstream Infections Among Patients in Intensive Care Units – Pennsylvania, April 2001-March 2005. Morbidity and Mortality Weekly Report. 2005: 54(40): 1013-1016.
10. “…up to 22 days…” Dimick J, et al. Increased Resource Use Associated With Catheter-Related Bloodstream Infection in the Surgical Intensive Care Unit. Archives of Surgery. 2001; 136: 229-234.