How Near-Infrared Vein Visualization Can Support IV Access in Older Patients

Establishing peripheral intravenous (PIV) access in older patients is frequently cited as one of the most demanding clinical procedures in inpatient care. Age-related physiological changes—such as decreased vascular elasticity, subcutaneous tissue atrophy, and hardened or fragile vessel walls—often result in Difficult Intravenous Access (DIVA). Repeated cannulation attempts not only increase physical trauma, pain, and anxiety for vulnerable patients, but also prolong nursing procedures and escalate the risk of complications such as phlebitis or extravasation.

To overcome these clinical bottlenecks, healthcare institutions increasingly rely on optical visualization tools. This article examines published clinical evidence evaluating the application of projection-type near-infrared (NIR) vascular imaging in geriatric patients, focusing on procedural efficiency and clinical outcomes.

Clinical Background and Equipment Overview

To provide transparent and verifiable clinical data, we examine a peer-reviewed study published in the Chinese medical literature regarding geriatric venipuncture:

• Study Reference: Zhang, T. (2018). Application effect of projection-type infrared vascular imaging instrument in peripheral vein puncture of elderly hospitalized patients. Practical Geriatrics, 32(4), 399-400.
• Study Cohort: A controlled clinical trial conducted with 124 elderly hospitalized patients (aged 75 to 95 years, average age approx. 82 years) admitted between June and December 2016.
• Investigated Equipment: Projection-type near-infrared vascular imaging system (developed by Vivolight).

Operating Principle of Near-Infrared Vein Visualization

The projection-type near-infrared vascular imaging system operates on the optical principle of differential near-infrared absorption:

• Hemoglobin Absorption: Deoxygenated hemoglobin circulating inside subcutaneous veins absorbs near-infrared light significantly more strongly than surrounding connective tissues, fat, and skin layers.
• Real-Time Projection: The device's optical sensor detects reflected near-infrared signals, processes the vascular contrast via internal algorithms, and projects an accurate 1:1 scale map of the superficial vein network directly back onto the patient's skin surface in real time.
• Procedural Guidance: This allows clinicians to clearly inspect venous bifurcations, evaluate vessel trajectory, estimate local depth, and identify valves prior to needle insertion.

Clinical Evaluation and Quantitative Results

In the comparative study, patients were allocated into a control group (standard manual palpation and visual inspection) and an observation group (assisted by the projection-type near-infrared vascular imaging system). Comparative analysis yielded the following statistically significant outcomes:

Clinical Implications for Geriatric Nursing

Based on published data and clinical practice feedback, incorporating near-infrared vein visualization into geriatric departments offers several distinct operational benefits:

• Minimizing Patient Trauma: By improving initial cannulation success and reducing the necessity of multiple needle insertions, the device limits painful subcutaneous tissue trauma and patient anxiety.
• Preserving Vascular Resources: In elderly patients with fragile, long-term infusion requirements, avoiding missed punctures and hematoma formation protects precious peripheral venous pathways.
• Optimizing Nursing Workflow: Non-contact, hands-free optical projection streamlines the vein assessment phase, enabling nursing staff to perform efficient catheter placement under clear visual guidance.

Procedural Considerations

While near-infrared projection technology provides valuable assistance during peripheral venous cannulation, clinical best practices dictate several operational boundaries:

• Complementary Adjunct: Near-infrared devices provide optical mapping of superficial venous geometry but do not replace tactile clinical palpation for assessing vessel elasticity, depth, and wall compressibility.
• Anatomical Penetration Depth: Optical near-infrared penetration is generally limited to superficial subcutaneous tissues (within 8–10 mm). In cases involving severe generalized edema, marked subcutaneous adipose accumulation, or hematoma, supplementary assessment or ultrasound guidance may be required.

References

[1] Zhang, T. (2018). Application effect of projection-type infrared vascular imaging instrument in peripheral vein puncture of elderly hospitalized patients. Practical Geriatrics, 32(4), 399-400. DOI: 10.3969/j.issn.1003-9198.2018.04.026.

[2] Infusion Nurses Society (INS). (2016). Infusion Therapy Standards of Practice. Journal of Infusion Nursing, 39(1S), S1–S159.