A Randomized Study of Biplane Imaging in Ultrasound-Guided Peripheral Vascular Access Performed by Novice Operators

Ultrasound guidance results in improved safety and success for vascular access procedures. Imaging can be performed in the short- or long-axis orientation; with each offering benefits and limitations. New technology has allowed for the deployment of the novel 'biplane' approach, wherein both the short and long axis can be viewed simultaneously.

The purpose of this study was to determine if the 'biplane' approach to ultrasound-guided vascular access improves competency in ultrasound-guided peripheral intravenous (USGIV) catheter placement among medical student trainees.

From November 2022 to February 2024, medical students on their required fourth-year emergency medicine rotation were randomized to either biplane ultrasound or traditional ultrasound guidance for USGIV placement on phantom models. Outcomes evaluated included perceived difficulty, time to placement, number of needlesticks, and number of posterior wall punctures.

Ninety-eight students were enrolled, with 51 randomized to biplane and 47 to the traditional ultrasound approach. Average time to successful placement was 64.4 s in the biplane arm (standard deviation [SD] 43 s) and 73 s in the traditional arm (SD 37 s), p = 0.29. Mean number of needlesticks for the biplane and traditional groups was 1.10 (SD 0.3) and 1.06 (SD 0.44), respectively, p = 0.65. Average number of posterior wall punctures for the biplane and traditional groups was 0.14 (SD 0.4) and 0.45 (SD 0.8) respectively, p = 0.019.

In a cohort of medical students with minimal prior experience in USGIV placement, biplane imaging was not associated with reduction in time to successful USGIV placement, but was associated with a reduction in posterior wall punctures.