Augmented Reality Ultrasound-Guided Intravenous Access vs Traditional Ultrasound-Guided Intravenous Access: Feasibility, Educational Utility, and Impact on User Confidence

Ultrasound-guided intravenous access (USGIV) is a core emergency medicine (EM) skill that requires significant visuomotor coordination and can be challenging for novice users. Augmented Reality (AR) uses a wearable headset to project the US image directly into the operator’s field of view, potentially enhancing procedural education by superimposing relevant anatomy during the procedure. While prior studies suggest AR may improve efficiency and confidence, others present concerns in that integrating virtual overlays with tactile feedback may impair performance. This study assessed whether ARUSGIV is non-inferior to traditional USGIV, with secondary outcomes assessing learner confidence and perceived educational utility.

We conducted a prospective, randomized, simulation-based study of junior EM residents at a single academic emergency department. Participants were randomized to either traditional or ARUSGIV groups. All completed baseline surveys assessing confidence and USGIV comfort, followed by a standardized USGIV didactic. Primary outcomes included time to successful cannulation and number of needle insertions, with a maximum of two attempts allowed. Success was confirmed by fluid return and US visualization in long axis. Long and short 20-gauge catheters were used equally. Post session surveys assessed confidence and educational utility.

A total of 32 residents participated (15 PGY1; 17 PGY2). Most reported moderate to high confidence to perform USGIV, while prior AR experience was uncommon. Time to cannulation did not differ between groups (AR 36.8 ± 26.1s, n=16; traditional 41.1 ± 39.0s, n=16; p=0.718). Needle reinsertions were similar (1.06 vs 1.19; p=0.302), with one failed attempt in the AR group. No significant difference in task completion time was observed between PGY levels (p=0.290) or catheter lengths (p=0.1344). Overall confidence improved post session (p=0.0014), including within the AR group alone (p=0.0034). 83% reported AR improved anatomic visualization, supported needle probe coordination, and 89% expressed interest in future AR procedural training.

ARUSGIV was feasible and non-inferior to traditional USGIV, with improved user confidence, enhanced visualization and high perceived educational value. These findings support further evaluation of AR incorporation into procedural training and clinical settings.