Tag Archives: technology

Technology: The VeinViewer

I’m always interested in technology that makes what we do easier. Here’s an objective look at an interesting machine that’s been around for a while. It uses near-infrared light to detect skin temperature changes to allow it to map out veins. It then projects an image of the map in real time onto the skin. In theory, this should make IV starts easier (as long as you can keep your head out of the way of the projector).

A paper just published from Providence, Rhode Island looked at this device to see if it could simplify IV starts in a tertiary pediatric ED. It was a prospective, randomized sample of 323 children from age 0 to 17 looking at time to IV placement, number of attempts, and pain scores.

Unfortunately, the authors did not find any differences. They found that nearly 80% of IVs were started on the first attempt with or without the VeinViewer, which is less than the literature reported 2-3 attempts. This is most likely due to the level of experience of the nurses in this pediatric ED. 

The authors did a planned subgroup analysis of the youngest patients (age 0-2) and found a modest decrease in IV start time (46 seconds) and the nurse’s perception of the child’s pain. Interestingly, the parents did not appreciate a difference in pain between the two groups. This may be due to the VeinViewer’s pretty green display acting as distraction therapy for the child.

Bottom line: This paper points out the importance of carefully reviewing all new (read: expensive at about $20,000 each) technology before blindly implementing it. In this case, an expensive peice of equipment can’t improve upon what an experienced ED nurse can already accomplish.

Reference: VeinViewer-assisted intravenous catheter placement in a pediatric emergency department. Acad Emerg Med, published online, doi: 10.1111/j.1553-2712.2011.01155.x, 2011.

I have no financial interest in Christie Digital Systems, distributor of the VeinViewer Vision®.

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Technology: A New Teaching Tool For Orthopedic Injury

Here’s a look at some new technology (made from five pieces of old technology) to help injured patients follow their activity and exercise regimens better after injury. It allows patients to “look beneath the surface” of their injured extremity to get a better idea of what is wrong and why they need to be compliant to heal.

Microsoft Research Labs cobbled together a projection unit from a handheld projector, a digital camera and an infrared camera. The control unit consists of a wireless controller and a laser pointer. Put them together and you can superimpose stock injury images over a patient’s extremity, or review images on a wall.

Two physical therapists did an uncontrolled test on several patients and indicated that overall compliance with the therapy regimen seemed to be better. Obviously, this is not sound science. But it does have some potential in allow physicians and therapists to give a better explanation about what is injured and what needs to be done about it. In my opinion, this could be generalized to just about any internal injury, and can provide an easy to understand teaching tool for trauma professionals.

Anatomic injury projector

New Technology II: Helping Paraplegics and Quadriplegics to Walk

The second company that makes a device to assist walking in spinal cord injured patients is Berkeley Bionics. Their exoskeleton is lighter (45 pounds) and more form-fitting, making it easier to maneuver indoors. It can operate for up to 6 hours between charges. The unit does require operator assistance in the form of a pair of canes for balance.

Prices were not available for the products from both Berkeley and Rex. However, the technology looks promising for several reasons. It allows the subject to stand upright, putting weight on their feet. This helps increase muscle tone and maintain joint flexibility. It also decreases pressure problems caused by remaining seated.

These devices are in an early stage right now. As the technology advances, expect to see smaller bionics with better (smoother) computer control, and more access for people with higher spinal cord injuries.

Disclaimer: I have no financial interest in Berkeley Bionics.

New Technology I: Helping Paraplegics and Quadriplegics to Walk

Several companies are working on technology to enable people with spinal cord injuries to walk again. Dave MacCalman, a New Zealand Paralympian with a cervical cord injury, recently purchased a robotic exoskeleton from Rex Bionics. This device allowed him to walk for the first time in 30 years. 

This exoskeleton is somewhat bulky (84 pounds), and allows only slow movement. The unit does not use crutches, but does require a modest amount of arm strength to use. It allows walking up slopes and building standard stairs with a handrail. To go down stairs, the user steps down facing backwards. The power supply lasts 3-4 hours.

This technology has only been in development for nonmilitary use for a few years. I expect that great strides (!) will be made as more companies join the fray. Tomorrow I’ll feature an exoskeleton from a US company, and point out the pros and cons of the two devices. 

Disclaimer: I have no financial interest in Rex Bionics.

A New Method For Killing Antibiotic Resistant Bacteria

IBM and the Institute for Bioengineering and Nanotechnology have developed a novel way of wiping out antibiotic resistant bacteria like MRSA. They created a type of nanoparticle that is activated by contact with water. When this occurs, it self-assembles into a new polymer structure that is attracted to infected cells and bacteria, but not healthy cells.

Changes in electrostatic charge on the cell surface attracts the nanoparticles, which then physically break through the cell walls and membranes of bacteria. The nanoparticles then degrade and are excreted.

Bottom line: This is a very exciting line of research. Bacteria multiply and evolve rapidly, sharing genetic information that allows them to change their biochemistry and become resistant to our usual antibiotics. Since the destructive process used by these nanoparticles is purely physical and not biochemical, it will be extremely difficult for any type of resistance to develop. This is an important advance in our efforts to control pathogens.

Reference: Biodegradable nanostructures with selective lysis of microbial membranes. Nature Chemistry, April 3, 2011 (online).