Original Article Veinlite Transillumination in the Pediatric Emergency Department A Therapeutic Interventional Trial Yiannis L. Katsogridakis, MD, MPH,*y Roopa Seshadri, PhD, AM,yzx Christine Sullivan, MBA, MS,x and Mark L. Waltzman, MDk Objectives: We hypothesized that transillumination would increase peripheral intravenous (IV) insertion success rates in pediatric emergency department patients. Primary outcome was success in rst attempt, and secondary outcome was success within 2 attempts. Methods: We evaluated IV insertion by pediatric emergency department physicians and nurses using the Veinlite (TransLite, Sugar Land, Tex). Patients who required nonemergent IV insertion were enrolled if younger than 3 years or aged 3 to 21 years with a history of difcult access. Participants were randomly assigned to transillumination or nontransillumination. Analyses were performed using a mixed-effects logistic regression model adjusting for provider effect. Results: We evaluated 240 patients. After adjusting for signicant covariates (safety catheter [P = 0.008], visibility [P = 0.01], and palpability [P = 0.03]) and controlling for provider effect, IV placement was more likely successful in rst attempt in transilluminated patients (P = 0.03; odds ratio, 2.1 [95% condence interval, 1.1Y3.9]). After adjusting for signicant covariates (safety catheter [P G 0.001], location [P = 0.005], and palpability [P = 0.05]) and controlling for provider effect, IV placement was more likely successful within 2 attempts in transilluminated patients (P = 0.01; odds ratio, 3.5 [95% condence interval, 1.4Y8.9]). Intracluster correlation for random effect of provider was 10% in rst attempt and 16% within 2 attempts. Conclusions: After adjusting for multiple signicant covariates and controlling for random effect of provider, our results indicated a benet in the use of Veinlite transillumination for IV insertion in rst attempt and within 2 attempts. This technique seemed to facilitate nonemergent IV placement in pediatric patients compared with standard practice. n 1998, Frey1 reported peripheral intravenous (IV) insertion success rates for admitted patients, at a large urban children’s hospital, of 23% for physicians, 44% for staff registered nurses (RNs), and 98% for IV nurse clinicians. The number of attempts ranged from 1 to 10 on a single patient, and the average time required per IV start was 20 minutes, with an estimated average cost of $24. In 1992, Friedland and Brown2 reported a 74% success rate in the rst IV attempt in 214 children in an emergency department (ED) by registered nurses. Kuhns et al3 described the use of transillumination of an extremity to facilitate infant venipuncture in 1975. They noted that venipuncture in infants could be difcult because supercial veins were often too small to palpate and were difcult to see with ambient light. The use of the initial transillumination devices required caution because of production of heat and iatrogenic second-degree burns.4,5 The development and improvement of ber optic lights has resulted in transilluminators that illuminate veins without danger of thermal injury when used appropriately.5Y9 In a pediatric ED, IV insertion is often a difcult experience for patients, parents, and medical providers. Increased dexterity is required in the cannulation of infants, and children and adolescents with chronic medical conditions. When unsuccessful, alternatives include intraosseous infusion, central venous access, and venous cutdown. These more invasive procedures require greater skill and are associated with increased morbidity.10Y13 Therefore, techniques that optimize peripheral line placement are essential. We know of no published prospective randomized controlled trial comparing the success of IV placement with and without transillumination in a pediatric ED. Our hypothesis was that transillumination would increase IV success rates in pediatric ED patients younger than 3 years and in those aged 3 to 21 years with a history of difcult access. We studied IV placement by 4 pediatric emergency medicine fellows (MDs) and 4 pediatric ED RNs, using the Veinlite (TransLite, Sugar Land, Tex). Our primary outcome was success rate of IV placement in the rst attempt and our secondary outcome was success rate of IV placement within 2 attempts. We planned enrollment of 240 patients to detect a difference of 20 percentage points in IV success rates, with 80% power using a 2-sided test. Key Words: transillumination, peripheral intravenous insertion, IV *Department of Pediatrics, Division of Pediatric Emergency Medicine, Children’s Memorial Hospital; yFeinberg School of Medicine, Northwestern University; and zDepartments of Pediatrics and Preventive Medicine, ‘Mary Ann and J. Milburn Smith Child Health Research Program, Children’s Memorial Research Center, Children’s Memorial Hospital, Chicago, IL; and kDepartment of Medicine, Division of Emergency Medicine, Children’s Hospital Boston and Harvard Medical School, Boston, MA. Presented at the Pediatric Academic Societies’ Annual Meeting in Washington, DC, in May 2005. Address correspondence and reprint requests to Yiannis L. Katsogridakis, MD, MPH, Division of Pediatric Emergency Medicine, Children’s Memorial Hospital, 2300 Children’s Plaza, Box 62, Chicago, IL 606143394. E-mail: [email protected]. Copyright * 2008 by Lippincott Williams & Wilkins ISSN: 0749-5161/08/2402-0083 Pediatric Emergency Care Volume 24, Number 2, February 2008 Copyright @ 2008 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Pediatric Emergency Care Volume 24, Number 2, February 2008 METHODS Providers included 4 MDs with experience placing IVs in a pediatric residency and pediatric emergency medicine fellowship and 4 RNs with 4 to 12 years experience placing IVs in a pediatric ED setting. Their prestudy success rates during a 4-week period were 56% in the rst attempt and 85% within 2 attempts. Their success rate in the rst attempt was similar to success rates reported in the literature.1,2,14 This study was a prospective, unblinded, randomized, open, therapeutic interventional trial. Parental or guardian written...