Simulator Development for Radial Artery Gasometry Collection

Abstract

Introduction - The collection of arterial gasometry is a common procedure, mainly in inpatient setting (1). Thus, analysing and monitoring arterial blood gas play an important role in diagnosing and managing health conditions (2). The development of a simulator can help professionals improving radial artery gasometry collection. However, there are a number of high cost simulators which may turns the learning difficult (3). Mainly in public Universities, which lack enough resources and financing, in low and middle-income countries, the sources for high cost simulators may be impeditive. It is responsibility of the institutions that still cares about students’ formation to develop low costs solutions that could be copied as example for any other university in the same situation. In this setting, we aimed to develop a low costs simulators prototype that could be manufactured for any other institution. The first project was the gasometry collection simulator in radial artery. Usually, the gasometry is responsibility of a resident. Therefore, it is essential the resident previous training to perform the procedure in the best way before a real situation. The objective of this project was the development of a gasometry collection simulator in radial artery and a training protocol for undergraduate students and resident physicians. Methods - The industrial silicon is an easy manipulation and low-cost material and, therefore, it was chosen for simulate a hand and wrist. The silicone was moulded in a common procedure latex glove. It was used a nº 10 silicon nasoenteral catheter to simulate artery because it mimics the diameter of an adult real radial artery and allows multiple punctures, turning the device more durable. An assistant performed intermittent pressure to a 20 mL syringe coupled to the catheter to simulate the arterial pulse, both in inspection and palpation. The simulation scene was prepared as a clinical case where the examined resident was asked to perform a radial artery gasometry collection. The checklist evaluated the resident attitude (presentation, procedure explanation for the patient and permission asking to proceed), the choice of necessary material, Allen’s test description, and finally the gasometry collection by use of the simulator. During the procedure, all the parameters necessary to the puncture were evaluated, such as pulse palpation, puncture site and angle, collection volume, compression after taking off the needle, and bandage. Results - Five standardized simulators were manufactured, at a cost of 25€ each one, for a pilot study. Experienced professionals tested and approved all models before authorizing the use in a large scale with undergraduate medical students (interns). It was evaluated 107 interns from 5th year of graduation, 55% male. In a first test, only 40% of 107 interns performed Allen’s test before the gasometry collection, 65% chose correctly the necessary material for the procedure, and 72% performed correctly the puncture in the simulator. Conclusion - The development and manufacture of the gasometry collection simulator for procedure in the radial artery is feasible at a reasonable cost (25 € each). The use of simulation may improve medical education in the means that allow the repetition without a patient risk and does not have to be expensive (4).