A learning curve analysis of ultrasound-guided in-plane and out-of-plane vascular access training with Perk Tutor

PURPOSE: Under ultrasound guidance, procedures that have been traditionally performed using landmark approaches have become safer and more efficient. However, inexperienced trainees struggle with coordinating probe handling and needle insertion. We aimed to establish learning curves to identify the rate of acquisition of in-plane and out-of-plane vascular access skill in novice medical trainees. METHODS: Thirty-eight novice participants were randomly assigned to perform either in-plane or out-of-plane insertions. Participants underwent baseline testing, four practice insertions (with 3D visualization assistance), and final testing; performance metrics were computed for all procedures. Five expert participants performed insertions in both approaches to establish expert performance metric benchmarks. RESULTS: In-plane novices (n=19) demonstrated significant final reductions in needle path inefficiency (45.8 vs. 127.1, p<0.05), needle path length (41.1 mm vs. 58.0 mm. p<0.05). probe path length (11.6 mm vs. 43.8 mm. p<0.01). and maximal distance between needle and ultrasound plane (3.1 mm vs. 5.5 mm, p<0.05) and surpassed expert benchmarks in average and maximal rotational error. Out-of-plane novices (n=19) demonstrated significant final reductions in all performance metrics, including needle path inefficiency (54.4 vs. 1102, p<0.0 1). maximum distance of needle past plane (0.0 mm vs. 7.3 mm, p<0.01). and total time of needle past plane (0.0 s vs. 3.4 s, p<0.01) and surpassed expert benchmarks in maximum distance and time of needle past plane. CONCLUSION: Our learning curves quantify improvement in in-plane and out-of-plane vascular access skill with 3D visualization over multiple attempts. The training session enables more than half of novices to approach expert performance benchmarks.