Augmented Reality Meets Nursing in Evena’s Vein-Hunting Glasses

Augmented Reality Meets Nursing in Evena’s Vein-Hunting Glasses

The first time I heard about Evena Medical’s new computer-powered glasses, I immediately thought of two obvious user groups for them. Nurses, and vampires.

Good thing vampires aren’t real.

If you’re looking for veins, Evena’s glasses can reveal them with a high-tech 3D light imaging system that maps the body’s vasculature. Nurses, unlike vampires, have a humane and compelling need for a better view of all those blood vessels lying beneath the skin. One of their most common tasks is to set up an intravenous line so that patients can receive fluids containing drugs or nourishment, or so blood can be drawn for diagnosis. But finding and correctly piercing a vein with a needle can be a sticky job.

“It’s a simple procedure, but not an easy procedure,” Evena CEO Frank Ball told me.

Ball didn’t need to persuade me of that much. As one of those people with tiny, elusive veins, I am the bane of the LabCorp technicians when I go in for occasional blood tests. But until I talked to Ball, I didn’t realize how complex and thorny a practice it is to gain intravenous access in many kinds of patients.

Nurses care for very ill people whose veins have already been frequently punctured, babies with minuscule veins, and very heavy patients whose veins are particularly hard to find. Evena estimates that in 60 percent of children and 40 percent of adults, nurses have to try more than once to access a vein. Sometimes the vein that’s easiest to find isn’t the best one to use, Ball said.

“It could be a large vein that has poor flow,” Ball said. Delays in establishing an IV line, or failures of compromised veins, can interfere with treatment and cause serious complications.

And then there’s long-term treatment strategy. For people such as diabetics, nurses want to preserve certain veins for the day when the patient may need dialysis. Ball says Evena’s glasses can reveal other veins as alternatives.

Los Altos, CA-based Evena has figured out how to use light at certain wavelengths to visualize the blood flowing through the veins—which amounts to a picture of the vessels themselves. When a nurse wearing the Evena Eyes-On Glasses looks at a patient’s arm, built-in cameras capture images of the veins, peering past the skin layer.

Veins visualized using Evena's Eyes-On glasses.

Veins visualized using Evena’s Eyes-On glasses.

A computer in the device integrates the images generated using four different wavelengths. Evena doesn’t reveal the exact wavelengths, but they include the near infrared part of the spectrum. The device is tuned to detect only veins, while dialing out arteries. The computer projects a 3D view of the vasculature onto the clear lenses of the Evena glasses. But wearers can still look past the transparent “vein map” before their eyes, and see what’s going on in the room.

“A nurse likes to see the patient’s eyes,” Ball said.

Evena had been working on the glasses for some time, Ball told me, but the 9-employee company had a breakthrough last May when it teamed up with Epson, maker of the Moverio “smart glasses” platform used by developers of augmented reality games.

When Ball and Evena’s chief financial officer David Gruebele talked to me recently, they were taking a breather from a two-month whirlwind of tech and healthcare conferences where the first public demos of the Eyes-On glasses drew a flurry of news stories. Gruebele says the tech watchers were excited to see one of the first medical applications of an imaging gizmo usually confined to consumer-oriented gamer products.

“Augmented reality becomes a life-saving, medical computing platform,” Gruebele said.

The Evena demo team were frequently asked to describe the difference between the Eyes-On glasses and Google Glass, the tech giant’s wearable Web interface. As Ball explains it, Evena’s eyewear projects the image of the veins front and center in the user’s near field of view, while Google’s headset shows messages, such as map directions or search results, in a side corner of the user’s field of vision.

Evena’s glasses were designed as an improvement on the company’s own Evena OWL product, a 10-inch tablet version of the multi-spectral vein imaging system that was launched in early 2013. The tablet, which can be connected to a rolling computer cart, is positioned over the area of the patient’s body where the veins are sought for an IV. The OWL, however, requires nurses to swivel their heads between the patient and the tablet screen, Ball said. And nurses are also tired of the thicket of carts that crowd hospital rooms, he told me.

“They call it ‘the forest,’ ’’ Ball said. Evena’s glasses, which are powered by a battery pack on a belt worn by the nurse, can send images of the patient’s veins to hospital electronic records systems via Bluetooth, 3G, or Wi-Fi.

A nurse whose comment I found in a Web search wondered whether Evena’s glasses would work on patients with darker skin—a factor that can make IV insertion harder.

Ball said the device can look through denser skin pigment to detect the veins. The company also has a solution for overweight patients. Evena’s glasses, as well as the OWL system, have an accessory that uses ultrasound to reveal veins located farther beneath the skin surface.

An IV needle is intended to penetrate one wall of a vein to reach the inside of the vessel. But one common problem with inserting the needle is that it can go straight through and puncture the back wall of the vein as well. The consequences of this “double-wall stick” may not be detected for hours, Ball said. In the meantime, blood leaks out of the hole into the surrounding tissues. This can cause swelling, pain and inflammation. And a portion of any drug being delivered through the IV may also leak out, leaving the patient undermedicated.

With the Evena glasses, nurses can detect a double-wall puncture immediately, Ball said. In the 3D image of the vein, the edge of the back wall will blur, and the blood flowing out of the hole will show a cauliflowering pattern, he said.

Even when an IV has been inserted successfully, nurses must check every eight hours to make sure the vein has maintained a good rate of flow, Ball said. To do this, nurses traditionally inject a clear slug of saline solution through the IV, and then feel the arm for the small bulge as the salty fluid moves down the vein. It’s a pretty subjective test.

“These saline slug tests are big time consumers for the nurses,” Ball said.

With the Evena glasses, a nurse can immediately see the slug of clear salt water moving through the vessel, pushing the darker blood ahead of it, Ball said.

Evena hopes to persuade hospitals and clinics that its glasses will save them both time and money. Gruebele estimates that if a typical 200-bed US hospital adopted the glasses in routine practice, its initial outlay would be about $500,000. But the savings could be as much as $2.3 million a year in increased efficiency, needle kit costs, labor, and the avoidance of IV-related complications that can extend hospital stays for patients, Gruebele said.

Ball said the company collected a backlog of pre-orders during its demo weeks, and plans to be ready for full production of the glasses by April. Evena announced recently that a medical products distributor in China has placed a $6.4 million order.

Even if hospitals are interested, however, Evena executives know that winning over nurses is the key to mass adoption. They have to find the glasses easy to use. Gruebele said the company has been spending more time recently on the ergonomics and miniaturization of the product than it has on the core imaging technology.

“The physics is the easy part,” Gruebele said.

Before Evena developed its Eyes-On glasses, the company had considered making wearable vein-finder devices in the form of a hat or helmet, Gruebele said. But the designers realized that nurses didn’t want to scare their patients by appearing like some sort of alien visitor. They also didn’t want their hair to end up looking like a fright wig every time they took off the helmet.

The glasses Evena developed can be worn over a health care worker’s own prescription glasses, but future models will be able to incorporate corrective lenses, Gruebele said. Beyond that, Evena plans to amp up the fashion sense of the glasses, and even their “sexiness,” he said.

Hearing that, I started thinking about a futuristic movie plot with hordes of glamorous high-tech Draculas wearing these things.

“How do you keep this out of the hands of vampires?” I actually asked the chief executive officer of a Silicon Valley medtech company.

Ball didn’t miss a beat.

“They’re our best customers,” Ball said.

Here’s an Evena video explaining the system; watch for the vein visualization at 0:41.

The Author

Bernadette Tansey is a freelance journalist based in Berkeley, CA.

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  • Dave Smith

    How do they project the image onto the Glass.. Or is it transmitted to a Computer Screen and how does that help the Nurse sticking the patient?