A "do-it-yourself" model can help healthcare trainees to learn the essential skill of chest tube placement in critically ill newborns, reports a study in the October issue of Advances in Neonatal Care, official journal of the National Association of Neonatal Nurses. The journal is published in the Lippincott portfolio by Wolters Kluwer.
Using inexpensive or discarded materials, Adrian Zurca, MD, and colleagues of Penn State Hershey Children's Hospital, Hershey, Pa., built a simulator to help in learning and practicing the Seldinger technique for pleural pigtail catheter placement. Dr. Zurca comments, "We are excited to share our simulator with the community caring for neonates, as we believe it provides a simple but effective tool to help ensure that all healthcare providers are able to work together to safely and effectively perform this potentially life-saving procedure."
Simple and affordable model for 'Pigtail' catheter placement in newborns
Collections of fluid (pleural effusion) or air (pneumothorax) around the lungs are common and serious complications in critically ill newborns. Successful placement of a pleural pigtail catheter using the Seldinger technique allows drainage of the fluid or air, making it easier for the infant to breathe. (It's called a "pigtail" catheter because the tube is curled at one end.)
However, it can be difficult for healthcare providers to gain practice and experience in performing this technique. "No realistic simulation models are commercially available for trainees to practice and learn this skill on infants," the researchers write.
To address this problem, Dr. Zurca and colleagues made their own training model for learning the Seldinger technique. The project started with a discarded plastic infant cardiopulmonary resuscitation mannikin. The mannikin was hollowed out to make room for two bags of saline solution (also discarded) to simulate the fluid-filled pleural sac.
Electrical wires were used to build simulated "ribs" a critical landmark for locating the proper catheter placement site and shelf liner was wrapped around the mannikin to create a "skin" layer. Using the model, trainees were able to locate the appropriate puncture site and practice advancing the catheter to reach and drain the simulated pleural fluid inside.
On testing by seven pediatric critical care faculty members, all agreed that the training model "provided a realistic simulated reproduction of placing a pleural pigtail." They felt the simulator was simple to use, and indicated that they would use it as a teaching tool in the future.
The total cost of constructing the simulator was just $15 (for electrical wire and shelf liner). Even if other components had to be bought, the cost would be under $150. By comparison, commercially available training models for chest tube placement in older children and adults are priced at $2,000 or more.
The simulator "may have the most impact in resource-poor settings, including in developing countries, where lack of financial resources and unreliable access to electricity may limit the ability to use other models," Dr. Zurca and coauthors write. They add that with a simple modification removing some of the fluid from the bags inside the model it might also be useful in teaching the technique for removing air around the lungs in infants with pneumothorax.
Dr. Zurca and colleagues believe their simulator provides an "inexpensive and reproducible" model for teaching an essential skill to physician trainees, nurse practitioners, and physician assistants caring for critically ill infants, as well as for bedside nurses assisting with the procedure. The authors conclude, "Future studies are needed to assess whether this model helps training providers and nurses develop and maintain the clinical skills for successful percutaneous pleural pigtail catheter placement."