A Randomized Study of Training with Large Versus Small Vessel Size On Successful Ultrasound Guided Peripheral Venous Access

Introduction Obtaining intravenous (IV) access is a fundamental skill in which healthcare professionals must be trained. It is essential for laboratory analysis, medication administration, and fluid infusion. The use of... [ view full abstract ]

Introduction

Obtaining intravenous (IV) access is a fundamental skill in which healthcare professionals must be trained. It is essential for laboratory analysis, medication administration, and fluid infusion. The use of ultrasonography for obtaining vascular access is increasingly becoming incorporated into guidelines and clinical practice.

With the increase in ultrasound-guided peripheral IV, understanding how to teach ultrasound-guided peripheral access will be increasingly important. One variable that has not been studied is the type of vascular simulation models (“phantoms”) that is used for training. We hypothesized that training on phantoms with smaller vessels would improve success rate in novice medical students learning USGPIV.

Methods

Students who participated in a voluntary, extracurricular ultrasound training day were asked to participate in the study as part of their procedural training. They were given a standardized education and demonstration of how to use ultrasound to place a peripheral IV. They were then allowed to practice on a homemade phantom models with either a 5mm diameter simulated vessel or a 2.5mm one. The simulated vessels were made of balloons filled with ultrasound gel and the simulated soft tissue was made of a 3:1 ratio of gelatin and psyllium fiber. Each student was allowed three attempts at vessel cannulation on their respective phantom.

After their training and three practice attempts, each student was observed by one of the researchers completing a USGPIV attempt on one of three large vessel test phantoms. The researcher recorded success rate, number of sticks, number of redirects, time to cannulation, and total time including setup. After their observed test, each student completed a brief demographic survey, including age, gender, year in medical school, previous USGPIV exposure, previous US exposure, whether or not they played video games as a child, and whether or not they own a smart phone.

Results

Fifty-one students from 5 institutions were included in the analysis. The average time to cannulation between both groups was 79.2 seconds and the success rate was 86% (44/51, Table 2). Overall, 6 students (11.8%) had more than one stick, and the average number of redirects per student was 4.28. There were no statistically significant differences between the small and large vessel groups on any of the variables measured. Of note, the group that reported having video game exposure had a statistically significant higher overall success rate of 97% (v. 70%, p<.01).

Conclusion

In our small sample, there was no difference in success rate of novice students trained in ultrasound-guided peripheral IV access using either a smaller or a larger vessel phantom. Future work should focus on elucidating other aspects of training in ultrasound-guided procedures and should attempt a similar study with a larger sample size.