AV400 Vein Visualization System
In addition to the Intraosseous Vascular Access System, the placement of an IV line may also be facilitated by laser devices such as AccuVein’s AV400 vein visualization technology. While earlier versions of both of these systems were comparable to that of a skilled technician in obtaining line placement, the latest generations of these devices have improved depth and visualization of truly difficult vascular access.
Internet-Connected Smart Glasses
In addition to the above-mentioned evolutionary changes in facilitating venous access, revolutionary technological advancements have been in development and are forthcoming. One such technology is network-connected smart glasses.
Eyes-On Glasses
Among the first in network-connected eyewear is Eyes-On Glasses (Evena Medical Inc, Los Altos, California).9 This system functions in a similar manner as other laser systems, except that the screen is a display mounted on eyeglasses, making venous placement much more intuitive (This is especially helpful for those who have difficulty translating the three-dimensional world to a two-dimensional screen).
Another variation on head-mounted technology is General Electric’s (GE) beta software for Google Glass (Google Inc, Mountain View, California) (Figure 4). This prototype links a GE ultrasound machine to Google Glass via WiFi, again simultaneously facilitating visualization of the field and the screen.10 While Google Glass is not currently available for the general public, there is still a place for it in the clinical setting.
Both the Eyes-On Glasses and Google Glass devices share a common thread: to improve patient comfort and facilitate time-consuming procedures.
Wound Care
Aquacel Ag
The EP sees a fair share of burn victims, the standard of care for which has been silver sulfadiazine and daily dressing changes. Care for burn wounds is beginning to change with the introduction of antimicrobial impregnated dressings such as Aquacel Ag (ConvaTec Inc, Greensboro, North Carolina).11 Aquacel Ag comes packaged in various forms and sizes ranging from large sheets for torsos to custom formed gloves for hands. This product is safe to use on the face and can be applied to partial thickness burns where the dermal layer is gone. The fluid from the wound moistens the bandage and helps it adhere to the skin. The dressings are then left in place until they slough-off on their own (approximately 7 to 10 days after placement). Consequently, no dressing changes are required, with cosmesis matching that of classic treatment.
While EPs may find Aquacel Ag useful in treating burns that do not require inpatient hospital admission, they also will find its use highly beneficial in treating patients with “road rash,” the abrasions that occur when one wipes-out at high speeds on asphalt (eg, motorcycle accidents). As with burn wounds, only a single application of Aquacel Ag is required on a debrided abrasion.
With respect to price, a single application of Aquacel Ag costs roughly the same as multiple dressing changes with other wound-care products.12 One concern relating to the use of advanced silver-impregnated dressings is the cost of care since silver-impregnated dressings are relatively expensive compared to traditional dressings. The higher cost, however, is partially offset by the reduced use of secondary gauze, and retention dressings, as well as improved wound healing together with the reduced costs of other care. Cost-effectiveness calculations comparing Aquacel Ag to standard of care in patients with acute and chronic wounds showed favorable results using Aquacel Ag.12-18
When using these dressings, the EP should make sure the follow-up clinic is familiar with their application so that they are not inadvertently removed at the patient’s first visit.
Medication Event Monitoring Systems
There have been a couple of recent changes in medication monitoring that are beginning to make manual pill-counting a thing of the past. Earlier generations of smart pill bottles came with a timer and an alarm that chimed and lit up to alert the patient when it was time to take his or her medication. Once the bottle was opened, the system reset itself. Unfortunately, the basic nature of these systems was not able to account for the number of pills a patient ingested at each scheduled dosing.
Smart Pill Bottle
An example of newer and more technologically advanced pill-monitoring systems is AdhereTech’s smart wireless pill bottle (AdhereTech, New York, New York). In this system, the pill bottle can be connected to a WiFi network, allowing medication information to be shared (Figure 5).19 For example, a user could have the bottle connected to his or her provider, home healthcare worker, and family member. If a patient misses a dose of medication, the appropriate person receives notification and can make contact with the patient or family member to intervene. As with earlier generation products, these systems cannot account for or prevent a patient from either overdosing or underdosing on a medication.
The patch and sensor-enabled pill system, the Ingestible Event Marker, (Proteus Digital Health, Redwood City, California), which became available this past year, provides more advanced medication monitoring.20 This system allows tracking of individual pills through small chips imbedded in the tablet (Figure 6). The chip is then monitored through a patch worn on the patient’s body. Once connected, the physician is able to not only track when a pill bottle is opened, but also when and how many tablets the patient is ingesting. Moreover, the system has the ability to perform physiologic tracking to monitor patient response to the medication.21