FEATURE
Ultrasound Guided Vascular Access Workshop: A DIY Guide for Homemade Phantoms By Marisa R. Carino Mason, BS
University of Miami, Miller School of Medicine
By Sadhana Anantha, BS
University of Miami, Miller School of Medicine
By Joshua Goldstein, MD
Jackson Memorial Hospital, Dept. of Emergency Medicine
By Jessica Le, BA
University of Miami, Miller School of Medicine
By Ankit Shah, BS
University of Miami, Miller School of Medicine
By Daniel Hercz, MD Jackson Memorial Hospital, Dept. of Emergency Medicine
Background Vascular cannulation is a fundamental clinical skill that is applied across diverse medical specialties. Insertion of central venous catheters (CVC) is a common procedure to establish definitive venous access for infusion of sclerosing or vasoactive medications. While these procedures are relatively straightforward, they do carry major risks particularly in patients with anatomically challenging or abnormal vascular anatomy.1 To help address these challenges, ultrasound guidance has become the standard of care for establishment of central venous access in the emergency department. Ultrasound (US) guidance for CVC placement has shown impressive benefits in the reduction of total complication rate, and number of attempts and improved overall success rate.2 Multiple observational and randomized controlled studies demonstrate improved procedural success rates with the use of ultrasound guidance for the insertion of all manner of vascular access devices.3,4,5,6
Current Practice To keep pace with the expansive use of US-guided procedures, medical education programs must evolve and create new opportunities for simulation-based, inexpensive, no-
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risk learning programs using lowfidelity models.7,8 Handmade and/ or commercial “phantoms,” tools designed to mimic the sonographic and physical properties of human tissue under ultrasound, have become popular training tools to teach vascular access techniques.9, 10 After receiving phantom training, operators reported significantly higher comfort using ultrasound compared to those who did not.6, 7 Low-cost handmade phantoms using chicken breast, tofu, and gelatin mixtures are utilized in settings where commercial models are not readily available or affordable11,12 and have been shown to be comparable to commercial phantoms.13 A recent systematic review of undergraduate medical education revealed that 21 out of 95 formal ultrasound curricula utilized phantoms, eight of which were handmade.14 This article details a workshop designed by the University of Miami’s Ultrasound and Anesthesia Interest Groups, facilitated by emergency medicine & anesthesia physician educators. The workshop utilized the advantages of affordable homemade gel phantoms to simulate US-guided procedures for undergraduate medical students in a safe, cost-effective manner. This article will provide the methods, resources, and workshop
