Handheld vs. Standard Ultrasound Systems for Vascular Access Training: Equivalent Performance Among Novice Medical Students

Venipuncture and intravenous (IV) line insertion are essential procedural skills that medical students must master. Ultrasound guidance has been shown to reduce failure rates and complications associated with IV placement. However, the high cost and limited portability of traditional cart-based ultrasound systems may restrict access to training resources. Handheld devices, such as the Butterfly iQ3™, offer a cost-effective ($3,899 vs over >$10,000) and portable alternative but have not been well studied in medical education. This study compared the performance of a handheld ultrasound system with biplane image settings and a conventional cart-based system with single-plane image settings during ultrasound-guided vascular access by novice learners.

First-year medical students participated in a 10-minute training session, followed by a crossover-controlled assessment, where they performed peripheral IV insertion using both the Butterfly iQ3™ in biplane view and Mindray MX7 in monoplane. Each student had three 60-second attempts per modality. Primary outcomes included overall success rate, time to successful cannulation, and incidence of posterior wall puncture. Student preferences were assessed through pre- and post-session surveys.

Eighty-one first-year medical students participated in the assessment. No statistically significant differences were found between the handheld and cart-based systems in overall success rate (p = 0.92, 0.66, 0.17 across attempts), back-wall puncture (p = 1.00, 0.60, 0.63), or time to cannulation (p = 0.77, 0.95, 0.14). However, students expressed a strong preference for biplane imaging on the questionnaire, with 71% of respondents finding the biplane portable ultrasound easier to use, 86% finding it more accurate, and 81% wanting to use it in future practice. Confidence in ultrasound-guided biplane access improved significantly after the session (p < 0.0001), where there was no such improvement for the monoplane confidence (p=0.11).

Performance outcomes were equivalent between the Butterfly iQ3™ and Mindray MX7 systems for novice users performing ultrasound-guided vascular access. Handheld ultrasound devices may serve as cost-effective and portable alternatives for medical education, supporting broader integration of ultrasound training in preclinical curricula without compromising performance outcomes.