Near-infrared vascular imaging in peripheral venous and arterial access

Venous and arterial access are among the most widespread medical procedures performed in children. Especially in young children venous and arterial access can be problematic due to tiny blood vessels that are difficult to localize beneath a layer of baby fat. This thesis describes the development and clinical evaluation of the VascuLuminator, a guidance tool for peripheral venous and arterial access by visualizing blood vessels underneath the skin with near-infrared light. In a third to a fifth of the pediatric patients, more than one attempt is required for a successful intravenous cannulation. Arterial cannulation is successful in one attempt in only 20% of the patients. To facilitate localization of blood vessels, near-infrared light can be used to visualize blood vessels underneath the skin. Based on this knowledge, we developed a device (the VascuLuminator) to facilitate peripheral access to the blood vessels. The VascuLuminator consists of a NIR emitting LED which is placed underneath the puncture site. The light, absorbed by blood and scattered by other tissue, is processed by a NIR-sensitive camera. An LCD display shows an image of the blood vessels as dark lines against a light background of tissue. The VascuLuminator was able to visualize blood vessels in most patients, and was clinically useful in venipunctures. There was a tendency to an increase in success at first attempt in arterial cannulation with the VascuLuminator. However, the VascuLuminator was not clinically beneficial for intravenous cannulation in a general pediatric population. Only in children with a dark skin and anticipated as difficult to cannulate, the VascuLuminator increased success at first attempt. Further research is required to affirm or refute clinical effectiveness of the VascuLuminator in this specific population. The main problem with difficult peripheral venous and arterial access is advancement of the cannula into the vessel, rather than localizing the vessel. Future research should focus on methods to facilitate successful cannula advancement within the vessel