Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018

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On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : UC09 - UC12 Full Version

Light-emitting Diode Vein Finding Device in Facilitating Peripheral Intravenous Cannulation in Children: A Randomised Clinical Study

Published: October 1, 2022 | DOI:
Satyaveer Verma, Nidhi Bangarwa, Geeta Ahlawat, Kirti Kamal

1. Senior Resident, Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. 2. Assistant Professor, Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. 3. Professor, Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. 4. Professor, Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.

Correspondence Address :
Dr. Geeta Ahlawat,
2nd Floor, New OT Complex, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.


Introduction: Peripheral venous cannulation in the paediatric age group is always a challenging task. The transillumination technique improves the visualisation of veins. The Light Emitting Diode (LED) vein finder device is based on the side transillumination principle.

Aim: To evaluate the role of transilluminating LED vein finder device (Optramed Vein-Lite), for peripheral intravenous cannulation in children with respect to ease of cannulation, time taken and number of attempts.

Materials and Methods: This randomised clinical study was conducted in Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2018 to January 2020. Total 130 patients, age <3 years, of either sex, and scheduled for surgery under general anaesthesia were included in the study. They were randomised into two groups. Group I (n=65), where venous cannulation was done using a transilluminating LED vein finder device, and group II (n=65) where venous cannulation was done after visualising and palpating the vein manually (conventional technique). Both the groups were compared with respect to the Difficult Intravenous Access (DIVA) score, number of attempts, ease of intravenous (i.v.) cannulation (cannulation on first or second attempt as ‘easy’, more than two attempts as ‘difficult’ cannulation) and time required for intravenous cannulation. The qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. A p-value <0.05 was considered statistically significant.

Results: The mean age of the population in group I was 17±13 months, and in group II was 15±23 months (p-value=0.5427). There was a significant variation with respect to the number of attempts; the first attempt success was 90.7% in group I vs. 63% in group II (p-value=0.0014). In group I, cannulation was easy in 95% of patients, while in group II, only 76.9% of patients had easy cannulation (p-value=0.0018). Time taken for intravenous cannulation in group I was 19.385±6.2015 sec and in group II was 22.886±11.6716 sec (p-value=0.0346).

Conclusion: Transillumination is a useful technique to improve the success rate of peripheral venous cannulation in infants and children.


Paediatric, Peripheral veins, Transillumination

Peripheral Intravenous Catheterisation (PIVC) is widely perceived as a routine procedure and is indeed a very crucial step in medical management. Accessing peripheral veins could sometimes be difficult in extremes of ages, neonates, children, obese patients, dark skin patients, i.v. drug abusers, patients in shock or patients treated with chemotherapy and patients with a history of long hospital stay.

Venepuncture in paediatric patients can be tedious and timeconsuming for anaesthesiologists as superficial veins may be too small to palpate or see in normal light. Children are usually more anxious and fearful of strangers. Multiple attempts at cannulation increase pain, anxiety, lifelong fear of needles and any procedurerelated anxiety during subsequent procedures and towards medical care providers. Numerous punctures can increase complications like skin bruising, phlebitis, extravasation, thrombosis and nerve damage (1),(2),(3). Moreover, these patients are generally kept Nil Per Oral (NPO) before surgery which makes it more difficult to PIVC as superficial veins get collapsed due to dehydration.

Delay in establishing venous access increases the incidence of central venous cannulation, venous cut-down and intraosseous infusions (4),(5). These procedures require greater skills, special equipment and are associated with increased morbidity and mortality (5),(6),(7). It is better to locate and map all visible superficial and deep peripheral veins before choosing a vein for cannulation. Blind cannulation is not good, as it increases the chance of procedure failure and damages the vein and renders it unfit for further use (8).

Various techniques have been used to facilitate peripheral venous cannulation. These include the application of a tourniquet, tapping the vein, applying alcohol, clenching the hand, use of constricting bands, application of nitroglycerine ointment and local warming. Apart from these, various other modalities have been tested and tried from time to time. Colour vision glasses or filters, night vision goggles, ultrasound needles and catheters, near infrared spectroscopy, visible light transilluminator, pressure sensing needles, and heat-sensitive bands are available to ease venous cannulation in children [9,10]. There are only a few studies available in the literature, where transillumination Light Emitting Diode (LED) devices are used to assist peripheral venous cannulation.

Transillumination LED vein finder is a device that uses side transillumination to transmit circular rays of light inclined inwards at an angle such that the light is focused towards the centre of the circle and under the skin surface (Table/Fig 1). This causes uniform transillumination of a small tissue region and increases visualisation of superficial peripheral veins (Table/Fig 2). This device uses a cold light source of the wave length 620-660 nm which can be transmitted through hand tissue, visible to the human eye, and absorbed by haemoglobin. The cost-effectiveness, safety, portability and convenience of LED transilluminating vein finder devices make them an ideal tool in patient care areas (11),(12).

The aim of the study was, to evaluate the role of transilluminating light emitting diode vein finder device (Optramed Vein-Lite), for peripheral intravenous cannulation in children. The primary outcome measures were the number of attempts and ease of intravenous cannulation. The secondary outcome measures were the time required for the procedure and the DIVA score.

Material and Methods

This randomised clinical study was conducted in Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, from January 2018 to January 2020. Approval was obtained from the Institutional Ethics Committee (IEC/Th/18/Anst22).

Sample size calculation: A previous study by Hosokawa K et al., on infants and children <2 years of age revealed that venous cannulation was successful at the first attempt in 73% in the transillumination method compared to 49% in the conventional method (11). Assuming these as reference values, the minimum required sample size at 5% level of significance and 80% power suggested the sample size of atleast 61 patients in each group.

Inclusion criteria: One hundred thirty patients, age <3 years, either sex, scheduled for surgery under general anaesthesia were included in the study after obtaining informed and written consent from parents/guardians of all the children.

Exclusion criteria: Patients already having an intravenous cannula, in hypovolemic shock, undergoing chronic steroid therapy, on chemotherapy and on i.v. fluid therapy within the preceding seven days, were excluded from the study.

The patients were assessed a day prior to surgery. Detailed clinical history from the parents was taken and a general physical examination was carried out. Other parameters like age, sex, weight, height, skin shade, and Body Mass Index (BMI) were also noted. Skin shade was evaluated using the Fitzpatrick scale and considered dark, if shade had a scale of 5 or more (13). All the routine investigations like haemoglobin, bleeding time, clotting time and urine complete examination were checked. Other investigations such as blood urea, blood sugar, serum electrolytes, ECG and chest X-Ray were done as per indication.

The study’ flow diagram is presented in (Table/Fig 3). Patients were randomly assigned using computer-generated random numbers to either of the following groups:

• Group I (n=65): Peripheral venous cannulation was done using a transilluminating LED vein finder device.
• Group II (n=65): Peripheral venous cannulation was done by conventional technique (by visualising or palpating the vein manually).

Study Procedure

On the day of surgery, patients were taken to the operation theatre and standard monitors like electrocardiogram and pulse oximeter were attached. Baseline vital data was noted. The patient’s characteristic features pertaining to peripheral vein-like visibility and palpability as well as skin complexion were noted. All patients received general anaesthesia with inhalation induction with nitrous oxide (70%) in oxygen (30%) and sevoflurane (upto 8%) using the Jackson Rees circuit. Methods to improve venous cannulation including tourniquet application and swabbing with alcohol were used in both the groups. The predicted difficulty score for intravenous cannulation was calculated before beginning the procedure in both the groups using the DIVA score.

Difficult intravenous access: Score is a four-variable clinical prediction score for predicting difficulty during intravenous cannulation in children. It takes into account following variables;

• Vein visibility after tourniquet application
Visible=score 0
Not visible=score 2
• Vein palpability after tourniquet application
Palpable=score 0
Not palpable=score 2
• Age
>3 years=score 0
1-2 years=score 1
<1 year=score 3
• History of prematurity
Not premature=score 0
Premature=score 3

A score of 4 or more predicts difficult intravenous cannulation in children (14).

Intravenous cannulation was attempted as per the group allocated. In group I LED device was used to locate the vein, before puncturing it and subsequently intravenous cannulation was done. In group II cannulation was performed after visualising or palpating the vein manually by the anaesthetist. Cannulation was attempted in the left hand first and if the initial three attempts in the arm failed then the right arm was considered for further cannulation. A new provider was asked to obtain venous access, if unsuccessful after six attempts and this was considered an unsuccessful intervention. An attempt was defined as a skin puncture with the chosen cannula with or without evidence of intravascular entry (blood flashback). Redirection of the needle tip while underneath the skin was counted as a separate attempt. The procedure was considered successful, if 2 mL of isotonic sodium chloride solution was infused without evidence of local infiltration. An unsuccessful attempt was defined as a skin puncture without blood flashback or resistance to i.v. fluid infusion with or without swelling at the insertion site. The rest of the procedure for anaesthesia and surgery proceeded, as planned.

Ease of cannulation: It was recorded as:

Easy cannulation on the first or second attempt OR
Difficult >2 attempts

Time taken: The time taken for peripheral i.v. cannulation was noted as the time from touching the skin for the first time, until the free flow of blood is seen in the hub of the cannula. If more than one attempt was required then the time interval between successive attempts to
further locate the vein was not counted.

Statistical Analysis

The quantitative variables in both groups were expressed as mean±SD and compared using unpaired t-test between groups. The qualitative variables were expressed as frequencies/percentages and compared using the Chi-square test. A p-value <0.05 was considered statistically significant. Statistical Package for Social sciences (SPSS) version 16.0 was used for statistical analysis.


The demographic profile including age, sex, weight and BMI were comparable in both the groups (Table/Fig 4). In group I, 28 out of 65 patients had a visible vein while 25 out of 65 patients in group II had a visible vein (Table/Fig 5). There was no significant statistical variation in both the groups with respect to vein visibility (p-value=0.7211). In Group I, 32 out of 65 patients had a palpable peripheral vein while 36 out of 65 patients in group II had a palpable vein (Table/Fig 5). Both the groups showed no significant variation, with respect to vein palpability (p-value=0.5983).

The skin shade of the patients among the two groups was also comparable. In group I, 31 out of 65 patients had dark skin, while 33 out of 65 patients in group II patients had dark skin (Table/Fig 5). Both the groups showed no significant variation with respect to skin shade (p-value=0.8607). In group I, 28 out of 65 patients had a DIVA score of more than 4, while, 25 out of 65 patients in group II had a DIVA score of more than 4 (Table/Fig 5). Both the groups showed no significant variation with respect to DIVA score, with a p-value 0.7211.

There was a significant difference with regard to the time required for i.v. cannulation between both the groups with a p-value of 0.0346. Time taken in group I was 19.385±6.2015 sec, and in group II was 22.886±11.6716 sec. Both the groups showed significant variation with respect to the number of attempts (p-value=0.0014). In group I, cannulation was easy in 63, while, in group II, cannulation was easy in 50 out of 65 patients. Both the groups showed significant variation with respect to ease of cannulation (p-value=0.0018) (Table/Fig 6).


Peripheral i.v. cannulation is a common, but essential procedure in everyday anaesthesia practice for administering fluids and medications. Securing venous access is often difficult and timeconsuming in paediatric patients due to the inability to identify peripheral veins. This is so because, their superficial peripheral veins are too small to palpate, difficult to see with ambient light and at times embedded in subcutaneous fat. The first attempt success rate is also low, ranging from 53-75.6% (9). Subcutaneous fat and tiny veins complicate the procedure in the paediatric population. Despite widespread marketing and clinical use, research evaluating the clinical utility of a transillumination LED vein finder for the visualisation of vessels for peripheral i.v. cannulation is scarce. So, the present randomised clinical trial was conducted to analyse the clinical benefits of transillumination LED vein finder in the paediatric population.

In the present study, the four variable DIVA score, suggested by Fitzpatrick TB, was used to assess the difficulty of iv cannulation (13). It is the only available score in the literature to predict these parameters which help to decide whether or not, to use any advanced technology for establishing i.v. access. Although, it is of particular importance in emergency settings, this was calculated in order to predict difficult cannulation. Both the groups showed no significant variation and were comparable with respect to DIVA score. This implies that the distribution of patients with predicted difficult venous cannulation (i.e. who would benefit from the use of an LED vein finder) was similar in both groups.

The time taken to establish successful venous cannulation in group I was less compared to group II. This is in accordance with the study done by Hosokawa K et al., in which the mean time for securing iv access was 47±34 sec in the TM group (Transillumination group) and 68±60 sec in UM (Usual Method) group (11). Thus, the use of a transilluminating LED device for establishing venous access in the paediatric population has made a tremendous impact on the success of the procedure. However, the mean time for establishing venous access in the present study was less than that of Hosokawa K et al., (11). This may be because the duration of the attempt mentioned in the later study, was defined as the time taken to inspect the vein until confirmation of successful venous cannulation or tourniquet release while in the former, it was defined as time for peripheral venous cannulation as the time skin puncture with the chosen cannula with or without evidence of intravascular entry (blood flashback). Thus, tourniquet time and inspection time for the vein were not included in the present study.

In the study done by Atalay H et al., the time taken for establishing venous access is much more (5 min or 300 sec). This may be because the study population also included emergency cases. They also included the time taken for cannulation by using a saline flush, and both the groups showed significant variation with respect to the number of attempts (p-value=0.0014) (15).

The number of attempts required for establishing venous access was less in group I as compared to group II. Thus, the use of transilluminating LED device (Optramed Vein-Lite) significantly improved the success of the first attempt at venous cannulation.

Similar findings were reported by Hosokawa K et al., who concluded that venous cannulation was successful in establishing the initial first attempt in 75% of patients in the TM group (11). Katsogridakis YL et al., also concluded that by illuminating the vein with transilluminating LED device, the i.v. placement was 2.1 times more likely to be successful in the first attempt (5). Atalay H et al., reported that out of 100 children, transillumination helped venous access in 80 patients and a vein could be cannulated on the second attempt in less than 5 minutes (15).

In the present study, both the groups showed significant variation with respect to ease of cannulation (p-value=0.0018). Thus, the use of transilluminating LED device clearly makes cannulation in paediatric patients much easier. The results are in accordance with those of Atalay H et al., Hosokawa et al., and Katsogridakis YL et al., (5),(11),(15). They also concluded that transillumination of veins has not only decreased the discomfort to the patient but also increased the rapidity of i.v. access and thus successful fluid and drug administration. Also, the frequency of i.v. establishment at uncomfortable sites like the foot or neck has decreased leading to more patient and parent satisfaction.

The LED devices can prevent unnecessary multiple cannulation as well as central venous catheterisation, thus, decreasing overall cost of procedure (5),(10). Various devices like ultrasound, infrared devices, and fibreoptic illumination have been acknowledged for facilitating i.v. cannulation (16),(17),(18). Use of ultrasound, infrared and fiberoptic devices requires learning curve and cost of these equipment hinders use in limited resource settings (12).

Hence, the transilluminating LED vein finder device is definitely useful for successful i.v. cannulation. But an assistant is required for holding it, which is a disadvantage of its use. Also, since the veins stand out so clearly, they give the illusion of being more superficial than they are and practice is required to develop a new sense of depth perception to puncture these veins. Lastly, this light is less useful in the antecubital fossa, wherein the fat above the veins is usually too thick to allow good visualisation of the veins and it is much more difficult to immobilise the elbow adequately, during venipuncture.


Only elective cases were enrolled for the study, the age group taken was only <3 years, and only upper limb i.v. cannulations were included. Therefore, studies including emergency cases, wider age groups, and i.v. cannulation at other sites too, are recommended in future to add further knowledge.


Transillumination is a useful technique to improve the success rate of peripheral venous cannulation in infants and children, which is otherwise challenging. The transilluminating LED vein finder device is a simple, economic and promising tool that can ease, the safe and rapid securing of i.v. access in minimal attempts. Thus, use of vein finder device is recommended, whenever difficult i.v. cannulation is anticipated.


Goren A, Laufer J, Yativ N, Kuint J, Ben Ackon M, Rubinshtein M, et al. Transillumination of the palm for venipuncture in infants. Pediatr Emerg Care. 2001;17:130-31. [crossref] [PubMed]
Nafiu OO, Burke C, Cowan A, Tutuo N, Maclean S, Tremper KK, et al. Comparing peripheral venous access between obese ad normal weight children. Paediatr Anaesth. 2010; 20:172-76. [crossref] [PubMed]
Cuper NJ, de Graaff JC, van Dijk ATH, Verdaasdonk RM, van der Werff DBM, Kalkman CJ, et al. Predictive factors for difficult intravenous cannulation in paediatric patients at a tertiary paediatric hospital. Paediatr Anaesth. 2012;20:223-29. [crossref] [PubMed]
Lamperti M, Pittiruti M. Difficult peripheral veins: Turn on the lights. Br J Anaesth. 2013;110:888-91. [crossref] [PubMed]
Katsogridakis YL, Seshadri R, Sullivan C, Waltzman ML. Veinlite transillumination in the paediatric emergency department: A therapeutic interventional trial. Paediatr Emerg Care. 2008;24:83-88. [crossref] [PubMed]
Kuensting LL, DeBoer S, Holleran R, Shultz BL, Steinmann RA, Venella J, et al. Difficult venous access in children: Taking control. J Emerg Nurs. 2009;35(5):419-24. [crossref] [PubMed]
Peterson KA, Phillips AL, Truemper E, Agrawal S. Does the use of an assistive device by nurses impact peripheral intravenous catheter insertion success in children? J Pediatr Nurs. 2012;27(2):134-43. [crossref] [PubMed]
Amsterdam JT, Hedges JR, Weinshenker E. evaluation of venous distension devices;phase 11: Cannulation of non emergent patients. Am J Emerg Med.1988;6(3);224-27. [crossref] [PubMed]
Haas NA. Clinical review: Vascular access for fluid infusion in children. Crit Care. 2004;8:478-84. [crossref] [PubMed]
Heinrichs J, Fritze Z, Klassen T, Curtis S. A systematic review and meta-analysis of new interventions for peripheral intravenous cannulation of children. Pediatr Emerg Care. 2013;29(7):858-66. [crossref] [PubMed]
Hosokawa K, Kato H, Kishi C, Kato Y, Shime N. Transillumination by light-emitting diode facilitates peripheral venous cannulations in infants and small children. Acta Anaesthesiol Scand. 2010;54:957-61. [crossref] [PubMed]
Cantor-Peled G, Halak M, Ovadia-Benchman Z. Peripheral vein locating technique.Imaging in Medicine. 2016;8(3):83-88.
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6):869-71. [crossref] [PubMed]
Yen K, Riegert A, Gorelick MH. Derivation of the DIVA score: A clinical prediction rule for the identification of children with difficult intravenous access. Pediatr Emerg Care. 2008;24(3):143-47. [crossref] [PubMed]
Atalay H, Erbay H, Tomatir E, Serin S, Oner O. The use of transillumination for peripheral venous access in paediatricanaesthesia. Eur J Anaesthesiol. 2005;22(4):317-18. [crossref] [PubMed]
De Graaff JC, Cuper NJ, Mungra RA, Vlaardingerbroek K, Numan SC, Kalkman CJ, et al. Near-infrared light to aid peripheral intravenous cannulation in children: A cluster randomised clinical trial of three devices. Anaesthesia. 2013;68(8):835-45. [crossref] [PubMed]
Chiao FB, Resta-Flarer F, Lesser J, Ng J, Ganz A, Pino-Luey D, et al. Vein visualization: Patient characteristic factors and efficacy of a new infrared vein finder technology. Br J Anaesth. 2013;110(6):966-71. [crossref] [PubMed]
De Graaff JC, Cuper NJ, Mungra RA, Vlaardingerbroek K, Numan SC, Kalkman CJ, et al. Near infrared light to aid peripheral intravenous cannulation in children: A cluster randomised clinical trial of three devices. Anaesthesia. 2013;68(8):835-45. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/58151.16995

Date of Submission: Jun 01, 2022
Date of Peer Review: Jun 27, 2022
Date of Acceptance: Aug 05, 2022
Date of Publishing: Oct 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Jun 05, 2022
• Manual Googling: Jul 20, 2022
• iThenticate Software: Aug 04, 2022 (14%)

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