Development of an ultrasound-guided vascular access simulator for training and propagating Cochrane evidence

Tags: Oral
Freitas T1, Attie G1, Estrutti C1, Ka PL1, Daolio R1, Carvalho VB1, Moura Neto A1, Prestes O1, Sarpe A1, Flumignan C1, Guedes LG1, Vasconcelos V1, Guedes H1, Amorim J1, Flumignan R1, Nakano L1
1Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo

Background: Cochrane evidence has shown a 70% reduction in the relative risk of complications when ultrasound-guidance is used to obtain internal jugular venous access. However, this is a procedure that must be trained for before being done on patients, and simulation can enable this training to be done safely. Although simulation has been used in healthcare education since the 18th century, this method has been responsible for a true revolution in the training and development of health professionals. Simulation allows for repetition and practice for the student, while avoiding unnecessary procedure-related patient risks. The big barrier to the popularization of such teaching methods is the high cost of simulators, which universities cannot afford. The weight of this burden increases every day and the universities' role is to find ways to modernize the learning within the economic reality that each country faces. In this setting, the Division of Vascular and Endovascular Surgery of a Federal University in Brazil has created a development and research centre to provide a realistic training area for healthcare students and professionals to specialize.

Objective: develop realistic simulators for professional training and best-evidence propagation in health, which have as premises: low cost, easy reproduction and easy handling. This specific work shows the creation of a simulator for ultrasound-guided central venous puncture.

Methods: the simulator basis was made with injectable polyurethane foam in the form of a human neck. The internal jugular vein was made from latex with taps that enabled it to be filled with coloured liquid to simulate blood and facilitate visualization of the puncture. After studying different substances that might evoke the simulated vessels, we found that ballistic gelatine provided the best ultrasound visualization.

Results: four simulators (Figure) were tested and demonstrated the improvement of catheterization success rate from 43% and 55% before to 100% after simulation training for medical students and residents, respectively. Both students’ and residents’ acceptance of the ultrasound-guided central venous access training was above 90%. The final production cost of the manufactured simulator was USD 81 versus USD 8100 for a similar industrialized simulator.

Conclusions: creation of a high-quality and low-cost simulator, reproducible and with easy handling proved to be feasible for students’ and residents’ training.

Patient or healthcare consumer involvement: ultrasound-guided vascular access has been strongly recommended by evidence-based medicine and propagation of this evidence, and training are mandatory. The affordable production cost of our simulator enabled dissemination of the best evidence through students’ and residents’ training in an upper-middle-income country that has been facing a lack of resources for innovations.