I.V. access is a frequent challenge faced by all emergency physicians. Patients hate getting stuck multiple times, nurses hate the amount of time consumed by difficult IVs, and we hate the delay in care. A difficult IV that requires physician involvement whether it be ultrasound, central access or other interventions can put the brakes on a smooth-running department. AccuVein has attempted to help alleviate the collective headache of difficult IV access with the AV300.
The AV300 is a handheld device used to help superficial vessels stand out through the use of space-aged laser technology. That’s right, I said lasers, a fact which I had to keep reminding people as they flashed the light around the room, nearly picking off one retina after another. The AV300 uses the absorption of light by hemoglobin to enhance blood vessels. When you pass the laser over the skin, veins appear as dark shadows. But it’s not as simple as waving a magic wand. You must take care to keep the device perpendicular to the vessels. Not being one for instruction manuals, it took me a whole day with the AV300 before I learned this lesson. Another quirk of the AV300 to keep in mind is that the distance you hold the device from the skin is related to the depth of the vessel and the patient’s skin, so again it’s not just a single pass device to scan for veins.
So how does the AccuVein AV300 perform in the field? The nurses, residents and I spent a couple weeks with the AV300 and opinions ran the gamut from unimpressed to, “This is the greatest thing since sliced bread!” I think that on the whole, the AV300 is a nice handheld replacement for the floor-standing monsters in use just a couple of years ago. While the AV300 is handheld, it also comes with a flexible arm for mounting on IV poles and a clamp for bed rails, allowing you to have both hands free to work. The device itself is a little larger than a big cordless phone and fits comfortably in your hand. A button on the left side of the device varies the laser emitted allowing for varying penetration depending on skin type and vessel depth. In my usage I found the third of three settings tended to work best.
While the AV300 certainly made veins stand out better than ambient light alone, most of the testers agreed that it simply made already identifiable vessels more prominent. An average-sized vessel virtually popped out at you when held under the AV300. But the AV300 seemed to have trouble with the same vessels that we all have trouble with, those that are smaller or deeper. Of the dozen or so experienced nurses I polled, only one found the AV300 to be useful. Contrast this with the dozen or so newer nursing grads of which about half felt the device came in handy. Personally, I feel the device is a great scanning tool to take a quick look at potential targets, which you can then more closely assess with the naked eye and ambient light. Between patients and volunteers I scanned approximately 100 people with the AV300 with about 20 being what I would consider a difficult stick. Of those, the AV300 pointed out missed vessels in 3. While I’m sure those three patients were happy to be poked and prodded less, we did not see the monumental benefit I was hoping for.
The AccuVein AV300 retails at $4,500 with some discount for group purchases. This includes 36 months of “spare-in-the-air” warranty. There is also a rental option starting at $99 a month. I think the AV300 makes leaps when compared to the larger technology of a couple of years back, but its limited assistance means that most of your difficult IVs will still be difficult and still require more of your time. Be that as it may, the AV300 will spare you and some of your patients from the pain of an ultrasound-guided or central venous line. In conclusion, the AV300 may not be quite ready to be standard of care, but I look forward to seeing what the next generation from AccuVein has to offer.
(out of 5)
Makes already accessible vessel really stand out; handheld size
Does not help with the majority if difficult IVs; high price