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Summary:
This study evaluated whether the line-of-sight approach improves the speed and accuracy of ultrasound-guided needle placement into the subdeltoid bursa among novice operators, compared to the side approach. A secondary aim was to assess the usefulness of the APPLES mnemonic (Angle, Position, Perpendicular, Line up, Entry, Sweep) as a teaching aid.
Methods:
Medical students and residents were randomized to perform the procedure using both approaches in a crossover design. Two blinded reviewers measured procedure time, and participants completed a survey on their preferences and perceptions of APPLES. Statistical tests (paired t test, McNemar test) compared performance time and accuracy.
Results:
The line-of-sight approach significantly reduced procedure time (mean 14.4 s vs. 18.6 s; P = .00029).
Participants were more likely to hit the target within 30 s using the line-of-sight approach (P = .035).
72.7% preferred the line-of-sight approach.
88.2% found the APPLES mnemonic helpful.
Conclusions:
The operator’s positioning plays a key role in ultrasound-guided procedures. The line-of-sight approach improves both speed and accuracy for novice users, and the APPLES mnemonic is a valuable educational tool for teaching these techniques.
Kerith Joseph MD, RMSK
Clinical Associate Professor
University of Maryland School of Medicine
Baltimore Veterans Affairs Medical Center, Emergency Department