Virtual Ultrasound-Guided Central Vascular Access Using Apple Vision Pro: An Evaluation and Proof of Concept

Central venous catheter (CVC) insertion is a frequently performed procedure that requires precise hand-eye coordination and image interpretation. Despite ultrasound guidance being the standard of care, some problems, especially in ergonomics, like misalignment between the ultrasound monitors and the puncture site, remain a challenge. This study aimed to assess the integration of real-time ultrasound imaging into the Apple Vision Pro (AVP) headset (Apple Inc., Cupertino, CA) for ultrasound-guided CVC cannulation in a simulated environment. Specifically, we aimed to (1) evaluate technical feasibility, (2) quantify usability using an adjusted system usability questionnaire, and (3) compare usability perceptions across different experience levels.

In a prospective, observational pilot study, 42 intensivists performed CVC cannulation on a mannequin using a wireless ultrasound probe (GE Vscan Air™ CL, GE Healthcare, Chicago, IL) and AVP. Participants were grouped according to their experience and assessed through an evaluation that included a usability questionnaire, an observer checklist, and qualitative interviews. Usability, image quality, subjective satisfaction, and task performance were evaluated.

Both junior and senior participants gave high ratings for the system's usability, image clarity, and educational potential, with no significant differences between groups. Notable strengths included intuitive handling, improved ergonomics, and precise image placement. The challenges identified were image resolution in the near field, as well as depth perception. Qualitative feedback supported the innovational character of the system and its potential sterile workflow.

Integrating real-time ultrasound guidance into the AVP is feasible and highly rated by users with varying levels of experience. This concept promises to improve ergonomics, the CVC accuracy, and medical education. Further studies in clinical environments are needed to validate our findings and the impact on patient outcomes.