Nachshon Akiva, Mitchell John D, Mueller Ariel, Banner-Goodspeed Valerie M, McSparron Jakob I
Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
J Educ Perioper Med. 2017 Jul 1;19(1):E503. eCollection 2017 Jan-Mar.
Ultrasound-guided central venous catheterization (CVC) is a commonly performed procedure which carries significant risks for complications. Current models used for simulation-based teaching are expensive and may not replicate tissue feel and ultrasound qualities of human tissues. We aimed to evaluate a tissue model composed of chicken breast and balloons and compare it to a commercially available mannequin.
Forty attending physicians from four departments with extensive CVC experience were enrolled. Participants completed an ultrasound-guided central line placement utilizing both models during a hands-on workshop. Following CVC placement on each model, participants completed a survey to assess their experience with that particular model.
40 attending physicians (12 (30%) anesthesia, 11 (28%) emergency medicine, 11 (28%) internal medicine, and 6 (15%) surgery) participated in the study. The chicken model was rated significantly higher than the mannequin model with regard to ultrasound quality (p=0.02) and tissue feel (p=0.002). In a direct comparison, participants rated the chicken model more highly than the mannequin in all categories except similarity to the human anatomy. Overall the chicken model was preferred to the mannequin, (mean score 44.5; standard deviation 26.0). The mannequin was rated higher with regard to similarity to human anatomy (mean score 52.8; standard deviation 25.7). The comparison between key features (ultrasound characteristics, similarity to human anatomy and teaching trainees) of the models did not vary significantly by area of practice, with the exception of ease of use (p=0.045).
In this prospective study of experienced clinicians we found that a novel tissue model for ultrasound-guided CVC placement was rated more highly compared to a commercially available mannequin task trainer.
超声引导下中心静脉置管（CVC）是一种常见的操作，但存在显著的并发症风险。目前用于基于模拟教学的模型价格昂贵，且可能无法复制人体组织的手感和超声特性。我们旨在评估一种由鸡胸和气球组成的组织模型，并将其与市售人体模型进行比较。
招募了来自四个科室、具有丰富CVC经验的40名主治医师。参与者在实践工作坊中使用这两种模型完成了超声引导下中心静脉置管操作。在每种模型上完成CVC置管后，参与者完成一项调查，以评估他们对该特定模型的体验。
40名主治医师（12名（30%）麻醉科、11名（28%）急诊科、11名（28%）内科和6名（15%）外科）参与了研究。在超声质量（p=0.02）和组织手感（p=0.002）方面，鸡肉模型的评分显著高于人体模型。在直接比较中，除了与人体解剖结构的相似性外，参与者在所有类别中对鸡肉模型的评价都高于人体模型。总体而言，鸡肉模型比人体模型更受青睐（平均得分44.5；标准差26.0）。在与人体解剖结构的相似性方面，人体模型的评分更高（平均得分52.8；标准差25.7）。除易用性外（p=0.045），模型关键特征（超声特性、与人体解剖结构的相似性和培训学员）的比较在不同执业领域之间没有显著差异。
在这项针对经验丰富临床医生的前瞻性研究中，我们发现，与市售人体模型任务训练器相比，一种用于超声引导下CVC置管的新型组织模型获得了更高的评价。
