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.
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.