In Situ vs. Monitor-Based: Evaluating Augmented Reality for Ultrasound-Guided Peripheral Venous Catheter Insertion

Ultrasound-guided placement of peripheral venous catheters (PVCs) is a cognitively demanding routine medical procedure that requires operators to constantly divide their attention between the ultrasound display and the spatial relationship among the probe, the needle, and the vein. As a result of this difficulty, the procedure is associated with a high complication rate for patients. The goal of this paper is to evaluate the potential of augmented reality (AR) to facilitate the procedure for clinicians by displaying ultrasound (US) images in situ. To do so, we conducted a mixed-design user study involving 30 healthcare professionals (9 experts and 21 novices). The study was conducted within a virtual reality (VR) environment to provide a standardized and controlled setting. We compared two visualization modes: a conventional monitor-based setup replicating the standard clinical display, and an AR-assisted interface where the ultrasound image is spatially anchored directly under the probe and augmented with real-time distance cues. Participants performed ten insertions per condition. We measured procedure time, successful insertion attempts, tissue perforations, and needle-beam alignment accuracy, while also assessing perceived workload (NASA-TLX) and system usability (SUS). Experts completed the procedure in 524.2±154 s with AR, compared to 1125.7±472 s using the traditional monitor-based layout, whereas novices completed the procedure in 746±410 s, compared to 1165±597 s. Spatial accuracy in novices increased from 50.6±8.2% to 65.9±13.6%, corresponding to a reduction in mean targeting error from 1.26 mm to 0.79 mm. The AR condition also greatly reduced tissue perforations in novices, decreasing from 29.4±45.6 to 3.0±2.7. Participants reported a lower perceived workload with AR, which indicates that placing the ultrasound image directly under the probe helps reduce attention shifts and supports spatial understanding. These findings demonstrate that AR-based in situ visualization can meaningfully enhance the efficiency, accuracy, and safety of ultrasound-guided procedures.