Infrared technology to improve efficacy of venous access in burns population

Background

Obtaining venous access in the burn population is challenging both in the acute and elective surgical settings. In paediatric burns, this is further compounded by smaller veins, thicker subcutaneous fat and poor cooperation. The introduction of infrared technology (Accuvein®) to identify veins up to 10 mm deep has been shown to increase efficacy. It has been promoted in challenging cases. We aim to ascertain whether Accuvein® is a useful clinical tool in the context of burns population.

Methods

A formal service evaluation of the device was carried out prospectively during a 6-week period. User feedback questionnaires were circulated. We reviewed patient demographics, indication of use, number of attempts and skin quality. We rated user satisfaction using visual analogue scales and a free text comment section.

Results

Twenty-eight questionnaires were returned. We noted inclination for use of device in paediatric patients compared to adults. Ethnicity included Caucasian, Asians, Afro-Caribbean and Hispanic. Skin quality in majority was described as normal; only four patients had poor quality skin (burn scars, friable thin skin). Fifteen patients had successful first attempts. Ninety-six percent of practitioners felt that the device was useful, although 59 % required assistance initially. We noted that it was not useful in detecting veins through grafted burn sites.

Conclusions

Accuvein® is a useful adjunct for venous access particularly in the paediatric population. By reducing the number of attempts to obtain venous access, this saves time and improve efficacy of care. However, we noted that it is not helpful over grafted burn sites. This could be attributable to the nature of the initial burn surgery (tangential excision) rather than the thickness of overlying skin.Level of Evidence: Level IV, risk/prognostic study.