Biplane Utilization Improves Accuracy for Peripheral IV Placement.

Abstract

Introduction: Ultrasound provides an advantage for obtaining vascular access in deep peripheral veins. Short-axis imaging gives the spatial relationship between the needle and the blood vessel, while long-axis allows for visualization of the whole length of the needle. Biplane imaging allows for simultaneous visualization of both views.

Methods: Thirty participants were enrolled to assess whether biplane imaging provided an advantage for placing intravenous (IV) catheters in a commercially available phantom. Volunteers then performed 6 ultrasound guided attempts to place an IV, with the ultrasound view randomized between either biplane or single-plane imaging. Wilcoxon signed-rank tests and Spearman correlation analyses were used for data analysis by the study biostatistician using SAS software version 9.4 (Cary, NC).

Results: Only one participant had prior experience with the biplane modality. Across both imaging modalities, prior experience and comfort with placing IVs with ultrasound were correlated with better performance. Biplane imaging had significantly fewer mean needle redirections, 1.5 versus 2.1 (p = 0.002), and fewer mean posterior vessel wall penetration complications, 0.1 versus 0.3 (p = 0.03). There was no statistically significant difference in time to successful placement or the number of attempts between conditions.

Discussion: While there was no significant difference in time to IV placement, other outcomes were consistent with the study's hypothesis that biplane imaging would provide an advantage. Further studies are needed to evaluate if skills performed on phantoms are transferable to patient care.