human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND It is not known whether the choice of topical anaesthetic influences the likelihood of successful i.v . cannulation in the paediatric population . The null hypothesis of this study was that no difference exists in the initial success rate of cannulation between two commonly used topical anaesthetics . METHODS A r and omized double-blind trial conducted on patients between the age of 12 months and 12 yr presenting to a tertiary hospital emergency department . Patients requiring cannulation were r and omized to either 4 % amethocaine gel ( AnGEL ) or 5 % lidocaine and prilocaine in a 1:1 emulsion ( EMLA ) . The primary endpoint was success of initial attempt at i.v . cannulation . RESULTS One hundred and seventy-seven patients were analysed of 203 enrolled . The success rate of AnGEL ( 73/97 , 75 % ) and EMLA ( 59/80 , 74 % ) did not significantly differ ( chi2(1 ) 0.05 , P=0.82 ) . CONCLUSIONS No difference exists in the cannulation success rates between the two anaesthetics . The choice of topical anaesthetic in paediatric cannulation should be based on other factors such as cost , time to anaesthesia , efficacy of the agent , and adverse effect profile R and omized controlled trial which aim ed to verify whether the use of vascular ultrasound ( VUS ) increases assertiveness in the use of  peripheral venous catheter in children , and the catheter dwell time , when compared to traditional puncture . Data were collected after approval of theethical merit . Children and adolescents undergoing VUS-guided peripheral intravenous ( GVUS ) or puncture guided by clinical assessment of the venous conditions(CG ) were included in the study . Significance level was set at p < or = 0.05 . The sample was composed of 382 punctures  , 188 ( 49.2 % ) in VUS G and 194 ( 50.8 % ) in CG , performed in 335 children . Assertiveness was found in 73 ( 71.6 % ) GVUS catheters and in 84(71.8 % ) of the CG ( p=0.970 ) , and catheter dwell time presented a median of less than one day in both groups ( p=0.121 ) , showing nostatistically significant difference . VUS did not significantly influence the results of the dependent variables investigated . Clinical Trials.govNCT00930254 Background : Topical anaesthetics reduce the pain of venous cannulation . The emergency department at the Starship Children ’s Hospital in Auckl and uses EMLA ( an eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine ) for topical anaesthesia . Amethocaine has recently been shown to be a more effective topical anaesthetic . It is suggested that , because amethocaine does not vasoconstrict veins , it may increase the success of cannulation . Aim : The primary aim was to determine if amethocaine improves the success of cannulation compared with EMLA . The secondary aim was to determine if amethocaine is a more effective topical anaesthetic in a children ’s emergency department . Methods : A parallel , r and omised , double-blind controlled study was performed in children aged 3 months to 15 years who were offered topical anaesthesia for venous cannulation .  Caregivers gave verbal consent at triage , followed by written consent . Children were r and omised into amethocaine or EMLA groups . Those who went on to have an intravenous cannula were analysed on an intention-to-treat basis . The primary outcome was a successful first attempt at cannulation . A convenience cohort was also observed for distress using a visual analogue scale and the Faces , Legs , Activity , Cry and Consolability Score . Results : From November 2006 to June 2007 , 2837 children were enrolled and 809 were known to have had intravenous cannulation . 679 complete data and consent forms were returned . There was no significant difference between the first attempt success rates ( 75.8 % amethocaine vs 73.9 % EMLA ) or between pain scores for the 65 observed cannulations . Conclusion : Amethocaine is not more successful than EMLA for first attempt intravenous cannulation in a children ’s emergency department . Trial registration number : Australian New Zeal and Clinical Trials Register ACTRN12606000409572 OBJECTIVES To assess the implementation and utility of US for assisting peripheral venous access in a paediatric ED . METHODS A prospect i ve , observational study of a convenience sample comparing the l and mark and US-guided technique for peripheral vascular access in children from July 2006 to February 2007 . Clinicians involved under went 3 months of training in US physics and with practical models . Clinicians estimated the degree of difficulty of insertion ( using a Likert scale ) before each line placement . Data including time of procedure and success or failure were collected , using a st and ardized clinical record form , by an observing research er . RESULTS A total of 84 patients were enrolled . There were 61 line placement episodes in the l and mark group ( with 253 attempts ) , and 38 in the US group ( with 90 attempts ) . US recorded slightly higher success per attempt overall ( 42 % vs 38 % , P=0.08 ) , and performed better in the patients with difficult access ( success 35 % vs 18 % , P=0.003 ) .  US attempts took longer than l and mark attempts ( 2 min 15 s vs 4 min , P<0.001 ) . CONCLUSION The US guidance may improve the success rate of peripheral vascular access in children rated to have difficult or very difficult vascular access Objectives : To determine whether the use of a near-infrared light venipuncture aid ( VeinViewer ; Luminetx Corporation , Memphis , Tenn ) would improve the rate of successful first-attempt placement of intravenous ( IV ) catheters in a high-volume pediatric emergency department ( ED ) . Methods : Patients younger than 20 years with st and ard clinical indications for IV access were r and omized to have IV placement by ED nurses ( in 3 groups stratified by 5-year blocks of nursing experience ) using traditional methods ( st and ard group ) or with the aid of the near-infrared light source ( device group ) . If a vein could not be cannulated after 3 attempts , patients crossed over from one study arm to the other , and study nurses attempted placement with the alternative technique . The primary end point was first-attempt success rate for IV catheter placement . After completion of patient enrollment , a question naire was completed by study nurses as a qualitative assessment of the device . Results : A total of 123 patients ( median age , 3 years ) were included in the study : 62 in the st and ard group and 61 in the device group . There was no significant difference in first-attempt success rate between the st and ard ( 79.0 % , 95 % confidence interval [ CI ] , 66.8%-88.3 % ) and device ( 72.1 % , 95 % CI , 59.2%-82.9 % ) groups . Of the 19 study nurses , 14 completed the question naire of whom 70 % expressed neutral or unfavorable assessment s of the device in nondehydrated patients without chronic underlying medical conditions and 90 % found the device a helpful tool for patients in whom IV access was difficult . Conclusions : First-attempt success rate for IV placement was nonsignificantly higher without than with the assistance of a near-infrared light device in a high-volume pediatric ED . Nurses placing IVs did report several benefits to use of the device with specific patient groups , and future research should be conducted to demonstrate the role of the device in these patients OBJECTIVE : Intravenous cannulation is a widespread medical procedure that can be difficult in children . Visualization of veins with near-infrared ( NIR ) light might support intravenous cannulation . Therefore , we investigated the effectiveness of an NIR vascular imaging system ( VascuLuminator ) in facilitating intravenous cannulation in children in the operating room . METHODS : This was a pragmatic , cluster r and omized clinical trial in all consecutive children ( 0–18 years ) scheduled for elective surgery and in need of intravenous cannulation at a tertiary pediatric referral hospital . Daily operating rooms ( 770 patients ) were r and omized for allocation of the VascuLuminator or control group . The primary outcome was success at first attempt ; the secondary outcome was time to successful cannulation . RESULTS : Success at first attempt was 70 % ( 171/246 ) with and 71 % ( 175/245 ) without the use of the VascuLuminator ( P = .69 ) . Time to successful cannulation was 162 ( ±14 ) seconds and 143 ( ±15 ) seconds respectively ( P = .26 ) . In 83.3 % , the vein of first choice was visible with the VascuLuminator . CONCLUSIONS : Although it was possible to visualize veins with NIR in most patients , the VascuLuminator did not improve success rate or time to obtain intravenous cannulation . There are 3 possible explanations for this result : first , it could be that localization of the vein is not the main problem , and therefore visualization is not a solution ; second , the type of system used in this study could be less than optimal ; and , third , the choice of the patient population in this study could be inappropriate OBJECTIVES Ultrasound-guided peripheral venous access ( USG-PIVA ) presents many advantages over the reference ' blind ' technique in both adults and children in emergency situations . AIM To compare USG-PIVA with the blind technique in children <3 years undergoing general anesthesia . METHODS After obtaining the approval of the ethics committee and informed consent from the parents , we included all children <3 years scheduled to undergo general anesthesia [ surgery , magnetic resonance imaging ( MRI ) ] , who presented difficult venous access . The children were r and omized into two groups : the US group ( USG-PIVA ) and the B group ( blind ) . The primary endpoint was time to cannulation ( from tourniquet placement to successful IV cannulation ) , compared between USG-PIVA group and B group by intention-to-treat analysis . Secondary outcomes were success rate at the first puncture , number of punctures , and diameter of the catheters . Cannulations requiring > 15 min were considered as failures . In case of failure in group B , USG-PIVA was attempted for a further 15 min . RESULTS Twenty children were included in each group . Groups were comparable for sex , age , and BMI . Significant differences were observed in median time to cannulation ( 63.5 s vs 420.5 s , USG-PIVA vs B respectively , P < 0.001 ) ; median number of punctures ( 1 vs 2.5 , USG-PIVA vs B , P = 0.004 ) ; and success rate at first cannulation ( 85 % vs 35 % , USG-PIVA vs B , P = 0.0012 ) . In contrast , overall success rate did not differ significantly between groups ( 90 % vs 85 % , USG-PIVA vs B , P = 0.63 ) . CONCLUSIONS Ultrasound-guided peripheral venous access leads to faster peripheral IV access and should therefore be recommended in children presenting with difficult venous access Background : Peripheral intravenous catheterization in children is challenging , and success rates vary greatly . We conducted a pragmatic r and omized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the st and ard approach in achieving successful catheter placement on the first attempt . Methods : We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012 . We stratified them by age ( ≤ 3 yr and > 3 yr ) and r and omly assigned them to undergo the procedure with the st and ard approach , or with the help of either ultrasound or near-infrared vascular imaging . The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt . Results : The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the st and ard approach group ( differences in proportions −3.9 % , 95 % confidence interval [ CI ] −14.2 % to 6.5 % , for ultrasound imaging ; −8.7 % , 95 % CI −19.4 % to 1.9 % , for near-infrared imaging ) . Among children 3 years and younger , the difference in success rates relative to st and ard care was also not significant for ultrasound imaging ( −9.6 % , 95 % CI −29.8 % to 10.6 % ) , but it was significantly worse for near-infrared imaging ( −20.1 % , 95 % CI −40.1 % to −0.2 % ) . Among children older than 3 years , the differences in success rates relative to st and ard care were smaller but not significant ( −2.3 % , 95 % CI −13.6 % to 9.0 % , for ultrasound imaging ; −4.1 % , 95 % CI −15.7 % to 7.5 % , for near-infrared imaging ) . None of the pairwise comparisons were statistically significant in any of the outcomes 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND It is not known whether the choice of topical anaesthetic influences the likelihood of successful i.v . cannulation in the paediatric population . The null hypothesis of this study was that no difference exists in the initial success rate of cannulation between two commonly used topical anaesthetics . METHODS A r and omized double-blind trial conducted on patients between the age of 12 months and 12 yr presenting to a tertiary hospital emergency department . Patients requiring cannulation were r and omized to either 4 % amethocaine gel ( AnGEL ) or 5 % lidocaine and prilocaine in a 1:1 emulsion ( EMLA ) . The primary endpoint was success of initial attempt at i.v . cannulation . RESULTS One hundred and seventy-seven patients were analysed of 203 enrolled . The success rate of AnGEL ( 73/97 , 75 % ) and EMLA ( 59/80 , 74 % ) did not significantly differ ( chi2(1 ) 0.05 , P=0.82 ) . CONCLUSIONS No difference exists in the cannulation success rates between the two anaesthetics . The choice of topical anaesthetic in paediatric cannulation should be based on other factors such as cost , time to anaesthesia , efficacy of the agent , and adverse effect profile R and omized controlled trial which aim ed to verify whether the use of vascular ultrasound ( VUS ) increases assertiveness in the use of  peripheral venous catheter in children , and the catheter dwell time , when compared to traditional puncture . Data were collected after approval of theethical merit . Children and adolescents undergoing VUS-guided peripheral intravenous ( GVUS ) or puncture guided by clinical assessment of the venous conditions(CG ) were included in the study . Significance level was set at p < or = 0.05 . The sample was composed of 382 punctures  , 188 ( 49.2 % ) in VUS G and 194 ( 50.8 % ) in CG , performed in 335 children . Assertiveness was found in 73 ( 71.6 % ) GVUS catheters and in 84(71.8 % ) of the CG ( p=0.970 ) , and catheter dwell time presented a median of less than one day in both groups ( p=0.121 ) , showing nostatistically significant difference . VUS did not significantly influence the results of the dependent variables investigated . Clinical Trials.govNCT00930254 Background : Topical anaesthetics reduce the pain of venous cannulation . The emergency department at the Starship Children ’s Hospital in Auckl and uses EMLA ( an eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine ) for topical anaesthesia . Amethocaine has recently been shown to be a more effective topical anaesthetic . It is suggested that , because amethocaine does not vasoconstrict veins , it may increase the success of cannulation . Aim : The primary aim was to determine if amethocaine improves the success of cannulation compared with EMLA . The secondary aim was to determine if amethocaine is a more effective topical anaesthetic in a children ’s emergency department . Methods : A parallel , r and omised , double-blind controlled study was performed in children aged 3 months to 15 years who were offered topical anaesthesia for venous cannulation .  Caregivers gave verbal consent at triage , followed by written consent . Children were r and omised into amethocaine or EMLA groups . Those who went on to have an intravenous cannula were analysed on an intention-to-treat basis . The primary outcome was a successful first attempt at cannulation . A convenience cohort was also observed for distress using a visual analogue scale and the Faces , Legs , Activity , Cry and Consolability Score . Results : From November 2006 to June 2007 , 2837 children were enrolled and 809 were known to have had intravenous cannulation . 679 complete data and consent forms were returned . There was no significant difference between the first attempt success rates ( 75.8 % amethocaine vs 73.9 % EMLA ) or between pain scores for the 65 observed cannulations . Conclusion : Amethocaine is not more successful than EMLA for first attempt intravenous cannulation in a children ’s emergency department . Trial registration number : Australian New Zeal and Clinical Trials Register ACTRN12606000409572 OBJECTIVES To assess the implementation and utility of US for assisting peripheral venous access in a paediatric ED . METHODS A prospect i ve , observational study of a convenience sample comparing the l and mark and US-guided technique for peripheral vascular access in children from July 2006 to February 2007 . Clinicians involved under went 3 months of training in US physics and with practical models . Clinicians estimated the degree of difficulty of insertion ( using a Likert scale ) before each line placement . Data including time of procedure and success or failure were collected , using a st and ardized clinical record form , by an observing research er . RESULTS A total of 84 patients were enrolled . There were 61 line placement episodes in the l and mark group ( with 253 attempts ) , and 38 in the US group ( with 90 attempts ) . US recorded slightly higher success per attempt overall ( 42 % vs 38 % , P=0.08 ) , and performed better in the patients with difficult access ( success 35 % vs 18 % , P=0.003 ) .  US attempts took longer than l and mark attempts ( 2 min 15 s vs 4 min , P<0.001 ) . CONCLUSION The US guidance may improve the success rate of peripheral vascular access in children rated to have difficult or very difficult vascular access Objectives : To determine whether the use of a near-infrared light venipuncture aid ( VeinViewer ; Luminetx Corporation , Memphis , Tenn ) would improve the rate of successful first-attempt placement of intravenous ( IV ) catheters in a high-volume pediatric emergency department ( ED ) . Methods : Patients younger than 20 years with st and ard clinical indications for IV access were r and omized to have IV placement by ED nurses ( in 3 groups stratified by 5-year blocks of nursing experience ) using traditional methods ( st and ard group ) or with the aid of the near-infrared light source ( device group ) . If a vein could not be cannulated after 3 attempts , patients crossed over from one study arm to the other , and study nurses attempted placement with the alternative technique . The primary end point was first-attempt success rate for IV catheter placement . After completion of patient enrollment , a question naire was completed by study nurses as a qualitative assessment of the device . Results : A total of 123 patients ( median age , 3 years ) were included in the study : 62 in the st and ard group and 61 in the device group . There was no significant difference in first-attempt success rate between the st and ard ( 79.0 % , 95 % confidence interval [ CI ] , 66.8%-88.3 % ) and device ( 72.1 % , 95 % CI , 59.2%-82.9 % ) groups . Of the 19 study nurses , 14 completed the question naire of whom 70 % expressed neutral or unfavorable assessment s of the device in nondehydrated patients without chronic underlying medical conditions and 90 % found the device a helpful tool for patients in whom IV access was difficult . Conclusions : First-attempt success rate for IV placement was nonsignificantly higher without than with the assistance of a near-infrared light device in a high-volume pediatric ED . Nurses placing IVs did report several benefits to use of the device with specific patient groups , and future research should be conducted to demonstrate the role of the device in these patients OBJECTIVE : Intravenous cannulation is a widespread medical procedure that can be difficult in children . Visualization of veins with near-infrared ( NIR ) light might support intravenous cannulation . Therefore , we investigated the effectiveness of an NIR vascular imaging system ( VascuLuminator ) in facilitating intravenous cannulation in children in the operating room . METHODS : This was a pragmatic , cluster r and omized clinical trial in all consecutive children ( 0–18 years ) scheduled for elective surgery and in need of intravenous cannulation at a tertiary pediatric referral hospital . Daily operating rooms ( 770 patients ) were r and omized for allocation of the VascuLuminator or control group . The primary outcome was success at first attempt ; the secondary outcome was time to successful cannulation . RESULTS : Success at first attempt was 70 % ( 171/246 ) with and 71 % ( 175/245 ) without the use of the VascuLuminator ( P = .69 ) . Time to successful cannulation was 162 ( ±14 ) seconds and 143 ( ±15 ) seconds respectively ( P = .26 ) . In 83.3 % , the vein of first choice was visible with the VascuLuminator . CONCLUSIONS : Although it was possible to visualize veins with NIR in most patients , the VascuLuminator did not improve success rate or time to obtain intravenous cannulation . There are 3 possible explanations for this result : first , it could be that localization of the vein is not the main problem , and therefore visualization is not a solution ; second , the type of system used in this study could be less than optimal ; and , third , the choice of the patient population in this study could be inappropriate OBJECTIVES Ultrasound-guided peripheral venous access ( USG-PIVA ) presents many advantages over the reference ' blind ' technique in both adults and children in emergency situations . AIM To compare USG-PIVA with the blind technique in children <3 years undergoing general anesthesia . METHODS After obtaining the approval of the ethics committee and informed consent from the parents , we included all children <3 years scheduled to undergo general anesthesia [ surgery , magnetic resonance imaging ( MRI ) ] , who presented difficult venous access . The children were r and omized into two groups : the US group ( USG-PIVA ) and the B group ( blind ) . The primary endpoint was time to cannulation ( from tourniquet placement to successful IV cannulation ) , compared between USG-PIVA group and B group by intention-to-treat analysis . Secondary outcomes were success rate at the first puncture , number of punctures , and diameter of the catheters . Cannulations requiring > 15 min were considered as failures . In case of failure in group B , USG-PIVA was attempted for a further 15 min . RESULTS Twenty children were included in each group . Groups were comparable for sex , age , and BMI . Significant differences were observed in median time to cannulation ( 63.5 s vs 420.5 s , USG-PIVA vs B respectively , P < 0.001 ) ; median number of punctures ( 1 vs 2.5 , USG-PIVA vs B , P = 0.004 ) ; and success rate at first cannulation ( 85 % vs 35 % , USG-PIVA vs B , P = 0.0012 ) . In contrast , overall success rate did not differ significantly between groups ( 90 % vs 85 % , USG-PIVA vs B , P = 0.63 ) . CONCLUSIONS Ultrasound-guided peripheral venous access leads to faster peripheral IV access and should therefore be recommended in children presenting with difficult venous access Background : Peripheral intravenous catheterization in children is challenging , and success rates vary greatly . We conducted a pragmatic r and omized controlled trial to determine whether the use of ultrasound or near-infrared vascular imaging to guide catheterization would be more effective than the st and ard approach in achieving successful catheter placement on the first attempt . Methods : We enrolled a convenience sample of 418 children in a pediatric emergency department who required peripheral intravenous catheterization between June 2010 to August 2012 . We stratified them by age ( ≤ 3 yr and > 3 yr ) and r and omly assigned them to undergo the procedure with the st and ard approach , or with the help of either ultrasound or near-infrared vascular imaging . The primary outcome was the proportion of patients who had successful placement of a catheter on the first attempt . Results : The rate of successful first attempts did not differ significantly between either of the 2 intervention groups and the st and ard approach group ( differences in proportions −3.9 % , 95 % confidence interval [ CI ] −14.2 % to 6.5 % , for ultrasound imaging ; −8.7 % , 95 % CI −19.4 % to 1.9 % , for near-infrared imaging ) . Among children 3 years and younger , the difference in success rates relative to st and ard care was also not significant for ultrasound imaging ( −9.6 % , 95 % CI −29.8 % to 10.6 % ) , but it was significantly worse for near-infrared imaging ( −20.1 % , 95 % CI −40.1 % to −0.2 % ) . Among children older than 3 years , the differences in success rates relative to st and ard care were smaller but not significant ( −2.3 % , 95 % CI −13.6 % to 9.0 % , for ultrasound imaging ; −4.1 % , 95 % CI −15.7 % to 7.5 % , for near-infrared imaging ) . None of the pairwise comparisons were statistically significant in any of the outcomes 
    Output:
    