Ultrasound IV Trainer

Read this first

What this trains, and what it can't

Ultrasound-guided IV placement is two skills: knowing what to do and what the screen is telling you, and doing it with your hands. This trainer covers the first one.

You can practice

Picking the vein. Size, depth, whether it compresses, and what sits next to it.
Choosing the catheter. Whether enough of it will end up inside the vein at that depth and angle.
Reading the screen. Tip or shaft, the wall denting before it pops, artery versus vein, clot.
Keeping the tip in view. In short axis the needle shows as one dot, and the shaft looks the same as the tip. You practice the standard fix: slide the probe ahead until the dot disappears, then advance the needle until it comes back, so the dot you see is always the tip. In long axis you practice keeping the whole needle lined up in a beam about 1 mm thick.
What goes wrong and why. Back wall, artery, nerve, a rolling vein, a catheter that would not thread.

It can't teach

Hand control. Holding the probe still with one hand while the other moves the needle. Here a tap is exactly 1 mm. At the bedside it won't be.
Feel. The give of skin and vein wall, how much pressure collapses a vein, the resistance of a catheter that is hanging up.
The patient. Someone who flinches, a vein that spasms, a tourniquet that is too loose.
Real scans. The images are generated from typical anatomy. They behave like ultrasound but are not recordings.

Use it to learn the steps and the screen, then spend your phantom and supervised time on your hands.

What is in the trainer

Four kinds of arm

Superficial basilic, deep basilic, a small basilic beside brachial veins that tempt you, and a deep obese arm near the depth limit. Every patient is generated fresh.

Real mode

No side view and no hints. You only see what you would see at the bedside, and the debrief tells you afterward where the tip actually was.

Scoring

Advances made with the tip out of view, redirections, skin punctures, complications, and how much catheter ended up in the vein.

Compression and color

Veins collapse, the artery stays round and pulses, clotted segments don't compress. Color Doppler responds to probe tilt.

Catheter length

Pick 1.25, 1.88 or 2.5 inch. The debrief shows what share sat in the vein and what the evidence says about it.

Short or long axis

Switch the probe across or along the vein. In long axis the whole needle shows as a line, and you learn how little sideways drift it takes to lose it.

Questions

Does this replace practice on a phantom?

No. It covers the decisions and the screen reading so your phantom and supervised time can go to hand control. It does not train the motor skill itself.

Can I buy it for my unit or program?

Yes. Group licenses cover 10 or 25 people with one key, and larger programs can email for a quote. See group licenses.

Who is it for?

Nurses, PAs, NPs, residents, medics and techs learning ultrasound-guided IVs, and anyone who teaches them.

Are these real ultrasound images?

No. They are generated live from typical upper-arm anatomy, so the image responds to every probe and needle move. They are simplified and do not replace real scanning.

How do I get access after I buy?

Checkout gives you a license key and a button that unlocks the trainer in that browser. The key is also in your receipt email, so you can unlock up to 3 browsers or devices.

What if it is not useful to me?

Email within 14 days of purchase for a full refund. See the refund policy.

Does it work on a phone?

Yes. The probe and needle controls sit right below the image.

Notes

The technique and the evidence

Picking the vein

Tourniquet on, high-frequency linear probe, scan the upper arm in short axis.
Compress. A vein flattens with light pressure. An artery stays round and pulses. A vein that won't compress may hold thrombus: move on.
Size beats depth, up to a point. In ED patients with difficult access, each 1 mm of extra vein diameter raised the odds of success (OR 1.79), depth made no difference until 1.6 cm, and no vein deeper than that was cannulated (Panebianco 2009). Moderate depth (0.3 to 1.5 cm) and width of at least 4 mm did best in Witting 2010.
The brachial veins sit right next to the brachial artery and median nerve. If the basilic is usable, it is the safer target.

Catheter length: how much ends up in the vein

Every catheter loses length in the tissue between skin and vein wall. That track is about the vein depth divided by the sine of the needle angle.
In ultrasound-guided IVs, all catheters with less than 30% of their length in the vein failed, 32% failed with 30 to 64%, and none failed with 65% or more (Pandurangadu 2018).
So the catheter should be roughly 3 times the skin-to-vein track. Long catheters failed less often than standard ones in a randomized trial (14% vs 45%, Elia 2012).

Following the tip in short axis (dynamic needle tip positioning)

In short axis the needle shows as one bright dot. The shaft and the tip look the same, so a dot on screen does not prove the tip is there. The tip can already be past the beam, through the back wall or in the artery.
The fix: once you see the dot, slide the probe 1 mm toward the shoulder until the dot just disappears. Then advance the needle until it reappears. Now the dot is the tip. Repeat in small steps until the tip sits in the middle of the vein (the target sign).
Then flatten the needle and walk the tip 2 to 3 more millimetres inside the lumen, so the catheter, which sits 1 to 2 mm behind the needle tip, is also in the vein before you thread it.
Described by Clemmesen 2012 in a blinded phantom trial with novices. A 2023 network meta-analysis of pediatric trials found higher first-attempt success with this technique than with palpation (RR 1.67) or short-axis ultrasound without it (RR 1.43) (Takeshita 2023).
Flashback only tells you blood reached the hub at some point. It does not tell you where the tip is now.

Short axis or long axis

Short axis (out of plane): the probe sits across the vein, which shows as a circle, and the needle crosses the beam as a single dot. You can see the vein and what is beside it, but you have to work to keep track of the tip.
Long axis (in plane): the probe runs along the vein, which shows as a tube, and the whole needle shows as a bright line with the tip at its end. The catch is that the beam is only about a millimetre thick, so a small sideways drift of the needle or the probe loses part or all of the line. The artery and nerve beside the vein are out of view.
For peripheral IVs, a meta-analysis of three trials found higher success with short axis (97.7% vs 89.1%, OR 5.35), with no clear difference in needle passes and mixed results for time (Gottlieb 2018). The evidence base is small. Long axis is still worth knowing for straight, larger veins and as a check on tip position.

Where to puncture

At 45 degrees, a needle that enters the skin a distance d from the probe crosses the beam at depth d. That is geometry, and it is the reason for the common teaching to enter at a distance equal to the vein depth.
With dynamic tip positioning you can also enter close to the probe, find the tip shallow, and walk both down together.
In long axis, puncture just beyond the end of the probe, in line with it, so the needle enters the beam at the edge of the screen.

What this can't teach

Your hands. Holding the probe still with one hand while the other moves the needle, the feel of skin and vein wall giving way, how much pressure collapses a vein, a patient who flinches. Here every step is exactly 1 mm. At the bedside it won't be.
Use it to learn the sequence and to read the screen, then take that to a phantom and to supervised patients. The images are generated drawings of typical anatomy, not real scans.

Sources

Panebianco NL, Fredette JM, Szyld D, et al. What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Acad Emerg Med. 2009;16(12):1298-1303.
Witting MD, Schenkel SM, Lawner BJ, Euerle BD. Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. J Emerg Med. 2010;39(1):70-75.
Pandurangadu AV, Tucker J, Brackney AR, Bahl A. Ultrasound-guided intravenous catheter survival impacted by amount of catheter residing in the vein. Emerg Med J. 2018;35(9):550-555. Link
Elia F, Ferrari G, Molino P, et al. Standard-length catheters vs long catheters in ultrasound-guided peripheral vein cannulation. Am J Emerg Med. 2012;30(5):712-716.
Clemmesen L, Knudsen L, Sloth E, Bendtsen T. Dynamic needle tip positioning: ultrasound guidance for peripheral vascular access. A randomized, controlled and blinded study in phantoms performed by ultrasound novices. Ultraschall Med. 2012;33(7):E321-E325.
Takeshita J, Nakayama Y, Tachibana K, Nakajima Y, Shime N. Ultrasound-guided short-axis out-of-plane approach with or without dynamic needle-tip positioning for peripheral venous catheterization in pediatric patients: a systematic review with network meta-analysis. J Cardiothorac Vasc Anesth. 2023.
Gottlieb M, Holladay D, Peksa GD. Comparison of short- vs long-axis technique for ultrasound-guided peripheral line placement: a systematic review and meta-analysis. Cureus. 2018;10(5):e2718. Link
Blanco P. Ultrasound-guided peripheral venous cannulation in critically ill patients: a practical guideline. Ultrasound J. 2019;11:27. Link

Practice ultrasound-guided IVs on a simulated arm.