First-in-human evaluation of a hand-held automated venipuncture device for rapid venous blood draws

Obtaining venous access for blood sampling or intravenous (IV) fluid delivery is an essential first step in patient care. However, success rates rely heavily on clinician experience and patient physiology. Difficulties in obtaining venous access result in missed sticks and injury to patients, and typically require alternative access pathways and additional personnel that lengthen procedure times, thereby creating unnecessary costs to healthcare facilities. Here, we present the first-in-human assessment of an automated robotic venipuncture device designed to safely perform blood draws on peripheral forearm veins. The device combines ultrasound imaging and miniaturized robotics to identify suitable vessels for cannulation and robotically guide an attached needle toward the lumen center. The device demonstrated results comparable to or exceeding that of clinical standards, with a success rate of 87% on all participants ([Formula: see text]), a 97% success rate on nondifficult venous access participants ([Formula: see text]), and an average procedure time of [Formula: see text][Formula: see text]s ([Formula: see text]). In the future, this device can be extended to other areas of vascular access such as IV catheterization, central venous access, dialysis, and arterial line placement.

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Peripherally Inserted Central Catheters in the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/088506669601100107 ◽

1996 ◽

Vol 11 (1) ◽

pp. 49-54 ◽

Cited By ~ 33

Author(s):

Philip K. Ng ◽

Mark J. Ault ◽

Lawrence S. Maldonado

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Success Rate ◽

Complication Rate ◽

Central Venous Access ◽

Tertiary Care ◽

Venous Access ◽

Success Rates ◽

Peripherally Inserted Central Catheters ◽

Central Catheters

We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians requested a PICC service consultation were included. Main outcome measurements included (1) the success rate for initial PICC placement, (2) the placement complication rate, and (3) the overall success and complication rate. Of the 91 consecutive attempts at PICC placement, 89 (97.8%) were successful: of the 89 successful placements, 25 (28%) required cutdown procedures. There were 20 complications of initial placement and 8 delayed complications, which occurred in 19 PICCs. Complications included recatheterization after first attempt was unsuccessful (10), catheter malposition (7), palpitations or catheter clotting (3 each), heavy bleeding or mechanical phlebitis (2 each), and arterial puncture (1). The overall success rate for completion of therapy using the PICC was 74.7%. The most frequent reasons for failure to complete therapy were catheter dislodgment in 8 patients and “infection” in 9 patients. Of these 9 patients with “infections,” 8 catheters were discontinued due to potential infection, and only 1 was removed due to confirmed infection. The confirmed infection rate was 6/10,000 patient days. The PICC appears to be a reasonable alternative to other approaches to peripheral and central venous access. The initial and overall success rates from this preliminary study justify' further evaluation of the PICC in critically ill patients.

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Haematemesis

Oxford Cases in Medicine and Surgery ◽

10.1093/oso/9780198716228.003.0011 ◽

2015 ◽

Author(s):

Hugo Farne ◽

Edward Norris-Cervetto ◽

James Warbrick-Smith

Keyword(s):

Head Injury ◽

Central Venous Access ◽

Venous Blood ◽

Venous Access ◽

High Flow ◽

High Flow Oxygen ◽

Do It Yourself ◽

Venous Blood Gas ◽

Accessory Muscles ◽

Intraosseus Access

First of all, call for help. You cannot manage an emergency alone—it involves teamwork. Call for help and involve your seniors. Second, this patient has potentially lost a lot of blood. Start with ABCDE—Airway, Breathing, Circulation, Disability, Exposure. Airway: Ensure it is patent. Can he talk? Is there any gurgling or stridor? Beware of blood in the oropharynx in a patient with haematemesis. If necessary, use suction to remove the blood. Breathing: Are there any signs of respiratory distress (tachypnoea, use of accessory muscles, low saturations)? Circulation: Does he have a pulse? Is he in shock (tachycardia, narrow pulse pressure, hypotension, cold peripheries)? Disability: what is the patient’s Glasgow Coma Score (GCS)? Always calculate this in an emergency as a GCS ≤8 (or rapidly dropping towards that point) suggests that the patient may soon require intubation to protect their airway. If you can’t remember the components of a GCS in an emergency, use the AVPU score (patient is Alert, responds to Voice, responds to Pain or is Unresponsive), where an avPu score (i.e. a patient who is responding to painful stimuli but not voice) is roughly equivalent to a GCS = 8. Exposure: The patient may have suffered multiple trauma and/or have various sites of blood loss. Although it is unlikely, what the hostel staff perceived as drunken behaviour may in fact represent behaviour from an unwitnessed assault resulting in significant head injury, and the haematemesis may reflect a stab wound to the chest or abdomen. Always expose the patient or you will be caught out by unsuspected findings. Mr Tucker is in shock, often defined as a BP <90/60 mmHg. He needs fluid resuscitation: • Apply high flow oxygen (15 L/min). • Get intravenous (IV) access: insert a large-bore (14G–16G) cannula and if you can’t do it yourself, ask a senior to help. They may need to resort to ultrasound-guided peripheral vascular access, to intraosseus access or to central venous access. • Send bloods for: ■ Venous blood gas: this will give you a rapid estimate of the patient’s haemoglobin.

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Practical procedures

10.1093/med/9780199593972.003.0018_update_001 ◽

2018 ◽

Author(s):

James Thomas ◽

Tanya Monaghan ◽

Prarthana Thiagarajan

Keyword(s):

Central Venous Access ◽

Venous Catheter ◽

Venous Access ◽

Chest Drain ◽

Arterial Line ◽

Tube Insertion ◽

Central Venous ◽

Urethral Catheterization ◽

Arterial Blood Gas ◽

Arterial Blood

Using this chapterInfiltrating anaesthetic agentsHand hygieneConsentAseptic techniqueSubcutaneous and intramuscular injectionsIntravenous injectionsVenepunctureSampling from a central venous catheterArterial blood gas (ABG) samplingPeripheral venous cannulationFemoral venous catheter insertionCentral venous access: internal jugular veinCentral venous access: subclavian veinCentral venous access: ultrasound guidanceIntravenous infusionsArterial line insertionFine needle aspiration (FNA)Lumbar punctureMale urethral catheterizationFemale urethral catheterizationBasic airway managementOxygen administrationPeak expiratory flow rate (PEFR) measurementInhaler techniqueNon-invasive ventilationPleural fluid aspirationPneumothorax aspirationChest drain insertion (Seldinger)Recording a 12-lead ECGCarotid sinus massageVagal manoeuvresTemporary external pacingDC cardioversionPericardiocentesisNasogastric tube insertionAscitic fluid sampling (ascitic tap)Abdominal paracentesis (drainage)Sengstaken–Blakemore tube insertionBasic interrupted suturingCleaning an open woundApplying a backslabManual handling

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A modified approach for ultrasound-guided axillary venipuncture in the infraclavicular area: A retrospective observational study

The Journal of Vascular Access ◽

10.1177/1129729819838135 ◽

2019 ◽

Vol 20 (6) ◽

pp. 630-635

Author(s):

Minmin Yao ◽

Wanxia Xiong ◽

Liying Xu ◽

Feng Ge

Keyword(s):

Observational Study ◽

Success Rate ◽

Central Venous Access ◽

Demographic Data ◽

Venous Access ◽

Axillary Vein ◽

Ultrasound Guided ◽

Central Venous ◽

Venous Catheterization ◽

Out Of Plane

Background: Catheterization of the axillary vein in the infraclavicular area has important advantages in patients with long-term, indwelling central venous catheters. The two most commonly used ultrasound-guided approaches for catheterization of the axillary vein include the long-axis/in-plane approach and the short-axis/out-of-plane approach, but there are certain drawbacks to both approaches. We have modified a new approach for axillary vein catheterization: the oblique-axis/in-plane approach. Methods: This observational study retrospectively collected data from patients who underwent ultrasound-guided placement of an axillary vein infusion port in the infraclavicular area at the Central Venous Access Clinics of Zhongshan Hospital at Fudan University between March 2014 and May 2017. The patients’ demographic data, success rate of catheterization, venous catheterization site, and immediate complications associated with catheterization were recorded. Results: Between March 2014 and May 2017, a total of 858 patients underwent placement of an axillary vein infusion port in the infraclavicular area at our center. The ultrasound-guided oblique-axis/in-plane approach was used for all patients, and the venipuncture success rate was 100%. Two cases of accidental arterial puncture and one case of local hematoma formation were reported, and no other complications, such as pneumothorax or nerve damage, were reported. Conclusion: The ultrasound-guided oblique-axis/in-plane approach is a safe and reliable alternative to the routine ultrasound-guided approach for axillary venous catheterization.

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Supraclavicular versus infraclavicular approach in inserting totally implantable central venous access for cancer therapy: A comparative retrospective study

PLoS ONE ◽

10.1371/journal.pone.0242727 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242727

Author(s):

Amine Souadka ◽

Hajar Essangri ◽

Imad Boualaoui ◽

Abdelilah Ghannam ◽

Amine Benkabbou ◽

...

Keyword(s):

Retrospective Study ◽

Intraoperative Complications ◽

Central Venous Access ◽

Venous Access ◽

Demographic Characteristics ◽

Success Rates ◽

Central Venous ◽

Chemotherapy Administration ◽

Significant Difference ◽

Ultrasonographic Guidance

Introduction The insertion of an implantable central venous access is performed according to a variety of approaches which allow the access to the subclavian vein, yet the supraclavicular technique has been underused and never compared to the other methods. The aim of this study was to testify on the efficacy and safety of the subclavian puncture without ultrasound guidance « Yoffa » in comparison with the classical infraclavicular approach (ICA). Material and methods This is a retrospective study with prospective data collection on patients followed at the national oncology institute for cancer, in the period extending from May 1st 2017 to August 31st 2017. All patients had a totally implantable central venous access device inserted by the same surgeon AS for chemotherapy administration and demographic characteristics, as well as procedure details were examined. The primary outcomes were the intraoperative complications, while the secondary outcomes represented immediate postoperative and mid-term complications (at 15 months of follow up). Outcomes were compared between techniques by means of non parametric tests and the Fischer test. Results Our study included 135 patients with 70 patients undergoing the subclavian technique, while 65 were subject to the infraclavicular approach. Both groups had no statistically significant demographic characteristics. The number of vein puncture attempts exceeding once, the accidental artery puncture and operative time were more significant in the ICA group; (39,6 vs 17,6 p = 0,01) (9.2% vs 0; p = 0,01) and (27± 13 vs 23± 8min, p = 0.045) respectively. There was no statistically significant difference in the immediate and midterm complication rate between the two methods 1(1,4) vs 2 (3) p = 0.5. Conclusion In case of unavailability of ultrasonographic guidance, the use of the supra-clavicular landmarks approach is linked to higher success rates and less arterial punctures, thereby proving to be a safe and reliable approach.

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Problems Associated with Vascular Access: An Analysis of 2000 Incident Reports

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100531 ◽

1993 ◽

Vol 21 (5) ◽

pp. 664-669 ◽

Cited By ~ 28

Author(s):

R. J. Singleton ◽

R. K. Webb ◽

G. L. Ludbrook ◽

M. A. L. Fox

Keyword(s):

Vascular Access ◽

Vascular System ◽

Central Venous Access ◽

Blood Pressure Measurement ◽

Air Embolism ◽

Venous Access ◽

Arterial Line ◽

X Rays ◽

Peripheral Venous Access ◽

Peripheral Arterial

There were 65 incidents involving access to the vascular system amongst the first 2000 reported to the Australian Incident Monitoring Study. Thirty-three involved peripheral venous access (14 cases of extravascular extravasation, 8 of unintended arterial cannulation, 6 of disruptions to intravenous lines, and 5 of problems with infusion lines, taps, pumps and connectors). Eighteen cases involved central venous access (9 cases of arterial puncture with haematomas, 5 with morbidity and/or prolonged admission), 5 of catheter misplacement and pneumo- or hydro-thorax and 4 of problems arising from operator inexperience. Thirteen cases involved peripheral arterial acces (5 involved equipment problems (3 with possible air embolism), 3 of mistaking an arterial for a venous line (drugs were injected in 2), 3 of losing arterial lines or signals, and 2 in which the presence of an arterial line placed the patient at risk). The anaesthetist should always question the continued integrity of any vascular access system, even when it has recently been shown to be functioning, and the possibility of later “migration” and misplacement should always be borne in mind. Whenever possible, correct placement of the tip should be checked (e.g. by visual inspection of the site, use of test doses, aspiration of blood, pressure measurement, X-rays). When there is more than one line, all lines and sites of access (e.g. 3-way taps) should be clearly labelled and checked before anything is injected or infused.

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Common emergency procedures

10.1093/med/9780199696277.003.0017 ◽

2013 ◽

Author(s):

Martin Beed ◽

Richard Sherman ◽

Ravi Mahajan

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Fibreoptic Bronchoscopy ◽

Rapid Sequence Intubation ◽

Abdominal Pressure ◽

Chest Drain ◽

Laryngeal Mask Airway Insertion ◽

Arterial Line ◽

Emergency Procedures ◽

Rapid Sequence

Transfers and retrievalsRapid sequence intubationLaryngeal mask airway insertionNeedle cricothyroidotomyNeedle thoracocentesisIntercostal chest drain insertionArterial line insertionCentral venous accessIntravenous cutdownIntraosseous accessExternal pacingPericardiocentesisFibreoptic bronchoscopyIntra-abdominal pressure measurementLumbar punctureSengstaken–Blakemore tube insertionProne positioning• Intrahospital transfer (e.g. to ICU or to CT scan)....

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Central Venous Catheter Complications

PEDIATRICS ◽

10.1542/peds.71.5.865a ◽

1983 ◽

Vol 71 (5) ◽

pp. 865-865

Author(s):

DENNIS J. HOELZER ◽

CHARLES S L'HOMMEDIEU

Keyword(s):

Central Venous Catheter ◽

Success Rate ◽

Central Venous Access ◽

Venous Catheter ◽

Venous Access ◽

Technical Expertise ◽

Central Venous ◽

Catheter Complications ◽

Central Venous Catheter Complications

To the Editor.— We read with interest the paper of Dolcourt and Bose.1 We commend them on their technical expertise and success rate in establishing central venous access. There are several conclusions with which we take issue. 1. Duration of Line Usage. The authors report that their catheters remained in place for a mean of 24.8 days (variance of 15.9 days). More informative would be median days of usage. They compare their results with other reports and claim that their catheters lasted twice as long.

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Peripherally Inserted Central Venous Catheters Provide Safe and Easy Central Venous Access in Patients with Head and Neck Cancer

International Journal of Practical Otolaryngology ◽

10.1055/s-0041-1728747 ◽

2021 ◽

Vol 04 (01) ◽

pp. e29-e33

Author(s):

Ryosuke Sato ◽

Takumi Kumai ◽

Ryusuke Hayashi ◽

Hiroki Komatsuda ◽

Kan Kishibe ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Success Rate ◽

Bloodstream Infection ◽

Neck Cancer ◽

Central Venous Access ◽

Venous Access ◽

Central Venous Catheters ◽

Central Venous ◽

Catheter Related Bloodstream Infection

Abstract Purpose The use of peripherally inserted central venous catheters (PICCs) has increased recently; several reports have revealed that they can be easily and safely used in patients with various diseases. However, there are few reports on the use of PICCs in patients with head and neck cancer. This study was aimed at evaluating the safety and feasibility of use of PICCs in patients with head and neck cancer. Materials and Methods We retrospectively analyzed the date of 118 PICC insertions in 85 patients with head and neck cancer from January 2014 to December 2017. The PICCs have been placed under ultrasound guidance in all cases. Results The PICC puncture success rate was 95.2%. Catheter-related bloodstream infection occurred in four cases. The most common complication necessitating PICC removal was suspected catheter-related bloodstream infection (24 cases). All cases with confirmed and suspected catheter-related bloodstream infection improved with administration of antimicrobial agents. Phlebitis occurred in five cases, in all of whom the PICC placement had been made via an antecubital vein; the condition improved without treatment in all five cases. Deep vein thrombosis occurred in two cases, both of which improved with oral anticoagulant therapy. Conclusion This study demonstrated that the complications associated with ultrasound-guided PICC insertion are manageable, and improve with conservative treatment in the majority of cases. Therefore, use of PICCs may be considered for easy and safe central venous access in patients with head and neck cancer, because the insertion success rate was acceptable.

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Successful Long-Term Central Venous Access

Home Hemodialysis International ◽

10.1002/hdi.1998.2.1.38 ◽

1998 ◽

Vol 2 (1) ◽

pp. 38-40

Author(s):

Franco Tesio ◽

Hamurabi De Baz ◽

Giacomo Panarello

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Central Venous

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