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A reusable ultrasound phantom

2004; Wiley; Volume: 59; Issue: 11 Linguagem: Francês

10.1111/j.1365-2044.2004.03990.x

1365-2044

Jonathan Chantler, L Tang Gale, O. G. W. Weldon,

Central Venous Catheters and Hemodialysis

AnaesthesiaVolume 59, Issue 11 p. 1145-1146 Free Access A reusable ultrasound phantom J. Chantler, J. ChantlerSearch for more papers by this authorL. Gale, L. GaleSearch for more papers by this authorO. Weldon, O. WeldonSearch for more papers by this author J. Chantler, J. ChantlerSearch for more papers by this authorL. Gale, L. GaleSearch for more papers by this authorO. Weldon, O. WeldonSearch for more papers by this author First published: 12 October 2004 https://doi.org/10.1111/j.1365-2044.2004.03990.xCitations: 13 A response to a previously published article or letter can be submitted to the Online Correspondence section at http://www.anaesthesiacorrespondence.com. A selection of this correspondence is published several times a year in Anaesthesia. All correspondence intended for publication in Anaesthesia should be addressed to Dr David Bogod, Editor-in-Chief, and submitted as an e-mail attachment to [email protected]. For multi-author letters, a covering letter signed by all authors must be submitted either by post, fax (44 (0) 115 962 7670) or by e-mail as a scanned document before correspondence can be published. Alternatively, letters may be submitted typewritten on one side of paper, double spaced with wide margins to Anaesthesia, 1st Floor, Maternity Unit, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK. All paper submissions must include a signed covering letter, a disc or CD-ROM with a Word for Windows or .rtf version of the letter and an email address for the corresponding author. Copy should be prepared in the usual style of the Correspondence section. Authors must follow the advice about references and other matters contained in the Author Guidelines at http://www.blackwellpublishing.com/journals/ana/submiss.htm. Correspondence presented in any other style or format will be returned to the author for revision. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL The use of ultrasound guidance for the placement of a central line catheter (CVC) has assumed increased importance following the issuing of the NICE guideline in 2002 [1]. One of the recommendations was that 'all those involved in placing CVCs using … ultrasound guidance should undertake appropriate training to achieve competence'. The use of ultrasound simulators (or 'phantoms') is an attractive component in such training. Simulation of the ultrasound appearances during CVC placement might aid the development of the necessary manual co-ordination skills without compromising patient safety. Furthermore, the experiences of part task simulation in the training of other similar clinical skills suggest that it can play an important role [2]. The main disadvantage of phantoms is the production costs and degradation of the ultrasound medium during use. For example, one commercially available phantom costs £225 with a degradation of the image after 50 cannulations or 3 weeks, whichever is the sooner (Instructions for Use, Ultrasound Guided Venous Access Phantom, Department of Clinical Engineering, University of Liverpool, 2003). In addition, improper use such as the injection of fluid or air into the medium can ruin the phantom earlier. We have developed a phantom for ultrasound training that is cheap, renewable and effective (see Fig. 2). It consists of a 100 mm diameter Perspex cylinder (ICI, UK) with a silastic tube inserted longitudinally and filled with coloured fluid to represent the vein. The silastic tube was 'harvested' from a piece of 22 mm ventilator tubing (Siemens, Bracknell, UK). We use chlorhexidine 0.5% as the 'intravenous' fluid. A silastic rubber skin is placed over a window on the top of the cylinder (DOW Corning Limited, Coventry, UK). The seals are made watertight with silicon rubber compound (RS Components, Corby, UK), which allows easy dismantling for cleaning. A hole is drilled in one end to allow the phantom to be filled with a suitable fluid with realistic ultrasound properties. We have found bacteriological agar (Agar No.1, Bioconnections, Leeds, UK) to be ideal at a reduced concentration to that used for agar plating of microbiological specimens (1 part agar powder to 100 parts water). The agar sets at room temperature in 4 h (and even quicker in a fridge). After use, the agar is melted with hot water or in a microwave and discarded. Figure 2Open in figure viewerPowerPoint Phantom assembled ready for use. The main advantage of the phantom is that each time it is set up, virgin ultrasound appearances are obtained. In addition, it costs little to build initially (£25 per phantom for materials) and virtually nothing to set up (agar cost is 20p per fill). We make up the phantom before each training session and discard it afterwards to minimise the small risk of bacterial propagation. We have used the phantom to train 45 trainees to date, with varying levels of previous ultrasound experience, using the SonoSite 180plus (SonoSite, Hitchin, UK). Feedback has suggested that it provides an excellent simulation of needle entry into a vessel with real time ultrasound guidance in both transverse and longitudinal orientation. In summary, we believe that we have developed a cheap and realistic simulator for the training of CVC placement under real time ultrasound guidance. The replacement of the ultrasound medium for each session provides excellent ultrasound appearances each time. We would be delighted to discuss our experiences with individuals interested in building their own phantoms. References 1 National Institute for Clinical Excellence. Technology Appraisal 49. London: National Institute for Clinical Excellence, 2002. (http://www.nice.org.uk/page.aspx?o=36753). 2 Owen H, Follows V, Reynolds KJ, Burgess G, Plummer J. Learning to apply effective cricoid pressure using a part task trainer. Anaesthesia 2002; 57: 1098– 9.DOI: 10.1046/j.1365-2044.2002.02836.x Citing Literature Volume59, Issue11November 2004Pages 1145-1146 FiguresReferencesRelatedInformation