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Abstract
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Background and Aims Delays to intravenous (IV) access are an independent predictor of delayed care and prolonged length of stay, leading to worse outcomes and poor patient experience. As populations become more comorbid and with rising levels of obesity this is an increasingly prevalent issue and medical teams are frequently turning to the anaesthetic department for support. Ultrasound-guided (USG) peripheral venous catheter (PVC) insertion has emerged as a safe and effective technique to establish vascular access in difficult patients, but training opportunities are limited, and commercially available phantom models are costly.
Methods We assessed the impact of difficult IV access requests on the anaesthetic department and identified a need for greater training. We developed a cost-effective, high-fidelity phantom model easily produced from commonly available materials (gelatin, ispaghula husk and modelling balloons) to train doctors and allied health professionals in USG PVC insertion. We subsequently piloted and delivered training sessions to different departments within our hospital.
Results Our training sessions resulted in increased operator confidence performing USG PVC insertion and out-of-plane needling. Participants agreed that the session also improved related complementary skills including USG arterial blood gas sampling and arterial or central line insertion.
Ultrasound phantom model
(A) Axial view of phantom vein. (B) Bull’s eye sign: visualisation of cannula and needle within the lumen of the phantom vein, out-of-plane. (C) Longitudinal view; cannula and needle within the vessel lumen, in-plane. (D) Inserted cannula, needle partially withdrawn, in plane
Conclusions These phantom models provide an effective simulation for teaching USG PVC insertion. Following these results, our difficult vascular access team have requested we use these models to train their members and adapt them to also teach peripherally inserted central catheter (PICC) line insertion. There are potential applications to needling and catheter insertion for regional anaesthesia that we intend to develop further.