"Cathe-tre": Making a new simulator for ultrasound-guided central venous catheter insertion using the Seldinger technique Yoshikazu ASADA * , Yoshihiko SUZUKI, Tsuyoshi HASEGAWA, Masayuki YOSHITOMI, Ryutaro KAWANO *the work was carried out at Jichi Medical University / E-mail : [email protected] Overview Conclusions Objectives Methods Results "Cathe-tre (a phonetic contraction of catheter + training)" is a new simulator for training central venous catheter insertion using the Seldinger technique. "Cathe-tre" is made from a Japanese food, "Konnyaku". The echographic image and the haptic feedback are similar to that in patients. The simulator has some training-purpose-only consumables, including guide wires, needles, dilator and tube. The pilot study of the simulator, learners and instructors said that "Cathe-tre" has equal or better haptic feedback than traditional central venous catheter simulators. The cost of the simulator is not so high and some initial users wanted to use it on their own facilities. 1.To make a more effective and less expensive simulator for ultrasound-guided central venous catheter insertion using the Seldinger technique. 2.To conduct a pilot study of the simulator for residents and attending physicians to evaluate the effectiveness of the simulator. 1. Making "Cathe-tre" The main body was made from Japanese food, "Konnyaku", which is from konjac root. The following consumables were included: blunt-tipped needle, mock guide wire, dilator and catheter tube. All consumables were made for training purposes only to reduce costs. The total cost of "Cathe- tre" was approximately ¥12,000 (about 130 AUD). Both Konnyaku and consumables are made by the company near Jichi Medical University. Figure 1 shows a picture of "Cathe-tre". 1. Cost-effectiveness Figure 2 shows the "Cathe-tre" training kit. Total costs of traditional central venous catheter simulators and consumables is approximately ¥300,000 (about 3,300 AUD). "Cathe-tre" reduces costs about 95%. Figure 3 shows simulation training using "Cathe-tre". Figure 4 shows the surface of "Cathe-tre" after 8 uses. Although there are some holes, the simulator is still usable. The simulator is now sold in Japan. Promotional video -> http://www.youtube.com/watch?v=jJI_QVkPDYk 2. From questionnaires ・ From residents ( N = 11 ) Difficulty of the training using "Cathe-tre" was 4.5 ± 1.2 (scale 1-7 with 1 = very easy , 7 = very difficult). Residents thought that the difficulty of the training was moderate. Effectiveness of "Cathe-tre" was 6.6 ± 0.8 (scale 1-7 with 1 = very ineffective , 7 = very effective). Residents thought that training with "Cathe-tre" was effective. ・ From advising doctors ( N = 2 ) The similarity of the ultrasound image was 6.0(scale 1-7 with 1 = very different , 7 = very same), suggesting that the ultrasound image is very similar. Figure 5 compares the ultrasound images of "Cathe-tre" and a patient. The similarity of the haptic feedback was 5.5 (scale 1-7 with 1 = very different , 7 = very same). Effectiveness of "Cathe-tre" was 6.5 (scale 1-7 with 1 = very different , 7 = very same). Attending physicians also thought that the simulator was effective for central venous catheter training. 3. Problem A few users said that "Cathe-tre" has an unusual odor which is attributed to Konnyaku and should be improved. We are trying to use coal to refresh it. 4. Future Plans ・Some users want another version of "Cathe-tre", such as a training kit for pediatric central venous catheter or blood draw training. ・In this pilot study, only the evaluation (level one of the Kirkpatric evaluation model) is surveyed. For the next step of the research, we should evaluate the learning (level two of the Kirkpatric evaluation model) of "Cathe-tre". For evaluating the skill level of learners, we are developing learning materials including a manual and checklist. These materials are also useful for standardizing simulation training. Based on the results of two questionnaires, the effectiveness of "Cathe-tre" is high. Although the sample size is limited, we will expand the trial. The quality of the simulator is good from a cost-effectiveness perspective. To improve the simulator, we will get more data, and develop learning materials to evaluate the learning of the simulation training. 2. Pilot test of "Cathe-tre" A central venous catheter training seminar for a pilot study using a "Cathe-tre" was done to determine effectiveness. Training was done with residents as learners and attending physicians as instructors. After the training, a questionnaire was given to both residents and attending physicians using a 7 point Likert scale and free comments. Residents were asked about the difficulty and effectiveness of "Cathe-tre". Attending physicians were asked about the similarities of the ultrasound image and feeling between "Cathe-tre" and a patient, and the effectiveness of "Cathe-tre". Figure 2: The ”Cathe-tre" Training Kit contains the main body and some consumables. Figure 5: Comparison of the ultrasound view. The view of "Cathe-tre" is almost the same as that of a patient. (Left : Patient, Right : "Cathe-tre" ) Figure 4: After 8 uses, the surface of the simulator is still clean and usable. Figure 1: There are two simulated central vein. One is shallow and the other is deep. The size of "Cathe-tre" is almost the same as A4 paper. Figure 3: Simulation training with ”Cathe-tre". "Cathe-tre" simulator was developed, and pilot study of the simulator is done by a few residents and advising doctors. "Cathe-tre" simulator is cost-effective. The results of questionnaires showed that the similarity and the effectiveness of the simulator is high. We have plans for future improvement of "Cathe-tre" Youtube URL http://y2u.be/ jJI_QVkPDYk
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"Cathe-tre": Making a new simulator for ultrasound-guided central venous catheter insertion using the Seldinger technique
Yoshikazu ASADA*, Yoshihiko SUZUKI, Tsuyoshi HASEGAWA, Masayuki YOSHITOMI, Ryutaro KAWANO*the work was carried out at Jichi Medical University / E-mail : [email protected]
Overview
Conclusions
Objectives
Methods
Results
"Cathe-tre (a phonetic contraction of catheter + training)" is a new simulator for training central venous catheter insertion using the Seldinger technique. "Cathe-tre" is made from a Japanese food, "Konnyaku". The echographic image and the haptic feedback are similar to that in patients. The simulator has some training-purpose-only consumables, including guide wires, needles, dilator and tube. The pilot study of the simulator, learners and instructors said that "Cathe-tre" has equal or better haptic feedback than traditional central venous catheter simulators. The cost of the simulator is not so high and some initial users wanted to use it on their own facilities.
1.To make a more effective and less expensive simulator for ultrasound-guided central venous catheter insertion using the Seldinger technique.2.To conduct a pilot study of the simulator for residents and attending physicians to evaluate the effectiveness of the simulator.
1. Making "Cathe-tre" The main body was made from Japanese food, "Konnyaku", which is from konjac root. The following consumables were included: blunt-tipped needle, mock guide wire, dilator and catheter tube. All consumables were made for training purposes only to reduce costs. The total cost of "Cathe-tre" was approximately ¥12,000 (about 130 AUD). Both Konnyaku and consumables are made by the company near Jichi Medical University. Figure 1 shows a picture of "Cathe-tre".
1. Cost-effectiveness Figure 2 shows the "Cathe-tre" training kit. Total costs of traditional central venous catheter simulators and consumables is approximately ¥300,000 (about 3,300 AUD). "Cathe-tre" reduces costs about 95%. Figure 3 shows simulation training using "Cathe-tre". Figure 4 shows the surface of "Cathe-tre" after 8 uses. Although there are some holes, the simulator is still usable. The simulator is now sold in Japan.Promotional video -> http://www.youtube.com/watch?v=jJI_QVkPDYk
2. From questionnaires・From residents ( N = 11 ) Difficulty of the training using "Cathe-tre" was 4.5 ± 1.2 (scale 1-7 with 1 = very easy , 7 = very difficult). Residents thought that the difficulty of the training was moderate. Effectiveness of "Cathe-tre" was 6.6 ± 0.8 (scale 1-7 with 1 = very ineffective , 7 = very effective). Residents thought that training with "Cathe-tre" was effective.
・From advising doctors ( N = 2 ) The similarity of the ultrasound image was 6.0(scale 1-7 with 1 = very different , 7 = very same), suggesting that the ultrasound image is very similar. Figure 5 compares the ultrasound images of "Cathe-tre" and a patient. The similarity of the haptic feedback was 5.5 (scale 1-7 with 1 = very different , 7 = very same). Effectiveness of "Cathe-tre" was 6.5 (scale 1-7 with 1 = very different , 7 = very same). Attending physicians also thought that the simulator was effective for central venous catheter training.
3. Problem A few users said that "Cathe-tre" has an unusual odor which is attributed to Konnyaku and should be improved. We are trying to use coal to refresh it.
4. Future Plans・Some users want another version of "Cathe-tre", such as a training kit for pediatric central venous catheter or blood draw training. ・In this pilot study, only the evaluation (level one of the Kirkpatric evaluation model) is surveyed. For the next step of the research, we should evaluate the learning (level two of the Kirkpatric evaluation model) of "Cathe-tre". For evaluating the skill level of learners, we are developing learning materials including a manual and checklist. These materials are also useful for standardizing simulation training.
Based on the results of two questionnaires, the effectiveness of "Cathe-tre" is high. Although the sample size is limited, we will expand the trial. The quality of the simulator is good from a cost-effectiveness perspective. To improve the simulator, we will get more data, and develop learning materials to evaluate the learning of the simulation training.
2. Pilot test of "Cathe-tre" A central venous catheter training seminar for a pilot study using a "Cathe-tre" was done to determine effectiveness. Training was done with residents as learners and attending physicians as instructors. After the training, a questionnaire was given to both residents and attending physicians using a 7 point Likert scale and free comments. Residents were asked about the difficulty and effectiveness of "Cathe-tre". Attending physicians were asked about the similarities of the ultrasound image and feeling between "Cathe-tre" and a patient, and the effectiveness of "Cathe-tre".
Figure 2: The ”Cathe-tre" Training Kit contains the main body and some consumables.
Figure 5: Comparison of the ultrasound view. The view of "Cathe-tre" is almost the same as that of a patient.
(Left : Patient, Right : "Cathe-tre" )
Figure 4: After 8 uses, the surface of the simulator is still clean and usable.
Figure 1: There are two simulated central vein. One is shallow and the other is deep. The size of "Cathe-tre" is almost the same as A4 paper.
Figure 3: Simulation training with ”Cathe-tre".
"Cathe-tre" simulator was developed, and pilot study of the simulator is done by a few residents and advising doctors.
"Cathe-tre" simulator is cost-effective.
The results of questionnaires showed that the similarity and the effectiveness of the simulator is high.
We have plans for future improvement of "Cathe-tre"
Youtube URL
http://y2u.be/jJI_QVkPDYk
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