A Novel, Low-cost, Low-fidelity Pericardiocentesis Teaching Model.

INTRODUCTION: Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during residency training. Because the coronavirus disease 2019 pandemic limited cadaver-based practice, we developed a novel, low-cost, low-fidelity pericardiocentesis model using three dimensional-printing technology to provide advances on prior home-made models. METHODS: Residents watched a 20-minute video about performing a pericardiocentesis and practiced both a blind and ultrasound-guided technique. We assessed model fidelity, convenience, and perceived provider competence via post-workshop questionnaire. RESULTS: A total of 24/26 (93%) individuals practicing on the ultrasound-guided model and 22/24 (92%) on the blind approach model agreed or strongly agreed that the models reasonably mimicked a pericardial effusion. CONCLUSION: Our low-cost, low-fidelity model is durable, mimics the clinical case, and is easy to use. It also addresses known limitations from prior low-fidelity models.

Inexpensive, High-Fidelity Model to Simulate Ultrasound-Guided Pericardiocentesis for Cardiology Resident Training.

Adult cardiology residency training programs require residents to become proficient at many procedural skills, including pericardiocentesis. However, in many programs, opportunities to perform this procedure are limited. Expensive mannequins have been developed to assist with teaching this skill, however, the associated cost make them impractical for many programs. We hypothesized that a low-cost, high-fidelity pericardiocentesis model could be constructed using items easily accessible to any consumer. We describe a pericardiocentesis model made from pork skin, pork ribs, gelatin, a plastic bag, and an avocado. Total cost was less than CAD$40.00 and preparation time was approximately 60 minutes. The model was evaluated with a survey by 14 senior cardiology and critical care residents as well as 3 experienced senior cardiologists. Imaging results from the ultrasound revealed that the target fluid was easily visualized and all trainees were successful in aspirating fluid. The model was durable and withstood more than a dozen punctures, demonstrating its ability to train multiple residents. Respondents to the survey reported the model as highly realistic. All cardiology residents agreed or strongly agreed that the model should be incorporated into their formal curriculum. This study shows that a low-cost, high-fidelity model can be constructed and easily implemented into the formal curriculum of adult cardiology residency programs. It allows residents the opportunity to practice pericardiocentesis in a low-risk setting on a high-yield device.

Efficacy of a Novel Surgical Manikin for Simulating Emergency Surgical Procedures.

The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among SurgeMan, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.

A Cost-Effective, Rapidly Constructed Simulation Model for Ultrasound-Guided Pericardiocentesis Procedural Training.

BACKGROUND: Emergent ultrasound-guided pericardiocentesis (USGP) is an uncommonly performed procedure by emergency physicians (EPs). USGP simulation models have previously been developed to increase procedural proficiency, but these models are limited for routine implementation secondary to high-cost, lengthy time to construct, and lack of durability. The objective of this study was to develop an USGP simulation model that is cost-effective, easily and rapidly constructed, and has procedure-specific fidelity. DISCUSSION: We have developed a novel tofu simulation model for USGP training. The model cost per unit was $1.81 and the average construction time was 2.5 ± 0.3 min. The model can withstand upward of 100 needle punctures. Our model provides USGP procedure-specific aspiration of a simulated pericardial effusion. CONCLUSIONS: The tofu USGP model provides a cost-effective and rapidly constructible simulation tool that could be readily integrated in EP procedural training.

A Practical Approach to Pericardiocentesis With Periprocedural Use of Ultrasound Training Initiative.

Tamponade is a life-threatening condition characterized by fluid accumulation in the pericardium, which compresses the cardiac chambers, impairs diastolic filling, and can lead to clinical shock. The diagnosis is a clinical one that is supported by echocardiographic findings. Pericardiocentesis is the definitive treatment for tamponade; however, it remains a challenge for trainees because of the infrequent exposure compared with other invasive procedures. Moreover, this technique, unlike others, can lead to serious complications including cardiac perforation and arrhythmia. There has been increased attention to periprocedural use of ultrasound in various techniques, particularly pericardiocentesis, given its ability to assess the pericardial effusion as well as the safety and feasibility of the procedure from various trajectories to minimize major and minor complications. As such, periprocedural use of ultrasound for pericardiocentesis has emerged as the preferred initial technique for pericardiocentesis. We outline a simple stepwise approach to prepare and perform pericardiocentesis, facilitated by periprocedural ultrasound, including practical tips from our centre's experiences. These include the proper assessment of the target area defined as the most pericardial fluid with the least interfering structures and troubleshooting the introduction of the needle into the pericardium. Absolute contraindications are few and often require surgery, but knowledge of them is mandatory when assessing patients for pericardiocentesis.

Adapting Gel Wax into an Ultrasound-Guided Pericardiocentesis Model at Low Cost.

Cardiac tamponade is a life-threatening emergency for which pericardiocentesis may be required. Real-time bedside ultrasound has obviated the need for routine blind procedures in cardiac arrest, and the number of pericardiocenteses being performed has declined. Despite this fact, pericardiocentesis remains an essential skill in emergency medicine. While commercially available training models exist, cost, durability, and lack of anatomical landmarks limit their usefulness. We sought to create a pericardiocentesis model that is realistic, simple to build, reusable, and cost efficient. We constructed the model using a red dye-filled ping pong ball (simulating the right ventricle) and a 250cc normal saline bag (simulating the effusion) encased in an artificial rib cage and held in place by gel wax. The inner saline bag was connected to a 1L saline bag outside of the main assembly to act as a fluid reservoir for repeat uses. The entire construction process takes approximately 16-20 hours, most of which is attributed to cooling of the gel wax. Actual construction time is approximately four hours at a cost of less than $200. The model was introduced to emergency medicine residents and medical students during a procedure simulation lab and compared to a model previously described by dell'Orto.1 The learners performed ultrasound-guided pericardiocentesis using both models. Learners who completed a survey comparing realism of the two models felt our model was more realistic than the previously described model. On a scale of 1-9, with 9 being very realistic, the previous model was rated a 4.5. Our model was rated a 7.8. There was also a marked improvement in the perceived recognition of the pericardium, the heart, and the pericardial sac. Additionally, 100% of the students were successful at performing the procedure using our model. In simulation, our model provided both palpable and ultrasound landmarks and held up to several months of repeated use. It was less expensive than commercial models ($200 vs up to $16,500) while being more realistic in simulation than other described "do-it-yourself models." This model can be easily replicated to teach the necessary skill of pericardiocentesis.

A cadaveric model for pericardiocentesis training.

BACKGROUND: Pericardiocentesis is a rare but potentially life-saving procedure. Improper technique can lead to life-threatening complications. DISCUSSION: Described is a cadaveric training model developed to train providers. CONCLUSION: This cadaveric model allows trainees to familiarize themselves with both proper landmark and ultrasound-based pericardiocentesis technique.

An inexpensive, easily constructed, reusable task trainer for simulating ultrasound-guided pericardiocentesis.

BACKGROUND: Pericardiocentesis is a low-frequency, high-risk procedure integral to the practice of emergency medicine. Ultrasound-guided pericardiocentesis is the preferred technique for providing this critical intervention. Traditionally, emergency physicians learned pericardiocentesis in real time, at the bedside, on critically ill patients. Medical education is moving toward simulation for training and assessment of procedures such as pericardiocentesis because it allows learners to practice time-sensitive skills without risk to patient or learner. The retail market for models for pericardiocentesis practice is limited and expensive. DISCUSSION: We have developed an ultrasound-guided pericardiocentesis task trainer that allows the physician to insert a needle under ultrasound guidance, pierce the "pericardial sac" and aspirate "blood." Our model can be simply constructed in a home kitchen, and the overall preparation time is 1 h. Our model costs $20.00 (US, 2008). Materials needed for the construction include 16 ounces of plain gelatin, one large balloon, one golf ball, food coloring, non-stick cooking spray, one wooden cooking skewer, surgical iodine solution, and a 4-quart sized plastic food storage container. Refrigeration and a heat source for cooking are also required. Once prepared, the model is usable for 2 weeks at room temperature and may be preserved an additional week if refrigerated. When the model shows signs of wear, it can be easily remade, by simply recycling the existing materials. CONCLUSION: The self-made model was well liked by training staff due to accessibility of a simulation model, and by learners of the technique as they felt more at ease performing pericardiocentesis on a live patient.

Practicing procedures on the recently dead.

We sought to measure the prevalence of practicing procedures on the recently dead in emergency departments. Surveys were mailed to all medical students, interns, residents in Emergency Medicine, emergency physicians, and trauma team leaders working in the teaching hospitals of a city with a population of 600,000. Of 447 distributed surveys, 222 (49%) were returned. Participants were divided into learners and teachers. Of the learners (n = 162), 6 (4%) had practiced intubation and 4 (3%) had practiced pericardiocentesis on a recently dead patient. Of the teachers (n = 30), 8 (27%) had had learners practice intubation and 4 (13%) had had learners practice pericardiocentesis on a recently dead patient. Of the students and teachers who practiced procedures on recently dead patients, none had obtained consent. The prevalence of practicing procedures on recently dead patients appears to be less than has been reported previously. Intubation is the most commonly practiced procedure on recently dead patients. None of the participants obtained consent before practicing a procedure.