Projects

Abstract : Guidelines support the use of ultrasound (US)-guided central venous cannulation in the intensive care unit. Traditional techniques based on anatomical landmarks are blind procedures and inexpert USG procedures may be hazardous. Commercially available phantoms for simulation and training are expensive. The technique of making a low-cost reusable gelatin phantom which simulates subclavian vein anatomy is described. Techniques to improve eyehand skills with this phantom are described. This phantom is easy to make, inexpensive and easily renewable

Introduction The use of ultrasound (US)-guided central venous cannulation (CVC) has increased in intensive care units (ICU). Guidelines on its use, reviews of safety and efficacy have been published.[1] The use of simulators and models for training in insertion of US-guided CVCs have been suggested.[2] In critical care units, the subclavian site for CVC insertion has a lower rate of infection,[3] but a higher rate of mechanical complications like pneumothorax/ hemothorax.[4] The use of US-guided subclavian CVC insertions has been strengthened by recent large case series with a very low incidence of pneumothorax and adverse events.[5] Insertion of CVC with the use of external anatomical landmarks is a blind procedure.[6] Insertion of CVC under US guidance without adequate training on phantoms or simulators may be hazardous. Inattention to traditional landmarks due to the use of ultrasound may result in a “double-blind” procedure. Training in Indian ICUs is likely to be hampered by the high cost of phantoms (Blue Phantom TM) and lack of easy availability.[7] We are describing the construction of a low-cost reusable phantom customized for subclavian cannulation, for use in the Indian ICU.