Take a Stab at It - A Novel and Economical Chest Tube Model for Procedural Skills Education

摘要

Background: Proper placement of chest tubes isrequired for efficacy and avoiding complications such aslung injury, blood loss, liver lacerations and damage tovessels and nerves. Simulators and models allow trainees topractice skills, overcome anxiety about complex procedures,and achieve higher levels of technical proficiency beforeattempting procedures on patients. High-fidelity simulatorsand commercially available task-trainers can be prohibitivelyexpensive and costly to maintain or replace when used forteaching large groups.Educational Objectives: Our educational needs includeda chest tube model that could economically provide multiplechest tube insertion attempts to a large number of learners, andcould be adapted to simulate different chest sizes.Curricular Design: Our model was constructed usingmaterials readily available: 1-gallon plastic jug ($1.00), plasticwrap ($2.19), package of latex balloons ($0.99), pork spareribs ($2.99/lbs.), 3-inch foam tape, and super glue.Model construction: Empty the jug and lay it on its side.Opposite the handle, cut a 3x4 inch rectangular window. Placea balloon in the spout of the jug and inflate so that it fills theinside of the jug and tie off. Glue the side opposite the openingto a piece of plywood. Cut a section of spare ribs to cover thewindow and wrap the ribs in plastic wrap. Next, use foam tapeto secure the slab of ribs over the opening.Procedure: Make an incision in the “skin” (foam tape),then bluntly dissect down to the ribs and puncture through theintercostal muscles. The opening can be enlarged with Kellyforceps and when a finger is inserted the “lung” (balloon) ispalpated. Next, insert a chest tube through the opening andsecure using silk suture.Impact/Effectiveness: The biggest impact of thisinnovation is that this model can be constructed for about $10whereas a commercially available task trainers cost $4,300and the replacement inserts (which endure 6 sticks) cost$184 each.3 It simulates some of the important landmarks forensuring proper placement, with direct visualization through theclear jug. Learners can also experience some of the potentialcomplications of chest tube placement such as, injury to lungtissue, misdirection of the tube, and tunneling under the skin.This model was used during our recent EmergencyMedicine Symposium where over 50 physicians and advancecare practitioners participated in a chest tube skills station.At a low-cost we were able to provide a realistic model formultiple learners to use. The feedback from this skills stationwas overwhelmingly excellent.