Technical Reports
Testing of a Complete Training Model for Chest Tube Insertion in Traumatic Pneumothorax Aiham Ghazali, MD; Cyril Breque, MSc, PhD; Alexandre Le´ger, MD; Michel Sce´pi, MD, PhD; Denis Oriot, MD, PhD
Introduction: Chest tube insertion is a frequent procedure in cases of traumatic pneumothorax, but severe complications can occur if not well performed. Although simulation-based training in chest tube insertion has improved performance, an affordable and realistic model for surgical insertion of a chest tube is lacking. Objective: The objective was to design a model for surgical chest tube insertion that would be realistic, affordable, and transportable and that would reflect all extrathoracic and intrathoracic steps of the procedure. Methods: The model was a task trainer designed by 4 experts in our simulation laboratory combining plastic, electronic, and biologic material. The cost of supplies needed for construction was evaluated. The model was used and tested over 30 months on 56 participants, of whom 44 were surveyed regarding the realism of the model. Results: The model involved a half chest wall (lamb) on a plastic box, connected to a webcam facilitating assessment of the extrathoracic and intrathoracic steps of the procedure, for a cost of €60. Chest tubes, water seal package, and sterile instruments costed €200. All anatomic structures were represented during surgical insertion of chest tube. The demonstration contributed to teaching small groups of up to 8 participants and was reproducible over 30 months of diversely located courses. Anatomic correlation, realism, and learning experience were highly rated by users. Conclusions: This model for surgical chest tube insertion in traumatic pneumothorax was found to be realistic, affordable, and transportable. Furthermore, it allowed comprehensive assessment of the extrathoracic and intrathoracic procedural steps. (Sim Healthcare 10:239Y244, 2015)
Key Words: Model, Simulation, Pneumothorax, Trauma, Chest drainage, Evaluation.
I
n a major trauma patient, pneumothorax occurs in up to 30% of cases.1,2 Chest tube insertion is not only a lifesaving procedure3 but also a stressful event, and opportunities to gain experience inserting chest drains are few and far between. Many physicians lack confidence either performing a chest tube drain or supervising juniors.4 Moreover, risk of procedural complications is highest among inexperienced operators.5,6 Timing of insertion may be crucial to global management of the patient, and chest tube insertion in trauma patients requires specific procedural skillsVincluding dissection of the intercostal space with a Kelly clamp, that is, surgical approachV(recommended by Advanced Trauma Life Support [ATLS]7). That is why training is indicated8 and justifies the use of a simulator.9 Simulation-based training has been reported to increase chest tube insertion performance10 From the Emergency Department (A.G., M.S.), and Pediatric Emergency Department (A.L., D.O.), University Hospital; and Simulation Laboratory (A.G., C.B., M.S., D.O.), Faculty of Medicine, Poitiers, France. Dedicated to the memory of Michel Sce´pi. Reprints: Denis Oriot, MD, PhD, Pediatric Emergency Department, University Hospital, 2 rue de la Mile´trie, 86000 Poitiers, France (e
Testing of a Complete Training Model for Chest Tube Insertion in Traumatic Pneumothorax Aiham Ghazali, MD; Cyril Breque, MSc, PhD; Alexandre Le´ger, MD; Michel Sce´pi, MD, PhD; Denis Oriot, MD, PhD
Introduction: Chest tube insertion is a frequent procedure in cases of traumatic pneumothorax, but severe complications can occur if not well performed. Although simulation-based training in chest tube insertion has improved performance, an affordable and realistic model for surgical insertion of a chest tube is lacking. Objective: The objective was to design a model for surgical chest tube insertion that would be realistic, affordable, and transportable and that would reflect all extrathoracic and intrathoracic steps of the procedure. Methods: The model was a task trainer designed by 4 experts in our simulation laboratory combining plastic, electronic, and biologic material. The cost of supplies needed for construction was evaluated. The model was used and tested over 30 months on 56 participants, of whom 44 were surveyed regarding the realism of the model. Results: The model involved a half chest wall (lamb) on a plastic box, connected to a webcam facilitating assessment of the extrathoracic and intrathoracic steps of the procedure, for a cost of €60. Chest tubes, water seal package, and sterile instruments costed €200. All anatomic structures were represented during surgical insertion of chest tube. The demonstration contributed to teaching small groups of up to 8 participants and was reproducible over 30 months of diversely located courses. Anatomic correlation, realism, and learning experience were highly rated by users. Conclusions: This model for surgical chest tube insertion in traumatic pneumothorax was found to be realistic, affordable, and transportable. Furthermore, it allowed comprehensive assessment of the extrathoracic and intrathoracic procedural steps. (Sim Healthcare 10:239Y244, 2015)
Key Words: Model, Simulation, Pneumothorax, Trauma, Chest drainage, Evaluation.
I
n a major trauma patient, pneumothorax occurs in up to 30% of cases.1,2 Chest tube insertion is not only a lifesaving procedure3 but also a stressful event, and opportunities to gain experience inserting chest drains are few and far between. Many physicians lack confidence either performing a chest tube drain or supervising juniors.4 Moreover, risk of procedural complications is highest among inexperienced operators.5,6 Timing of insertion may be crucial to global management of the patient, and chest tube insertion in trauma patients requires specific procedural skillsVincluding dissection of the intercostal space with a Kelly clamp, that is, surgical approachV(recommended by Advanced Trauma Life Support [ATLS]7). That is why training is indicated8 and justifies the use of a simulator.9 Simulation-based training has been reported to increase chest tube insertion performance10 From the Emergency Department (A.G., M.S.), and Pediatric Emergency Department (A.L., D.O.), University Hospital; and Simulation Laboratory (A.G., C.B., M.S., D.O.), Faculty of Medicine, Poitiers, France. Dedicated to the memory of Michel Sce´pi. Reprints: Denis Oriot, MD, PhD, Pediatric Emergency Department, University Hospital, 2 rue de la Mile´trie, 86000 Poitiers, France (e
