Ultrasound-guided oblique approach for peripheral venous access in a phantom model

Area of Science:

• Medical Imaging
• Ultrasound Technology
• Vascular Access

Background:

• Traditional ultrasound (US) vascular guidance uses transverse (T) and longitudinal (L) axes, each presenting limitations.
• A novel oblique (O) approach was hypothesized to enhance US-guided peripheral venous access success.
• This study evaluated emergency physician (EP) performance with the O approach using a gel US phantom.

Purpose of the Study:

• To assess the efficacy of a novel oblique (O) ultrasound approach for peripheral venous access compared to traditional transverse (T) and longitudinal (L) methods.
• To evaluate emergency physician performance across different experience levels using these US guidance techniques.

Main Methods:

• A prospective, case-control study enrolled EPs from postgraduate years 1-3 (PGY1-PGY3) and attending physicians.
• Participants performed simulated vessel aspiration using a linear probe in T, L, and O axes on a gel US phantom after brief training.
• Time to aspiration and number of attempts were recorded, with randomized approach order and descriptive statistics.

Main Results:

• The first-attempt success rate was lower for the O approach (45.83%) compared to T (70.83%) and L (83.33%).
• Average time to aspiration was 12.5s for O, versus 9.47s for T and 9.74s for L.
• No significant differences were found in total time or attempts across experience levels, though PGY3 and attending physicians showed a trend toward quicker, fewer attempts.

Conclusions:

• In this pilot study using a simulated model, the novel oblique (O) ultrasound approach did not demonstrate superior success rates compared to transverse (T) and longitudinal (L) techniques for peripheral venous access.
• Further research may be needed to explore the potential of the O approach or refine its application.