title: Ultrasound-guided oblique approach for peripheral venous access in a phantom model.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center Main, Charlotte, NC 28232, USA. vtayal@aol.com.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tassone
authors.forename: Vivek S
authors.initials: VS
authors.lastname: Tayal
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Weekes
authors.forename: Craymon L
authors.initials: CL
authors.lastname: Garner
authors.forename: James H
authors.initials: JH
authors.lastname: Norton