TF-16 Innovation Per Diem: Design in Emergency Medicine

Abstract

and illustration. This project details the construction of a novel ultrasound phantom, the "laser phantom," that provides a visual representation of a simulated B-mode imaging plane within the semitransparent phantom itself. Using the laser phantom, learners can "see the slice" of the B-mode image in 3 dimensions.This project specifically describes one application of the laser phantom for central venous access training. Central venous catheter (CVC) placement is an essential skill for providers who care for critically ill patients. Even providers who are experienced with CVC placement may have deficient technique for the ultrasound-guided venipuncture portion of the procedure. This project focuses on improving that technique. The target audience is medical students, residents, advanced practice providers, and attending physicians undergoing basic training in ultrasound-guided CVC placement.Study Objectives: During the laser phantom CVC activity, each learner demonstrates knowledge of the steps of ultrasound-guided venipuncture, awareness of the finder needle position and B-mode image orientation and understanding of how to correctly manipulate the transducer. Through hands-on experience, direct observation, immediate feedback, and repetitive practice, learners synthesize a robust understanding of the procedure. Learners evaluate the merits and challenges of the technique and assess their own strengths and weaknesses.Methods: The laser phantom is made from gelatin and tonic water, and the simulated probe uses a 405 nm laser to make the phantom fluoresce in the region of the "beam." After pre-session education on central venous access which can be tailored to the needs of the learners, each learner participates in a small group activity during which each learner takes turns performing simulated venipuncture 4 times, as follows: 1) with a traditional phantom under ultrasound guidance; 2) with the laser phantom and simulated probe; 3) with the laser phantom using ultrasound; and 4) again with a traditional phantom using ultrasound. Learners are evaluated in real time on their technique, their understanding of the relevant geometry, and their response to feedback over the course of the activity. Each learner is given an opportunity to provide feedback on the experience, including the perceived usefulness of the laser phantom in aiding understanding.Conclusions: The laser phantom is an inexpensive simulation tool that can be made with readily available components. In this project, it is used to enhance learners' conceptualization and technical prowess with ultrasound-guided central venous access. Future directions could include other point-of-care ultrasound applications, hybrid laser/ultrasound training systems, and non-aqueous gel formulations. Learners could also use the laser phantom to practice ultrasound technique in settings without access to an ultrasound machine.