Purpose <p>First-pass peripheral intravenous catheter (PIVC) insertion failure rates are up to 40%, with vein localization often critical for success in subsequent attempts. This study aimed to evaluate a novel ultrasound-based device with coronal pathway visualization for improving PIVC accuracy compared to point localization (single ultrasound frame) in untrained users.</p> Methods <p>We conducted a benchtop study using n = 14 untrained investigators and observed PIVC insertion into tissue and blood vessel mimicking phantoms using pathway visualization and point localization assistance. Key metrics such as first attempt insertion success rate, cannula tip-to-vessel distance, and angle alignment were collected. Secondary aims included assessing user factors such as cannulation familiarity, handedness, and grip technique to guide prototype development. Reliability of calibration and analysis measurements was calculated, and grip types were retrospectively analyzed for their influence on accuracy.</p> Results <p>Fourteen investigators achieved non-significantly higher first-pass success rates with pathway visualization (85.7%) compared to point localization (71.4%), with failure rates halving (28.6% vs. 14.3%, n = 14, p = .625). Pathway visualization also demonstrated superior accuracy compared to point localization in critical metrics, including cannula tip-to-vessel distance (1.91 ± 1.47 mm vs. 4.21 ± 1.88 mm, p = .004) and angle alignment (3.49 ± 1.89° vs. 12.50 ± 5.73°, p &lt; .001).</p> Conclusion <p>Pathway visualization improves PIVC placement accuracy, success rates, and alignment compared to point localization. The findings highlight its potential to improve cannulation in difficult intravenous access (DIVA) patients. Future studies comparing the efficacy and accuracy of insertion with the use of transverse visualization (traditional handheld ultrasound) versus coronal pathway visualization provided by the prototype device are required.</p>