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This blog focuses on the latest products, devices, and ideas to improve emergency medicine practice. Brief news releases and photographs are welcome, and must be submitted electronically. Images must be 300 dpi, in tif, jpeg, or eps format, and at least 4“x4” in size. Please send information to emn@lww.com.

Wednesday, February 28, 2018

Intraosseous (IO) access was first introduced in 1922, but soon fell out of favor with the emergence of IV catheters. Even when IO was picked back up to benefit peripheral IV in the 1980s, it was only indicated for children 6 years old or under. (Crit Care 2016;20:102.) But that changed with the invention of automatic IO devices like the New Intraosseous device (NIO).

The NIO is designed for emergency physicians, paramedics, military medics, and practitioners who treat medical emergencies involving patients with difficult venous access or the need to administer drugs or fluids, among others. It is a single-use automatic injector that inserts the catheter to the primary site of proximal tibia or secondary site of humeral head in less than 10 seconds. It comes with an intraosseous access and fixation kit (GoIO), and requires no assembly or power source to operate. The device can also be used in those wearing bulky personal protection equipment and caregivers can't find standard IV access.

To obtain IO access with the NIO, use your nondominant hand to place the device on the insertion site and your dominant hand to press it firmly against the patient's disinfected skin. Press down on the device, and pull the trigger wings up. This activates the NIO's primary safety mechanism, triggering the device to insert the needle to a predetermined depth. Simply pull the needle out to remove the NIO. The NIO was also featured in EMN's Procedural Pause blog. (Feb. 1, 2017; http://bit.ly/2CdRUj3.)

The NIO's ease of use and safety have been confirmed by clinical research. The New York Institute of Technology College of Osteopathic Medicine tested the NIO and found a 98 percent and 91percent overall success rate in the proximal tibia and the humeral head respectively. Another study conducted in Lima, Peru, found no occurrences of microfractures to the bone from the insertion of the device, and one in Georgia Regents University in Augusta, GA, recorded an average procedure time for using the NIO of 18.3 seconds.

One of the main challenges facing potential users of IO access is lack of training. (Emerg Med J 2012;29[6]:506.) The NIO helps practitioners overcome this hurdle by providing realistic training through the NIO-SIM kit. The NIO-SIM looks just like the normal NIO but does not contain a needle, and it sticks to the trainee's limb after the simulated deployment. Clinical trainers can then correct user errors, and users can practice intraosseous access multiple times on a real limb.​

Find more information at www.ps-med.com, call 1-888-737-7978, or visit PerSys Medical's Facebook page.

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The NIO deployed on the proximal tibia.

Tuesday, April 18, 2017

​Vein visualization is a growing technology used to aid venipuncture and avoid complications. Two systems, the VeinViewer and VeinViewer Flex by Christie Medical and AccuVein AV400, project near-infared light on skin to see veins in real time.​

The small VeinViewer model is a handheld vein illuminator, and the VeinViewer Flex is designed for durability. The illuminators use HD imaging and digital full field technology. The projected near-infrared light is absorbed by the blood and reflected by surrounding tissue. The information is captured, processed, and projected digitally in real time directly onto the surface of the skin, providing an image of the patient's blood pattern.​

The technology allows providers to see blood patterns up to 15mm deep and clinically relevant veins up to 10mm. Clinicians can see peripheral veins, bifurcations and valves, and assess the refill/flushing of veins in real time.

The VeinViewer Flex comes with two S-mounts and two clamps so clinicians can mount the device to existing fixtures such as bed rails and IV poles. The VeinViewer Flex operates via AC power or battery, and comes with two rechargeable lithium ion batteries for up to four hours of continuous run time. Learn more at www.christiemed.com/vein-illuminaton. (Information and photo provided by Christie Medical.)


The VeinViewer Flex uses near-infrared light that is absorbed by the blood and reflected by surrounding tissue.

The AV400 by AccuVein helps locate veins for IV starts and blood draws. The device is handheld and noncontact, and provides a map of the patient's vasculature on the skin's surface to improve access to veins. AccuVein's device is held above the skin, and the hemoglobin in the blood absorbs its infrared light, projecting a map of the veins on the skin above them.


The AccuVein AV400 displays the vasculature on the surface of the skin.

AccuVein said the device improves the first-stick success rate and nurses' ability to cannulate veins, also reducing the number of sticks required for patients and decreasing pain during venipuncture in patients with difficult venous access.

Providers hold the device above the skin, and the vasculature is displayed on the surface of the skin, which can save time for nurses and patients. The device weighs 10 ounces and can fit in the pocket of scrubs. It also attaches to a chair or bedrail to be hands-free and works in normal or low light. The AV400 includes a rechargeable battery, and accommodates patient movement when operated properly.

Find more information by visiting www.accuvein.com or call 816/997-9400. (Information and photo provided by AccuVein.)​

Tuesday, April 18, 2017

Study after study has pointed out the scary bugs lurking in hospitals and emergency departments, and Indigo-Clean has developed a technology using visible light that continuously disinfects the environment and bolsters infection prevention efforts.

The 405 nanometers emitted from the light reflect off walls and surfaces, penetrating microorganisms and targeting the porphyrins that exist inside bacteria. The light is absorbed, and the excited molecules produce reactive oxygen species inside the cell, similar to the effects of bleach. This inactivates the bacteria, preventing them from repopulating the space.

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The standard white light disinfection mode is employed when people are in the room.

The system is automated and doesn't require a person to operate it, which can be helpful when rooms are in constant use. It uses light-emitting diodes (LEDs) to generate visible white light that also contains a narrow spectrum of indigo-colored light, not UV light.

The light has two modes of disinfection: The white disinfection mode provides ambient lighting and continuous environmental disinfection while the room is occupied, and the indigo disinfection mode provides a more powerful blue light when the room is not in use.

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The indigo disinfection mode, which is all blue for increased disinfection, is used when the area is unoccupied.

Find out more by visiting at www.indigo-clean.com​ or by calling 262/891-9200. (Information and photos courtesy of Indigo Clean.)

Tuesday, December 20, 2016

d2i provides cloud-based performance dashboards, key metric analytics, and peer benchmarks for emergency departments. Its clients use out-of–the-box solutions to monitor and benchmark every aspect of their emergency department, including incremental patient and service turnaround times, productivity, practice variation, satisfaction, quality measures, and risk.

The company also offers a data clearinghouse subscription service. The critical success factor for both services is getting data from hospital EMRs and then processing the data using the analytics platform, cleaning it, normalizing it, and integrating it into other data sources like patient satisfaction and clinicians' work hours. The d2i Performance Dashboard clients access their solution from any internet-connected device, and data clearinghouse clients receive files that they can consume with their enterprise Business Intelligence solutions.

Having data in a data warehouse is just the first step in any journey to deliver a Business Intelligence solution. This transforms data into actionable information and makes it available so it can be used to create value.

d2i also collects detailed, transaction-level clinical and operation EMR data from more than 130 hospitals. They have added more than 3.2 million unique ED patient visits to its data warehouse over the past 12 months, and are adding around 300,000 every month. The company's data warehouse will surpass 10 million unique ED patient visits sometime this year.

Learn more at www.d2ihc.com.

Tuesday, December 20, 2016

 

TAPSemr, an electronic physician documentation system designed specifically for the emergency department, was created by emergency physicians frustrated with current EMR systems that they said are adequate for some specialties but are impractical in the ED.

TAPSemr uses tablets that the company provides to users. Each tablet has handwriting recognition, an electronic pen, dual batteries for hot swapping, rubber casing to reduce heat, a suspended hard drive to withstand falls, splash resistance, and a quick release dock for charging and using as a desktop computer. The system is portable and does not require the use of a mouse.

The tablets require no computer skills and virtually no training. The TAPSemr interface eliminates all navigation techniques; physicians simply tap and slash words with the electronic pen, and charting is automatically completed. The system provides specific emergency medicine content that is easily accessible. Physicians can choose what to use from panels contained within words on the screen, allowing for information to be organized in a logical and accessible way, like the roots of a tree.

TAPSemr also provides an easy-to-use tracking board that allows physicians to toggle between patients, and the tracking board can notify users of each patient's progress, letting you know when x-rays and labs are back. The system is endorsed by Scribe America, with which TAPSemr collaborated to make the program scribe-friendly. Physicians and scribes can also share patient charting in real time.

TAPSemr can be deployed as an add-on physician documentation module to current EMRs. It can input patient registration information, autopopulate labs, and export final documents into the hospital medical record library. It can also be used as a standalone product for paper-based departments.

TAPSemr provides a website interface for the ED's billing company and allows chart-viewing in real time, even as they are being built. The final document is displayed in a format that is easy to code, and physicians are alerted for potential missing documentation before they sign. ED directors can also use this interface to track physician charting and generate reports such as daily logs and 72-hour return visits.

Contact TAPSemr about entry pricing and annual subscription fees based on patient volume at (888)840-6398 and read more at www.tapsemr.com.