Veinuino

Otiong,KristianneS.J.,Pacis,JohnMichaelC.,Ramirez,JohnCairuB.

Abstract:Venipuncture,theprocessofobtainingintravenous(IV)access,isaneverydayinvasiveprocedurein
[Link] facedbythedoctorstodayisdifficultyinaccessingveinsforintra-venousdrug
delivery&[Link],bruises,rashes,[Link]
[Link]-richbloodthatalmost
[Link]
spectroscopy(NIRS)isanimagingtechniqueusedinbothclinicalandemergencymedicine,aswellasinresearch
laboratoriestoquantifyandmeasurethenoxygenationstatusofhumantissuenon-invasivelyA non-invasive
subcutaneousveindetectionsystem hasbeendevelopedbasedonnearIRspectroscopyandinterfacedtoalaptop
[Link]
comparingthemeansofunprocessedhandimages,handimagesobtainedfrom thedeviceandthehandimages
[Link]
theaccuracyofthedevice(x=3.67)ascomparedtoacommercially-availableveindetectiondevice(x=3.87).In
addition,resultsshowthatthereisasignificantdifferenceinthelevelofveinvisibilityupontheapplicationofthevein
imagingsystem [Link],thereismoderateacceptancein
thelevelofacceptabilityofthedeviceintermsoffunctionality,usefulnessandmaintenance.

Keywords:Venipuncture,IRSpectroscopy,veindetection,vein,blood

▬▬▬▬▬▬▬▬▬▬▬▬♦▬▬▬▬▬▬▬▬▬▬▬▬
anddisstressinpatients,orcanleadtosevere
INTRODUCTION harmfulinjuries(Juric&Zalik,2014).Childrenare
Venipuncture, the process of obtaining probablythemostcommonlystudiedpopulation
intravenous(IV)access,isaneverydayinvasive [Link] be
procedureinmedicalsettings(Lamperti&Pittiruti, difficult to catheterize due to lack of
2013).Ithasbeenestimatedthattherearenearly cooperation,decreasedamountofsubcutaneous
500millionvenipuncturesdoneeveryyear,95.2– fat,andsmallerveins([Link],2012).
97.3percentofthesearesuccessfulinthefirst Locatingveinsinyoungchildrenandinfantsmay
attempt,whichindicatesthatitisdifficulttofind beespeciallydifficultandhavingtopuncturethem
veinsinaround14millioncasesonthefirsttry severaltimeswithaneedleisveryfrightfuland
(Anduig,2015).Themajorproblem facedbythe agonizingforthechild(Apte&Bawase,2015).
doctorstodayisdifficultyinaccessingveinsfor Obesepatientsareahighlyspecializedpopulation
intra-venous drug delivery & other medical [Link] weight
situations(Limbad&Parmar,2014).Anaverageof contributes to changes in patients'
2.35attemptsisnecessarytoinsertaperipheral anatomyandphysiology(Houston,2013).Geriatric
IVcatheterinachild([Link],2013). patientshaveveinswhichcancollapseeasilydue
_____________________________ tolossoftheirelasticitywhilepediatricpatients
possessveinsthataretautbutfragileandvery
∙ Otiong,[Link] smallinsizecausingthepatient’sbloodpressure
NationalScienceHighSchool,Batingan, torisetherebynarrowingtheveins(Ganesh,2007). The
Binangonan,Rizal,Mobile09228522590.E overallprevalence ofobesity among US childrenand
-mail:krisotiong@[Link] adolescents in 2010 was 16.9% assessedthe
∙ Pacis,[Link] relationship between body mass
NationalScienceHighSchool,Batingan, index(BMI)andeaseofvenousaccessin103 children
Binangonan,Rizal,Mobile09178190885.E aged 2 to 18 yearsandfoundoutthat
-mail:jmcpacis@[Link] obesechildrenweremorelikelytohavefailedfirst
∙ Ramirez,[Link] attemptcannulations than lean controls,and
NationalScienceHighSchool,Batingan, thatobesepatientsweremorelikelytorequire
Binangonan,Rizal,Mobile09155086363.E 2attemptsatcannulation([Link],2010).
-mail:johncairu@[Link] Unlikemuscleandskin,bloodisastrongabsorber
Excessive venipunctures are both time and ofNIRradiationwhichcontraststhesubcutaneous
resourceconsumingeventscausinganxiety,pain vesselsagainstskinandmuscleinNIRimaging
([Link],2007).Hemoglobinmoleculeisthe [Link] ER pediatric
primarytransporterofoxygeninmammalsand nursesmostfrequently(73.5%)definedtheuseof
manyotherspecies(Casiday&Frey,2007). [Link].(2012),in another
Theveinpatternisnotobservableunderthevisible light study that assessed peripheral
(Yuksel et. al, 2011). Veins contain intravenouscatheterinsertioncarried outbya
deoxygenatedhemoglobin-richbloodthatalmost neonatalnursing team in preterm and term neonates,
completely absorbs light at near-infrared reported that patients of similar gestationalage had a
wavelengths ata distance ofup to several highersuccess ofIV
[Link] placementassociatedwiththeuseoftheVein Imaging
thisdifferentialabsorptiontoclearlydistinguish [Link] another clinical trial of peripheral IV
theveinsfrom thearteriesandthesurrounding tissue catheter insertion in pediatric
(Juric & Zalik, 2014). Near infrared intensivecareunit(ICU)patients(3months–17 years
spectroscopy(NIRS)isanimagingtechniqueused old),found that the NIR device was associated with a
inbothclinicalandemergencymedicine,aswell shortertime to identifyan
as in research laboratories to quantify and appropriateveinandafewernumberofattempts
measurethenoxygenationstatusofhumantissue required compared to the standard technique.
non-invasively(Bakker,2012). Also,thetimeforIVplacementwasshorterinthe
Many studies revealed the efficacy of vein NIRgroup,arelevantfactorincriticallyillpatients
detectionsystem inimprovingcatheterizationdue ([Link],2013).Inanotherclinicaltrialconducted
toadecreaseinthenumberofinjuriesandtime byHess(2010),NIRdevicewasusedbynursesto
spentascausedbyseveralattemptsinpuncturing perform a series of peripheral IV catheter
[Link](2005) entitled insertionsinagroupofpatients(newbornto17
“Vein Detection System using Infrared yearsold)[Link]
Light”,thestand-alone,portableNIRveindetection case,theuseoftheNIRdevicewasassociated witha31%
system wasabletovisualizeanddetectvessels from improvementinfirststickinsertion success,a 35%
[Link] decrease in the numberof
[Link]’s(2013)study“Real-timelaw castinfrared vein attempts,anda39%decreaseintimerequiredfor
imaging system” showed efficacy of illuminating a IVinsertioncomparedtohistoricalcontrolsatthe
desired body partwith infrared [Link] [Link]
[Link](2004) on the clinical bytrainedphlebotomistsledbyCuperetal.(2011)
evaluation of vein contrast enhancement described showedthatNIRimagingwasassociatedwithan
the application ofa prototype vein contrast enhancer improvedfailurerateanddecreasedblooddraw
system in 146 pediatric time,comparedtohistoricalcontrolsinchildren aged 0
subjectsandfoundimprovedvisibilityin84%.The to 6 years [Link] [Link](2013) explained the
studypresentedinthisreporthasdemonstrated effect of the application of
thatanear-infraredimagingsystem canbeused enhancementtechniquessuchasimagenegative,
toaidvenipunctureandcannulationinchildrenof graylevelslicing,histogram equalization,contrast
[Link] stretching,laplaciansharpening,unsharpmasking,
insertioninemergencyroom (ER)patients,Perry highboostfiltering,andhistogram equalizationof
[Link](2011)reportedthateventhoughtherewas [Link]
noimprovementinthefirstattemptsuccessrate equalization ofhigh boostfiltering technique provides
associatedwiththeuseofVeinViewer,90%ofthe better enhancement of vein
surveyedpediatricERnursesexpressedthatthe [Link](2008)different
devicewashelpfulindifficultaccesspatients. NIRilluminationscanbecombinedtoimprovethe
Chapmanetal.(2011)evaluatedtheefficacyof contrastofvenousimageryandthattheform of this
VeinViewerinagroupofpatients(0–17yearsold) combination may vary under different
[Link] physiologicalcharacteristics.
showedthattherewasnoimprovementintimeto
peripheralIV catheter placement,number of
attempts,orpainscoresincasesassociatedwith MATERIALSANDMETHODS
[Link],asubgroupanalysisof
children(0–2yearsold)demonstratedabenefitin PreparationofMaterials
peripheralIVcatheterinsertiontimeandalower The materials used in the study were
 purchasedinthelocalmarketsuchas E
gizmoMechatronixCenterlocatedatTaftAve., PrototypingtheCasing
Malate,Manila,Circuit-helpinKatipunan,Quezon The researchers used an aluminum casing
[Link] [Link]
Avenue,[Link],Manila. addition,moreholesweredrilledonthealuminum
casingfortheswitches,andRCAfemaleadapters.
WiringtheLEDs
High powered infrared LEDswere powered by ProgrammingtheDevice
establishingacommongroundfortheseLEDsand The researchers used an arduino sketch in
connectingthecathodestotheground(GND).The uploading the following code to the microcontroller:
anodeswereconnectedtoseparatedigitalpins,
representingeachsetofcircularlyarrangedLEDs. intledPins[]={9,10,11,12};//digitalPindeclaration
intCount=4;//totalnumberofpins
WiringtheCamera voidsetup(){
ThecamerausedwasaTTLSerialCamerainitially for(intiPin=0;iPin<Count;iPin++){
[Link] could pinMode(ledPins[iPin],OUTPUT);
snap pictures at640x480,320x240 or }
[Link],thecamerais }
[Link]
[Link] voidloop(){
researchersusedthe+5Vpin,Groundpin,CBVS for(intiPin=0;iPin<Count;iPin++){
pinandCVBS [Link] pinMode(ledPins[iPin],HIGH);
connectedtotheArduinoUno,anopensource }
computing platform based on a simple }
input/output(I/O)boardandtheuseofstandard
programminglanguage;inotherwords,itisatool SelectionofRespondents
forimplementingaprogram youhavedesigned. Itis wellestablished thatwhen developing a
Thewireswereconnectedtotheirassignedpins. medicaldevice,itis importantto involve and
considerdifferentperspectivesateverystageof the
TestingtheCamera developmentlifecycle,to optimize clinical
TheArduinoUnowasconnectedtoalaptopusing usability, improve patient safety, reduce
[Link] developmenttimeandcosts,andachievehigher
[Link] levelsofpatientandusersatisfaction,whichall
testthecamera,aCVBSjackwasconnectedto resultinahigherqualityendproduct(Money,[Link],
[Link] 2011).Furthermore,mostofthem do noteven mention
recorder(DVR)wasusedtoconnectthecamerato any sortofhealth professionals'or
thelaptopforitsvideooutput. accuracyassessmentsduringtheirdevelopment,
whichquestionstheirqualityindeliveringhealth
ConstructionoftheDevice relatedinterventions(Bender,[Link],2013).Inthis
Theresearchersusedanacrylicglasswherein study,apurposiveresearchgroupcomposedof30
[Link] children aged 1-10 years old whereby the
weredrilledatthecenterofeachLEDarrayforthe researchers teamed up with 30 clinicians and
[Link] otherhealthprofessionalswasestablished,with the
commonground,aseriescircuitwasestablished aim to evaluate the design and prototype
[Link],thecamera was throughmultipleiterationsfrom theclinicaland
placed atthe middle ofthe LED array, technicalpointsofview.
[Link] TestingoftheDevice
wasinstalledatthetopoftheacrylicsheet,along
[Link] from
theLEDarrayswereseparatelyconnectedto
[Link],
switcheswereinstalledbetweenthecamerasand
theCVBSjack.
 professionals in terms of its functionality,
usefulnessandmaintenance.

RESULTSANDDISCUSSION
Materials Qty. Price(in
Peso)

TTLSerialCamera 4 8400

ArduinoUno(SecondHand) 1 800

NearInfraredLED 64 352

SolidWire 5m 30

MaletoMaleWires 25 175

[Link] RCAFemaleAdapter 1 50

Imageacquisitionisthefirststepinanyimage ToggleSwitch 4 80
processingapplicationsfrom setdistancewith
[Link] AluminumBody 1 1000
thesimplestandmostappealingareasofdigital
TOTAL 10887
[Link]
techniquesistobringoutdetailthatisobscured
orsimplytohighlightcertainfeaturesofinterestin
[Link]
[Link]
[Link] on
the nature ofthe image [Link]
Thedevicewasconstructedusinglocallyavailable
enhancements improve the perceptibility of [Link]-basedinfrared
objectsinthescenebyenhancingthebrightness sensitiveserialcameraandanarrayofinfrared
differencebetweenobjectsandtheirbackgrounds. [Link] studyfocused on a serialcamera
Contrastenhancementsaretypicallyperformedas a programming and storage using Arduino Uno
contrast stretch followed by a tonal microcontroller. The materials used in the
enhancement,although these could both be developmentoftheveindetectorwerepurchased
[Link] atE-gizmo MechatronixCenterlocatedatTaft
[Link] see the Ave.,Malate,Manila,Circuit-help in Katipunan,
clear difference between vein and QuezonCityandDeecoElectronicsCenterinC.M.
[Link] RectoAvenue,[Link],Manila.
inthisstudy,theresearchmethodologywillbe
comprisedofthreeset-upswith30subjectsand DataPresentation
30evaluatorsthatwasconductedinMay2017. Thepresentationofthedataisdividedintofour
parts,(1)thecostofproductionofthedevice(2)
StatisticalAnalysis thelevelofacceptabilityofVeinuinoasperceived by
The researchers used Microsoft Excel Data medical professionals with respect to
AnalysisofMicrosoftExcel2013incomputingfor the functionality,usefulness and maintenance (3)
t-test which determines the difference weightedarithmeticmeanintermsofvisibility
betweenthevisibilityoftheunprocessedsubject betweenthedeviceandanunprocessedsubject
andthesubjectputundertheimplementationof the and(4)weightedarithmeticmeanintermsof
device and the difference between the accuracybetweenthedeviceandacommercially
accuracyofthe device and the commercially
availabledevice.
availableveindetectiondeviceindeterminingthe
levelofacceptabilityofthedevicetothemedical
 ameanof3.9and3.8,verballyinterpretedas
FUNCTIONALITYOFT Wx VI
“moderatelyaccepted.”
HE PROJECT
USEFULNESSOFTHE Wx VI
[Link] 3.8 MA PROJECT
providesadequate
illuminationtoenablevein [Link] 3.73 MA
imaging. andclearlyshown.

[Link] 4.2 EA [Link] 4 EA

lveinimages. accurateveinimages.

[Link] 4.067 EA [Link] 3.67 MA

specificveinlocations. timespentforvein
detection.
[Link] 4.03 EA
variousveinlocationsalong [Link] 4.067 EA
thesubjecttobedisplayed. perceptionofthevein.

[Link] 3.9 MA [Link] 3.83 MA

specialfeaturesofthe veindetection.
devicetodisplayrealtime
footage. Mean 3.8594 MA

Mean 3.9994 MA

[Link]
[Link] acceptabilityofVeinuinoasperceivedbymedical
acceptabilityofVeinuinoasperceivedbymedical professionalswithrespecttousefulness.
professionalswithrespecttofunctionality.
Theperceptionofthemedicalprofessionalstothe
Theperceptionofthemedicalprofessionalstothe deviceintermsofusefulnesshasanaverage
deviceintermsoffunctionalityhasanaverage weightedmeanof3.8594,verballyinterpretedas
weightedmeanof3.9994,verballyinterpretedas “ModeratelyAccepted.”
“ModeratelyAccepted.”
The fourth indicator,“the device improves the
Indicatornumber2,“thedevicedisplaysactual perceptionofthevein”rankedfirstwithaweighted
veinimages”rankedfirstwithaweightedmeanof meanof4.067,verballyinterpretedas“extremely
4.2,verballyinterpretedas“extremelyaccepted.” accepted.”Followedbyindicatornumber2,“the device
Followed by indicatornumber3,“the device displays accurate vein images”with a weighted mean
providesspecificveinlocations”withaweighted of4.0,verballyinterpreted as
meanof4.067,verballyinterpretedas“extremely “extremelyaccepted.”Indicatornumber5,“the
accepted.”Indicatornumber4,“thedeviceenables deviceiseffectiveforveindetection”rankedthird
variousveinlocationsalong thesubjectto be withaweightedmeanof3.83,verballyinterpreted as
displayed”rankedthirdwithaweightedmeanof “moderately accepted.”The firstand third
4.03,verballyinterpretedas“extremelyaccepted.” indicator,“theveiniseasilydetectedandclearly
Thefifthindicator,“thesystem allowsthespecial shown”and“thedevicedecreasesthetimespent
featuresofthedevicetodisplayrealtimefootage” and forveindetection”rankedfourthandfifthwitha weighted
firstindicator,“the vein detection system provides mean of3.73 and 3.67 respectively,
adequate illumination to enable vein verballyinterpretedasmoderatelyaccepted.”
imaging”rankedfourthandfifthrespectivelywith
 MAINTENANCEOFT Wx VI
HE PROJECT

[Link] 4 EA
troubleshooting,thedevice
canbeeasilyrepaired.

[Link] 4.3 EA
locally–available

[Link] 4.03 EA
[Link](3)set ups.
ofthedeviceplaceareeasy
Treatment Mean Standard Mea df tc tz H V
tofind. Deviation n 0 1

Diff.

[Link] 3.93 MA 58 8.11 1.67

Unprocee 1.5 0.861 2.17 R S
requireslesstimeandcost sed
HandIma
. ge

[Link] 4.3 EA Veinuino 3.67 1.184

maintenance.

Mean 4.112 EA ]

[Link]
visibilityoftheunprocessedsubjectandthe
[Link] Veinuino
acceptabilityofVeinuinoasperceivedbymedical
Intermsofveinvisibility,theunprocessedhand
professionalswithrespecttomaintenance.
imageobtainedanaveragemeanof1.5,verbally
Theperceptionofthemedicalprofessionalstothe interpretedas“lowlyaccepted.”Meanwhile,the
deviceintermsofmaintenancehasanaverage developedlow costsubcutaneousveindetector
weightedmeanof4.112,verballyinterpretedas (Veinuino)obtained an average mean of3.67,
“ExtremelyAccepted.” verbally interpreted as “moderately accepted.”
Sincethecomputedt-valueof8.11ishigherthan the
Indicators number2,“The materials used are criticalvalue of 1.67 at 0.05 levelof
locally–available”andnumber5,“Thedeviceisof significancewith58degreesoffreedom,thenull
lowmaintenance”bothrankedfirstwithaweighted [Link],thereisasignificant
meanof4.3,verballyinterpretedas“extremely difference between the vein visibility of an
accepted.”Followedbyindicatornumber3,“the unprocessedhandimageandtheimageproduced
partsorcomponentsofthedeviceplaceareeasy bytheVeinuino.
tofind.”withaweightedmeanof4.03,verbally Treatment Mean Standard Mea df tc tz H V
interpreted as “extremely accepted.” Indicator Deviation n 0 1

Diff.
number1,“Intimesoftroubleshooting,thedevice can be
easily repaired” ranked third with a weighted mean Veinuino 3.67 1.184 0.2 58 0.71 1.67 F N
R S
of4.0,verballyinterpreted as “extremely accepted.”
The fourth indicator, Commerci 3.87 0.973
ally
“maintenanceProcessrequireslesstimeandcost” -availablev
ranked fourth with a mean of3.93,verbally ein
detection
interpretedas“moderatelyaccepted.” device
 [Link] intimesofpressureaspartofaccomplishingthe
accuracyoftheVeinuinoandthecommercially wholestudy.
availableveindetectiondevice.
REFERENCES
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mean of 3.67. Comparatively, the ofsuperficialveinsoncamera-based
commercially-availableveindetectiondevicehasa Photoplethysmograms.
mean of 3.87,both verbally interpreted as
“moderatelyaccepted.”There is no significant Apte,[Link],A.(2015).InfraredHand Vein
differenceintheaccuracyoftheVeinuinoandthe Detection System. IOSR Journal of
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CONCLUSION Near-Infrared Spectroscopy, Applied Aspects
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deviceisoflowcostandiseconomicaltouseas PhilipAinslie(Ed.).
comparedtootherexistingveinviewingdevices.
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developed low cost subcutaneous vein detector rightdirection:systematic review and content analysis
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ACKNOWLEDGEMENT
Casiday,[Link],R.(2007).Hemoglobinand
Firstandforemost,wewouldliketoofferour
theHemeGroup:MetalComplexesintheBlood
sincerestgratitudetotheGodAlmightyforgiving us
forOxygenTransport.
strength and wisdom to surpass alllife’s
challengesthatweencounteredthroughoutthe Chapman,L.L.,Sullivan,B.,Pacheco,A.L.,Draleau,
[Link] [Link],B.M.(2011).VeinViewer-assisted
RizalNationalScienceHighSchool,especiallyto intravenous catheterplacementin a pediatric
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[Link] also like
Vlaardinherbroek,K.,Numan,[Link],
to show ourgratitude to [Link]
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[Link]
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pearlsofwisdom withusduringthecourseofthis
randomized clinical trial of three devices.
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andsupport,[Link],toourfriendsand
fellowresearchers,whosupportedandliftedusup deNegri,D.C.,Avelar,AF,Andreoni,[Link],
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Lovhoiden,G.,Deshmukh,H.,Vrancken,C.,Zhang,
APPENDIXA
SampleImagesfromtheTrials
 SampleImagesofUnprocessedHandImages

SampleImagesfromaCommerciall-availableVeinDetectionDevice

SampleImagesfromVeinuino
APPENDIXB
StatisticalComputation
IndependetT-Testbetweenthelevelofveinvisibilityoftheunprocessedhandimage
andimageobtainedfromVeinuino

IndependetT-Testbetweentheaccuracyofacommercially-availablevein
detectiondeviceandVeinuino