Improvement of a prototype device using near-infrared light to visualize invisible veins for peripheral intravenous cannulation in healthy subjects

13301甲第4115号博士（保健学）金沢大学博士論文本文Full 以下に掲載：金沢大学つるま保健学会誌 38(1) pp.11-19 2014. 金沢大学つるま保健学会. 共著者：木森 佳子, 中山 和也, 宮地 利明, 中谷 壽男, 須釜 淳

Improvement of a prototype device using near - infrared light to visualize invisible veins for peripheral intravenous cannulation in healthy subjects

13301甲第4115号博士（保健学）金沢大学博士論文要旨Abstract 以下に掲載：金沢大学つるま保健学会誌 38(1) pp.11-19 2014. 金沢大学つるま保健学会. 共著者：木森 佳子, 中山 和也, 宮地 利明, 中谷 壽男, 須釜 淳

Venipuncture-Induced Hematomas Alter Skin Barrier Function in the Elderly Patients

We aimed to compare the barrier function of the skin site with the color of hematoma induced by venipuncture and the area surrounding the skin site to help improve skin care for hospitalized elderly patients. There were 50 patients with a median age of 84 years who were included in the analysis. There was no significant difference between the hematoma site-induced venipuncture and the area surrounding the hematoma site in terms of transepidermal water loss and skin sebum level. The status of stratum corneum hydration and skin elasticity on the hematoma sites was significantly lower than that on nonhematoma sites. The median skin pH was significantly higher on hematoma sites than that on nonhematoma sites. The study variables did not reveal any significant correlation with the intensity of skin erythema. These findings showed that hematoma formation in the subcutaneous tissue affected the skin barrier function and that these sites need moisturizing skin care regardless of the intensity of skin erythema

An observational study comparing the prototype device with the existing device for the effective visualization of invisible veins in elderly patients in Japan

Objective: To compare the performance on the detection of the invisible veins between our modified prototype device and an existing device in elderly hospitalized patients. Methods: A prospective, cross-sectional, and observational study was performed in the invisible veins in elderly patients. The major variables, skin color near the invisible veins, and diameter and depth of the invisible veins were measured. The vein visualization rate was calculated as the ratio of the visualized veins to the invisible veins by the visualization device. Results: We analyzed 53 invisible veins in the cubital fossa and 56 invisible veins in the forearm in a total of 72 patients (median age, 73 years). The visualization rate for our prototype device was higher than that for an existing device in the cubital fossa and the forearm sites. The visualized veins of the prototype device had a higher intensity ratio than that of an existing device. No significant differences were observed in the body mass index, vein depth, and vein diameter of the visualized veins at the cubital fossa and forearm sites. Conclusion: The prototype surpassed the existing device in visualizing the invisible veins. However, the prototype was unable to visualize all the invisible veins. We need to look for ways to reduce noise and to visualize the invisible veins, and the visualization rate of devices needs to be investigated in further association with the percentage of success with actual intravenous access and locating time to vein

末梢静脈カテーテル留置において目視困難な静脈を確実・安全に穿刺するための基礎研究: 血管径・深さ・皮膚色の非侵襲的計測

金沢大学医薬保健研究域保健学系末梢静脈内カテーテル留置法では，対象静脈が目視困難な場合，確実な穿刺，合併症の発生に影響を及ぼす．本研究の目的は目視困難静脈の穿刺技術向上に向け，目視の可否による血管径 ・ 深さ，動脈との位置関係を超音波診断装置で，皮膚色を色差計で計測し違いを明らかにすることである．研究デザインは実態調査型研究である．対象者は健常若年女性 20名，計測静脈は 58本，計測動脈は 18本であった．その結果，目視の可否に有意差があったのは深さのみで，血管径，動脈との位置関係，皮膚色は同等であることが明らかになった．静脈の深さの平均 (SD) は，目視可能静脈が2.7 (0.7) mm，目視困難静脈が4.6 (1.8) mmであった (p=.0001)．目視の可否の分離値は 3.0mm (AUC=0.919，95％CI 0.84－0.99)で，深さ3mm以上の留置カテーテル用末梢静脈は目視困難になることが明らかとなった．したがって，目視困難な静脈は深さ3mm以上の穿刺技術が，動脈穿刺の防止は，目視の可否に関わらない穿刺技術の必要性が示唆された．During catheter placement, peripheral intravenous access is affected by the visibility of the vein, such that the risk of peripheral nerve injuries and arterial punctures, increases as the visibility decreases. This study examined the relation between vein visibility and (a) vein width, (b) vein depth, (c) position of the artery relative to the vein, and (d) skin color. This was an observational study with prospective data collection. A total of 20 healthy young women (58 veins and 18 arteries) were examined. As a result, vein visibility demonstrated significant differences in relation to vein depth, but not in relation to the other three factors. The mean depth (SD) was 2.7 (0.7) mm for visible veins and 4.6 (1.8) mm for invisible veins (p=0.0001). The cut off point was 3.0 mm (AUC=0.919　95％ CI-0.84 to 0.99), indicating that peripheral veins for catheter placement are more likely to be invisible when the depth is 3.0 mm or more. These findings highlight the need for two kinds of venipuncture skills : those for invisible veins with a depth of 3.0 mm or more, and those that will prevent arterial puncture regardless of vein visibility