Evaluation of low cost high fidelity USB powered arterial line simulation device for ultrasound guided vascular puncture and cannulation
Chauhan G, Garzon-Serrano J. Evaluation of low cost high fidelity USB powered arterial line simulation device for ultrasound guided vascular puncture and cannulation. Anesthesia & Analgesia 2017; 124(5):26.
Anesthesia & Analgesia
Background: The use of ultrasound imaging before or during vascular cannulation greatly improves first-pass success and reduces complications. Appropriate training is required for ultrasound-guided vascular cannulation and a portion of this training can be accomplished in a simulated environment that allows a trainee to develop the dexterity needed for simultaneous probe manipulation and needle insertion. In this instance, the use of ultrasound simulators (or phantoms) is an attractive component in such training. However, commercial phantoms are expensive and the homemade phantoms require time, skill and suffer from a short shelf life. Objective: To create a low cost, effective, high fidelity arterial line insertion simulator to help train medical professionals to insert radial arterial lines. We developed a fully functional Universal Serial Bus (USB) powered arterial line simulator with a high shelf life. Material and methods: We used low cost materials for the device, which was made based on sizes of an average radial artery. The device is capable of simulating blood flow that can be identified by using the color Doppler mode of Ultrasound and with cannulation of the simulated artery. 18 trainees (medical students and residents) were trained by a staff anesthesiologist on how to perform the US guided arterial line cannulation using the model. The trainees were able to practice both catheter-over-needle and catheter-over-guidewire techniques. The simulator was then evaluated as a training tool using an established assessment questionnaire. Results: So far a total of 18 residents and medical students participated in the anonymous survey out of which 4 were medical students, 7 were CA1, 4 were CA2 and 3 were CA3. All the participants unanimously agreed that they would have preferred to have used this model to practice before placing one on a patient. The survey is still ongoing. (Table presented) Discussion: The dexterity required to successfully manipulate the ultrasound probe and negotiate a needle into a target vessel needs to be taught and practiced prior to its application on a real patient. For this training, a model or phantom is required. An ideal phantom should replicate the texture and resistance of human soft tissue, it should withstand multiple needle punctures, have a long shelf life, be easily transportable, easily reproducible, be inexpensive, simple to construct and finally be reusable. The simulator created by our team has all the above mentioned attributes. Conclusion: It is possible to construct a high fidelity arterial line access simulator phantom device that functions as an effective teaching tool. We believe that formal training, using this simulator will boost trainee's confidence, reduce the failure rate of ultrasound-guided radial artery cannulation and ultimately improve patient safety.