https://dx.doi.org/10.14528/snr.2017.51.1.141
2017. Obzornik zdravstvene nege, 51(1), pp. 52–74.
ABSTRACT 
Introduction: Biomedical devices are tools used for locating invisible and impalpable peripheral veins. The 
purpose of this article is to give a systematic review and analysis of existing studies on the available biomedical 
devices used for locating peripheral veins and on their effectiveness in clinical practice.
Methods: Databases CINAHL, Medline and ScienceDirect were used for the literature review and analysis. 
The search was performed with the following key words in English: devices, visualization, technology, 
cannulation, vein, nursing care, with Boolean operators 'AND' and 'OR'. The analysis included randomized 
and experimental clinical studies published in the English language in the period from 2000 to August 2016. 
From a total of 1,020 retrieved studies, 17 were included in the detailed analysis.
Results: The results of the analysis have shown that the success rate of the first attempt of intravenous 
cannulation using biomedical devices in more than half of the studies was not significantly higher than when 
the process was performed using the conventional method. The success of the first attempt of intravenous 
cannulation mostly depends on the experience and skills of nurses. Biomedical devices are more helpful for 
novice nurses who do not perform cannulation on a daily basis, for beginners and nursing students. 
Discussion and conclusions: Based on research, we cannot affirm that biomedical devices significantly 
contribute to easier peripheral venous cannulation. Further research is required to validate the advantages of 
such an approach. However, this is limited due to the affordability issues of such biomedical devices.
IZVLEČEK
Uvod: Biomedicinski pripomočki za vstavljanje intravenske kanile so danes pomemben del opreme, ki naj bi 
jo medicinske sestre uporabljale pri svojem delu. Namen članka je sistematičen pregled obstoječih raziskav 
o razpoložljivih biomedicinskih pripomočkih za iskanje perifernih ven, pogostnost in koristnost njihove 
uporabe v klinični praksi.
Metode: Za pregled literature in analizo virov so bile uporabljene zbirke podatkov CINAHL, MEDLINE 
in ScienceDirect. Iskanje je bilo izvedeno z naslednjimi angleškimi ključnimi besedami in njihovimi 
sopomenkami, povezanimi z Boolovima operatorjema AND oz. OR: »devices«, »visualization«, »technology«, 
»cannulation«, »vein«, »nursing care«. V analizo so bile vključene ekperimentalne in neeksperimentalne 
klinične raziskave, objavljene od leta 2000 do avgusta 2016 v angleškem jeziku. Iz iskalnega nabora 1020 
zadetkov je bilo v končno analizo vključenih 17 raziskav. 
Rezultati: Rezultati so pokazali, da uspešnost prvega poskusa vstavljanja intravenske kanile z biomedicinskimi 
pripomočki pri več kot polovici raziskav ni značilno višja od konvencionalne metode. Uspešnost prvega poskusa 
vstavljanja je odvisna predvsem od izkušenosti in spretnosti medicinske sestre. Biomedicinski pripomočki so 
dragocena pomoč neizkušenim medicinskim sestram, ki venepunkcije ne izvajajo vsakodnevno, začetnicam 
in študentom zdravstvene nege. 
Diskusija in zaključek: Na podlagi raziskave ne moremo z gotovostjo trditi, da biomedicinski pripomočki 
bistveno pripomorejo k lažji vzpostavitvi perifernega venskega kanala. Za potrjevanje prednosti takšnega 
pristopa bodo potrebna nadaljnja raziskovanja, vendar pa so le-ta omejena z majhno dostopnostjo 
biomedicinskih pripomočkov.
Key words: biomedical devices; 
intravenous cannula; nursing; 
difficult venous access
Ključne besede: biomedicinski 
pripomočki; intravenska kanila; 
zdravstvena nega; otežen venski 
dostop
Assistant Zvonka Fekonja, 
MSN, BSc, RN; University of 
Maribor, Faculty of Health 
Sciences, Žitna ulica 15,  
2000 Maribor, Slovenia
Correspondence e-mail/
Kontaktni e-naslov:  
zvonka.fekonja@um.si
Associate Professor Majda 
Pajnkihar, PhD, MSc, BSc, RN; 
University of Maribor, Faculty 
of Health Sciences, Žitna ulica 
15, 2000 Maribor, Slovenia and 
University of Maribor, Faculty 
of Medicine, Taborska ulica 8, 
2000 Maribor, Slovenia
Review article/Pregledni znanstveni članek
Use of cutting-edge biomedical devices for intravenous cannulation in the health 
care of a patient: literature review
Uporaba sodobnih biomedicinskih pripomočkov za vzpostavljanje periferne venske 
poti v zdravstveni oskrbi pacienta: pregled literature
Zvonka Fekonja, Majda Pajnkihar
Received/Prejeto: 27. 10. 2016
Accepted/Sprejeto: 24. 2. 2017
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 53
Introduction
Establishing peripheral venous access is a routine 
invasive procedure, which is performed on 
approximately 70 % of patients during hospitalisation 
(Bernatchez, 2014). Peripheral venous line refers to the 
insertion of various plastic needles or catheters in the 
peripheral vain. Establishing peripheral venous access 
is one of the most frequently performed interventional 
procedures in nursing care (Bauman, et al., 2009; 
Walsh, 2008; Juric & Zalik, 2014) and is one of the 
most invasive procedures for patients who seek help 
in an emergency department (Bernatchez, 2014). The 
peripheral venous line is important for a critically 
ill patient due to the need for blood sampling for 
laboratory testing, medicine administration, and fluid 
or parenteral infusion, which a patient might need in 
a given moment (Alekseyev, et al., 2012). Insertion of 
peripheral venous cannula is a skill that a competent 
registered nurse has (Strgar & Macura Višić, 2013). The 
patient's medical condition plays an important role in 
establishing venous access. Risk factors and the patient 
medical conditions which may result in difficult vein 
access include the patient's age, experience of the 
person performing the procedure, the size of the 
cannula and the site of insertion (Chinnock, et al., 
2007; Sebbane, et al., 2013; Heinrichs, et al., 2013). 
In addition, there are some characteristic groups of 
patients with whom establishing a peripheral venous 
line is more difficult: obese patients, patients with 
peripheral oedema, patients undergoing chemotherapy, 
intravenous drug abusers, severely dehydrated patients 
(Gregg, et al., 2010; Fields, et al., 2014), dark skinned 
patients (Aulagnier, et al., 2014), as well as children and 
the elderly (Walsh, 2008). Lack of skill, inept nurses or 
difficult intravenous access contribute to the need for 
repeated attempts of insertion (Walsh, 2008). Cuper 
and colleagues (2010) have found that while the risk 
factors are well known in practice, they are quite poorly 
described in the literature. There is a higher probability 
that difficulties arise when performing cannulation in 
children younger than two years and particularly in 
infants (Chapman, et al., 2011; Heinrichs, et al., 2013). 
Arbique and colleagues (2014) think that a successful 
insertion of intravenous cannula requires the operator 
to be familiar with the vein and endothelial cell anatomy, 
as well as the names and sites most appropriate for 
venepuncture of the most suitable peripheral veins; 
the operator should know before the first attempt of 
insertion why the intravenous cannula is necessary 
and which vein is most suitable for venepuncture. 
Furthermore, the operator should also be familiar with 
the complications related to a damaged vein caused by 
the application of medicines or fluid administration. 
When the nursing staff understand these mentioned 
key elements, their knowledge may decrease the 
chances of causing the patient unnecessary pain or 
discomfort as a result of several unsuccessful attempts 
of intravenous cannulation, less delays in medical care, 
decreased use of expensive biomedical equipment, as 
well as less non-productively used time in nursing and 
thus a general improvement of nursing care.
To supplement the standard procedure of blind 
intravenous cannulation, procedures based on 
additional visualisation of subcutaneous veins 
have been developed: use of ultrasound devices, 
transillumination (illumination of the peripheral 
parts of the human body with other sources of light 
– with red or white light) and biomedical devices for 
near infrared spectroscopy. Biomedical devices were 
developed with the purpose of improving the success 
rate of venepuncture and consequently reducing the 
number and scope of the negative effects of multiple 
or unsuccessful cannulation, and with the additional 
purpose of avoiding the frustrations of health care 
workers in cases of unsuccessful intervention. In 
comparison to the conventional method of establishing 
the peripheral venous channel, the use of biomedical 
devices has several advantages as it enables the placement 
of intravenous cannula in veins that are invisible and 
impalpable, thus eliminating the need to establish a 
central peripheral line, which in turn decreases the 
risk of infection and other complications (Sirk, et al., 
2013). Early identification of patients with risk factors 
for a difficult establishment of the peripheral venous 
line is important because it offers the chance to adjust 
the strategy in order to increase the success rate or a 
critical evaluation of employing alternative methods for 
establishing peripheral venous line or venous devices 
(Walsh, 2008; Pagnutti, et al., 2016). 
The oldest technique used for the visualisation of 
subcutaneous veins is called transillumination, which 
involves placing sources of light under or around the 
selected limb (John, 2007). The use of near infrared 
spectroscopy (NIR) is relatively new and includes a 
direct illumination and visualisation of the venepuncture 
site (Fukuroku, et al., 2016). Due to a higher content of 
deoxygenated haemoglobin, subcutaneous veins are 
nearly entirely absorbed in infrared light (IR) with a 
wavelength between 740 nm to 760 nm, while the arteries 
almost completely translucent due to a higher content 
of oxygenated haemoglobin. The mentioned interval of 
the wavelength belongs to the so called near infrared 
area encompassing the wavelength from 700 nm to 1400 
nm (Juric, et al., 2014). Based on the available literature 
the following devices are available on the market: 
VascuLuminator® (Cuper, et al., 2013), VeinViewer® in 
Wee Sight® (Peterson, et al., 2012), AccuVein® (Kaddoum, 
et al., 2012), VenoScope®, VeinLocator® in VeinLite® 
(Ernst, 2009) and Veinsite® (Chiao, et al., 2013).
The mentioned biomedical devices differ in their 
approach of visualising the veins and use of various 
components. The VeinViewer® device with NIR light 
analyses the skin and projects the received image back 
on the skin, whereby the veins are visible as black lines 
on a green background (Hess, 2010). This image serves 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.54
as a kind of map for the nurse to use, hence making 
them more efficient at cannulation (Lamperti & Pittiruti, 
2013). The advantage of using this device is that the 
operator may look straight at the site of the cannulation 
while performing the puncture, however, the normal 
view of the site of insertion is changed and this technique 
requires the image to be processed as it can be sensitive to 
outside influences (Miyake, et al., 2006). The AccuVein® 
device functions in a similar way, but it projects the 
veins as black lines on a red background (Cuper, et al., 
2013). The VascuLuminator® device is different as the 
NIR light is placed under the insertion site, while the 
insertion site is visible on the screen where the veins are 
black on a light background (Cuper, et al., 2013). The 
insertion site should therefore be observed on the screen 
where an image is projected through a camera (Dunn & 
Conrad, 2005). A review and analysis of the market have 
revealed that there are other devices being developed 
which focus on the issue of difficult venepuncture. Such 
devices are: Evena Eyes-On Glasses® (Medical, 2015), 
EasyVein® (InSono, 2015), Vein Display® (Fukuroku, et 
al., 2016) in mVeinVison®, which enables visualisation of 
subcutaneous veins on mobile devices with the Android 
operational system (Juric & Zalik, 2014). 
Aims and objectives
The purpose of this article is to present the results 
of a systematic review and data analysis of existing 
research on the available biomedical devices that are 
based on using NIR light to locate peripheral veins. A 
review of presently available devices and the results of 
their use in clinical practice are presented. 
Methods
We used a five-step methodological approach as 
described by Higgins and Green (2009). This approach 
encompasses setting a research question, setting 
suitability criteria, searching for relevant evidence, 
critically reviewing collected data, and analysing and 
synthesising results. We set a specific research question 
using the PICO (Population, Intervention, Comparison, 
Outcome) (Melnyk & Fineout-Overholt, 2015) approach 
for literature review: To what extent does using cutting-
edge biomedical devices based on near infrared 
spectroscopy affect the success rate of the first attempt 
of peripheral venous cannulation in comparison to the 
conventional peripheral venous cannulation method in 
patients with a difficult venous access? 
Review methods 
We conducted a systematic literature review as it 
enables the obtainment of data from various sources 
and ensures a holistic understanding of the research 
subject. The literature search was conducted in 
the following databases: CINAHL, MEDLINE and 
ScienceDirect by means of several combinations of 
selected search words in the English language, and 
their synonyms, with Boolean operators AND or OR: 
'devices', 'visualization', 'technology', 'cannulation', 
'vein', and 'nursing care'. The criterion in selecting 
the literature was that articles were published in the 
period from 2000 to August 2016. 
In addition to the language and publication time 
restriction, the main inclusion factors were also peer-
review, quantitative research, subject focus, the use 
and functions of biomedical devices for intravenous 
cannulation in the health care of a patient, and 
accessibility of full text. The exclusion criteria were: 
editorials, letters, interviews, posters, systematic 
reviews and no access to full text. The search results 
obtained in electronic databases were imported into the 
Mendeley programme and coded with reference to the 
inclusion criteria. The process of the literature review 
is displayed in the PRISMA (Preferred Reporting Items 
for Systematic Reviews and Meta-Analyses) diagram 
(Moher, et al., 2010) as shown in Figure 1. 
The results of the review
The search produced 1,020 results. We reviewed the 
topics and abstracts of research articles and identified 
duplicates. Articles on the use, functions and 
clinical results of biomedical devices for intravenous 
cannulation were included in the literature review. 
The quality assessment of the review and the 
description of data processing
We selected the narrative approach to analyse data 
as it connects a wide range of research methods. 
Data synthesis was conducted using the descriptive 
method, table creation method and content analysis, as 
recommended by Popay and colleagues (2006). For the 
evaluation of included research projects, a programme 
for critical appraisal, CASP (Critical Appraisal Skills 
Programme), was used. The selection of CASP as the 
most appropriate tool was influenced by two factors; 
the fact that this is a frequently used tool in evaluating 
the quality of articles and that it includes all the most 
relevant aspects of critical review (reliability, objectivity 
and validity) (Young & Solomon, 2009). It is a tool 
composed of 10 questions and described as suitable for 
all types of research. Its characteristic is that it clearly 
defines each individual criterion, which is particularly 
useful for researchers with little experience. By using 
the appraisal programme we appraised the articles from 
low to high quality (Keyko, et al., 2016).
Results
The literature search was conducted in three 
databases: CINAHL, MEDLINE and ScienceDirect, 
and other sources ('grey literature'). The total 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 55
number of search results was 1,020. After excluding 
7 duplicates, 1,013 results remained. Based on the set 
inclusion criteria (language and time of publication, 
peer-review, full text access, suitable topic and 
methodology established based on the title and 
abstract), 911 articles were excluded. In a detailed 
review of the remaining 102 fully accessible texts, we 
excluded a further 85 search results that failed to focus 
on the topic in great detail. The final result of locating 
relevant search results was 17 articles, which we then 
appraised in terms of quality. In all the 17 studies we 
established medium to high quality. None of the studies 
was appraised with the highest possible grade nor was 
any study excluded due to poor quality. Figure 1 shows 
a diagram of the literature search process, review and 
inclusion process. 
Literature search 
Id
en
tif
ic
at
io
n 
of
 se
ar
ch
 re
su
lts Identification of search results: CINAHL, 
MEDLINE and ScienceDirect databes 
(n = 1,018) 
Additional search  
('grey literature') 
(n = 2)
Total number of search results 
(n = 1,020) 
Review of titles and abstracts and other 
data on publication 
(n = 1,013) 
Excluded duplicates (n = 7)
(n = 1,020)
R
ev
ie
w
 a
cc
or
di
ng
 to
 c
ri
te
ri
a
Excluded search results  
(non peer-reviewed publication, 
inadequate language, time of 
publication, methodology or topic, 
no access to full text) 
(n = 911)
Review of full texts 
(n =102) 
Excluded search results  
(review article, inadequate 
population or research 
environment etc.) 
(n = 85) 
Research included in detailed analysis  
(n = 17) 
D
et
ai
le
d 
re
vi
ew
A
na
ly
si
s 
Figure 1: Flowchart of search strategy and literature selection process (PRISMA diagram)
Slika 1: Diagram poteka strategije iskanja in izbora literature (diagram PRISMA)
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.56
Ta
bl
e 
1:
 R
ev
ie
w
 o
f b
io
m
ed
ica
l d
ev
ice
s a
nd
 th
ei
r e
ffe
ct
iv
en
es
s i
n 
cli
ni
ca
l p
ra
ct
ice
Ta
be
la
 1
: P
re
gl
ed
 u
po
ra
be
 b
io
m
ed
ici
ns
ki
h 
pr
ip
om
oč
ko
v 
in
 n
jih
ov
e u
čin
ko
vi
to
sti
 v
 k
lin
ičn
i p
ra
ks
i
Au
th
or
 
an
d 
ye
ar
/
Av
to
r i
n 
le
to
/
Re
se
ar
ch
 d
es
ig
n/
Ra
zi
sk
ov
al
ni
 
di
za
jn
Sa
m
pl
e 
ch
ar
ac
te
ri
st
ic
s/
La
st
no
st
i v
zo
rc
a
C
ou
nt
ry
 a
nd
 
se
tti
ng
/
D
rž
av
a 
in
 v
rs
ta
 
zd
ra
vs
tv
en
e 
us
ta
no
ve
Pr
oc
ed
ur
e 
pe
rf
or
m
ed
 b
y/
Iz
va
ja
le
c 
ra
zi
sk
av
e
Bi
om
ed
ic
al
 
de
vi
ce
 u
se
d/
U
po
ra
bl
je
ni
 
bi
om
ed
ic
in
sk
i 
pr
ip
om
oč
ek
K
ey
 fi
nd
in
gs
/ 
K
lju
čn
e u
go
to
vi
tv
e
H
es
s, 
20
10
Pr
os
pe
ct
iv
e 
no
n-
ra
nd
om
ise
d 
st
ud
y
3−
17
 y
ea
rs
n 
= 
91
U
ni
te
d 
St
at
es
 o
f 
A
m
er
ic
a
Te
rt
ia
ry
 h
os
pi
ta
l
N
ur
se
s
Ve
in
V
ie
w
er
 
Th
e 
us
e 
of
 th
e 
de
vi
ce
 st
at
ist
ic
al
ly
 si
gn
ifi
ca
nt
ly
 in
cr
ea
se
d 
th
e 
su
cc
es
s r
at
e 
of
 fi
rs
t a
tte
m
pt
 (p
 <
 0
.0
01
), 
th
e 
nu
m
be
r o
f a
tte
m
pt
s 
de
cr
ea
se
d 
(p
 <
 0
.0
01
) a
nd
 ti
m
e 
ne
ed
ed
 to
 p
er
fo
rm
 th
e 
pr
oc
ed
ur
e 
de
cr
ea
se
d 
(p
 <
 0
.0
01
).
(+
)
St
re
hl
e, 
20
10
Pr
os
pe
ct
iv
e 
no
n-
ra
nd
om
ise
d 
st
ud
y
< 
16
 y
ea
rs
n 
= 
50
 
En
gl
an
d 
C
hi
ld
re
n'
s 
ho
sp
ita
l a
nd
 
pa
ed
ia
tr
ic
s 
de
pa
rt
m
en
t i
n 
a 
ge
ne
ra
l h
os
pi
ta
l
M
ed
ic
al
 d
oc
to
rs
 
an
d 
nu
rs
es
Ve
in
V
ie
w
er
 
O
pe
ra
to
rs
 a
ss
es
se
d 
th
e 
de
vi
ce
 a
s u
se
fu
l a
s v
ei
n 
id
en
tifi
ca
tio
n 
im
pr
ov
ed
 b
y 
76
 %
. I
n 
so
m
e 
pa
tie
nt
s o
pe
ra
to
rs
 h
ad
 d
iffi
cu
lti
es
 
id
en
tif
yi
ng
 v
ei
n 
de
pt
h.
 D
ue
 to
 it
s s
iz
e 
so
m
e 
op
er
at
or
s a
ss
es
se
d 
th
e 
de
vi
ce
 a
s i
m
pr
ac
tic
al
. 
(+
/–
)
C
ha
pm
an
, 
et
 a
l.,
 2
01
1
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
st
ud
y
< 
17
 y
ea
rs
n 
= 
32
3
U
ni
te
d 
St
at
es
 o
f 
A
m
er
ic
a
Pa
ed
ia
tr
ic
 cl
in
ic
N
ur
se
s
Ve
in
V
ie
w
er
 
N
o 
de
m
on
st
ra
te
d 
di
ffe
re
nc
es
 re
ga
rd
in
g 
tim
e 
ne
ed
ed
 to
 p
er
fo
rm
 
th
e 
pr
oc
ed
ur
e 
(p
 =
 0
.4
0)
, n
um
be
r o
f a
tte
m
pt
s (
p 
= 
0.
5)
, 
ev
al
ua
tio
n 
of
 p
ai
n 
(p
 =
 0
.3
7)
 a
nd
 a
ss
es
sm
en
t o
f u
se
fu
ln
es
s o
f 
de
vi
ce
 b
y 
st
aff
 (p
 =
 0
.2
9)
. 
(–
)
Pe
rr
y, 
et
 
al
., 
20
11
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
cr
os
s-
se
ct
io
na
l 
st
ud
y
< 
20
 y
ea
rs
 
n 
= 
12
3 
U
ni
te
d 
St
at
es
 o
f 
A
m
er
ic
a
Pa
ed
ia
tr
ic
 cl
in
ic
N
ur
se
s
Ve
in
V
ie
w
er
 
U
se
 o
f d
ev
ic
e 
di
d 
no
t h
av
e 
a 
st
at
ist
ic
al
ly
 si
gn
ifi
ca
nt
 e
ffe
ct
 o
n 
th
e 
su
cc
es
s r
at
e 
of
 c
an
nu
la
tio
n 
at
 fi
rs
t a
tte
m
pt
. S
uc
ce
ss
 ra
te
 o
f t
he
 
co
nv
en
tio
na
l p
ro
ce
du
re
 w
as
 7
9 
%
, w
ith
 th
e 
us
e 
of
 d
ev
ic
e 
72
.1
 %
.
(–
)
K
ad
do
um
, 
et
 a
l.,
 2
01
2
Pr
os
pe
ct
iv
e 
co
nt
ro
lle
d 
ra
nd
om
ise
d 
st
ud
y
< 
18
 y
ea
rs
n 
= 
14
6 
Au
st
ra
lia
Pa
ed
ia
tr
ic
 cl
in
ic
D
oc
to
r 
an
ae
st
he
sio
lo
gi
st
A
cc
uV
ei
n 
N
o 
de
m
on
st
ra
te
d 
st
at
ist
ic
al
ly
 si
gn
ifi
ca
nt
 d
iff
er
en
ce
s b
et
w
ee
n 
th
e 
co
nv
en
tio
na
l m
et
ho
d 
of
 ca
nn
ul
at
io
n 
an
d 
in
tr
av
en
ou
s c
an
nu
la
tio
n 
w
ith
 a 
de
vi
ce
 (n
um
be
r o
f a
tte
m
pt
s o
f p
la
ce
m
en
t (
p 
= 
0.
85
), 
tim
e 
sp
en
t f
or
 p
la
ce
m
en
t (
p 
= 
0.
10
). 
(–
)
Pe
te
rs
on
, 
et
 a
l.,
 2
01
2
Pr
os
pe
ct
iv
e 
no
n-
ra
nd
om
ise
d 
st
ud
y
< 
19
 y
ea
rs
n 
= 
15
5 
U
ni
te
d 
St
at
es
 o
f 
A
m
er
ic
a
Pa
ed
ia
tr
ic
 cl
in
ic
N
ur
se
s
Ve
in
V
ie
w
er
 ,
 
W
ee
 S
ig
ht
 
C
on
ve
nt
io
na
l m
et
ho
d 
of
 ca
nn
ul
at
io
n 
w
as
 d
em
on
str
at
ed
 to
 b
e m
or
e 
su
cc
es
sfu
l t
ha
n 
ca
nn
ul
at
io
n 
w
ith
 d
ev
ic
es
. Th
e r
es
ea
rc
h 
in
clu
de
d 
1,
39
9 
at
te
m
pt
s o
f p
la
ce
m
en
t o
f i
nt
ra
ve
no
us
 ca
nn
ul
a (
p 
< 
0.
00
1)
. 
(–
)
Co
nt
in
ue
s/
Se
 n
ad
al
ju
je
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 57
Au
th
or
 
an
d 
ye
ar
/
Av
to
r i
n 
le
to
/
Re
se
ar
ch
 d
es
ig
n/
Ra
zi
sk
ov
al
ni
 
di
za
jn
Sa
m
pl
e 
ch
ar
ac
te
ri
st
ic
s/
La
st
no
st
i v
zo
rc
a
C
ou
nt
ry
 a
nd
 
se
tti
ng
/
D
rž
av
a 
in
 v
rs
ta
 
zd
ra
vs
tv
en
e 
us
ta
no
ve
Pr
oc
ed
ur
e 
pe
rf
or
m
ed
 b
y/
Iz
va
ja
le
c 
ra
zi
sk
av
e
Bi
om
ed
ic
al
 
de
vi
ce
 u
se
d/
U
po
ra
bl
je
ni
 
bi
om
ed
ic
in
sk
i 
pr
ip
om
oč
ek
K
ey
 fi
nd
in
gs
/ 
K
lju
čn
e u
go
to
vi
tv
e
C
hi
ao
, e
t 
al
., 
20
13
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
st
ud
y
< 
65
 y
ea
rs
n 
= 
38
4 
U
ni
te
d 
St
at
es
 o
f 
A
m
er
ic
a
G
en
er
al
 h
os
pi
ta
l
H
ea
lth
 c
ar
e 
pr
of
es
sio
na
ls 
(p
hl
eb
ot
om
ist
, 
m
ed
ic
al
 d
oc
to
r 
an
d 
nu
rs
e)
Ve
in
sit
e 
U
se
 o
f t
he
 d
ev
ic
e 
is 
m
or
e 
eff
ec
tiv
e. 
In
 co
m
pa
ris
on
 to
 th
e 
co
nv
en
tio
na
l m
et
ho
d 
it 
w
as
 m
or
e 
eff
ec
tiv
e 
in
 o
be
se
 p
at
ie
nt
s (
p 
= 
0.
03
4)
, i
n 
A
fr
ic
an
-A
m
er
ic
an
s a
nd
 A
sia
ns
 (p
 =
 0
.0
14
6)
, a
nd
 d
ar
k-
sk
in
ne
d 
pa
tie
nt
s (
p 
= 
0.
00
14
). 
In
 co
m
pa
ris
on
 to
 th
e 
co
nv
en
tio
na
l 
m
et
ho
d 
th
e 
de
vi
ce
 sh
ow
ed
 b
y 
9.
1 
m
or
e 
po
ss
ib
le
 si
te
s f
or
 
ve
ne
pu
nc
tu
re
. 
(+
)
de
 G
ra
aff
, 
et
 a
l.,
 2
01
3
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
'cl
us
te
r' 
st
ud
y
< 
19
 y
ea
rs
n 
= 
13
83
 
Th
e 
N
et
he
rla
nd
s
Pa
ed
ia
tr
ic
 cl
in
ic
M
ed
ic
al
 d
oc
to
rs
 
an
d 
nu
rs
es
Ve
in
V
ie
w
er
 
, A
cc
uV
ei
n 
, 
Va
sc
uL
um
in
at
or
 
Su
cc
es
s r
at
e 
at
 fi
rs
t a
tte
m
pt
 w
as
 n
ot
 si
gn
ifi
ca
nt
ly
 d
iff
er
en
t (
p 
= 
0.
93
). 
W
e 
ca
n 
de
du
ce
 th
at
 in
 co
m
pa
ris
on
 to
 th
e 
co
nv
en
tio
na
l 
m
et
ho
d 
of
 c
an
nu
la
tio
n,
 u
sin
g 
de
vi
ce
s d
oe
s n
ot
 a
ffe
ct
 th
e 
su
cc
es
s 
ra
te
 o
f i
ns
er
tin
g 
in
tr
av
en
ou
s c
an
nu
la
.
(–
)
Cu
pe
r, 
et
 
al
., 
20
13
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
'cl
us
te
r' 
st
ud
y
< 
18
 y
ea
rs
n 
= 
49
4 
Th
e 
N
et
he
rla
nd
s
Pa
ed
ia
tr
ic
 cl
in
ic
Ex
pe
rie
nc
ed
 
an
ae
st
he
sio
lo
gi
st
, 
ex
pe
rie
nc
ed
 
an
ae
st
he
sio
lo
gi
st
 
nu
rs
es
Va
sc
uL
um
in
at
or
 
Su
cc
es
s r
at
e a
t fi
rs
t a
tte
m
pt
 d
id
 n
ot
 si
gn
ifi
ca
nt
ly
 d
iff
er
 in
 re
fe
re
nc
e 
to
 u
sin
g 
or
 n
ot
 u
sin
g 
th
e d
ev
ic
e. 
W
ith
 th
e u
se
 o
f t
he
 d
ev
ic
e t
he
 
su
cc
es
s r
at
e w
as
 7
0 
%
, i
n 
th
e g
ro
up
 w
ith
 n
o 
de
vi
ce
 7
1 
%
 (p
 =
 0
.6
9)
. 
Th
e d
ev
ic
e d
id
 n
ot
 im
pr
ov
e t
he
 su
cc
es
s r
at
e n
or
 sh
or
te
ne
d 
th
e t
im
e 
of
 p
la
ci
ng
 in
tr
av
en
ou
s c
an
nu
la
. 
(–
)
Su
n,
 e
t a
l.,
 
20
13
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
st
ud
y
< 
17
 y
ea
rs
n 
= 
60
 
Ta
iw
an
Pa
ed
ia
tr
ic
 cl
in
ic
N
ur
se
s
Ve
in
V
ie
w
er
 
It 
w
as
 fo
un
d 
th
at
 th
e 
us
e 
of
 th
e 
de
vi
ce
 in
 co
m
pa
ris
on
 to
 th
e 
co
nt
ro
l g
ro
up
 co
nt
rib
ut
es
 to
 fa
st
er
 id
en
tifi
ca
tio
n 
of
 th
e 
fir
st
 
av
ai
la
bl
e 
ve
in
 (p
 =
 0
.0
27
), 
fe
w
er
 at
te
m
pt
s (
p 
= 
0.
00
4)
 a
nd
 sh
or
te
r 
to
ta
l t
im
e 
of
 th
e 
ne
ce
ss
ar
y 
at
te
m
pt
s (
p 
= 
0.
01
4)
.
(+
)
Sz
m
uk
, e
t 
al
., 
20
13
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
st
ud
y
< 
18
 y
ea
rs
 
n 
= 
60
0 
U
ni
te
d 
St
at
es
 o
f 
A
m
er
ic
a
Pa
ed
ia
tr
ic
 cl
in
ic
Ex
pe
rie
nc
ed
 
nu
rs
es
Ve
in
V
ie
w
er
 
Th
e d
ev
ice
 d
ec
re
as
ed
 th
e s
uc
ce
ss
 ra
te
 o
f t
he
 fi
rs
t a
tte
m
pt
 (p
 =
 0
.2
2)
. 
Th
e s
uc
ce
ss
 o
f t
he
 fi
rs
t a
tte
m
pt
 d
id
 n
ot
 d
ec
re
as
e w
ith
 o
be
se
 p
at
ie
nt
s 
(p
 =
 0
.9
4)
. 
(–
)
Au
la
gn
ie
r, 
et
 a
l.,
 2
01
4
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
st
ud
y
53
–6
1 
ye
ar
s
n 
= 
26
6 
Fr
an
ce
Em
er
ge
nc
y
N
ur
se
s
A
cc
uV
ei
n 
Th
e 
us
e 
of
 th
e 
de
vi
ce
 d
id
 n
ot
 h
av
e 
a 
st
at
ist
ic
al
ly
 si
gn
ifi
ca
nt
 e
ffe
ct
 
on
 th
e 
tim
e 
of
 p
er
fo
rm
in
g 
th
e 
pr
oc
ed
ur
e 
(p
 =
 0
.2
4)
, o
cc
ur
re
nc
e 
of
 p
ai
n 
di
d 
no
t d
ec
re
as
e 
ei
th
er
 (p
 =
 0
.1
1)
. A
ss
es
sm
en
t o
f t
he
 
de
vi
ce
 b
y 
th
e 
op
er
at
or
s w
as
 a
lso
 m
or
e 
ne
ga
tiv
e 
th
an
 p
os
iti
ve
.
(–
)
Co
nt
in
ue
s/
Se
 n
ad
al
ju
je
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.58
Au
th
or
 
an
d 
ye
ar
/
Av
to
r i
n 
le
to
/
Re
se
ar
ch
 d
es
ig
n/
Ra
zi
sk
ov
al
ni
 
di
za
jn
Sa
m
pl
e 
ch
ar
ac
te
ri
st
ic
s/
La
st
no
st
i v
zo
rc
a
C
ou
nt
ry
 a
nd
 
se
tti
ng
/
D
rž
av
a 
in
 v
rs
ta
 
zd
ra
vs
tv
en
e 
us
ta
no
ve
Pr
oc
ed
ur
e 
pe
rf
or
m
ed
 b
y/
Iz
va
ja
le
c 
ra
zi
sk
av
e
Bi
om
ed
ic
al
 
de
vi
ce
 u
se
d/
U
po
ra
bl
je
ni
 
bi
om
ed
ic
in
sk
i 
pr
ip
om
oč
ek
K
ey
 fi
nd
in
gs
/ 
K
lju
čn
e u
go
to
vi
tv
e
Ju
ric
, e
t 
al
., 
20
14
C
ro
ss
-s
ec
tio
na
l 
ex
pe
rim
en
ta
l a
nd
 
ob
se
rv
at
io
na
l 
st
ud
y
N
o 
da
ta
. 
n 
= 
45
Sl
ov
en
ia
Ed
uc
at
io
na
l 
in
st
itu
tio
n 
an
d 
cl
in
ic
al
 
en
vi
ro
nm
en
t
N
ur
sin
g 
st
ud
en
ts
 
(te
st
in
g)
, m
ed
ic
al
 
do
ct
or
 a
nd
 n
ur
se
s 
m
Ve
in
V
isi
on
 
In
 co
m
pa
ris
on
 to
 co
nv
en
tio
na
l m
et
ho
ds
 o
f v
isu
al
isa
tio
n 
an
 
in
cr
ea
se
d 
su
cc
es
s r
at
e 
by
 3
5.
2 
%
 in
 v
isu
al
isa
tio
n 
an
d 
ve
in
 
id
en
tifi
ca
tio
n 
w
as
 e
st
ab
lis
he
d;
 in
 th
e 
cl
in
ic
al
 e
nv
iro
nm
en
t 1
.6
 %
 
m
or
e 
ve
in
s w
er
e 
id
en
tifi
ed
 o
n 
av
er
ag
e.
(+
)
G
ui
llo
n,
 e
t 
al
., 
20
15
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
st
ud
y
1.
8−
90
.6
 y
ea
rs
n 
= 
45
0
Fr
an
ce
G
en
er
al
 h
os
pi
ta
l 
(n
 =
 4
)
N
ur
se
s
A
cc
uV
ei
n 
Th
e 
di
ffe
re
nc
e 
in
 th
e 
nu
m
be
r o
f a
tte
m
pt
s w
as
 n
ot
 st
at
ist
ic
al
ly
 
sig
ni
fic
an
t (
p 
= 
0.
45
). 
A
n 
ad
va
nt
ag
e 
of
 th
e 
de
vi
ce
 is
 th
at
 it
 
id
en
tifi
es
 v
ei
ns
 (p
 =
 0
.0
02
) a
nd
 d
ec
re
as
es
 p
ai
n 
(p
 =
 0
.0
19
).
(+
/–
)
Ra
m
er
, e
t 
al
., 
20
15
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
co
ho
rt
 st
ud
y
1–
21
 y
ea
rs
n 
= 
53
U
ni
te
d 
St
at
es
 o
f 
A
m
er
ic
a
Pa
ed
ia
tr
ic
 cl
in
ic
 
(h
ae
m
at
ol
og
ic
al
 
on
co
lo
gy
)
Ex
pe
rie
nc
ed
 
nu
rs
es
Ve
in
V
ie
w
er
 
In
 co
m
pa
ris
on
 to
 th
e 
gr
ou
p 
w
ith
 th
e 
co
nv
en
tio
na
l a
pp
ro
ac
h,
 
le
ss
 ti
m
e 
w
as
 n
ee
de
d 
to
 id
en
tif
y 
th
e 
ve
in
 in
 th
e 
gr
ou
p 
of
 p
at
ie
nt
s 
w
ith
 th
e 
us
e 
of
 th
e 
de
vi
ce
 fo
r i
de
nt
ifi
ca
tio
n 
(p
 ≤
 0
.0
5)
. P
at
ie
nt
s o
f 
th
is 
gr
ou
p 
ga
ve
 h
ig
he
r a
ss
es
sm
en
ts
 fo
r t
he
 n
ur
sin
g 
st
aff
 sk
ill
s (
p 
≤ 
0.
05
) a
nd
 th
e 
w
ho
le
 e
xp
er
ie
nc
e 
w
ith
 v
en
ep
un
ct
ur
e 
(p
 ≤
 0
.0
5)
 
th
an
 th
e 
pa
tie
nt
s w
ho
 a
ss
es
se
d 
m
ed
ic
al
 n
ur
se
s w
ho
 d
id
 n
ot
 u
se
 
th
e 
de
vi
ce
.
(+
)
Fu
ku
ro
ku
, 
et
 a
l.,
 2
01
6
C
ro
ss
-s
ec
tio
na
l 
ex
pe
rim
en
ta
l a
nd
 
ob
se
rv
at
io
na
l 
st
ud
y
20
–3
8 
ye
ar
s
n 
= 
10
Ja
pa
n
Ed
uc
at
io
na
l 
in
st
itu
tio
n
N
ur
sin
g 
st
ud
en
ts
Ve
in
 D
isp
la
y 
Ti
m
e n
ee
de
d 
fo
r t
he
 se
lec
tio
n 
or
 id
en
tifi
ca
tio
n 
of
 th
e v
ei
n 
de
cr
ea
se
d 
in
 th
e c
as
es
 w
ith
 ri
sk
 fa
ct
or
s f
or
 d
iffi
cu
lt 
ve
in
 ac
ce
ss
 (p
 =
 0
.0
06
). 
N
o 
sta
tis
tic
al
ly
 si
gn
ifi
ca
nt
 d
iff
er
en
ce
s w
er
e e
sta
bl
ish
ed
 in
 th
e q
ua
lit
y o
f 
th
e p
er
fo
rm
an
ce
 o
f v
en
ep
un
ct
ur
e.
(+
/–
) 
Fu
m
ag
al
li,
 
et
 a
l.,
 2
01
6
Pr
os
pe
ct
iv
e 
ra
nd
om
ise
d 
st
ud
y
62
–8
6 
ye
ar
s
n 
= 
10
3
Ita
ly
In
te
ns
iv
e 
un
it 
of
 a
 
G
en
er
al
 H
os
pi
ta
l
N
ur
se
s
Ea
sy
Ve
in
 
In
 co
m
pa
ris
on
 to
 th
e 
co
nv
en
tio
na
l m
et
ho
d 
no
 d
iff
er
en
ce
s w
er
e 
es
ta
bl
ish
ed
 in
 th
e 
du
ra
tio
n 
of
 th
e 
pr
oc
ed
ur
e 
(p
 =
 0
.1
73
) n
or
 in
 
th
e 
nu
m
be
r o
f a
tte
m
pt
s (
p 
= 
0.
36
1)
 n
or
 in
 p
ai
n 
in
ci
de
nc
e 
(p
 =
 
1.
00
0)
. L
ow
er
 in
ci
de
nc
e 
of
 h
ae
m
at
om
a 
w
as
 fo
un
d 
(p
 =
 0
.0
5)
, 
an
xi
et
y 
(p
 =
 0
,0
38
) a
nd
 sy
m
pt
om
s o
f d
ep
re
ss
io
n 
in
 p
at
ie
nt
s (
p 
= 
0.
03
7)
.
(+
/–
)
Le
ge
nd
/L
eg
en
da
: (
+)
 –
 es
ta
bl
ish
ed
 u
se
fu
ln
es
s/
ug
ot
ov
lje
na
 k
or
ist
no
st,
 (–
) –
 n
o 
es
ta
bl
ish
ed
 u
se
fu
ln
es
s/
ni
 u
go
to
vl
je
ne
 k
or
ist
no
sti
, (
+/
–)
 –
 es
ta
bl
ish
ed
 a
dv
an
ta
ge
s a
nd
 d
isa
dv
an
ta
ge
s/
ug
ot
ov
lje
ne
 
pr
ed
no
sti
 in
 sl
ab
os
ti 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 59
Research characteristics
17 quantitative studies were included in the systematic 
literature review (12 prospective randomised studies, 
3 prospective non-randomised studies and 2 cross-
sectional experimental and observational studies), 
which relate to the results of using biomedical devices 
in clinical practice.
The most frequently used device in the selected 
studies was VeinViewer®. It was used in more than a half 
of these studies – in nine of them. Next, is AccuVein®, 
used four times, followed by VascuLuminator® used 
twice and mVeinVision®, Wee Sight®, Veindisplay® 
and EasyVein® used once. The use of a biomedical 
device was most often studied in children's hospitals or 
paediatric clinics (n = 10), significantly less in general 
and tertiary hospitals (n = 4), with only a few studies 
conducted in emergency care departments ER (n = 
1) and educational institutions (n = 2). The selected 
studies were conducted in various countries around 
the world; the United States of America (n = 7), the 
Netherlands (n = 2), France (n = 2), England (n = 1), 
Australia (n = 1), Japan (n = 1), Italy (n = 1), Taiwan 
(n = 1) and Slovenia (n = 1). A detailed description of 
each study is given in Table 1.
Results of using biomedical devices in clinical 
practice 
Currently there are three devices available on the 
market that have obtained marketing authorisation 
from the American Food and Drug Administration 
(Juric & Zalik, 2014). These biomedical devices are: 
VeinViewer®, AccuVein® and VascuLuminator®. The 
first clinical trials using biomedical devices utilising 
NIR light were published in scientific journals from 
2010 onwards. Most of these studies were conducted 
on a small sample of newborns, children or both, 
who needed peripheral venous cannula (Hess, 2010; 
Strehle, 2010; Chapman, et al., 2011; Perry, et al., 
2011; Kaddoum, et al., 2012; Peterson, et al., 2012; De 
Graaff, et al., 2013; Cuper, et al., 2013; Sun, et al., 2013; 
Szmuk, et al., 2013; Ramer, et al., 2015). The literature 
contains positive and negative results of using a 
biomedical device in practice. Eight studies report on 
its uselessness in a clinical setting, while five studies 
report on both positive and negative results.
Findings of various authors regarding the uselessness 
of a biomedical device determined that the device does 
not significantly decrease patients' pain (Chapman, 
et al., 2011; Aulagnier, et al., 2014; Fumagalli, et al., 
2016). There were also no other established significant 
differences in the results of using a biomedical 
device in comparison to the conventional method 
of intravenous cannulation (Chapman, et al., 2011; 
Perry, et al., 2011; Kaddoum, et al., 2012; Peterson, et 
al., 2012; De Graaff, et al., 2013; Cuper, et al., 2013; 
Aulagnier, et al., 2014).
Two studies (Hess, 2010; Sun, et al., 2013) have 
found that VeinViewer® may make the venepuncture 
and intravenous cannulation simpler as a result of an 
improved success rate at the first attempt and decreased 
time of conducting the procedure.Sun and colleagues 
(2013) have found that health care workers spent less 
time locating the peripheral vein when using an NIR 
light device in comparison to the control group (p = 
0.027) and that the use of the biomedical device results 
in a statistically significant decrease of cannulation 
attempts (p < 0.001) (Hess, 2010). The results of 
later controlled randomised research projects were 
less positive. In a randomised study Chapman and 
colleagues (2011) studied the differences between 
a group with a conventionally placed intravenous 
cannula and the group using VeinViewer®. There were 
no established statistical differences between the groups 
regarding the time of placement of the cannula nor the 
success rate of the first placement of the intravenous 
cannula (78 % success rate in the group with a 
conventional placement method and a 79 % success 
rate in the group using a biomedical device; p = 0.53). 
A randomised cross-sectional study was conducted in 
the same year, which did not find any advantages in 
using VeinViewer® in comparison to the conventional 
method (Perry, et al., 2011) in regards to the success 
of venepuncture and lower process time. Szmuk and 
colleagues (2013) additionally demonstrated that 
the use of VeinViewer® by experienced nursing staff 
may even lower the success rate of the first attempt of 
cannulation (p = 0.22).
Since 2010 the device AccuVein® has been available 
in the market. It is a technological device, which is very 
similar to VeinViewer®, but slightly technically simpler, 
easy to use and mobile. Studies have been conducted 
since 2012. The study was conducted on patients 
suffering from hemophillia and showed that the use of 
AccuVein® had no statistically significant effect on the 
differences in the number of venepuncture attempts in 
comparison to the control group with no mentioned 
illness (p = 0.45), however, the identification of veins 
was significantly better in the group of haemophiliacs 
(p = 0.002). Furthermore, pain was significantly less 
present (p = 0.019) (Guillon, et al., 2015). Also, two 
studies conducted on the healthy adult population 
by Aulagnier (2014) and Kaddoum and colleagues 
(2012) showed no differences found between the 
venepuncture using AccuVein® and the common 
cannulation method in terms of the success rate of 
intravenous cannulation at first attempt or decrease in 
the process time.
Further, the authors have found that the reason for 
the inefficiency of the devices for vein visualisation 
may be found in the image, as such a device only 
depicts a two-dimensional image of veins and does 
not show vein depth, which may lead to overrated 
estimates of vein sizes (Chiao, et al., 2013; Aulagnier, 
et al., 2014). Peterson and colleagues (2012) also 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.60
defend the conventional method of intravenous 
cannulation as experienced nurses are more 
successful at conventional intravenous cannulation 
than at cannulation with a biomedical device for vein 
visualisation. In the study conducted by De Graaff and 
colleagues (2013), the use of VeinViewer®, AccuVein® 
and VascuLuminator® was compared to conventional 
venepuncture in a group of patients aged 0–18 years 
who needed an emergency surgery. The results 
showed that VeinViewer® (95.3 % patients) and 
AccuVein® (94.1 %) were better at vein identification 
than VascuLuminator® (89.1 %). There was also no 
significant difference (p = 0.93) regarding the success 
rate of placing the cannula using the conventional 
method of venepuncture and the venepuncture 
technique using the mentioned biomedical devices. 
The reason for the failure of VascuLuminator® may be 
the difficulty of visualisation of the insertion site as the 
operator must be observing the site of insertion on the 
screen on which the image is projected (De Graaff, et 
al., 2013). In other two biomedical devices the image 
is projected onto the patient's skin thus, enabling the 
insertion of the intravenous cannula on the site or 
within the projected image (Peterson, et al., 2012).
According to the operators' opinion the main 
usefulness and advantage of the biomedical devices is 
that they help to find a new vein (38 %), thus enabling 
faster localisation (33 %) (Sun, et al., 2013; Juric & 
Zalik, 2014; Guillon, et al., 2015; Ramer, et al., 2015; 
Fukuroku, et al., 2016). In addition, haematoma 
incidence in patients reduces (Fumagalli, et al., 2016), 
as well as pain incidence (Guillon, et al., 2015). The 
use of biomedical devices for vein visualisation proved 
useful with nursing care students where the selection 
of the venepuncture site improves significantly, 
particularly when there are factors related to difficult 
vein access (Fukuroku, et al., 2016). Juric and Zalik 
(2014) have also found that a biomedical device for 
vein visualisation identified 1.6 % (s = 1.8) more 
veins in comparison to the conventional visualisation 
method.
Discussion
On the basis of the analysed studies the research 
question may be answered – we have found that 
the success rate of the first attempt of inserting the 
intravenous cannula with biomedical devices was 
not significantly higher than the success rate of the 
conventional method of venepuncture in more than 
one half of the research works (Chapman, et al., 2011; 
Perry, et al., 2011; Kaddoum, et al., 2012; Peterson, et al., 
2012; De Graaff, et al., 2013; Cuper, et al., 2013; Szmuk, 
et al., 2013; Aulagnier, et al., 2014; Fumagalli, et al., 
2016;). On the basis of results analysis we may deduce 
that the success rate of the first attempt of inserting 
the cannula depends especially on the experience and 
skills of the medical nurse. The advantage of using the 
biomedical device in comparison to the conventional 
method of venepuncture in terms of a higher success 
rate at first insertion of cannula was demonstrated 
only with inexperienced nurses and nursing students 
(Hess, 2010; Juric & Zalik, 2014; Fukuroku, et al., 
2016). Experienced and educated nurses found the 
biomedical device useful only in three studies (Chiao, 
et al., 2013; Sun, et al., 2013, Ramer, et al., 2015), while 
in other studies experienced nurses assessed the device 
as useless or the device even lowered the success rate 
of the first attempt of insertion.
Other health care professionals were also included in 
studies which attempted to establish the usefulness of 
a biomedical device for the visualisation of peripheral 
veins. These were especially medical doctors, 
paediatricians, anaesthesiologists and phlebotomists. 
Only two studies report on their positive assessment 
of the biomedical device. Strehle and colleagues 
(2010) report that the operators (paediatricians 
and nurses) assessed the device as useful since vein 
identification in children improved in 76 % of the 
cases. Chiao and colleagues (2013) have found that 
the use of a biomedical device is efficient in obese 
patients (p = 0.03), African-Americans and Asians (p 
= 0.01), and dark-skinned patients (p = 0.00). On the 
other hand, in reference to the number of attempts of 
insertion (p = 0.8) or the time needed for insertion, 
(p = 0.10) three studies did not demonstrate or find 
any statistically significant difference between the 
conventional method of venepuncture and insertion 
of the intravenous cannula with a biomedical device 
(Kaddoum, et al., 2012; De Graaff, et al., 2013; Cuper, 
et al., 2013). 
Peterson and colleagues (2012) strongly defend the 
advantages of the conventional method of inserting the 
intravenous cannula compared to a biomedical device. 
In their study they found that the basic methods of 
palpation and visualisation of the veins are more 
successful than inserting the intravenous cannula 
with a biomedical device (VeinViewer®, Wee Sight®). 
They have therefore found that the use of biomedical 
devices for vein identification does not necessarily 
correlate with a higher rate of successfully inserted 
cannulas. The reason may be that this technology 
is not three-dimensional – the potential drawback 
of using the device is the two-dimensional image of 
veins (Chiao, et al., 2013) and consequently a difficult 
assessment of vein depth. We should also consider the 
fact that experienced nurses to a great extent do not 
need to utilise biomedical devices when inserting the 
intravenous cannula. Szmuk and colleagues (2013) 
have found that the use of the biomedical device by 
an experienced nurse even lowers the success rate of 
the first attempt at inserting the intravenous cannula. 
Nevertheless, devices for venous visualisation are 
a valuable aid to inexperienced nurses and nursing 
students. The use of biomedical devices for venous 
visualisation significantly contributes to a greater 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 61
success rate of inserting the intravenous cannula due to 
a simpler selection of the venepuncture site, but it does 
not affect the quality of the procedure (Juric & Zalik, 
2014; Fukuroku, et al., 2016). These devices contribute 
to additional vein identification and shorten the time 
of the procedure. The results of the use were positive 
also in the case when risk factors in relation to a more 
difficult vein visualisation such as patient's obesity or 
darker skin (Chiao, et al., 2013) were present; when 
using the devices the medical nurses appeared to be 
more confident (Ramer, et al., 2015). Nurses should 
continue to improve their basic abilities of assessing 
the veins with vein visualisation and palpation. These 
skills serve as the basis for inserting the cannula, 
while support technology should be used when this is 
suitable and necessary (Peterson, et al., 2012). 
New mobile NIR devices enable visualisation of 
several veins in comparison to conventional methods 
also in cases when veins are not visible or palpable. 
Several factors affect the visibility of surface veins 
under standard conditions: infants have adipose tissue 
distributed more on the surface, which has the effect 
of a restricted visibility of the subcutaneous tissue. The 
case is similar with obese people, while in people of 
Asian descent veins are at first glance less visible due to 
a smaller cross-sectional diameter of the surface veins 
(Lamperti & Pittiruti, 2013). Chiao and colleagues 
(2013) have found that good vein identification and 
successful venepuncture result in less tissue damage, 
lower costs and greater satisfaction of patients. Multiple 
attempts of venepuncture are connected to an increased 
incidence of extravasation or vein perforation, which 
causes haematoma or bleeding and phlebitis. All of 
this not only increases the fear and suffering of the 
patient, but also affects patients' trust in nurses (Walsh, 
2008). Support technologies are therefore most useful 
for children and the elderly, dark-skinned people 
as well as for individuals with risk factors of a more 
difficult venepuncture. Those nurses that were using 
the device in comparison to those who were not using 
it were evaluated as more skilled by patients and were 
attributed higher grades in relation to the experience 
of insertion the intravenous cannula (Ramer, et al., 
2015). Patient satisfaction should always come first 
when establishing the peripheral venous access. It is 
important to be aware that unsuccessful and multiple 
consecutive attempts of insertion cause patients a 
certain amount of fear, pain and suffering and that the 
haematoma incidence decreases with success at first 
attempt (Guillon, et al., 2015; Fumagalli, et al., 2016). 
Multiple attempt of insertion directly or indirectly 
lowers patient satisfaction (due to increased injuries of 
skin and veins), increases anxiety, lowers self-esteem in 
nurses and increases costs of the treatment (Kuensting, 
et al., 2009). If the nursing staff has access to cutting-
edge technology, their success rate, satisfaction and 
productivity may increase, their work conditions 
improve and patient satisfaction increases. According 
to the findings of Ramer and colleagues (2015) nurses 
see the possibility of using biomedical devices as 
positive and not as an additional responsibility. On the 
contrary, Aulagnier and colleagues (2014) have found 
that operators assessed the device more negatively than 
positively. It should also be considered that the two 
studies did not deal with the same biomedical device. 
Using biomedical devices for vein visualisation is 
still far from being commonly used in real life and 
clinical practice. The reason for a low availability of 
these devices in health care institutions is especially 
the cost of training and purchase as well as their 
impracticality, as in life-threatening situations the 
device often proved to be an obstacle. It should also be 
taken into consideration that most studies fail to report 
on how many procedures of inserting the cannula 
with a biomedical device the operator had to perform 
before they became skilled. In cannulation, not only 
the success rate of insertion should be considered but 
also the time needed for the insertion itself, as these 
devices are supposed to be of help also in emergency 
situations, such as securing immediate venous access. 
It is interesting that most studies on the usefulness 
of these devices were conducted with the same 
assumptions or limitations: exclusive focus on the child 
population (eleven out of seventeen studies), limited 
sampling, difficult and unsuitable randomisation, poor 
standardisation of procedure, too little emphasis of the 
need of training to use the device, low requirements 
or no requirements regarding the experience of the 
operator of the device (Lamperti & Pittiruti, 2013). In 
nine studies the manufacturer of the device provided 
training in the duration from 30 min to 2h. Such 
training was attended by experienced nurses (Perry, 
et al., 2011; Peterson, et al., 2012; Chiao, et al., 2013; 
Cuper, et al., 2013; Sun, et al., 2013; Szmuk, et al., 
2013) and nursing students (Juric & Zalik, 2014). Some 
studies did not mention the experience of nurses, or 
they were not required to conduct the study (Hess, 
2010; Strehle, 2010; Chapman, et al., 2011; Kaddoum, 
et al., 2012; De Graaff, et al., 2013; Aulagnier, et al., 
2014; Guillon, et al., 2015). 
Despite the fact that we had access to a large 
number of search results, there is a possibility that 
due to certain inclusion criteria we excluded some 
significant studies. Only fully accessed articles written 
in the English language were included in the literature 
review. The fact that the search, review and inclusion 
of the literature was done by one researcher (first 
author) is also a limitation.
In order to confirm the advantages of such an 
approach more studies should be conducted, however, 
this might be restricted due to the cost of these devices. 
Further development of technology to ensure access 
and the simplicity of using biomedical devices will 
contribute to ensuring the highest standard in patient 
safety and health care, in the aim to achieve better 
treatment results of patients worldwide. 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.62
Conclusion 
Intravenous cannulation with using biomedical 
devices is a useful method for patients with difficult 
venous access. We have found that the findings of 
studies vary and point to the fact that the devices do 
not make any significant clinical benefit if they are 
used by experienced nurses. 
Based on the reviewed literature we cannot claim with 
all certainty that the devices have a significant effect on 
easier establishment of peripheral venous access. Here, 
several factors that contribute to the usefulness or useless 
of using the devices should be considered: knowledge of 
anatomy, severely or critically ill patients and children, 
familiarity with the devices and the possibility of 
using them. The new approach based on the use of 
these devices significantly contributes to a decreased 
haematoma incidence in patients and to decreased 
feelings of anxiety and inaptitude in inexperienced 
medical nurses and students in clinical practice. Such 
an approach provides nursing care students with a 
comfortable and safe learning environment and enables 
them to learn about a skill necessary to work successfully 
in a clinical environment.
Slovenian translation/Prevod v slovenščino
Uvod
Vzpostavitev periferne venske poti spada med 
rutinske invazivne posege in je v času hospitalizacije 
izveden pri približno 70 % pacientov (Bernatchez, 
2014). Z izrazom periferna venska pot poimenujemo 
vstavljanje različnih plastičnih igel ali katetrov v 
periferno veno. Vzpostavljanje periferne venske 
poti je ena izmed najpogosteje izvedenih intervencij 
zdravstvene nege (Bauman, et al., 2009; Walsh, 2008; 
Juric & Zalik, 2014) in velja za enega najbolj invazivnih 
postopkov za paciente, ki iščejo pomoč v urgentni 
ambulanti (Bernatchez, 2014). Periferna venska pot 
je za kritično bolnega pacienta pomembna zaradi 
potrebe po odvzemu krvi za laboratorijske preiskave, 
aplikaciji zdravil, tekočin ali parenteralne prehrane, ki 
jih v danem trenutku potrebuje (Alekseyev, et al., 2012). 
Uvajanje periferne intravenske (i.v.) kanile je veščina, 
ki je v kompetencah diplomirane medicinske sestre/
diplomiranega zdravstvenika (Strgar & Macura Višić, 
2013). Pomembno vlogo pri vzpostavljanju venskega 
dostopa pogosto igra stanje pacienta. Dejavniki tveganja 
in stanja, povezana s težkimi žilnimi dostopi, vključujejo 
starost pacienta, izkušnje izvajalca, velikost izbrane 
i.v. kanile in izbrano mesto vstavljanja (Chinnock, 
et al., 2007; Sebbane, et al., 2013; Heinrichs, et al., 
2013). Obstajajo tudi značilne skupine pacientov, pri 
katerih je vzpostavljanje periferne venske poti oteženo: 
pacienti s prekomerno telesno težo ali s perifernimi 
edemi, pacienti na kemoterapiji, i.v. uporabnikih drog, 
močno dehidrirani pacienti (Gregg, et al., 2010; Fields, 
et al., 2014), pacienti temnejše polti (Aulagnier, et al., 
2014), otroci in starostniki (Walsh, 2008). Pomanjkljive 
veščine, nespretnost medicinskih sester ali težak i.v. 
dostop prispevajo k večkratnim poskusom vboda 
(Walsh, 2008). Cuper in sodelavci (2010) ugotavljajo, 
da so dejavniki tveganja v praksi sicer dobro poznani, 
vendar v literaturi zelo skopo opisani. Večja verjetnost 
za pojav težav pri vzpostavljanju i.v. dostopa obstaja pri 
otrocih, mlajših od dveh let, in še posebej pri dojenčkih 
(Chapman, et al., 2011; Heinrichs, et al., 2013). Arbique 
in sodelavci (2014) menijo, da je za uspešno vstavitev i.v. 
kanile treba poznati anatomijo ven in endotelijskih celic 
ter imena in lokacije za venepunkcijo najprimernejših 
perifernih ven; že pred poskusom vstavljanja je treba 
vedeti, zakaj je i.v. kanila potrebna in katera vena je za 
venepunkcijo primerna; poznati je treba tudi zaplete 
poškodbe vene, povzročene z aplikacijo zdravil in 
dovajanimi tekočinami. Ko medicinske sestre razumejo 
te ključne točke, to znanje pripomore k zmanjšanju 
nepotrebne bolečine pri pacientu, povzročene z več 
zaporednimi neuspešnimi poskusi vboda, k zmanjšanju 
zamud pri medicinski oskrbi, k zmanjšanju porabe dragih 
biomedicinskih pripomočkov in neproduktivnega časa 
zdravstvene nege ter k izboljševanju zdravstvene nege. 
Za dopolnjevanje standardnega postopka slepega 
uvajanja i.v. kanile so strokovnjaki razvili postopke, 
ki temeljijo na dodatni vizualizaciji podkožnih ven: 
uporabo ultrazvočnih naprav, transiluminacijo 
(presvetljevanje perifernih delov telesa z drugimi 
viri svetlobe – z rdečo ali belo svetlobo) in uporabo 
biomedicinskih pripomočkov za bližnjo infrardečo 
spektroskopijo (Walsh, 2008; Juric, et al., 2014). 
Biomedicinski pripomočki so bili razviti z namenom 
izboljšati uspešnost venepunkcije in posledično 
zmanjšati število in obseg negativnih učinkov ob 
večkratnem oziroma neuspešnem vbadanju ter z 
namenom izogibati se frustracijam pri zdravstvenih 
delavcih v primeru neuspešno izvedene intervencije. 
Uporaba biomedicinskih pripomočkov ima v primerjavi 
s tradicionalno metodo vzpostavljanja perifernega 
venskega kanala številne prednosti, saj omogoča 
vstavljanje i.v. kanile v žile, ki niso vidne niti tipljive, 
in odpravlja potrebo po vzpostavljanju osrednjega 
venskega kanala ter posledično zmanjša stopnjo 
tveganja za okužbo in druge zaplete (Sirk, et al., 2013). 
Zgodnja prepoznava pacientov z dejavniki tveganja 
za oteženo vzpostavljanje venske poti je pomembna 
zaradi prilagoditve strategije za povečanje uspešnosti 
oz. zaradi kritične ocene uporabe alternativnih načinov 
vzpostavljanja i.v. poti oz. venskih pripomočkov (Walsh, 
2008; Pagnutti, et al., 2016).
Najstarejša tehnika vizualizacije podkožnih ven 
se imenuje transiluminacija in vključuje postavitev 
svetlobnih virov pod ali okoli izbrane okončine (John, 
2007). Uporaba bližnje infrardeče spektroskopije (Near 
Infrared Spectroscopy – NIR) je relativno nov dodatek 
in vključuje neposredno osvetlitev in vizualizacijo mesta 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 63
venepunkcije (Fukuroku, et al., 2016). Podkožne vene 
zaradi višje vsebnosti deoksigeniranega hemoglobina 
skoraj v celoti absorbirajo infrardečo (IR) svetlobo valovne 
dolžine od 740 nm do 760 nm, medtem ko arterije zaradi 
višje vsebnosti oksigeniranega hemoglobina omenjeno 
svetlobo skoraj v celoti prepuščajo. Omenjeni interval 
valovnih dolžin spada v t. i. bližnje infrardeče območje, 
ki v celoti zajema valovne dolžine od 700 nm do 1400 
nm (Juric, et al., 2014). Na podlagi dostopne literature 
je na tržišču najti naslednje naprave: VascuLuminator® 
(Cuper, et al., 2013), VeinViewer® in Wee Sight® 
(Peterson, et al., 2012), AccuVein® (Kaddoum, et al., 
2012), VenoScope®, VeinLocator® in VeinLite® (Ernst, 
2009) ter Veinsite® (Chiao, et al., 2013). 
Našteti biomedicinski pripomočki se razlikujejo v 
pristopu vizualizacije krvnih žil in uporabi različnih 
komponent. Naprava VeinViewer® z NIR-svetlobo 
analizira kožo in sprejeto sliko projicira nazaj na kožo, 
pri čemer vene prikazuje kot črne črte na zelenem 
ozadju (Hess, 2010). Prikazana slika medicinski sestri 
daje nekakšen zemljevid za delo, da bi bila lahko bolj 
učinkovita pri vstavljanju i.v. kanile (Lamperti & 
Pittiruti, 2013). Prednost uporabe tega pripomočka je, da 
pri izvajanju punkcije uporabnik lahko gleda naravnost 
na mesto vboda, toda normalen pogled mesta vboda je 
spremenjen in ta tehnika potrebuje obdelavo slike, ki 
je lahko občutljiva na zunanje vplive (Miyake, et al., 
2006). Naprava AccuVein® deluje na podoben način, le 
da vene projicira kot črne črte na rdečem ozadju (Cuper, 
et al., 2013). Drugače je pri napravi VascuLuminator®, 
kjer je NIR-svetloba nameščena pod mestom vboda, 
slika mesta vboda pa se vidi na zaslonu, kjer se vene 
prikazujejo s črno barvo na svetlem ozadju (Cuper, 
et al., 2013). Mesto vboda je tako treba opazovati na 
zaslonu, kamor se projicira preko kamere zajeta slika 
(Dunn & Conrad, 2005). Pregled in analiza tržišča sta 
razkrila, da so v razvoju še druge namenske naprave, ki 
se osredotočajo na problematiko otežene venepunkcije. 
Take naprave so še: Evena Eyes-On Glasses® (Medical, 
2015), EasyVein® (InSono, 2015), Vein Display® 
(Fukuroku, et al., 2016) in mVeinVison®, ki omogoča 
vizualizacijo podkožnih ven na mobilnih napravah z 
operacijskim sistemom Android (Juric & Zalik, 2014).
Namen in cilji
Namen članka je predstaviti rezultate sistematičnega 
pregleda in analize podatkov obstoječih raziskav 
o razpoložljivih biomedicinskih pripomočkih, ki 
temeljijo na NIR-svetlobi za iskanje perifernih ven. 
Izpostavljen je pregled danes dostopnih naprav ter 
rezultati njihove uporabe v klinični praksi.
Metode
Uporabili smo 5-stopenjski metodološki pristop, ki 
ga opisujeta Higgins in Green (2009). Pristop vključuje 
oblikovanje in določitev raziskovalnega vprašanja, 
določanje kriterijev primernosti, iskanje relevantnih 
dokazov, kritično presojo zbranih podatkov, analizo in 
sintezo rezultatov. Oblikovali in razvili smo specifično 
raziskovalno vprašanje s pomočjo pristopa za pregled 
literature PICO (Population, Intervention, Comparison, 
Outcome) (Melnyk & Fineout-Overholt, 2015): V 
kolikšni meri pri pacientih s težkim žilnim dostopom 
uporaba sodobnih biomedicinskih pripomočkov, 
temelječih na bližnji infrardeči spektroskopiji, vpliva 
na uspešnost prvega poskusa vstavljanja i.v. poti v 
primerjavi s klasičnim načinom vstavljanja?
Metode pregleda
Izvedli smo sistematični pregled literature, ker le-
ta omogoča pridobitev podatkov iz različnih virov in 
zagotavlja holistično razumevanje obravnavane teme. 
Iskanje literature je bilo opravljeno v podatkovnih 
bazah CINAHL, MEDLINE in ScienceDirect s pomočjo 
različnih kombinacij izbranih iskalnih pojmov v 
angleškem jeziku in njihovih sopomenk, povezanih 
z Boolovima operaterjema AND oz. OR: »devices«, 
»visualization«, »technology«, »cannulation«, »vein«, 
»nursing care«. Kriterij pri izboru literature je bila 
objava prispevkov v angleščini v časovnem obdobju 
od leta 2000 do avgusta 2016. 
Poleg jezikovne omejitve in omejitve časovnega 
obdobja objave raziskave so bili glavni vključitveni 
kriterij še recenzirana objava, kvantitativna osnova 
raziskav, tematska osredotočenost na opis, uporabo 
in delovanje biomedicinskih pripomočkov za 
vzpostavljanje i.v. kanile v zdravstveni oskrbi pacienta 
in dostopnost polnega besedila. Med izključitvenimi 
kriteriji so tako bili: uvodniki, pisma, intervjuji, plakati 
sistematični pregledni članki in nedostopnost polnega 
besedila. Zadetke rezultatov, dobljenih v elektronskih 
podatkovnih bazah, smo uvozili v program Mendeley 
in jih kodirali glede na vključitvene kriterije. Potek 
pregleda literature je prikazan s pomočjo diagrama 
PRISMA (Preferred Reporting Items for Systematic 
Rewievs and Meta-Analyses) (Moher, et al., 2010) in 
je razviden iz Slike 1.
Rezultati pregleda
Iskanje je dalo 1020 zadetkov. Pregledali smo 
naslove in izvlečke raziskav ter identificirali duplikate. 
V pregled literature so bili vključeni članki, ki se 
nanašajo na uporabo, delovanje in klinične rezultate 
uporabe biomedicinskih pripomočkov za vzpostavitev 
i.v. kanile.
Ocena kakovosti pregleda in opis obdelave 
podatkov
Za analizo podatkov smo izbrali narativni pristop, 
ki omogoča povezovanje široke palete raziskovalnih 
metod. Sintezo podatkov smo izvedli s pomočjo 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.64
deskriptivne metode, metode tabeliranja in analize 
vsebine, ki jih priporočajo Popay in sodelavci (2006). 
Za ocenjevanje vključenih raziskav smo uporabili 
program za kritično vrednotenje CASP (Critical 
Appraisal Skills Programme). Na izbiro CASP kot 
najbolj primernega orodja je vplivalo dvoje, in sicer 
dejstvo, da je to orodje pogosto uporabljeno in 
sprejeto za ocenjevanje kakovosti člankov in da zajema 
najpomembnejše vidike kritične presoje (zanesljivost, 
objektivnost in veljavnost) (Young & Solomon, 2009). 
To orodje, ki ga sestavlja 10 vprašanj, je opisano kot 
primerno za vse tipe raziskav. Zanj je značilno, da 
jasno opredeljuje vsak posamezen kriterij, kar posebej 
koristi raziskovalcem z malo izkušnjami. Ocenjene 
članke smo na podlagi uporabe ocenjevalnega orodja 
ocenili od nizke do visoke kakovosti (Keyko, et al., 
2016).
Rezultati
Iskanje literature je potekalo v treh podatkovnih 
bazah: CINAHL, MEDLINE in ScienceDirect, ter 
drugih virih (»siva literatura«). Skupno število zadetkov 
v vseh podatkovnih bazah in v drugih virih je bilo 1020. 
Iskanje literature 
  
Identifikacija zadetkov: baze CINAHL, 
MEDLINE in ScienceDirect 
(n = 1018) 
Dodatna iskanja  
Id
en
tif
ik
ac
ija
 za
de
tk
ov
 
(»siva literatura«) 
(n = 2)
Skupno število zadetkov 
(n = 1020) 
 
Pregled naslovov in povzetkov ter 
drugih podatkov o objavi 
(n = 1013) 
Odstranjeni duplikati (n = 7)
(n = 1020)
Pr
eg
le
d 
po
 k
ri
te
rij
ih
 
Izključeni zadetki  
(nerecenzirana objava, neustrezni 
jezik, čas objave, metodologija ali 
tema, nedostopnost polnega besedila) 
(n = 911)  
Po
dr
ob
ne
jši
 p
re
gl
ed
 
Pregled polnih besedil 
(n =102) 
Izključeni zadetki  
(pregledni članek, neustrezna 
populacija ali raziskovalno 
okolje ipd.) 
(n = 85) 
Raziskave, vključene v podrobno analizo  
(n = 17) 
A
na
liz
a 
Slika 1: Diagram poteka strategije iskanja in izbora literature (diagram PRISMA)
Figure 1: Flowchart of search strategy and literature selection process (PRISMA diagram)
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 65
Se
 n
ad
al
ju
je
/C
on
tin
ue
s
Ta
be
la
 1
: P
re
gl
ed
 u
po
ra
be
 b
io
m
ed
ici
ns
ki
h 
pr
ip
om
oč
ko
v 
in
 n
jih
ov
e u
čin
ko
vi
to
sti
 v
 k
lin
ičn
i p
ra
ks
i
Ta
bl
e 
1:
 R
ev
ie
w
 o
f b
io
m
ed
ica
l d
ev
ice
s a
nd
 th
ei
r e
ffe
ct
iv
en
es
s i
n 
cli
ni
ca
l p
ra
ct
ice
Av
to
r i
n 
le
to
/
Au
th
or
 
an
d 
ye
ar
Ra
zi
sk
ov
al
ni
 
di
za
jn
/R
es
ea
rc
h 
de
sig
n
La
st
no
st
i v
zo
rc
a/
Sa
m
pl
e 
ch
ar
ac
te
ri
st
ic
s 
D
rž
av
a 
in
 v
rs
ta
 
zd
ra
vs
tv
en
e 
us
ta
no
ve
/
C
ou
nt
ry
 a
nd
 
se
tti
ng
Iz
va
ja
le
c 
ra
zi
sk
av
e/
Pr
oc
ed
ur
e 
pe
rf
or
m
ed
 b
y
U
po
ra
bl
je
ni
 
bi
om
ed
ic
in
sk
i 
pr
ip
om
oč
ek
/
Bi
om
ed
ic
al
 
de
vi
ce
 u
se
d
K
lju
čn
e u
go
to
vi
tv
e/
 
K
ey
 fi
nd
in
gs
H
es
s, 
20
10
Pr
os
pe
kt
iv
na
 
ne
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
3−
17
 le
t
n 
= 
91
Zd
ru
že
ne
 d
rž
av
e 
A
m
er
ik
e
Te
rc
ia
rn
a 
bo
ln
išn
ic
a
M
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 
U
po
ra
ba
 p
rip
om
oč
ka
 je
 st
at
ist
ič
no
 zn
ač
iln
o 
po
ve
ča
la
 st
op
nj
o 
us
pe
šn
os
ti 
pr
ve
ga
 p
os
ku
sa
 (p
 <
 0
,0
01
), 
zm
an
jša
lo
 se
 je
 št
ev
ilo
 
po
sk
us
ov
 (p
 <
 0
,0
01
) i
n 
zm
an
jša
n 
je
 b
il 
ča
s, 
po
tr
eb
en
 za
 iz
ve
db
o 
po
st
op
ka
 (p
 <
 0
,0
01
).
(+
)
St
re
hl
e, 
20
10
Pr
os
pe
kt
iv
na
 
ne
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
< 
16
 le
t
n 
= 
50
 
A
ng
lij
a 
O
tr
oš
ka
 
bo
ln
išn
ic
a 
in
 
ot
ro
šk
i o
dd
el
ek
 v
 
sp
lo
šn
i b
ol
ni
šn
ic
i
Zd
ra
vn
ik
i i
n 
m
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 
U
po
ra
bn
ik
i s
o 
pr
ip
om
oč
ek
 o
ce
ni
li 
ko
t k
or
ist
ne
ga
, s
aj
 se
 je
 
pr
ep
oz
na
vn
os
t ž
il 
iz
bo
ljš
al
a 
v 
76
 %
. P
ri 
ne
ka
te
rih
 p
ac
ie
nt
ih
 
so
 iz
va
ja
lc
i i
m
el
i t
ež
av
e 
pr
i p
re
so
ji 
gl
ob
in
e 
ve
ne
. Z
ar
ad
i 
nj
eg
ov
e 
ve
lik
os
ti 
so
 n
ek
at
er
i u
po
ra
bn
ik
i p
rip
om
oč
ek
 o
ce
ni
li 
za
 
ne
pr
ak
tič
ne
ga
. 
(+
/–
)
C
ha
pm
an
, 
et
 a
l.,
 2
01
1
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
< 
17
 le
t
n 
= 
32
3
Zd
ru
že
ne
 d
rž
av
e 
A
m
er
ik
e
Pe
di
at
rič
na
 
kl
in
ik
a
M
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 
N
i d
ok
az
an
ih
 ra
zl
ik
 g
le
de
 č
as
a,
 p
ot
re
bn
eg
a 
za
 iz
ve
db
o 
po
st
op
ka
 
(p
 =
 0
,4
0)
, š
te
vi
la
 p
os
ku
so
v 
(p
 =
 0
,5
), 
oc
en
e 
bo
le
či
ne
 (p
 =
 0
,3
7)
 in
 
oc
en
e 
up
or
ab
no
st
i p
rip
om
oč
ka
 s 
st
ra
ni
 o
se
bj
a 
(p
 =
 0
,2
9)
. 
(–
)
Pe
rr
y, 
et
 
al
., 
20
11
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
na
vz
kr
iž
na
 
ra
zi
sk
av
a
< 
20
 le
t 
n 
= 
12
3 
Zd
ru
že
ne
 d
rž
av
e 
A
m
er
ik
e
Pe
di
at
rič
na
 
kl
in
ik
a
M
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 
U
po
ra
ba
 p
rip
om
oč
ka
 n
i s
ta
tis
tič
no
 zn
ač
iln
o 
vp
liv
al
a 
na
 
us
pe
šn
os
t v
st
av
itv
e 
i.v
. k
an
ile
 v
 p
rv
em
 p
os
ku
su
. U
sp
eš
no
st
 
st
an
da
rd
ne
ga
 p
os
to
pk
a 
je
 b
ila
 7
9-
%
, z
 u
po
ra
bo
 p
rip
om
oč
ka
 p
a 
72
,1
-%
.
(–
)
K
ad
do
um
, 
et
 a
l.,
 2
01
2
Pr
os
pe
kt
iv
na
 
ko
nt
ro
lir
an
a 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
< 
18
 le
t
n 
= 
14
6 
Av
st
ra
lij
a
Pe
di
at
rič
na
 
kl
in
ik
a
Zd
ra
vn
ik
 
an
es
te
zi
ol
og
A
cc
uV
ei
n 
N
i d
ok
az
an
ih
 st
at
ist
ič
no
 p
om
em
bn
ih
 ra
zl
ik
 m
ed
 k
la
sič
no
 
m
et
od
o 
vs
ta
vl
ja
nj
a 
in
 v
st
av
lja
nj
em
 i.
v. 
ka
ni
le
 s 
pr
ip
om
oč
ko
m
 
(š
te
vi
lo
 p
os
ku
so
v 
vs
ta
vl
ja
nj
a 
(p
 =
 0
,8
5)
, č
as
 v
st
av
lja
nj
a 
(p
 =
 0
,1
0)
. 
(–
)
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.66
Se
 n
ad
al
ju
je
/C
on
tin
ue
s
Av
to
r i
n 
le
to
/
Au
th
or
 
an
d 
ye
ar
Ra
zi
sk
ov
al
ni
 
di
za
jn
/R
es
ea
rc
h 
de
sig
n
La
st
no
st
i v
zo
rc
a/
Sa
m
pl
e 
ch
ar
ac
te
ri
st
ic
s 
D
rž
av
a 
in
 v
rs
ta
 
zd
ra
vs
tv
en
e 
us
ta
no
ve
/
C
ou
nt
ry
 a
nd
 
se
tti
ng
Iz
va
ja
le
c 
ra
zi
sk
av
e/
Pr
oc
ed
ur
e 
pe
rf
or
m
ed
 b
y
U
po
ra
bl
je
ni
 
bi
om
ed
ic
in
sk
i 
pr
ip
om
oč
ek
/
Bi
om
ed
ic
al
 
de
vi
ce
 u
se
d
K
lju
čn
e u
go
to
vi
tv
e/
 
K
ey
 fi
nd
in
gs
Pe
te
rs
on
, 
et
 a
l.,
 2
01
2
Pr
os
pe
kt
iv
na
 
ne
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
< 
19
 le
t
n 
= 
15
5 
Zd
ru
že
ne
 d
rž
av
e 
A
m
er
ik
e
Pe
di
at
rič
na
 
kl
in
ik
a
M
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 ,
 
W
ee
 S
ig
ht
 
K
la
sič
na
 m
et
od
a 
vs
ta
vl
ja
nj
a 
i.v
. k
an
ile
 se
 je
 iz
ka
za
la
 za
 b
ol
j 
us
pe
šn
o 
ka
ko
r m
et
od
a 
vs
ta
vl
ja
nj
a 
s p
om
oč
jo
 p
rip
om
oč
ko
v. 
Ra
zi
sk
av
a 
je
 o
bs
eg
al
a 
13
99
 p
os
ku
so
v 
vs
ta
vl
ja
nj
a 
i.v
. k
an
ile
 (p
 <
 
0,
00
1)
. 
(–
)
C
hi
ao
, e
t 
al
., 
20
13
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
< 
65
 le
t
n 
= 
38
4 
Zd
ru
že
ne
 d
rž
av
e 
A
m
er
ik
e
Sp
lo
šn
a 
bo
ln
išn
ic
a
Zd
ra
vs
tv
en
i 
de
la
vc
i 
(fl
eb
ot
om
ist
, 
zd
ra
vn
ik
 in
 
m
ed
ic
in
sk
a 
se
st
ra
)
Ve
in
sit
e 
U
po
ra
ba
 p
rip
om
oč
ka
 je
 u
či
nk
ov
ita
. V
 p
rim
er
ja
vi
 s 
ko
nv
en
ci
on
al
no
 m
et
od
o 
je
 b
ila
 b
ol
j u
či
nk
ov
ita
 p
ri 
de
be
lih
 
pa
ci
en
tih
 (p
 =
 0
,0
34
), 
pr
i A
fr
oa
m
er
ič
an
ih
 in
 A
zi
jc
ih
 (p
 =
 
0,
01
46
) t
er
 p
ri 
te
m
ne
jši
 b
ar
vi
 k
ož
e 
(p
 =
 0
,0
01
4)
. V
 p
rim
er
ja
vi
 s 
ko
nv
en
ci
on
al
no
 m
et
od
o 
je
 p
rip
om
oč
ek
 p
ok
az
al
 v
 p
ov
pr
eč
ju
 za
 
9,
1 
ve
č m
ož
ni
h 
m
es
t z
a 
ve
ne
pu
nk
ci
jo
. 
(+
)
de
 G
ra
aff
, 
et
 a
l.,
 2
01
3
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
»c
lu
st
er
« 
ra
zi
sk
av
a
< 
19
 le
t
n 
= 
13
83
 
N
iz
oz
em
sk
a
Pe
di
at
rič
na
 
kl
in
ik
a
Zd
ra
vn
ik
i i
n 
m
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 ,
 
A
cc
uV
ei
n 
, 
Va
sc
uL
um
in
at
or
 
U
sp
eh
 v
 p
rv
em
 p
os
ku
su
 se
 g
le
de
 n
a 
na
či
n 
vs
ta
vl
ja
nj
a 
ni
 
po
m
em
bn
o 
ra
zl
ik
ov
al
 (p
 =
 0
,9
3)
. S
kl
ep
am
o 
la
hk
o,
 d
a 
v 
pr
im
er
ja
vi
 s 
kl
as
ič
ni
m
 n
ač
in
om
 v
st
av
lja
nj
a 
up
or
ab
a 
pr
ip
om
oč
ko
v 
ne
 v
pl
iv
a 
na
 iz
bo
ljš
an
je
 u
sp
eh
a 
vs
ta
vl
ja
nj
a 
i.v
. k
an
ile
.
(–
)
Cu
pe
r, 
et
 
al
., 
20
13
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
»c
lu
st
er
« 
ra
zi
sk
av
a
< 
18
 le
t
n 
= 
49
4 
N
iz
oz
em
sk
a
Pe
di
at
rič
na
 
kl
in
ik
a
Iz
ku
še
ni
 
an
es
te
zi
ol
og
i 
in
 iz
ku
še
ne
 
an
es
te
zi
jsk
e 
m
ed
ic
in
sk
e 
se
st
re
Va
sc
uL
um
in
at
or
 
U
sp
eh
 v
 p
rv
em
 p
os
ku
su
 se
 g
le
de
 n
a 
up
or
ab
o 
oz
. n
eu
po
ra
bo
 
pr
ip
om
oč
ka
 n
i p
om
em
bn
o 
ra
zl
ik
ov
al
. Z
 u
po
ra
bo
 p
rip
om
oč
ka
 
je
 b
ila
 u
sp
eš
no
st
 7
0-
%
, v
 sk
up
in
i b
re
z p
rip
om
oč
ka
 7
1-
%
 (p
 =
 
0,
69
). 
Pr
ip
om
oč
ek
 n
i i
zb
ol
jša
l s
to
pn
je
 u
sp
eš
no
st
i n
iti
 sk
ra
jša
l č
as
 
vs
ta
vi
tv
e 
i.v
. k
an
ile
.
(–
)
Su
n,
 e
t a
l.,
 
20
13
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
< 
17
 le
t
n 
= 
60
 
Ta
jv
an
Pe
di
at
rič
na
 
kl
in
ik
a
M
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 
U
go
to
vl
je
no
 je
, d
a 
up
or
ab
a 
pr
ip
om
oč
ka
 v
 p
rim
er
ja
vi
 s 
ko
nt
ro
ln
o 
sk
up
in
o 
pr
ip
om
or
e 
k 
hi
tr
ej
ši 
id
en
tifi
ka
ci
ji 
pr
ve
 ra
zp
ol
ož
lji
ve
 
ve
ne
 (p
 =
 0
,0
27
), 
k 
m
an
jše
m
u 
št
ev
ilu
 p
os
ku
so
v 
(p
 =
 0
,0
04
) i
n 
h 
kr
aj
še
m
u 
sk
up
ne
m
u 
ča
su
 p
ot
re
bn
ih
 p
os
ku
so
v 
(p
 =
 0
,0
14
).
(+
)
Sz
m
uk
, e
t 
al
., 
20
13
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
< 
18
 le
t 
n 
= 
60
0 
Zd
ru
že
ne
 d
rž
av
e 
A
m
er
ik
e
Pe
di
at
rič
na
 
kl
in
ik
a
Iz
ku
še
ne
 
m
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 
Pr
ip
om
oč
ek
 je
 u
sp
eš
no
st
 p
rv
eg
a 
po
sk
us
a 
po
sla
bš
al
 (p
 =
 0
,2
2)
. 
U
sp
eš
no
st
 p
rv
eg
a 
po
sk
us
a 
ni
 b
ila
 sl
ab
ša
 p
ri 
de
be
lo
st
i (
p 
= 
0,
94
). 
(–
)
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 67
Av
to
r i
n 
le
to
/
Au
th
or
 
an
d 
ye
ar
Ra
zi
sk
ov
al
ni
 
di
za
jn
/R
es
ea
rc
h 
de
sig
n
La
st
no
st
i v
zo
rc
a/
Sa
m
pl
e 
ch
ar
ac
te
ri
st
ic
s 
D
rž
av
a 
in
 v
rs
ta
 
zd
ra
vs
tv
en
e 
us
ta
no
ve
/
C
ou
nt
ry
 a
nd
 
se
tti
ng
Iz
va
ja
le
c 
ra
zi
sk
av
e/
Pr
oc
ed
ur
e 
pe
rf
or
m
ed
 b
y
U
po
ra
bl
je
ni
 
bi
om
ed
ic
in
sk
i 
pr
ip
om
oč
ek
/
Bi
om
ed
ic
al
 
de
vi
ce
 u
se
d
K
lju
čn
e u
go
to
vi
tv
e/
 
K
ey
 fi
nd
in
gs
Au
la
gn
ie
r, 
et
 a
l.,
 2
01
4
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
53
–6
1 
le
t
n 
= 
26
6 
Fr
an
ci
ja
U
rg
en
ca
M
ed
ic
in
sk
e 
se
st
re
A
cc
uV
ei
n 
U
po
ra
ba
 p
rip
om
oč
ka
 n
i s
ta
tis
tič
no
 p
om
em
bn
o 
vp
liv
al
a 
na
 č
as
 
iz
ve
db
e 
po
st
op
ka
 (p
 =
 0
,2
4)
, t
ud
i p
oj
av
no
st
 b
ol
eč
in
e 
ni
 b
ila
 
m
an
jša
 (p
 =
 0
,1
1)
. O
ce
na
 p
rip
om
oč
ka
 s 
st
ra
ni
 iz
va
ja
lc
ev
 je
 b
ila
 
pr
av
 ta
ko
 b
ol
j n
eg
at
iv
na
 k
ot
 p
oz
iti
vn
a.
(–
)
Ju
ric
, e
t 
al
., 
20
14
Pr
es
eč
na
 
ek
sp
er
im
en
ta
ln
o 
op
az
ov
al
na
 
ra
zi
sk
av
a
N
i p
od
at
ka
. 
n 
= 
45
Sl
ov
en
ija
Iz
ob
ra
že
va
ln
a 
us
ta
no
va
 in
 
kl
in
ič
no
 o
ko
lje
Št
ud
en
ti 
zd
ra
vs
tv
en
e 
ne
ge
 (t
es
tir
an
je
), 
zd
ra
vn
ik
 in
 
m
ed
ic
in
sk
e 
se
st
re
 
m
Ve
in
V
isi
on
 
V
 p
rim
er
ja
vi
 s 
tr
ad
ic
io
na
ln
im
i m
et
od
am
i v
iz
ua
liz
ac
ije
 je
 b
ila
 
pr
i u
po
ra
bi
 p
rip
om
oč
ka
 u
go
to
vl
je
na
 za
 3
5,
2 
%
 v
eč
ja
 u
sp
eš
no
st
 
pr
i v
iz
ua
liz
ac
iji
 in
 id
en
tifi
ka
ci
ji 
ve
n,
 v
 k
lin
ič
ne
m
 o
ko
lju
 je
 b
ilo
 
id
en
tifi
ci
ra
ni
h 
tu
di
 v
 p
ov
pr
eč
ju
 za
 1
,6
 v
eč
 d
od
at
ni
h 
ve
n.
(+
)
G
ui
llo
n,
 e
t 
al
., 
20
15
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
1,
8−
90
,6
 le
t
n 
= 
45
0
Fr
an
ci
ja
Sp
lo
šn
a 
bo
ln
išn
ic
a 
(n
 =
 4
)
M
ed
ic
in
sk
e 
se
st
re
A
cc
uV
ei
n 
Ra
zl
ik
a v
 št
ev
ilu
 p
os
ku
so
v 
ni
 b
ila
 st
at
ist
ič
no
 p
om
em
bn
a (
p 
= 
0,
45
). 
Zn
ač
iln
a p
re
dn
os
t p
rip
om
oč
ka
 je
 to
, d
a i
de
nt
ifi
ci
ra
 ži
le
 (p
 =
 0
,0
02
) 
in
 zm
an
jšu
je
 b
ol
eč
in
e (
p 
= 
0,
01
9)
.
(+
/–
)
Ra
m
er
, e
t 
al
., 
20
15
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ko
ho
rt
na
 
ra
zi
sk
av
a
1–
21
 le
t
n 
= 
53
Zd
ru
že
ne
 d
rž
av
e 
A
m
er
ik
e
Pe
di
at
rič
na
 
kl
in
ik
a 
(h
em
at
ol
oš
ka
 
on
ko
lo
gi
ja
)
Iz
ku
še
ne
 
m
ed
ic
in
sk
e 
se
st
re
Ve
in
V
ie
w
er
 
V
 p
rim
er
ja
vi
 s 
sk
up
in
o 
s t
ra
di
ci
on
al
ni
m
 p
ris
to
po
m
 je
 b
ilo
 p
ri 
pa
ci
en
tih
 v
 sk
up
in
i z
 u
po
ra
bo
 p
rip
om
oč
ka
 za
 id
en
tifi
ka
ci
jo
 
pr
im
er
ne
 v
en
e 
po
tr
eb
ne
ga
 m
an
j č
as
a 
(p
 ≤
 0
,0
5)
. P
ac
ie
nt
i t
e 
sk
up
in
e 
so
 tu
di
 v
iše
 o
ce
ni
li 
sp
re
tn
os
t m
ed
ic
in
sk
ih
 se
st
er
 (p
 ≤
 
0,
05
) i
n 
ce
lo
st
no
 iz
ku
šn
jo
 v
en
ep
un
kc
ije
 (p
 ≤
 0
,0
5)
, k
ot
 so
 te
 
pa
ra
m
et
re
 o
ce
ni
li 
pa
ci
en
ti,
 k
i s
o 
oc
en
je
va
li 
m
ed
ic
in
sk
e 
se
st
re
, k
i 
pr
ip
om
oč
ka
 n
iso
 u
po
ra
bl
ja
le
.
(+
)
Fu
ku
ro
ku
, 
et
 a
l.,
 2
01
6
Pr
es
eč
na
 
ek
sp
er
im
en
ta
ln
o 
op
az
ov
al
na
 
ra
zi
sk
av
a
20
–3
8 
le
t
n 
= 
10
Ja
po
ns
ka
Iz
ob
ra
že
va
ln
a 
us
ta
no
va
Št
ud
en
ti 
zd
ra
vs
tv
en
e 
ne
ge
Ve
in
 D
isp
la
y 
Č
as
, p
ot
re
be
n 
za
 iz
bi
ro
 o
z. 
id
en
tifi
ka
ci
jo
 v
en
e, 
se
 je
 zm
an
jša
l v
 
pr
im
er
ih
 s 
pr
iso
tn
im
i d
ej
av
ni
ki
 tv
eg
an
ja
 za
 te
žj
i v
en
sk
i d
os
to
p 
(p
 =
 0
,0
06
). 
V
 k
ak
ov
os
ti 
iz
ve
db
e 
ve
ne
pu
nk
ci
je
 st
at
ist
ič
no
 
po
m
em
bn
e 
ra
zl
ik
e 
ni
so
 b
ile
 u
go
to
vl
je
ne
.
(+
/–
) 
Fu
m
ag
al
li,
 
et
 a
l.,
 2
01
6
Pr
os
pe
kt
iv
na
 
ra
nd
om
iz
ira
na
 
ra
zi
sk
av
a
62
–8
6 
le
t
n 
= 
10
3
Ita
lij
a
In
te
nz
iv
na
 
en
ot
a 
Sp
lo
šn
e 
bo
ln
išn
ic
e
M
ed
ic
in
sk
e 
se
st
re
Ea
sy
Ve
in
 
V
 p
rim
er
ja
vi
 s 
kl
as
ič
no
 m
et
od
o 
ni
 b
ilo
 u
go
to
vl
je
ni
h 
ra
zl
ik
 n
e 
v 
do
lž
in
i p
os
to
pk
a 
(p
 =
 0
,1
73
) n
e 
v 
št
ev
ilu
 p
os
ku
so
v 
(p
 =
 0
,3
61
) 
ne
 v
 p
oj
av
no
st
i b
ol
eč
in
e 
(p
 =
 1
,0
00
). 
U
go
to
vl
je
na
 p
a 
je
 b
ila
 
ni
žj
a 
po
ja
vn
os
t h
em
at
om
ov
 (p
 =
 0
,0
5)
, t
es
no
be
 (p
 =
 0
,0
38
) i
n 
de
pr
es
iv
ni
h 
sim
pt
om
ov
 p
ri 
pa
ci
en
tih
 (p
 =
 0
,0
37
).
(+
/–
)
Le
ge
nd
a/
Le
ge
nd
: (
+)
 –
 u
go
to
vl
je
na
 k
or
ist
no
st/
es
ta
bl
ish
ed
 u
se
fu
ln
es
s /
, (
–)
 –
 n
i u
go
to
vl
je
ne
 k
or
ist
no
sti
/n
o 
es
ta
bl
ish
ed
 u
se
fu
ln
es
s, 
(+
/–
) –
 u
go
to
vl
je
ne
 p
re
dn
os
ti 
in
 sl
ab
os
ti/
es
ta
bl
ish
ed
 a
dv
an
ta
ge
s 
an
d 
di
sa
dv
an
ta
ge
s
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.68
Po odstranitvi 7 duplikatov je ostalo 1013 zadetkov. Od 
teh smo na podlagi postavljenih vključitvenih kriterijev 
(jezik in čas objave, recenzija besedila, dostopnost 
polnega besedila, tematska in metodološka ustreznost, 
ugotovljeni na podlagi naslova in povzetka) izključili 
911 člankov. Po podrobnem pregledu preostalih 102 
polno dostopnih besedil smo izključili še nadaljnjih 
85 zadetkov, saj se na iskano tematiko niso ozko 
osredotočali. Končni rezultat iskanja uporabnih 
zadetkov je 17 člankov, le-te smo ocenili po kakovosti. 
Pri vseh 17 raziskavah smo ugotovili srednjo do visoko 
kakovost, nobena od raziskav ni bila ocenjena z najvišjo 
možno oceno in tudi nobena ni bila zaradi slabe 
kakovosti izključena. Slika 1 prikazuje diagram poteka 
iskanja, pregleda in vključevanja literature.
Karakteristike raziskav
V sistematičen pregled literature smo vključili 17 
kvantitativnih raziskav (12 prospektivnih randomiziranih 
raziskav, 3 prospektivne nerandomizirane raziskave 
in 2 presečni eksperimentalno opazovalni raziskavi), 
ki se navezujejo na rezultate uporabe biomedicinskih 
pripomočkov v klinični praksi. 
V izbranih raziskavah je najpogosteje uporabljen 
pripomoček VeinViewer®. Uporabili so ga v več kot 
polovici teh raziskav, in sicer v devetih primerih. 
Sledi AccuVein®, ki je bil uporabljen štirikrat, dvakrat 
so raziskovalci uporabili VascuLuminator® in po 
enkrat mVeinVision®, Wee Sight®, Veindisplay® in 
EasyVein®. Uporaba biomedicinskega pripomočka je 
bila najpogosteje raziskovana v otroških bolnišnicah 
oz. pediatričnih klinikah (n = 10), precej manj v 
splošnih in terciarnih bolnišnicah (n = 4), le nekaj 
raziskav je bilo opravljenih na urgenci (n = 1), 
izobraževalni ustanovi (n = 2). Izbrane raziskave so 
bile izvedene v različnih državah po svetu, in sicer v 
Združenih državah Amerike (n = 7), na Nizozemskem 
(n = 2), v Franciji (n = 2), Angliji (n = 1), Avstraliji (n 
= 1), na Japonskem (n = 1), v Italiji (n = 1), Tajvanu (n 
= 1) in Sloveniji (n = 1). Podroben opis posameznih 
raziskav je prikazan v Tabeli 1.
Rezultati uporabe biomedicinskih pripomočkov 
v klinični praksi
Trenutno so na tržišču tri naprave, ki so pridobile 
dovoljenje za uporabo s strani Urada za živila in 
zdravila ZDA (Juric & Zalik, 2014). Ti biomedicinski 
pripomočki so VeinViewer®, AccuVein® in 
VascuLuminator®. Prve klinične raziskave o uporabi 
biomedicinskih pripomočkov, delujočih na podlagi 
NIR-svetlobe, so bile objavljene v znanstvenih revijah 
od leta 2010 naprej. Večina teh raziskav je bila izvedena 
na majhnem vzorcu novorojenčkov, otrok ali obojih, 
ki so potrebovali periferno vensko kanilo (Hess, 2010; 
Strehle, 2010; Chapman, et al., 2011; Perry, et al., 2011; 
Kaddoum, et al., 2012; Peterson, et al., 2012; De Graaff, 
et al., 2013; Cuper, et al., 2013; Sun, et al., 2013; Szmuk, 
et al., 2013; Ramer, et al., 2015). V literaturi je mogoče 
zaslediti tako pozitivne kot tudi negativne rezultate 
uporabe biomedicinskega pripomočka v praksi. Osem 
raziskav poroča o nekoristnosti njegove uporabe v 
kliničnem okolju, medtem ko pet raziskav poroča o 
pozitivnih učinkih in štiri raziskave o pozitivnih in 
negativnih rezultatih hkrati. 
Ugotovitve različnih avtorjev glede nekoristnosti 
biomedicinskega pripomočka se nanašajo na dejstvo, 
da pripomoček bistveno ne vpliva na zmanjševanje 
bolečine pri pacientih (Chapman, et al., 2011; 
Aulagnier, et al., 2014; Fumagalli, et al., 2016), prav 
tako tudi ni bilo ugotovljenih nobenih drugih bistvenih 
razlik pri rezultatih uporabe biomedicinskega 
pripomočka v primerjavi s tradicionalnim načinom 
vstavljanja i.v. kanile (Chapman, et al., 2011; Perry, et 
al., 2011; Kaddoum, et al., 2012; Peterson, et al., 2012; 
De Graaff, et al., 2013; Cuper, et al., 2013; Aulagnier, 
et al., 2014).
Dve raziskavi (Hess, 2010; Sun, et al., 2013) 
ugotavljata, da VeinViewer® lahko olajša venepunkcijo 
in vensko vstavljanje kanile na račun izboljšanega 
uspeha v prvem poskusu in zmanjšanega časa izvedbe 
postopka. Sun in sodelavci (2013) ugotavljajo, da so v 
primerjavi s kontrolno skupino zdravstveni delavci pri 
iskanju periferne vene z uporabo NIR-svetlobe porabili 
manj časa (p = 0,027) ter da uporaba biomedicinskega 
pripomočka statistično značilno zmanjšuje število 
poskusov vboda (p < 0,001) (Hess, 2010). Rezultati 
kasnejših kontroliranih randomiziranih raziskav so 
bili manj pozitivni. V randomizirani raziskavi so 
Chapman in sodelavci (2011) preiskovali razlike med 
skupino s klasično vstavljeno i.v. kanilo in skupino z 
uporabo VeinViewerja®. Med skupinama niso ugotovili 
nobenih statističnih razlik niti glede časa vstavitve niti 
glede uspešnosti prvega vstavljanja i.v. kanile (78-
% uspešnost v skupini s klasično tehniko vstavljanja 
in 79-% uspešnost v skupini s biomedicinskim 
pripomočkom; p = 0,53). Še isto leto je bila izvedena 
randomizirana navzkrižna raziskava, ki glede 
uspešnosti venepunkcije in skrajšanja procesnega 
časa podobno ni odkrila nobene prednosti uporabe 
VeinViewerja® v primerjavi s tradicionalno metodo 
(Perry, et al., 2011). Szmuk in sodelavci (2013) so 
dodatno dokazali, da uporaba VeinViewerja® s strani 
izkušenih medicinskih sester celo poslabša izid prvega 
poskusa vstavljanja i.v. kanile (p = 0,22).
Od leta 2010 je na tržišču pripomoček AccuVein® 
– tehnološka naprava, zelo podobna VeinViewerju®, 
vendar nekoliko tehnično poenostavljena, enostavna 
za uporabo in prenosna. Prve raziskave je moč 
zaslediti od leta 2012 naprej. Raziskava, opravljena 
pri pacientih s hemofilijo, je pokazala, da uporaba 
AccuVeina® ni statistično pomembno vplivala na 
razlike v številu poskusov venepunkcije v primerjavi s 
kontrolno skupino brez omenjene bolezni (p = 0,45), 
vendar pa je bila pri skupini hemofilikov bistveno 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 69
boljša identifikacija ven (p = 0,002), značilno manj 
pogosto prisotna je bila tudi bolečina (p = 0,019) 
(Guillon, et al., 2015). Tudi v dveh raziskavah, ki so ju 
na zdravi odrasli populaciji opravili Aulagnier (2014) 
in Kaddoum in sodelavci (2012), med venepunkcijo z 
uporabo AccuVeina® in običajno tehniko vstavljanja 
kanile glede vpliva na uspešnost vstavljanja i.v. kanile 
v prvem poskusu in na skrajšanje procesnega časa ni 
bilo ugotovljenih nobenih razlik. 
Nadalje avtorji menijo, da je razlog za neučinkovitost 
pripomočkov za vizualizacijo ven moč iskati v prikazu 
slike, saj taka naprava prikazuje le dvodimenzionalno 
sliko žil oz. ne prikazuje njene globine, kar vodi 
v precenjenost velikosti žile (Chiao, et al., 2013; 
Aulagnier, et al., 2014). Tudi Peterson in sodelavci 
(2012) zagovarjajo klasično metodo vstavljanja i.v. 
kanile, saj so izkušene medicinske sestre bolj uspešne 
pri klasičnem vstavljanju i.v. kanile kot pri vstavljanju 
le-te z uporabo biomedicinskih pripomočkov za 
vizualizacijo ven. V raziskavi, ki so jo opravili De 
Graaff in sodelavci (2013), so primerjali uporabo 
VeinViewerja®, AccuVeina® in VascuLuminatorja® s 
klasično venepunkcijo, in sicer pri skupini pacientov, 
starih 0–18 let, ki so potrebovali urgentni kirurški 
poseg. Rezultati so pokazali, da sta VeinViewer® 
(95,3 % pacientov) in AccuVein® (94,1 %) žile bolje 
identificirala kot VascuLuminator® (89,1 %). Izkazalo 
pa se je tudi, da glede stopnje uspešnosti nastavitve i.v. 
kanile med tehniko klasične venepunkcije in tehniko 
venepunkcije z uporabo omenjenih biomedicinskih 
pripomočkov ni bistvene razlike (p = 0,93). Razlog 
za neuspešnost VascuLuminatorja® je moč iskati v 
oviranosti normalne inspekcije mesta vboda, saj mora 
izvajalec mesto vboda opazovati na zaslonu, kamor se 
slika projicira (De Graaff, et al., 2013). Pri ostalih dveh 
biomedicinskih pripomočkih se slika projicira na 
kožo pacienta in tako omogoča vstavljanje i.v. kanile 
na mestu oz. znotraj projicirane slike (Peterson, et al., 
2012).
Po mnenju izvajalcev je glavna koristnost in prednost 
biomedicinskih pripomočkov v tem, da tak pripomoček 
pomaga najti novo žilo (38 %) in s tem omogoča njeno 
hitrejšo lokalizacijo (33 %) (Sun, et al., 2013; Juric & 
Zalik, 2014; Guillon, et al., 2015; Ramer, et al., 2015; 
Fukuroku, et al., 2016), pri pacientih pa sta zmanjšana 
tudi incidenca nastanka hematoma (Fumagalli, et al., 
2016) in incidenca bolečine (Guillon, et al., 2015). 
Uporaba biomedicinskih pripomočkov za vensko 
vizualizacijo se je pokazala koristna pri študentih 
zdravstvene nege, pri katerih je bil izbor mesta za 
venepunkcijo značilno izboljšan zlasti v primeru 
prisotnosti dejavnikov, povezanih s težkim žilnim 
dostopom (Fukuroku, et al., 2016). Tudi Juric in Zalik 
(2014) ugotavljata, da je uporaba biomedicinskega 
pripomočka za vensko vizualizacijo v primerjavi s 
klasično vizualizacijsko metodo identificirala za 1,6 % 
(s = 1,8) več ven. 
Diskusija
Na podlagi analiziranih raziskav odgovarjamo na 
zastavljeno raziskovalno vprašanje – ugotavljamo, 
da uspešnost prvega poskusa vstavljanja i.v. kanile 
z biomedicinskimi pripomočki pri več kot polovici 
raziskav (Chapman, et al., 2011; Perry, et al., 2011; 
Kaddoum, et al., 2012; Peterson, et al., 2012; De 
Graaff, et al., 2013; Cuper, et al., 2013; Szmuk, et al., 
2013; Aulagnier, et al., 2014; Fumagalli, et al., 2016;) 
ni značilno višja od uspešnosti tradicionalne metode 
venepunkcije. Na podlagi analize rezultatov raziskav 
sklepamo, da je uspešnost prvega poskusa vstavljanja 
odvisna predvsem od izkušenosti in spretnosti 
medicinske sestre. Prednost uporabe biomedicinskega 
pripomočka v primerjavi s tradicionalno metodo 
venepunkcije, v smislu večje uspešnosti pri prvem 
vstavljanju i.v. kanile, se je pokazala le pri neizkušenih 
medicinskih sestrah oz. študentih zdravstvene nege 
(Hess, 2010; Juric & Zalik, 2014; Fukuroku, et al., 
2016). S strani izkušenih in izobraženih medicinskih 
sester je bila ugotovljena koristnost biomedicinskega 
pripomočka samo v treh raziskavah (Chiao, et al., 
2013; Sun, et al., 2013, Ramer, et al., 2015), v preostalih 
raziskavah so izkušene medicinske sestre pripomoček 
ocenile kot neuporabnega ali pa je pri njih celo 
poslabšal uspešnost prvega poskusa vstavljanja. 
V raziskave, ki so ugotavljale koristnost 
biomedicinskega pripomočka za vizualizacijo 
perifernih ven, so bili vključeni tudi drugi profili 
zdravstvenih delavcev. To so bili predvsem urgentni 
zdravniki, pediatri, anesteziologi in flebotomisti. Le dve 
raziskavi poročata o njihovi pozitivni oceni uporabe 
biomedicinskega pripomočka. Strehle in sodelavci 
(2010) poročajo, da so uporabniki (zdravniki pediatri 
in medicinske sestre) pripomoček ocenili kot koristen, 
saj se je prepoznavnost žil pri otrocih izboljšala v 76 
%. Chiao in sodelavci (2013) pa ugotavljajo, da se 
uporaba biomedicinskega pripomočka kot učinkovita 
izkaže pri debelih pacientih (p = 0,03), Afroameričanih 
in Azijcih (p = 0,01) ter pri ljudeh s temnejšo poltjo 
(p = 0,00). Na drugi strani glede števila poskusov 
vstavljanja (p = 0,8) ali časa, potrebnega za vstavitev, 
(p = 0,10) tri raziskave niso dokazale oz. ugotovile 
nobene statistično značilne razlike med klasično 
metodo venepunkcije in vstavljanjem i.v. kanile z 
biomedicinskim pripomočkom (Kaddoum, et al., 
2012; De Graaff, et al., 2013; Cuper, et al., 2013). 
Peterson in sodelavci (2012) močno zagovarjajo 
prednosti klasične metode vstavljanja i.v. kanil v 
primerjavi z uporabo biomedicinskih pripomočkov. 
V raziskavi so odkrili, da so bile osnovne sposobnosti 
tipanja in vizualizacije ven bolj uspešne kot vstavljanje 
i.v. kanil s pomočjo biomedicinskih pripomočkov 
(VeinViewer®, Wee Sight®). Ugotavljajo torej, da 
uporaba biomedicinskih pripomočkov za identifikacijo 
ven ne nujno korelira z višjo stopnjo uspešno 
vstavljenih i.v. kanil. Razlog je moč iskati v tem, da 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.70
tehnologija ni tridimenzionalna – morebitna omejitev 
uporabe naprave je prav dvodimenzionalni prikaz 
žil (Chiao, et al., 2013) in posledično težka ocena 
njihove globine. V obzir moramo vzeti tudi dejstvo, da 
izkušene medicinske sestre v veliki meri ne potrebujejo 
biomedicinskih pripomočkov za vstavljanje i.v. kanile. 
Szmuk in sodelavci (2013) namreč ugotavljajo, 
da uporaba biomedicinskega pripomočka s strani 
izkušene medicinske sestre celo poslabša izid prvega 
poskus vstavljanja i.v. kanile. Naprave za vensko 
vizualizacijo so bolj dragocena pomoč neizkušenim 
medicinskim sestram in študentom zdravstvene nege. 
Pri študentih uporaba biomedicinskih pripomočkov 
za vensko vizualizacijo značilno pripomore k večji 
uspešnosti vstavitve i.v. kanile zaradi olajšane izbire 
mesta venepunkcije, ne vpliva pa na kakovost izvedbe 
postopka (Juric & Zalik, 2014; Fukuroku, et al., 2016). 
Te naprave pripomorejo tudi k dodatni identifikaciji 
vene in skrajšajo izvedbo postopka. Rezultati uporabe 
so bili pozitivni tudi v primerih prisotnosti dejavnikov 
tveganja za težjo vizualizacijo žil, kot sta pacientova 
debelost in temnejša polt (Chiao, et al., 2013); ob 
uporabi pripomočkov so medicinske sestre delovale 
tudi bolj kompetentno (Ramer, et al., 2015). Medicinske 
sestre morajo še naprej izboljševati svoje osnovne 
sposobnosti ocenjevanja z vizualizacijo in tipanjem 
ven. Te veščine služijo kot temelj za vstavljanje i.v. 
kanile, ob njih pa se uporabljajo podporne tehnologije, 
kadar je to primerno in potrebno (Peterson, et al., 
2012). 
Nove prenosne NIR-naprave omogočajo vizualizacijo 
več žil v primerjavi s konvencionalnimi metodami 
tudi v primerih, ko vene niso vidne ali tipljive. Na 
vidljivost površinskih ven v standardnih pogojih 
vplivajo številni dejavniki: dojenčki imajo bolj 
površinsko porazdelitev maščobnega tkiva, kar vpliva 
na omejeno preglednost podkožja, enako je tudi pri 
debelih pacientih, medtem ko so pri Azijcih žile na prvi 
pogled manj očitne zaradi manjšega prečnega premera 
površinskih ven (Lamperti & Pittiruti, 2013). Chiao in 
sodelavci (2013) ugotavljajo, da dobro prepoznavanje 
žile oz. uspešna venepunkcija omogoča manj poškodb 
tkiva, nižje ekonomske stroške in večje zadovoljstvo 
pacientov. Večkratni poskusi venepunkcije so 
povezani s povečano incidenco ekstravazacije oz. 
žilne perforacije, ki posledično povzroči hematome 
ali krvavitve in flebitis. Vse to pa ne samo povečuje 
strah in trpljenje pacienta, ampak vpliva tudi na 
pacientovo zaupanje medicinskim sestram (Walsh, 
2008). Podporne tehnologije so zato najbolj uporabne 
pri otrocih in starostnikih, pri ljudeh s temnejšo poltjo 
in pri posameznikih s prisotnimi dejavniki tveganja 
za težjo venepunkcijo. Pacienti so tiste medicinske 
sestre, ki so uporabljale pripomoček, v primerjavi 
s tistimi, ki naprave niso uporabile, ocenili kot bolj 
spretne, hkrati so jim dodelili tudi boljše ocene skupne 
izkušnje vstavljanja i.v. kanile (Ramer, et al., 2015). Pri 
vzpostavljanju periferne venske poti je vedno treba 
na prvo mesto postaviti zadovoljstvo pacientov. Treba 
se je zavedati, da neuspešni in večkratni zaporedni 
poskusi vbadanja pri pacientih povzročajo določeno 
stopnjo strahu, bolečine, trpljenja, z večjo uspešnostjo 
pri prvem poskusu pa je posledično zmanjšana 
tudi incidenca nastanka hematoma (Guillon, et al., 
2015; Fumagalli, et al., 2016). Večkratno uvajanje 
neposredno ali posredno povzroča zmanjšano 
zadovoljstvo pacientov (zaradi povečanega števila 
poškodb kože in ven), povečano vznemirjenost 
in zmanjšano samozaupanje medicinskih sester 
ter povečanje stroškov zdravljenja (Kuensting, et 
al., 2009). Če pri vzpostavljanju periferne venske 
poti zdravstvenemu osebju omogočimo uporabo 
sodobnih pristopov in novosti, lahko povečamo 
njihovo uspešnost, zadovoljstvo ter produktivnost, 
omogočimo boljše delovne pogoje ter s tem povečamo 
pacientovo zadovoljstvo. Po ugotovitvah Ramer in 
sodelavcev (2015) medicinske sestre možnost uporabe 
biomedicinskih pripomočkov vidijo v pozitivni luči in 
ne kot dodatno obremenitev. Nasprotno pa Aulagnier 
in sodelavci (2014) ugotavljajo, da so izvajalci 
pripomoček ocenili bolj negativno kot pozitivno. 
Upoštevati pa je treba tudi dejstvo, da slednji dve 
raziskavi nista obravnavali istega biomedicinskega 
pripomočka. 
Uporaba biomedicinskih pripomočkov za vizualizacijo 
ven je še vedno daleč od resničnega življenja in uporabe 
v klinični praksi. Vzrok za nizko razpoložljivost 
teh naprav v zdravstvenih ustanovah je treba iskati 
predvsem v stroških izobraževanja in nakupa ter 
nepraktičnosti njihove uporabe, saj se pri reševanju 
življenjsko ogrožajočih stanj pripomoček velikokrat 
pojavi kot tehnična ovira. Upoštevati je treba tudi, 
da večina raziskav niti ne poroča, koliko postopkov 
vstavitve i.v. kanile z biomedicinskim pripomočkom 
je moral izvajalec opraviti, da je pri tem postal spreten. 
Pri vstavljanju i.v. kanile ne smemo upoštevati samo 
uspešnosti vstavljanja, treba je upoštevati tudi sam 
čas, potreben za vstavitev, saj naj bi bile te naprave v 
pomoč tudi v nujnih primerih, ko je potreben takojšen 
venski dostop. 
Zanimivo je dejstvo, da je večina raziskav o uporabnosti 
teh naprav opravljenih z enakimi predpostavkami 
oz. omejitvami: izključna osredotočenost na otroško 
populacijo (enajst od sedemnajstih raziskav), omejeno 
vzorčenje, težavna ali neprimerna randomizacija, 
slaba standardizacija postopka, premajhen poudarek 
na potrebi po usposabljanju z napravo, nizke zahteve 
ali kar odsotnost zahtev po izkušnjah uporabnika 
naprave (Lamperti & Pittiruti, 2013). V devetih 
raziskavah je bilo s strani proizvajalca zagotovljeno 
izobraževanje, in sicer po trajanju različno – od 30 
minut do 2 uri. Takega izobraževanja so se udeležile 
izkušene medicinske sestre (Perry, et al., 2011; 
Peterson, et al., 2012; Chiao, et al., 2013; Cuper, et 
al., 2013; Sun, et al., 2013; Szmuk, et al., 2013) in tudi 
študentje zdravstvene nege (Juric & Zalik, 2014). V 
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 71
nekaterih raziskavah izkušnje medicinskih sester niso 
bile omenjene oziroma za izvedbo raziskave sploh niso 
bile potrebne (Hess, 2010; Strehle, 2010; Chapman, et 
al., 2011; Kaddoum, et al., 2012; De Graaff, et al., 2013; 
Aulagnier, et al., 2014; Guillon, et al., 2015). 
Kljub temu da smo dostopali do velikega števila 
zadetkov, obstaja možnost, da smo zaradi določenih 
vključitvenih kriterijev izpustili nekatere pomembne 
raziskave. V analizo literature so bili vključeni le polno 
dostopni članki v angleškem jeziku. Med omejitve 
vključujemo tudi dejstvo, da je bilo iskanje, pregled 
in vključevanje literature opravljeno s strani le enega 
raziskovalca (prva avtorica). 
Za potrjevanje prednosti takšnega pristopa je 
potrebnih še več raziskav, toda njihova izvedba bo 
tudi v prihodnje verjetno omejena zaradi cenovno 
težke dostopnosti pripomočkov. Nadaljnji razvoj 
tehnologije za zagotovitev dostopnosti in enostavnosti 
uporabe biomedicinskih pripomočkov bo pripomogel 
k zagotavljanju najvišjega standarda varnosti pacientov 
in oskrbe za boljši izid zdravljenja pacientov po vsem 
svetu.
Zaključek
Vstavljanje i.v. kanile s pomočjo biomedicinskih 
pripomočkov je uporabna in koristna metoda za 
paciente s težkim venskim dostopom. Ugotavljamo, 
da so izsledki raziskav mešani in kažejo na to, da 
pripomočki ne doprinesejo nobene pomembne 
klinične koristi, če jih uporabljajo izkušene medicinske 
sestre. 
Na podlagi pregledane literature ne moremo z 
gotovostjo trditi, da pripomočki bistveno pripomorejo 
k lažji vzpostavitvi perifernega venskega dostopa. Pri 
tem je treba upoštevati več dejavnikov, ki doprinesejo h 
koristnosti oziroma nekoristnost uporabe pripomočkov: 
znanje anatomije, težji oz. kritično bolni pacienti 
in otroci, poznavanje pripomočkov ter možnosti 
uporabe le-teh. Novi pristop, ki temelji na uporabi 
pripomočkov, bistveno pripomore k zmanjšani 
pojavnosti hematomov pri pacientih ter k zmanjšanju 
pojavnosti občutka tesnobe in nesposobnosti pri 
neizkušenih medicinskih sestrah ter študentih na 
klinični praksi. Takšen pristop študentom zdravstvene 
nege zagotavlja udobno in varno učno okolje ter hkrati 
omogoča, da spoznajo veščino, potrebno za uspešno 
delo v kliničnem okolju.
Conflict of interest/Nasprotje interesov
The authors declare that no conflicts of interest 
exist./Avtorici izjavljata, da ni nasprotja interesov.
Funding/Financiranje
The study received no funding./Raziskava ni bila 
finančno podprta.
Ethical approval/Etika raziskovanja
No approval by the Ethics Committee was necessary 
to conduct the study due to the selected research 
methodology./Za izvedbo raziskave glede na izbrano 
metodologijo raziskovanja dovoljenje ali soglasje 
komisije za etiko ni bilo potrebno.
Author contributions/Prispevek avtorjev
The first author conceived the study, defined the 
search aims, and the methodology used for the 
identification and analysis of all included data. The 
first author conducted the literature search and review 
and the selection of included studies, including data 
extraction and results. The first author was assisted by 
the co-author in the writing of the Introduction and 
data synthesis. Both authors contributed to the writing 
of Discussion and Conclusion. The co-author greatly 
contributed to its revision and the final version of 
the manuscript./Prva avtorica je raziskavo zasnovala, 
definirala namen in metodologijo za identifikacijo in 
analizo podatkov. Opravila je tudi iskanje in pregled 
literature ter izbor vključenih raziskav. Druga avtorica 
je sodelovala pri pisanju uvoda in sinteze podatkov. 
Obe avtorici sta prispevali pri pisanju razprave in 
zaključka. Druga avtorica je z revizijo pomembno 
pripomogla k dopolnitvam prispevka in k oblikovanju 
končne različice besedila. 
Literature/Literatura
Alekseyev, S., Byrne M., Carpenter A., Franker C., Kidd 
C. & Hulton L., 2012. Prolonging the life of a patient's IV: 
an integrative review of intravenous securement devices. 
MEDSURG Nursing, 21(5), pp. 285–292.
PMid:23243786
Arbique, D., Bordelon, M., Dragoo, R. & Huckaby, S., 2014. 
Ultrasound-guided access for peripheral intravenous therapy. 
MEDSURG Nursing, 23(3), pp. 1–15. 
Aulagnier, J., Hoc, C., Mathieu, E., Dreyfus, J.F., Fischler, M. & 
Le Guen, M., 2014. Efficacy of Accuvein to facilitate peripheral 
intravenous placement in adults presenting to an emergency 
department: a randomized clinical trial. Academic Emergency 
Medicine, 21(8), pp. 858–863.
https://dx.doi.org/10.1111/acem.12437.
PMid:25176152
Bauman, M., Braude, D., & Crandall, C., 2009. Ultrasound-
guidance vs. standard technique in difficult vascular access 
patients by ED technicians. American Journal of Emergency 
Medicine, 27(2), pp. 135–140.
https://dx.doi.org/10.1016/j.ajem.2008.02.005. 
PMid:19371518
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.72
Bernatchez, S. F., 2014. Care of peripheral venous catheter sites: 
advantages of transparent film dressings over tape and gauze. 
Journal of the Association for Vascular Access, 19(4), pp. 256–261.
https://dx.doi.org/10.1016/j.java.2014.09.001.
Chapman, L.L., Sullivan, B., Pacheco, A.L., Draleau, C.P. & 
Becker, B.M., 2011. VeinViewer-assisted intravenous catheter 
placement in a pediatric emergency department. Academic 
Emergency Medicine, 18(9), pp. 966–971.
https://dx.doi.org/10.1111/j.1553-2712.2011.01155.x.
PMid:21854488
Chiao, F.B., Resta-Flarer, F., Lesser, J., Ng, J., Ganz, A., Pino-
Luey, D., et al., 2013. Vein visualization: patient characteristic 
factors and efficacy of a new infrared vein finder technology. 
British Journal of Anaesthesia, 110(6), pp. 966–971.
https://dx.doi.org/10.1093/bja/aet003.
PMid: 23384732
Chinnock, B., Thornton, S. & Hendey, G.W., 2007. Predictors 
of success in nurse-performed ultrasound-guided cannulation. 
The Journal of emergency medicine, 33(4), pp. 401–405.
https://dx.doi.org/10.1016/j.jemermed.2007.02.027.
PMid:17976752
Cuper, N.J., De Graaff, J.C., Verdaasdonk, R.M., Van Der Werff, D.B.M. 
& Kalkman, C.J., 2010. Predictability of complicated peripheral venous 
access in children. Pediatric Research, 68, p. 592. 
https://dx.doi.org/10.1203/00006450-201011001-01198.
Cuper, N.J., Klaessens, J.H.G., Jaspers, J.E.N., de Roode, R., 
Noordmans, H.J., de Graaff, J.C., et al., 2013. The use of near-
infrared light for safe and effective visualization of subsurface 
blood vessels to facilitate blood withdrawal in children. Medical 
Engineering and Physics, 35(4), pp. 433–440.
https://dx.doi.org/10.1016/j.medengphy.2012.06.007.
PMid:22841651
Dunn, M.R., & Conrad, S., 2005. Utilization of infrared trans-
illumination as an aid for peripheral arterial access. Academic 
Emergency Medicine, 12(5, Suppl 1), pp. S34–S35.
Ernst, D.J., 2009. Take the guesswork out of venepunctures. 
MLO: Medical Laboratory Observer, 41(4), pp. 18–20.
PMid:19456062
Fields, J.M., Piela, N.E., & Ku, B.S., 2014. Association between 
multiple IV attempts and perceived pain levels in the emergency 
department. The journal of vascular access, 15(6), pp. 514–518.
https://dx.doi.org/10.5301/jva.5000282.
PMid:25198807
Fukuroku, K., Narita, Y., Taneda, Y., Kobayashi, S. & Gayle, 
A.A., 2016. Does infrared visualization improve selection of 
venepuncture sites for indwelling needle at the forearm in second-
year nursing students? Nurse education in practice, 18, pp. 1–9.
https://dx.doi.org/10.1016/j.nepr.2016.02.005.
PMid:27235559
Fumagalli, S., Torricelli, G., Massi, M., Calvani, S., Boni, S., 
Roberts, A.T., et al., 2016. Effects of a new device to guide 
venous puncture in elderly critically ill patients: results of a pilot 
randomized study. Aging clinical and experimental research.
https://dx.doi.org/10.1007/s40520-016-0547-0
PMid: 26914485
De Graaff, J.C., Cuper, N.J., Mungra, R.A.A., Vlaardingerbroek, 
K., Numan, S.C. & Kalkman, C.J., 2013. Near-infrared light to aid 
peripheral intravenous cannulation in children: a cluster randomised 
clinical trial of three devices. Anaesthesia, 68(8), pp. 835–845.
https://dx.doi.org/10.1111/anae.12294.
PMid:23763614
Gregg, S.C., Murthi, S.B., Sisley, A.C., Stein, D.M. & Scalea, T.M., 
2010. Ultrasound-guided peripheral intravenous access in the 
intensive care unit. Journal of Critical Care, 25(3), pp. 514–519.
http://dx.doi.org/10.1016/j.jcrc.2009.09.003.
PMid:19836193
Guillon, P., Makhloufi, M., Baillie, S., Roucoulet, C., Dolimier, 
E. & Masquelier, A.M., 2015. Prospective evaluation of venous 
access difficulty and a near-infrared vein visualizer at four French 
haemophilia treatment centres. Haemophilia, 21(1), pp. 21–26.
http://dx.doi.org/10.1111/hae.12513
PMid:25335191
Heinrichs, J., Fritze, Z., Vandermeer, B., Klassen, T. & Curtis, 
S., 2013. Ultrasonographically guided peripheral intravenous 
cannulation of children and adults: a systematic review and meta-
analysis. Annals of emergency medicine, 61(4), pp. 444–454, e1.
http://dx.doi.org/10.1016/j.annemergmed.2012.11.014.
PMid:23415740
Hess, H.A., 2010. A biomedical device to improve pediatric 
vascular access success. Pediatric nursing, 36(5), pp. 259–263.
PMid:21067078
Higgins, J.P.T. & Green, S., eds., 2011. Cochrane handbook for 
systematic reviews of interventions, Version 5.1.0. London: The 
Cochrane Collaboration. 
Available from http://handbook.cochrane.org [20. 9. 2016].
InSono, 2015. InSono Biomedical division EasyVein. 
Available from http://www.insono.it/wp-content/uploads/presentazione_
EasyVein.pdf [20. 9. 2016].
John, J.M., 2007. Transillumination for vascular access: old concept, 
new technology. Pediatric Anesthesia, 17(2), pp. 197–198. 
https://dx.doi.wiley.com/10.1111/j.1460-9592.2006.02061.x.
PMid:17238901
Juric, S., Flis, V., Debevc, M., Holzinger, A. & Zalik, B., 2014. 
Towards a low-cost mobile subcutaneous vein detection 
solution using near-infrared spectroscopy. Scientific World 
Journal, p. 365902.
https://dx.doi.org/10.1155/2014/365902.
PMid:24883388
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74. 73
Juric, S. & Zalik, B., 2014. An innovative approach to near-infrared 
spectroscopy using a standard mobile device and its clinical 
application in the real-time visualization of peripheral veins. BMC 
Medical Informatics and Decision Making, 14(100), p. 9. 
https://dx.doi.org/10.1186/s12911-014-0100-z.
PMid:25421099
Kaddoum, R.N., Anghelescu, D.L., Parish, M.E., Wright, B.B., 
Trujillo, L., Wu, J., et al., 2012. A randomized controlled trial 
comparing the AccuVein AV300 device to standard insertion 
technique for intravenous cannulation of anesthetized children. 
Paediatric Anaesthesia, 22(9), pp. 884–889.
https://dx.doi.org/10.1111/j.1460-9592.2012.03896.x.
PMid:22694242
Keyko, K., Cummings, G.G.,Yonge, O. & Wong, C.A., 
2016. Work engagement in professional nursing practice: A 
systematic review. International Journal of Nursing Studies, 61, 
pp. 142–164.
https://dx.doi.org/10.1016/j.ijnurstu.2016.06.003.
PMid:27351831
Kuensting, L.L., DeBoer, S., Holleran, R., Shultz, B.L., 
Steinmann, R.A. & Venella, J., 2009. Difficult Venous Access in 
Children: Taking Control. Journal of Emergency Nursing, 35(5), 
pp. 419–424.
http://dx.doi.org/10.1016/j.jen.2009.01.014.
PMid:19748021
Lamperti, M. & Pittiruti, M., 2013. II. Difficult peripheral 
veins: turn on the lights. British Journal of Anaesthesia, 110(6), 
pp. 888–891.
https://dx.doi.org/10.1093/bja/aet078.
PMid:23687310
Medical, E., 2015. Evena eyes-on glasses wearable medical 
computing & precision IV placement. Available at: 
http://evenamed.com/wp-content/uploads/2015/11/Evena-
Eyes-On-Glasses-datasheet-1115.pdf [15. 9. 2016].
Melnyk, B. M. & Fineout-Overholt, E., 2015. Evidence-based 
practice in nursing & healthcare : a guide to best practice. 
Philadelphia: Wolters Kluwer Health.
Miyake, R.K., Zeman, H.D., Duarte, F.H., Kikuchi, R., 
Ramacciotti, E., Lovhoiden, G., et al., 2006. Vein imaging: a new 
method of near infrared imaging, where a processed image is 
projected onto the skin for the enhancement of vein treatment. 
Dermatologic surgery, 32(8), pp. 1031–1038.
https://dx.doi.org/10.1111/j.1524-4725.2006.32226.x
PMid:16918565
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. & PRISMA 
Group, 2010. Preferred reporting items for systematic reviews 
and meta-analyses: the PRISMA statement. International 
Journal of Surgery, 8(5), pp. 336–341. 
https://dx.doi.org/10.1016/j.ijsu.2010.02.007.
PMid:20171303
Pagnutti, L., Bin, A., Donato, R., Di Lena, G., Fabbro, C., 
Fornasiero, L., et al., 2016. Difficult intravenous access tool 
in patients receiving peripheral chemotherapy: a pilot-
validation study. European Journal of Oncology Nursing, 20, 
pp. 58–63. 
https://dx.doi.org/10.1016/j.ejon.2015.06.008.
PMid:26163026
Perry, A.M., Caviness, A.C. & Hsu, D.C., 2011. Efficacy of a 
near-infrared light device in pediatric intravenous cannulation: 
a randomized controlled trial. Pediatric emergency care, 27(1), 
pp. 5–10.
https://dx.doi.org/10.1097/PEC.0b013e3182037caf.
PMid:21178814
Peterson, K.A., Phillips, A.L., Truemper, E. & Agrawal, S., 2012. 
Does the use of an assistive device by nurses impact peripheral 
intravenous catheter insertion success in children? Journal of 
Pediatric Nursing, 27(2), pp. 134–143. 
https://dx.doi.org/10.1016/j.pedn.2010.10.009.
PMid:22341192
Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., 
Rodgers, M., et al., 2006. Guidance on the conduct of narrative 
synthesis in systematic reviews. A product from the ESRC 
methods programme Version, 1, p. 92.
Ramer, L., Hunt, P., Ortega, E., Knowlton, J., Briggs, R. & 
Hirokawa, S., 2015. Effect of Intravenous (IV) Assistive Device 
(VeinViewer) on IV access attempts, procedural time, and 
patient and nurse satisfaction. Journal of pediatric oncology 
nursing, 33(4), pp. 273–281.
https://dx.doi.org/10.1177/1043454215600425.
PMid:26510643
Sebbane, M., Claret, P.-G., Lefebvre, S., Mercier, G., Rubenovitch, 
J., Jreige, R., et al., 2013. Predicting peripheral venous access 
difficulty in the emergency department using body mass index 
and a clinical evaluation of venous accessibility. The Journal of 
emergency medicine, 44(2), pp. 299–305.
https://dx.doi.org/10.1016/j.jemermed.2012.07.051.
PMid:22981661
Sirk, B., Fekonja, Z., & Strnad, M., 2013. Identifikacija žil in 
vzpostavitev periferne venske poti s pomočjo. In: R. Vajd & M. 
Gričar, eds. Urgentna medicina: izbrana poglavja 2013. Dvajseti 
mednarodni simpozij o urgentni medicini. Portorož, Slovenija, 
13.-15. junij 2013. Ljubljana: Slovensko združenje za urgentno 
medicino, pp. 388–389.
Strehle, E. M., 2010. Making the invisible visible: near-infrared 
spectroscopy and phlebotomy in children. Telemedicine and 
e-Health, 16(8), pp. 889–893.
https://dx.doi.org/10.1089/tmj.2010.0061.
PMid:20925568
Fekonja, Z., & Pajnkihar, M., 2017. / Obzornik zdravstvene nege, 51(1), pp. 52–74.74
Strgar, M. & Macura Višić, N., 2013. Dejavniki, ki vplivajo 
na uvajanje periferne intravenozne kanile – primerjava 
med internistično in pediatrično prvo pomočjo v Splošni 
bolnišnici Jesenice. In: D. Klemenc, et al., eds. Moč za 
spremembe – medicinske sestre in babice smo v prvih vrstah 
zdravstvenega sistema: zbornik prispevkov z recenzijo / 
9. kongres zdravstvene in babiške nege Slovenije, Brdo pri 
Kranju, 9. in 10. maj 2013. Ljubljana: Zbornica zdravstvene 
in babiške nege Slovenije – Zveza strokovnih društev 
medicinskih sester, babic in zdravstvenih tehnikov Slovenije, 
pp. 389–395.
Sun, C.Y., Lee, K.C., Lin, I.H., Wu, C.L., Huang, H.P., Lin, Y.Y., 
et al., 2013. Near-infrared light device can improve intravenous 
cannulation in critically ill children. Pediatrics and Neonatology, 
54(3), pp. 194–197. 
https://dx.doi.org/10.1016/j.pedneo.2012.12.012.
PMid:23597539
Szmuk, P., Steiner, J., Pop, R.B., Farrow-Gillespie, A., Mascha, E.J. 
& Sessler, D.I., 2013. The VeinViewer vascular imaging system 
worsens first-attempt cannulation rate for experienced nurses in 
infants and children with anticipated difficult intravenous access. 
Anesthesia and analgesia, 116(5), pp. 1087–1092.
https://dx.doi.org/10.1213/ANE.0b013e31828a739e.
PMid:23492965
Walsh, G., 2008. Difficult peripheral venous access: recognizing 
and managing the patient at risk. Journal of the Association for 
Vascular Access, 13(4), pp. 198–203.
https://dx.doi.org/10.2309/java.13-4-7
Young, J.M. & Solomon, M.J., 2009. How to critically appraise an 
article. Nature Clinical Practice Gastroenterology & Hepatology, 
6(2), pp. 82–91. 
https://dx.doi.org/10.1038/ncpgasthep1331.
PMid:19153565
Cite as/Citirajte kot: 
Fekonja, Z. & Pajnkihar, M., 2017. Use of cutting-edge biomedical devices for intravenous cannulation in the health care of a 
patient: literature review. Obzornik zdravstvene nege, 51(1), pp. 52−74. https://dx.doi.org/10.14528/snr.2017.51.1.141