PROBLEM
Patient
High intravenous failure rates
40% of first pass cannulation fail [1,2]. This results in multiple insertion attempts being required to successfully cannulate the patient, which increases the risk of phlebitis, thrombosis and infection and can lead to premature failure of the cannula [3,4]. Furthermore the risk of failure increases with subsequent attempts [5], highlighting the critical nature of first attempt success to ensure not only improved health outcomes but comfort for the patient. Repeated insertion can cause apprehension, distress and pain to the patient often leaving them with bruising and scarring [6] . Post insertion 30-50% of cannulas fail prior to completion of therapy [7,8]. Often due to infection, infiltration or extravasation as well as phlebitis [8,9]. Additionally the location of insertion has been seen to affect the longevity of the PIVC. Specifically those inserted into the ante cubital fossa or hand / wrist regions fail at sigificantly higher rates, along with increased rate of infection than those in the forearm [7,8,10]. In DIVA patients 70% of first pass cannulas fail [11]. DIVA is defined as when a clinician has two or more failed attempts using traditional techniques or when physical examination findings are suggestive of DIVA (veins not visible or palpable) or the patient history of DIVA. [12] Other factors that increase difficulty for cannulation include bifurcations, valves, calcifications and thrombus presence [13]. The DIVA patient population represents 22% of all PIVC insertions [14].
Clinician
Difficult training requirements
80% of USA healthcare institutions rate their nursing cannulation proficiency as novice[15], highlighting the need of improved training and easy to use cannulation assistance devices. Ultrasound guidance in DIVA patients has been found to increases the first attempt success by 3 times [16]. In the general population use of ultrasound guidance has been seen to reduce first pass cannulation failure to 10-20%[17] . Ultrasound guidance also reduces risks associated with early puncture related complications [18] and shortens the time to successful cannulation. It allows for rapid assessment of whether a suitable vessel is present and avoids painful and likely unsuccessful attempts [18], [19], avoiding wasted clinician time and materials. Despite the clear improvements made with ultrasound guidance in cannulation, 66% of clinicians have never used ultrasound for peripheral cannulation [20]. The poor adoption likely due to the need for specialised equipment and extensive training required. To reach true competence 20-30 procedures are required [21], with studies showing success of greater than 88% can be achieved after 15 to 26 attempts [22]. As a traditional ultrasound machine is designed for a large range of diagnostic tests the average price is $115,000 [23], which remains a limiting factor for access. Other devices present in the market include near infrared (NIR) technologies which are portable and cheap, however have limited imaging capacity in terms of depth. A maximum visualisation depth of only 6mm has been achieved, resulting in no improvement in first pass cannulation success [24]. NIR devices also encounter challenges in obese, dark or tough skin which limits the devices use population drastically [25]. The poor performance of NIR devices is largely attributed to the 2D display which does not provide any evaluation of depth, a critical variable for cannulation success[26]. To ensure success, it is critical that the clinician chooses the ideal site and vein for cannulation, which only occurs in 26% of attempts by general inserters. In comparison, vascular access specialists (VAS) choose the ideal vein and site 82% of the time [27]. Insertion by VAS results in reduced mean time of cannulation, attempts and post cannulation failure. Unfortunately, VAS teams and individuals are not accessible majority of the time, therefore general inserters perform most cannulations and are the target population for our device.
Provider
Large preventable costs
The health economic burden of DIVA cannulations is estimated to be $2.68 Billion in emergency departments across the US [28]. DIVA patients often lead to multiple PIVC insertion attempts, prompting escalation and leading to significant increases in resource use and cost. The estimated cost for escalation per DIVA patient is $17.83 USD [28]. Irrespective of escalation each additional cannulation attempt increases the cost by $13 USD [29], [30], [31] considering increased clinicians time and additional materials required. The cost to the healthcare system for PIVC replacement, required in the case of post insertional failure is $45 USD per case [1], a cost that could be alleviated by improved initial cannulation site and vessel choice. 1.2 million kilograms of waste is produced by failed cannulation attempts each year [31], [32] and accounts for approximately 30% of total costs[32]. The method of disposal is via incineration which is both energy intensive and damaging to the environment. Incineration releases toxic gases, which can also lead to negative health impact [33]. By reducing the number of cannulation attempts required for success, VeinTech aims to reduce the overall waste generated by the procedure.
References
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