Revision of Training Models on Ultrasound-Guided Vascular Access: Presentation of an Animal Model

*J.M. López Álvarez, O. Pérez Quevedo, S. Alonso-Graña López-Manteola, J. Naya Esteban, J.F. Loro Ferrer and D.L. Lorenzo Villegas*

## **Abstract**

Simulation has been defined as the representation of something as real. It is necessary for performing the ultrasound-guided vascular cannulation technique correctly. The use of training models for diagnostic or therapeutic procedures: improves the quality of care for patients; decreases stress level that it can produce the realization of a new technique directly on the patient and; can be used as many times as the model is reproduced, also serving as a method for the resolution of some problems that may appear related to the in vivo technique. The evidence shows that simulation plays an important role in the acquisition of skills to perform invasive procedures. The use of ultrasound in vascular accesses whether peripheral or central, arterial, or venous, improves the success rate in the canalization and reduce the complications derived from the technique in certain critical situations (coagulopathy, thrombocytopenia, obesity, etc.) specially in pediatric patients given the variability of depth and diameter of its vessels with respect to the adult population. To facilitate learning in the technique of echoguided puncture, a training model is presented that is easily reproducible, economical and with a high fidelity in relation to the punctures performed on the patient.

**Keywords:** training, simulation, model, ultrasound

### **1. Introduction**

Simulation has been defined as the presentation of something as real, it means a situation in which some conditions are artificially created to resemble the reality [1–3]. This is used with the objectives of studying something or training in a new medical procedure. To implement a technique such as the ultrasound-guided vascular access, a series of skills must be acquired in order to reach the required aptitudes to perform vascular cannulations in a proper manner [2–5].

These skills include the following: (a) knowledge and comprehension of the device to be used as well as their technical bases, in our study, the ultrasound machine and ultrasonography; (b) the visualization and optimization of the

vascular image and of the needle, and; (c) the ability to acquire the required skills to use the ultrasound probe and to insert the needle (puncture) when performing the procedure of ultrasound-guided vascular access [6–11].

The use of simulation models as diagnostic or therapeutic procedures training models has the following advantages: (a) they increase patients' assistance quality, especially if these techniques are associated to complications and risks; (b) they decrease the stress level eventually provoked by the direct performance of a new technique on patients, and; (c) they can be used as many times as the model is reproduced, so they can be additionally used to solve some problems that could arise from the "in vivo" performance of the technique [10, 12, 13].

Evidence shows that simulation plays an important role in the acquisition of skills required to perform invasive procedures [13, 14]. The use of ultrasound scan on vascular access increases the success rate of the cannulation and reduce the complications derived from this technique. Irrespective of these vessels are peripheral or central and arteries or veins [15–18]. However, the ultrasound-guided vascular access is displaced for the benefit of the classical technique ("blindly" oriented by anatomic references) by some reasons, such as the learning curve that every invasive technique requires and the ultrasound machine preparation required to perform this technique (probe sterilization, choice of the proper "pre-set," puncture plane, etc.). The preference for the classical technique occurs even when it takes the risk of complications associated, which increase under certain critical conditions (coagulopathy, thrombocytopenia, obesity, etc.). These considerations are especially relevant in pediatric patients due to their vessels' depth and diameter variability, which is higher than in adult patients [19, 20].

### **2. Model types**

It is noticeable that experimental, simulation, or no-human models are used infrequently in learning invasive techniques/procedures such as ultrasound-guided vascular access. Any training process on a simulation model represents an opportunity to practice the technique without taking risks and entails the learning of the use of ultrasounds. All of the above is feasible to increase patients' security when performing invasive procedures on children [8, 13].

The training models usually are extremely expensive, hardly available, or not good at transmitting ultrasounds in an optimal manner.

Most of the training or experimental models than can be used to perform simulations for the ultrasound-guided vascular access training are synthetic or biological. Some of them are commercially available and other can be constructed manually by any person [11, 21–23]. They are the following: (a) "in vivo" models performed on research animals; (b) commercially available models such as Blue Phantom® or silicon or latex models, and; (c) synthetic handcrafted models constructed by using gelatine/agar or tissue animal models constructed by using chicken thighs, turkey thighs, or chicken breast [14, 24, 25]. Each of these models must contains tubular structures inside, that can be made on plastic, latex, or rubber, and filled with liquid, in order to simulate the vessels to be cannulated.

These models can be classified as cannulation-puncture models or puncturelocalization models depending on the use of them.

### **2.1 Characteristics of an ideal training model**

An ideal training model to perform ultrasound-guided vascular access procedures should:

*Revision of Training Models on Ultrasound-Guided Vascular Access: Presentation of an Animal… DOI: http://dx.doi.org/10.5772/intechopen.101901*

