Infrared Vein Viewing Technique: A Comprehensive Literature Review

This literature review explores the benefits of using infrared vein viewing techniques to improve intravenous cannulation in healthcare settings. It examines the drawbacks of conventional methods, including pain, anxiety, and multiple puncture attempts, which can lead to patient dissatisfaction and complications such as phlebitis and blood-borne infections. The review analyzes various research articles, including randomized controlled trials and case-control studies, to assess the effectiveness of infrared vein viewing in reducing cannulation errors and improving patient outcomes. It also discusses relevant local and international policies, change management strategies for successful implementation, and provides recommendations for integrating this technology into healthcare facilities worldwide. The review highlights the importance of proper training for healthcare professionals and the potential of infrared vein viewing to enhance the quality and safety of intravenous cannulation procedures.

Running head: LITERATURE REVIEW
LITERATURE REVIEW: BENEFIT OF INFRARED VEIN VIEWING TECHNIQUE
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1LITERATURE REVIEW
Introduction
Intravenous cannulation is one of the most common types of healthcare invasive
procedure followed by the clinical professionals around the world as more than 80% of patients
admitted to healthcare facility requires cannulation for further treatment. However, the majority
of patients undergoing surgery or who required intravenous cannulation, undergoes severe
anxiety due to the anticipated pain or the resulted pain of cannulation process (Yalçınlı et al.
2019). Several researchers have provided insights of application of local anaesthesia, ethyl
chloride spray and other solutions so that pain of cannulation could be limited, however the
degree of success remains limited (Ravik, Havnes and Bjørk, 2017). If the nursing professionals
are unable to find out the perfect site for cannulation in their first attempt, and puncture multiple
sites for the insertion of cannula, it increases the risk of stress, discomfort and dissatisfaction
among patients (Rodriguez-Calero et al. 2018). Moreover, it was also seen that experienced
nursing professionals also make mistakes while puncturing vein to incorporate intravenous
cannula and as perGoudra et al. (2014), majority of the nursing professionals required more than
one attempt of intravenous cannulation insertion prior to the surgery. Besides that, Keleekai et al.
(2016) also mentioned that despite of skilled nursing staff, 50% of the cannulation required more
than one attempt. Hence, besides providing the nursing professionals with training of cannula
insertion, healthcare should also include an advanced infrared laser vein viewing system so that
the healthcare professionals could palpate the vessel or become able to see blood vessel under
the skin (Rothbart et al. 2015).
The primary aim of this literature review paper will discuss the application of infrared
laser vein viewing system so that findings of different researchers about the improved
cannulation system could be obtained. This will help to identify the the pros and cons related to

2LITERATURE REVIEW
this process improvement strategies. Further, different local and international governmental
policies regarding the application of this system in cannulation process would be reviewed.
Besides these, application of change management for successful implementation of this system
and a detailed action plan to achieve this within a specific time frame would be included in the
assignment. Finally, few realistic recommendations would be suggested in the paper, so that
application of infrared vein viewing technique could be successfully implemented in healthcare
facilities around the world.
The focus of the proposal
The primary focus on this paper would be identifying the major concern of healthcare
physicians and patients while undertaking cannulation procedure as complications associated to
this process could lead to healthcare risks. Further, it was also noted that healthcare professionals
are not being provided with any specific training or education that would help them to determine
the perfect place for cannulation while conducting peripheral vein cannulation. However, as per
McGowan et al. (2016), it is important for the registered nursing professionals to be aware of all
the skills require to deliver quality healthcare service. Hence, the primary focus of this proposal
would be identifying the complications associated to the contemporary venous cannulation
process and analysing its effectiveness in decreasing the pain for the patient. Further, it would
his paper will propose the application of infrared laser associated vein viewing technique in
the healthcare facilities of UK so that nursing professionals could easily conduct cannulation
and apply for less manual error while cannulation. Hence, through these two primary aspects,
this proposal would help to compare the benefits that are associated to the infrared laser
associated vein viewing technique with the conventional or anaesthesia used vein cannulation
process.

3LITERATURE REVIEW
Literature review
Having completed the systematic review process, with implementation of systematic
search, with a wide range of databases (attached in apendix1) the collected research articles were
critically reviewed on the basis of two specific themes as critiqued.
Theme A: identifying the drawbacks of conventional and anaesthesia cannulation process
As per McCallum (2012), every one in three patients admitted in the healthcare facilities
in the United Kingdom have a venous cannulation and a peripheral venous catheter inserted in
that site. However, due to improper training and skill development about the venous cannulation
among the nursing professionals, the risk of blood borne infection and phlebitis increases. It was
mentioned in the paper that majority of the nursing professionals are unaware of the
characteristics of vein that should be observed prior to implementation of catheter and hence,
patients develops higher risk of phlebitis and other bacterial contamination in the insertion site.
As per McCallum (2012), phlebitis is the inflammation of the vein due to which the patients
suffer from pain and indurations of the vein. Besides these the type of complication which could
be observed in the patient due to improper cannulation of vein are catheter related blood- stream
infection, haemorrhage in the puncture site of vein, inflamed tunica intimae or presence of
phlebitis, extravasations or improper puncture of the vein, due to which the fluid passes in the
neighbouring tissue. As per Miliani et al. (2014), the complications associated to venous
complication could be life threatening to the patients and due to the unawareness of nursing
professionals and lack of proper cannulation skills, it has become one of the major issue for
hospital acquired infection in UK, which was found in their quantitative prospective
observational study.

4LITERATURE REVIEW
The first article included in this Similar findings were observed under this theme
was a quantitative randomised control trial research article of Parienti et al. (2015), as per
whom, three cannulation sites namely the femoral central vein, subclavian vein and the
jugular vein are the sites which are associated to phlebitis or the blood borne infection in
the patients. Similar thought was shared by the researchers Tawfik et al. (2017) however
they conducted the cannulation process by using anaesthesia and found that the risk of
blood borne infection remains same. This study was able to identify the fear and anxiety
that increases due to the improper cannulation and miss at the first chance among the
patients however, it mentions that majority of the patients are able to withstand the pain
and distress of the process so that they healthcare interventions could be applied easily.
Despite that, the intensity and type of infection, were similar in both of these articles. Both
of these articles conducted quantitative randomized control trail and the selection criteria
for the patients were more than 18 years of age, and 19 to 40 years of age respectively and
application of venous cannulation was the most important aspect for selection of
participants was their ability of decision- making. The quantitative randomization of
catheter insertion site was selected as 1:1:1 for the entire three sites selected for this study.
Besides these, the nursing staffs who were asked to perform the cannulation process were
selected on the basis of their experience of puncturing catheter in patients (Parienti et al.
2015). For the ethical consideration of the process, the patients were asked for consent and
after collection of consent, they were involved in the research group. In this qualitative
research. The data collection method in both the articles were collected from patient
interview so that the experience of patients could be understood and processes accordingly.
The primary cause of infection was determined as the catheter tip colonisation and the deep vein

5LITERATURE REVIEW
thrombosis after the catheter removal from the patient’s body. The statistical data analysis of
the qualitative research indicated to the fact that vein thrombosis was the primary issue
that majority of the patients faced after removal of the catheter and majority of this
incidence were observed in the femoral catheter insertion site. Therefore, this randomized
control trail related research process was able to identify the reasons due to which such
cannulation procedure should be replaced effectively.
On the other hand, the study by Tawfik et al. (2017) indicated that majority of the
patients experienced pain and distress in the process but the intensity of it was lower.
Therefore, it is evident that the first study was inclusive of significant sample population,
that are not a part of multiple departments of the healthcare facility, whereas, this study
was able to include multivariate population so that the experience of such aspect could be
assessed. Therefore, both of these studies were methodologically similar and found out
similar methodologies for the detailed assessment. Thereby increasing the implication of
the research findings.
Besides this, one quantitative case control study was also conducted in 48 public
healthcare facilities of Spain; so that the risk factors associated to venous cannulation and life
threatening conditions could be identified and addressed (Rodriguez-Calero et al. 2018).
Further, the aim was to identify the risks of venous puncture while conducting treatment of
patients. The patients who were included in the study had two to three failed attempts of venous
cannulation, required central access of cannulation after failed peripheral access of cannulation
and the patients who rejected the cannulation process after several failed attempts. Hence, the
research was ethically complied as majority of the patients provided the researchers with
ethical consent so that they could conduct the ethical interventions (Rodriguez-Calero et al.

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2018). Further it was also observed that due to several failed attempt of cannulation
insertion in the patients, majority of them were stigmatized of the procedure. However, as
per Zingg et al. (2014), while conducting such risk factor analysis it is important to include
the skills of nursing professionals which was lacking the research process of (Rodriguez-
Calero et al. 2018). Further, the risk factor of improper venous cannulation not only affects
patients in general or ICU wards, but also creates higher risk for patients undergoing
surgery. This aspect of venous cannulation and associated effects could be easily
understood from the research of Leung et al. (2016), in which to understand the effect of
improper venous cannulation in patients undergoing surgery, the prospective observation
study conducted. Researchers mentioned the fact that their aim was to understand the risk for
venous thrombosis due to the peripheral catheter insertion and hence, they conducted the study
with patients who were at higher risk of deep vein thrombosis and had a catheter inserted in their
peripheral vein. 54 patients were included in the study and the researchers observed them twice a
day for 30 days continuously so that their features of deep vein thrombosis could be collected to
determine the risk factors associated to it (Leung et al. 2016). In this mixed methodological
research, written consent was collected for ethical compliance of the paper. After the
conduction of the study the data indicated that majority of the nursing professionals,
despite of having proper skill of venous catheter insertion at the peripheral site, were
unable to puncture the correct site of patient at first attempt, however, the risk factor for
deep vein thrombosis was quite lower of compared to the rate of mechanical error in this
insertion site. Therefore, both the study mentioned in the first and second paper by
Rodriguez-Calero et al. (2018) and Leung et al. (2016) respectively were able to provide

7LITERATURE REVIEW
details of the loopholes and shortcomings of the traditional cannula insertion process due to
which effectiveness of the process decreases.
However, the research by Abdelaziz et al. (2017), found contradictory result while
conducting catheter insertion in the peripheral vein of children. This research was also a
qualitative prospective observational study or the mixed methodological study in which
paediatric patients from paediatric wards and paediatric surgery wards were selected and
then within those patients’ 250 peripheral venous cannulation processes were conducted
among 98 paediatric patients (Abdelaziz et al. 2017). This qualitative observational study
collected the time of catheter insertion, catheter removal and the reason for catheter
termination in all the 98 patients as the study population and after the collection of written
consent from them for the ethical implication and collection ethical compliance report form
the national ethical certification board, they conducted the study with the children. After
the statistical analysis it was found that in 51.9 cases the termination of the catheter was
done due to the improper insertion of venous catheter among patients that lead to higher
risk of blood borne and phlebitis associated conditions. Therefore, with relatable study
design, study population and study intervention by Abdelaziz et al. (2017) and by Leung et
al. (2016), both the articles found contradictory results thereby contradicting the study
results of the process. Besides these, the complications associated to venous cannulation
and the lack of knowledge and skills in nursing professionals were assessed in the research
by Heidemann et al. (2017), in which the researchers noted that the lack of data regarding
the central venous catheter insertion for the new and trainee nursing professionals so that
they could learn the cannulation process properly. For this purpose, the researchers
conducted qualitative electronic survey or mixed methodological assessment among the new

8LITERATURE REVIEW
and trainee nursing professionals between June 2014 and May 2015. Within this timeline, the
researchers collected all the data related to complication that raised after failed cannulation,
venous thrombosis among patients and then conducted statistical analysis of the process so that
emergence of the complications1.9% of the total social be statistically obtained. After the
completion of study it was seen that in 1.9% of cases, venous cannulation resulted in severe
complication for the patients, however the hospital management did not included this data in
their EHR system (Heidemann et al. 2017). This was the primary reason the new and trainee
nursing professionals were unaware about the skills and training they would be requiring for
conducting safe and accurate venous cannulation process (Chatterjee et al. 2014).
Therefore, all these research articles included the possible risk factors which could affect
patients in their healthcare process. These articles provided a holistic view of the risk factors,
starting from venous cannulation, error in nurse’s practice, and lack in the guideline and skill
development strategies for teaching the correct and accurate way for venous cannulation.
Theme B: benefits of application of infrared laser vein viewing system in the healthcare
facilities of UK to reduce the risk factors of the cannulation process
From the above- mentioned critical review of literatures it was evident that majority of
the cannulation associated complication raised in the healthcare process due to the lack of
training and skills in the nursing professionals so that they could puncture the correct site of vein
(peripheral and central) in first attempt, as well as due to the inability of detecting veins to insert
catheter. Therefore, in the second theme, benefits of the infrared cannulation method was
assessed. As per Çaglar et al. (2019), if the healthcare facilities includes a system through which

9LITERATURE REVIEW
the professionals could visualize the vein and correct location for cannulation, the rate of
mechanical error, venous thrombosis and bacterial blood borne infection would decrease by
57%. To develop the fact and provide detailed analysis of research article based on this process,
several research articles would be included in the study (Çaglar et al. 2019).
To determine the effectiveness of vein viewing technique for venous cannulation,
quantitative non- randomised control trial or the mixed method research by Rothbart et al.
(2015), should be included in the study. The study was conducted to understand the
benefits of using AV300 vein viewing technique. Further to understand the way this vein
viewing technique reduced the cannulation related complication in chosen population. For
this process, the researchers collected samples from January to March 2011 and in the
process included 238 paediatric patients who had a cannula inserted in their central venous
system. The consent was collected primarily and then after complying with the ethuical
means, the research was commenced. In this quantitative non-randomized control trail, 124
patients were included in the control group, whereas, 114 patients were included in the
intervention group, where, in the intervention group cannulation was done through vein
viewing system and in control group conventional process of cannulation was performed
(Rothbart et al. 2013). After completion of the study, it was found that the median time
required for cannulation in the intervention group was higher than the control group,
however, the rate of success in the control group was 0.45 compared to the intervention
group with 0.73, indicating higher rate of success with vein viewing technique. Further, after
the completion of the study it was also noted the number of attempts in the intervention group
was lower than that of the control group indicating to the fact that with the help of vein viewing
technique it was easier to puncture the central or peripheral vein for catheter insertion, compared

10LITERATURE REVIEW
to the conventional vein viewing technique. In the descriptive analysis of the complication of
venous cannulation nowadays was mentioned in the paper of Chiao et al. (2013), where it
was identified that multiple attempt of venous puncture is limiting for the healthcare
facility as well as increases the stress and anxiety in patients. Hence, application infrared
vein viewing technique should be done to develop processes in which, multiple attempt of
vein puncturing would be eliminated (Chiao et al. 2013). Therefore, to determine the
effectiveness of vein viewing system using infrared, it was required to directly compare it with
the conventional vein cannulation process so that effectiveness of the process could be easily
determined. Researchers, De Graaff et al. (2013) conducted the study in which each of the
patients included in the study undergone vein cannulation with conventional and infrared
vein viewing approach. The primary aim of this research was to understand the ability of
the infrared vein viewing system and to achieve that 384 patients included in the study
were provided with both type of cannulation, that lead to 768 observations. All these
participants were asked for the consent so that ethical compliance could be achieved. After
completion of the study, the statistical results revealed that the conventional vein
cannulation were not effective in patients who were obese, from African or Asian origin
because of their physical anatomy and inability of the nursing professionals to view the
vein underneath their fat tissues (De Graaff et al. 2013). On the other hand, while application
of infrared vein viewing technique, the researchers were able to determine 9.1% improvement
was notice compared to the conventional method as the nursing professionals were able to
visualize veins in obese patients. Hence, after completion of the study, it was observed that
application of vein viewing technique in the cannulation process increased the efficiency of the

11LITERATURE REVIEW
nursing professionals by providing them with the ability to view the vein and the correct site of
cannulation (Çaglar et al. 2019).
Research by Rothbart et al. (2015), also added to the findings of research by De
Graaff et al. (2013), as their randomized control trail or the mixed method indicated that
the paediatric patients also indicated to the fact that infrared laser vein viewing system is
effective in reducing the mechanical and human error of venous cannulation. To provide
factual data about the above- mentioned statement the researchers conducted a quantitative
cluster randomized clinical trial in which participants (paediatric patients) were divided in
control group and intervention group and a total 1913 patients were included in the study (De
Graaff et al. 2013). Both the groups were provided with similar care and observation whiles the
process. The research findings, collected after the completion of the process indicated that
implementation of vein viewing technique significantly increased the ability of the nursing
professionals to puncture accurate site of central and peripheral veins. Moreover, it was also
observed that nursing professionals who were new in the process or did not had any past
experience of puncturing vein for cannula insertion, were able to learn and conduct the process
without any failed attempts (De Graaff et al. 2013). Therefore, this was the most significant
research finding that was collected from this research article that indicated that application of
near infrared vein viewing technique in healthcare facilities of UK could significantly decrease
the risk factors associated to the process and the nursing professionals could implement this
crucial step without any failed attempt (De Graaff et al. 2013).
In a qualitative case study analysis related primary research article Ravik, Havnes
and Bjørk (2017) mentioned that learning and practicing the theoretical knowledge is an
important aspect for nursing competency development in every conventional and advanced