Construction of a Low-Cost Perfusion Cadaver for Ultrasound Guided Vascular Access Training

Introduction

Ultrasound guided vascular access in the prehospital industry is increasing in prevalence. Currently there are only a few ways to train a clinician prior to attempting cannulation on a living person. Low fidelity models do not simulate a realistic attempt at gaining vascular access on a human. Through the utilization of a fresh frozen or lightly embalmed cadaver this gap in training could be remedied.

Background

Ultrasound guided vascular access is a relatively common procedure within the scope of emergency medicine and prehospital nurses and paramedics. The gold standard training model of how to properly train clinicians on how to place ultrasound guided vascular access has yet to be established. Currently, you can find didactic training and ultrasound training limbs. These models have shown improvement in successful cannulation but have learning curves that do not mimic a real patient. This is why we set out to create a relatively low-cost perfusion cadaver for ultrasound guided vascular access. Hospitals and prehospital organizations that already have access to cadaver labs can use this model to increase trainee competence and confidence with placement of ultrasound guided vascular access.

Educational Methods

We created a perfusion cadaver by utilizing a lightly embalmed tissue specimen and placing a triple lumen catheter into the right femoral artery for infusion and a double lumen catheter in the left femoral vein for draining. The pump utilized to create flow within the cadaver was a Vivosun 800 GPH submersible pump on its lowest setting. The pump was connected to the triple lumen catheter, which was in the right femoral artery through system of hoses and a 3mL syringe. The distal latex tube required a loose knot to be tied into it to help lessen the overall flow. We infused water into the right femoral catheter using the submersible pump in a 30-gallon bucket. The triple lumen catheter was connected to two 10 drop iv sets with both drip chambers cut off. The drop sets ends were placed into a 28 French chest tube to lengthen the overall drainage system, which drain into the original 30-gallon bucket. This helped the reservoir to remain filled and the fluid to be cycled back through the system. The learners were then able to practice ultrasound guided vascular access under observation by facilitators able to offer realtime feedback.

Results

Flight clinicians were able to successfully visualize and cannulate the brachial artery under ultrasound guidance, allowing needle visualization. Flight clinicians reported subjective increase in procedural confidence and competence after practicing on a perfused cadaver.

Conclusion

The utilization of a perfused cadaver could grant subjective improvement of confidence and competence in ultrasound guided vascular access with relatively low additional cost associated with hosting a cadaver lab.