Biplane Imaging Versus Standard Transverse Single-Plane Imaging for Ultrasound-Guided Peripheral Intravenous Access: A Prospective Controlled Crossover Trial

Abstract

Obtaining peripheral IV access in critically ill patients is often challenging especially for novice providers. The availability of biplane imaging for ultrasound guided peripheral access has the potential to improve successful venous cannulation compared with standard plane imaging.

Design: Single-center quasi-randomized (alternate allocation) crossover trial.

Setting: Surgical ICU at the Massachusetts General Hospital.

Subjects: Twenty surgical ICU nurses with no prior experience using ultrasound for peripheral IV were enrolled.

Interventions: All participants viewed instructional videos on single-plane and biplane imaging for peripheral IV insertion. The participants were then quasi-randomly assigned to use either single-plane or biplane imaging for peripheral IV insertion using a phantom model. The time to catheter completion, successful lumen cannulation, and attempts in which the needle was observed to go through the back wall of the vessel were recorded for each of the three attempts. The following day the participants repeated the peripheral IV insertion with the alternate imaging modality.

Measurements and main results: Biplane imaging compared with single-plane imaging was associated with a significantly greater overall success rate (78.3% ± 22.4% vs 41.7% ± 26%; p < 0.001), higher first-pass success rate (80% ± 41% vs 45% ± 51%; p = 0.015), faster cannulation times (27.8 ± 14.8 vs 36.6 ± 15.8 s; p = 0.003), and reduced frequency of backwall perforations (0.4 ± 0.7 vs 1.5 ± 0.8; p < 0.001).

Conclusions: This proof-of-principle study demonstrates that the biplane ultrasound imaging approach for vessel cannulation resulted in an overall faster, more successful, and safer peripheral IV access than the standard single-plane transverse approach when performed by novice ultrasound users.

Keywords: biplane imaging; clinical trial; critical care ultrasound; multiple plane imaging; point-of-care ultrasound; vascular access; x-plane imaging.

Conflict of interest statement

Dr. Convissar received a Butterfly iQ+ for evaluation, which was used in this study. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.

Figures

Figure 1.

Study participants in this crossover trial were quasi-randomized by alternate allocation to either single-plane (sequence A) or biplane imaging (sequence B) for the first day of the study, followed by a switch to the opposite imaging modality for the next day of the study.

Figure 2.

Biplane imaging to determine successful (A) and unsuccessful (B) catheter placement, and needle tip back walling of the vessel (C). Top and bottom panels show out-of plane and in-plane images, respectively. A, Guidewire inside vessel indicating successful catheter placement. B, Catheter not located within the vessel after catheter placement. C, Example where the needle tip (yellow arrow) was observed to go through the back wall of the vessel.

Figure 3.

Comparative graph demonstrating the percent success rate with biplane and the standard transverse, single-plane imaging for each of the twenty participants (78.3 ± 22.4% vs 41.7% ± 26%; p < 0.001).

Figure 4.

Comparative graph demonstrating the differences in the first-pass success percentage when utilizing the biplane ultrasound imaging modality compared with the standard transverse single-plane imaging (80% ± 41% vs 45% ± 51%; p = 0.015).

Figure 5.

Comparative graph demonstrating the time in seconds taken for each attempt with the biplane imaging modality compared with the standard transverse single-plane imaging (27.8 ± 14.8 vs 36.6 ± 15.8 s; p = 0.003).

Figure 6.

Comparative graph demonstrating the number of instances through which the posterior wall of the phantom vessel was perforated with the biplane imaging modality compared with the standard transverse single-plane imaging (0.4 ± 0.7 vs 1.5 ± 0.8; p < 0.001).