Home Made IV Access Ultrasound Phantom

We recently had the pleasure to host the Emergency Department Registrars Trauma Workshop. For the station on difficult IV access, the consultants had collectively decided to push the challenge of teaching ultrasound guided deep vessel cannulation. Only problem, how to do it? I found quite a good recipe on youtube:

I followed the recipe quantities and size of container and this worked perfectly, but I wasn’t entirely satisfied with the design, so set about making some modifications. Major variations included, the use of replacement “vessels” from a standard IV cannulation task trainer arm. This was particularly good because they are self healing and also allowed for a trifurcation to create some anatomical variability in the model. The other major variation and one that certainly went down a treat with the registrars – I filled the vessels with simulated blood. Through some trial and error, I found that tying off the vessels and then injecting the blood solution into the closed system worked best to eliminate air completely and slightly pressurise the vessel, meaning, wait for it…. FLASHBACK. The flashback feature certainly got some excitement and enhanced the realism.

Layer One

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Blood Vessels

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Completed Product

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So for a total cost of $7 per phantom (about 70 times less than the Blue Phantom trademarked trainer) we were able to produce a great and realistic ultrasound for difficult access session. The trainer copped about 100 cannulations and is still useable one week down the track. Echogenic tracks do form after repeated attempts and I would strongly advocate the metamucil/psyllium husk as it created “noise” in the gel and gave the impression of tissue. I also chose blue food colouring as it was darker and obscured the vessels.

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Update 4th May 2015 – Here is a link to another sweet recipe for a homemade UGIV simulator, complete with step by step guide and video from Jacob Avila @UltrasoundMD of 5 Minute Sono UGIV

 

 

 

FOAM and Simulation: Kindred spirits in Education

We in clinical education can often be guilty of adopting academic terminology and educational theory at a very superficial level. In reading Chris Nickson’s recent post on ‘curriculum’ , I registered some overt parallels with my experiences in simulation education.

Simulation in healthcare is not a new thing. Madame du Coudray, the King’s midwife, is commonly attributed the title of the mother (yes a female, lady person) of technical health simulation. In 1751 Madame du Coudray observed startlingly high birth complication rates in rural France and devised an educational program for village lay midwives that incorporated the writing of a textbook and, more importantly, the development of rather sophisticated birthing trainers and technical instruction. This program was assessed to have a huge impact, with a massive decline in birthing complications subsequent to education. (Harry Owen, 2012 PMID 22374231)

Machine Pic BlogThe philosophy and practice of FOAM (Free Open Access Medical education) is not a particularly new concept either (read any post on the topic on LITFL – http://lifeinthefastlane.com featuring William Osler) and it seems that both have been lost and re-found over the past couple of centuries.

People have had bad experiences with simulation before… role play anyone? The debrief more like Roger Harris’ “shit sandwich without the bread”, than encouraged reflection. FOAM too, has no doubt alienated some.

Both simulation and FOAM are evolving as disciplines within the world of modern health delivery. The elegance, modalities and exposure are growing rapidly for largely the same reason – technology. Within this rapid evolution, the key is to not try and place all the eggs in one metaphoric basket. I have observed facilities that have received an injection of simulation resources (i.e.. freaking expensive mannequins), go simulation crazy, trying to simulate everything and surging on creating simulation “curriculum”. Why would we build a curriculum out of one teaching technique?

Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.

Professor David Gaba 2004 http://qualitysafety.bmj.com/content/13/suppl_1/i2.abstract

FOAM can learn a great deal from the mistakes made by eager early adopters of sim. We have started to realise that, done poorly simulation is detrimental and can damage the psyche and practice of clinicians. The parallel with FOAM at this point is somewhat blatant.

This was not meant to be a long winded post, just a reflection on some inklings I had at SMACC 2013, that crystallised with subsequent discussions on the topic of FOAM.

In extrapolating this relationship out, let’s think of FOAM as a tool, teaching technique and resource. In itself we don’t give a teaching technique a curriculum, but instead embed it into “the curriculum”. This progression is yielding results in simulation, as we see unanticipated benefits such as improvements in communication, processes, patient flow and clinician confidence in unfamiliar contexts (transfer learning – the ultimate). Hopefully FOAM, in it’s latest guise can realise some of the successes of it’s mannequin cousin.