Posterior Wall Punctures Between Long- and Short-Axis Techniques in a Phantom Intravenous Model

Area of Science:

• Medical Education
• Ultrasound Technology
• Vascular Access Procedures

Background:

• Ultrasound-guided vascular access is crucial for patient care.
• Novice practitioners face challenges in mastering ultrasound-guided techniques.
• Minimizing complications like posterior wall punctures is a key training objective.

Purpose of the Study:

• To compare the efficacy of long-axis, in-plane versus short-axis, out-of-plane approaches for novice ultrasound-guided vascular access.
• To evaluate the impact of each approach on posterior wall punctures.
• To assess secondary outcomes including cannulation success, time to cannulation, and provider preference.

Main Methods:

• A randomized controlled trial was conducted using a ballistic gel phantom.
• Participants (novices without prior experience) were randomized to one approach, then crossed over to the alternative.
• Primary outcome: posterior wall puncture occurrences; Secondary outcomes: cannulation success, time, and preference.

Main Results:

• The long-axis, in-plane approach resulted in significantly fewer posterior wall punctures (2.5% vs. 15%).
• No significant differences were observed in cannulation success rates or time to cannulation.
• Novices reported better needle tip visualization and higher preference for the long-axis approach (80-85%).

Conclusions:

• The long-axis, in-plane approach is superior for novice ultrasound-guided vascular access training on phantoms.
• This technique leads to fewer posterior wall punctures and enhanced needle tip visualization.
• Higher user preference suggests improved learning experience and potential for better clinical outcomes.