The Development and Initial End-Point User Feedback of a 3D-Printed Adult Proximal Tibia IO Simulator

Abstract

Intraosseous infusion (IO) remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients. In rural and remote areas, shortage of training equipment and human capacity (i.e., simulators) are the main contributors to the shortage of local training courses aiming at the development and maintenance of IO skills. Specifically, current training equipment options available for trainees include commercially available simulators, which are often expensive, or animal tissues, which lack human anatomical features that are necessary for optimal learning and pose logistical and ethical issues related to practice on live animals. Three-dimensional (3D) printing provides the means to create cost-effective, anatomically correct simulators for practicing IO where existing simulators may be difficult to access, especially in remote areas. This technical report aims to describe the development of maxSIMIO, a 3D-printed adult proximal tibia IO simulator, and present feedback on the design features from a clinical co-design team consisting of 18 end-point users. Overall, the majority of the feedback was positive and highlighted that the maxSIMIO simulator was helpful for learning and developing the IO technique. The majority of the clinical team responders also agreed that the simulator was more anatomically accurate compared to other simulators they have used in the past. Finally, the survey results indicated that on average, the simulator is acceptable as a training tool. Notable suggestions for improvement included increasing the stability of the individual parts of the model (such as tightening the skin and securing the bones), enhancing the anatomical accuracy of the experience (such as adding a fibula), making the bones harder, increasing the size of the patella, making it more modular (to minimize costs related to maintenance), and improving the anatomical positioning of the knee joint (i.e., slightly bent in the knee joint). In summary, the clinical team, located in rural and remote areas in Canada, found the 3D-printed simulator to be a functional tool for practicing the intraosseous technique. The outcome of this report supports the use of this cost-effective simulator for simulation-based medical education for remote and rural areas anywhere in the world.

Development of Simple and Advanced Adult Proximal Tibia Simulators for a Decentralized Simulation-Based Education Model to Teach Paramedics-in-Training the Intraosseous Infusion Procedure

“…The simple and advanced IO models in the scope of this project were previously created by the development team and considered good educational tools requiring a few minor adjustments by clinicians and medical trainees [15,16]. Based on this feedback, to develop these existing IO simulators further yet appropriately for the De-SBE model, a process was required that could facilitate ideation while providing content validity.…”

Hands-On Practice on Sustainable Simulators in the Context of Training for Rural and Remote Practice Through a Fundamental Skills Workshop

“…Content and delivery: A 3D-printed adult proximal tibia IO simulator, maxSIMIO, was utilized to teach rural and remote doctors and trainees the IO technique at one of the workshop stations [ 23 ]. The equipment was arranged at the station for participants with the simulator and a printout of an instruction manual describing how to perform the IO skill (Figure 8 ).…”

Hacking Intraosseous Infusion Skills Training With 3D Printing: maxSIMIO Drilling System

“…Intraosseous (IO) infusion access is an alternative path to vascular access when peripheral IV access is compromised. This allows drugs, and fluids to enter circulation fast and in the same concentration as those administered intravenously [4][5][6]. The IO infusion skills can be performed manually using a needle or using a specifically designed drill, such as Arrow® EZ-IO® Power Driver (Teleflex, Morrisville, North Carolina, United States), referred to as EZ-IO going forward [7,8].…”

“…Despite its potentially life-saving benefits in trauma patients, IO infusion remains an underutilized technique for obtaining vascular access in adults [ 9 ]. Commercially available IO simulators are often expensive and are not customizable to the needs of the learner [ 4 ]. Alternative do-it-yourself (DIY) IO simulators, such as animal bones, lack human anatomical features necessary for optimal learning and pose logistical and ethical concerns related to practicing on animals [ 6 ].…”