236 Low Fidelity Model for Chest Tube Thoracostomy

Abstract

Chest tube thoracostomy is a low frequency, high stress, life-saving procedure. Although non-cadaveric commercial trainers are available, their procurement and maintenance can be financially prohibitive. We designed and fabricated a trainer that contains enough structural detail to perform all of the steps of the procedure, is inexpensive, and easy to use and reuse. We used a 4-foot, 16-inch diameter hollow cardboard concrete tube mounted horizontally on a wooden base for the body of the trainer. A grouping of 2 parallel slats was cut into the tube, representing ribs and intercostal spaces. A total of 4 such groupings were made to create 4 workstations, 2 on each end of the tube form opposite one another. Small sheets of craft foam were placed over the slats to represent subcutaneous tissue and muscle. Microfoam tape was applied over the craft foam and to the inner surface of the slats to serve as the skin and the pleura, respectively. At each workstation, up to 4 chest tubes could be inserted before the craft foam and microfoam tape needed to be replaced. All learners were given instruction by an emergency medicine attending and then given time for supervised practice with feedback. The trainer was used by 36 different learners during intensive procedure labs, all over a 1.5-year period. The procedure was estimated to be performed 312 times. Learners were able to perform/experience all critical steps of the procedure (eg, palpate intercostal spaces, feel the “pop” of the pleura, suture the chest tube into place, etc) except for using axilla, nipple, or inframammary fold as anatomical landmarks. All learners stated they felt more comfortable performing the procedure and understood the steps, though this was not rigorously measured. The tube itself did not incur significant wear. Four learners could work on the trainer at the same time, and then could easily reset the trainer (in minutes) for the next repetition. The cost for construction of the body of the trainer (concrete tube form, wood base, and screws) was $26. The cost for microfoam tape and craft foam was $24 and $10, respectively. This comes out to about $0.20 per chest tube insertion. Our appropriately designed low fidelity trainer can provide an inexpensive and easy-to-use and reuse platform for learning chest tube thoracostomy. The trainer provided enough detail to perform the procedure and was sturdy enough for hundreds of uses by multiple users, with minimal wear. Future study should be done in this area to compare low fidelity versus high fidelity trainers for procedural knowledge acquisition.