Design and Evaluation of a More Realistic Tube Thoracostomy Task Trainer
INTRODUCTION: Tube thoracostomy (chest tube insertion) is a procedure taught to physicians during Advanced Trauma Life Support Courses and other procedure labs. Existing training models lack tactile and visual realism, and replacement skins are expensive. PURPOSE: To develop a tube thoracostomy task trainer (“T4”) with readily available materials that has enhanced realism and lower cost than existing, commercial trainers. MATERIALS/METHODS: A T4 model was created using inexpensive materials and spare parts from the Simulation Center. A window was cut into the side of a discarded plastic mannequin torso with a dremel tool, and a rod was threaded through holes drilled above and below the window. A slab of pig ribs was secured to this framework using the rod. Pig skin obtained from a local meat store was cut to size and secured to the ribs with bolts, washers, and wing nuts. This process was repeated on the opposite side. For added realism, an unused mannequin head and lungs were attached to the torso. Lungs were inflated and deflated through an endotracheal tube attached to a ventilator or bag/mask device. The T4 model allows a learner to palpate intercostal spaces through skin, prep and drape skin, make an incision, palpate the moving lung, insert a chest tube, and suture the tube in place. The T4 model was informally evaluated by learners, instructors and course directors after each use. RESULTS: The new model was used during three procedure labs and five ATLS courses. Each side of the model accommodated 12 tube placements. Once thawed, the ribs and skin were useable for about 24 hours. The total cost of building the model, excluding mannequin parts, was $54. Consumable costs (pig skin and ribs) were $9 per side. Compared to commercial products, use of the trainer provided a total cost savings per ATLS Course of $4,946. Learners and instructors described the model as highly realistic and superior to a commercial task trainer (Trauma ManTM) that was used previously. ATLS Course Directors have requested that the Simulation Center replace previous trainers with the T4 model for all courses during the past 16 months. Problems associated with the new model include the need to store perishable components in freezers, thaw them in a timely manner, and assemble the model the day of the event. CONCLUSION: A new tube thoracostomy task trainer is a satisfactory and cost-effective substitute for existing products.