Background NICE guidelines mandates use of ultrasound guided central venous cannulation (USGCVC). This gave rise to the need for a realistic, effective and cost-effective training tool to teach this skill, as available trainers were expensive and did not survive dilation and actual cannulation. Over several years we have developed and used a simulation model that we think fulfils this function.
Description of innovation We evaluated numerous venous surrogates and found latex racing cycle inner tube to have the same dimensions, ultrasonic appearance, haptic characteristics and resealability as central veins.1 This was used initially in a gelatine substrate which was repaired after use. After developing an Ispagula husk gel based medium that was self-repairing after dilation we switched to that.2 Both these mediums suffered from desiccation and fungal colonisation, which was solved by adding a preservative to create ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel). We combined the vessel and soft tissue analogue in existing manikins or food containers under a simulated skin. Also included was a pulsatile arterial simulator. The latex tubing was connected to a reservoir of coloured fluid under the correct pressure. Cost were £5–£10 per model.
Outcomes These models were then used in formal teaching on USGCVC workshops for medical students,3 junior doctors4 and Advanced Trauma and Life Support (ATLS) courses. They remained fully functional resealing after dilation and sonographically pristine without producing needletracts. Trainees scored them over 95% for realism, utility and models’ ability to remain fully functional without producing needletracts, with all participants recommending the model for teaching.4 Simulated skin analogue had to be periodically replaced and probably eventually the latex inner tubing as well.
Take home messages USGCVC simulation based training can be effectively provided at a reasonable cost enabling trainees to fulfil requirements for specialisation training.
Shaw C, Willers J, Bukunola B, et al. Searching for a superior central venous surrogate for ultrasound simulation. Anaesthesia 2013:68:43
Barnes L, Willers J, Hariharan S, et al. Gauging the gel in Fybogel. AABGI Annual Congress. Anaesthesia 2014;69:s4.11–88
Akrimi S, Malley T, Willers J, et al. A training day for undergraduate students using practical workshops combined with theatre sessions to teach essential skills and inspire interest in anaesthetics. Anaesthesia 2014,69:31
Hall A, De Barr P, Willers J, et al. Does simulation increase the familiarity of non-anaesthetists with central venous cannula insertion? Sent to AABGI Annual Congress, 2015
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