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

Abstract

{UNLABELLED}{ABSTRACT:}{BACKGROUND}Ultrasound ({US)} vascular guidance is traditionally performed in transverse (T) and longitudinal (L) axes, each with drawbacks. We hypothesized that the introduction of a novel oblique (O) approach would improve the success of {US-guided} peripheral venous access. We examined emergency physician ({EP)} performance using the O approach in a gel {US} phantom.{METHODS}In a prospective, case control study, {EPs} were enrolled from four levels of physician experience including postgraduate years one to three ({PGY1}, {PGY2}, {PGY3)} and attending physicians. After a brief training session, each participant attempted vessel aspiration using a linear probe in T, L, and O axes on a gel {US} phantom. Time to aspiration and number of attempts to aspiration were recorded. The approach order was randomized, and descriptive statistics were used.{RESULTS}Twenty-four physicians participated. The first-attempt success rate was lower for O, 45.83%, versus 70.83% for T (p = 0.03) and 83.33% for L (p = 0.01). The average time to aspiration was 12.5 s (O) compared with 9.47 s (T) and 9.74 s (L), respectively. There were no significant differences between all four groups in regard to total amount of time and number of aspiration attempts; however, a trend appeared revealing that {PGY3} and attending physicians tended to aspirate in less time and by fewer attempts in all three orientations when compared with the {PGY2} and {PGY1} physicians.{CONCLUSION}In this pilot study, {US-guided} simulated peripheral venous access using a phantom gel model in a mixed user group showed that the novel oblique approach was not initially more successful versus T and L techniques.