Name: manufacture of a multi-purpose low-cost animal bench-model for teaching tracheostomy
Uploaded: 2019-05-18T13:00:00
Description: Watch this Scientific Journal Video about Manufacture of a Multi-Purpose Low-Cost Animal Bench-Model for Teaching Tracheostomy at JoVE.com

The authors thank the Azienda Ospedaliera Universitaria Maggiore della Carit&#224;, Novara, for its help.

The animal anatomic segments, normally intended for human consumption, were purchased at a local butcher&#39;s shop ( Figure 1). Therefore, they could be easily transported and stored with no specific restrictions or sanitary regulations.
1. Cleaning the swine upper airways
<ol>
	<li>With the help of a dissecting scalpel, Adson forceps and Metzembaum scissors, clean the trachea and larynx from excess surrounding tissues (lateral muscles, excess of tongue), by cu...

<ol>
	<li>Langvad, S., Hyldmo, P. K., Nakstad, A. R., Vist, G. E., Sandberg, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Emergency+cricothyrotomy--a+systematic+review.">Emergency cricothyrotomy--a systematic review.</a> Scandinavian Journal of Trauma, Resuscitation And Emergency Medicine. 21, 43 (2013).</li><li>Ben-Nun, A., Altman, E., Best, L. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Emergency+percutaneous+tracheostomy+in+trauma+patients:+an+early+experience.">Emergency percutaneous tracheostomy in trauma patients: an early experience.</a> Annals of Thoracic Surgery. 77 (3), 1045-1047 (2004).</li><li>Cook, T. M., Woodall, N., Harper, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Major+complications+of+airway+management+in+the+UK:+results+of+the+Fourth+National+Audit.+Project+of+The+Royal+College+of+Anaesthetists+and+the+Difficult+Airway+Society.">Major complications of airway management in the UK: results of the Fourth National Audit. Project of The Royal College of Anaesthetists and the Difficult Airway Society.</a> British Journal of Anaesthesia. 106, 632-642 (2011).</li><li>Das, B., Nasreen, F., Haleem, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+&amp;#34;cannot+ventilate,+cannot+intubate&amp;#34;+situation+in+a+patient+posted+for+emergency+surgery+for+acute+intestinal+obstruction.">A &amp;#34;cannot ventilate, cannot intubate&amp;#34; situation in a patient posted for emergency surgery for acute intestinal obstruction.</a> Anesthesia Essays and Research. 7 (1), 140-141 (2013).</li><li>Bann, S., Khan, M. S., Datta, V. K., Darzi, A. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technical+performance:+relation+between+surgical+dexterity+and+technical+knowledge.">Technical performance: relation between surgical dexterity and technical knowledge.</a> World Journal of Surgery. 28 (2), 142-146 (2004).</li><li>Lesko, D., Showmaker, J., Ukatu, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Declining+Otolaryngology+Resident+Training+Experience+in+Tracheostomies:+Case+Log+Trends+from+2005+to+2015.">Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015.</a> Otolaryngology - Head and Neck Surgery. 156 (6), 1067-1071 (2017).</li><li>Patel, H. H., Siltumens, A., Bess, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+decline+of+tracheotomy+among+otolaryngologists:+a+14-year+review.">The decline of tracheotomy among otolaryngologists: a 14-year review.</a> Otolaryngology - Head and Neck Surgery. 152, 465-469 (2015).</li><li>Maran, N. J., Glavin, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Low-to+high-fidelity+simulation+-+a+continuum+of+medical+education?.">Low-to high-fidelity simulation - a continuum of medical education?.</a> Medical Education. 37 (1), 22-28 (2003).</li><li>Lippert, A., Dieckmann, P. G., Oestergaard, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+in+medicine.">Simulation in medicine.</a> Notfall Rettungsmedizin. 12 (2), 49 (2009).</li><li>Beaubien, J. M., Baker, D. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+simulation+for+training+teamwork+skills+in+health+care:+how+low+can+you+go?.">The use of simulation for training teamwork skills in health care: how low can you go?.</a> Quality &amp; Safety in Health Care. 13 (1), 51-56 (2004).</li><li>Terragni, P., Mascia, L., Faggiano, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+new+training+approach+in+endoscopic+percutaneous+tracheostomy+using+a+simulation+model+based+on+biological+tissue.">A new training approach in endoscopic percutaneous tracheostomy using a simulation model based on biological tissue.</a> Minerva Anestesiologica. 82 (2), 196-201 (2016).</li><li>Jayaraman, V., Feeney, J. M., Brautigam, R. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+simulation+procedural+training+to+improve+self-efficacy,+knowledge,+and+skill+to+perform+cricothyroidotomy.">The use of simulation procedural training to improve self-efficacy, knowledge, and skill to perform cricothyroidotomy.</a> The American Journal of Surgery. 80 (4), 377-381 (2014).</li><li>Takayesu, J. K., Peak, D., Stearns, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cadaver-based+training+is+superior+to+simulation+training+for+cricothyrotomy+and+tube+thoracostomy.">Cadaver-based training is superior to simulation training for cricothyrotomy and tube thoracostomy.</a> Internal and Emergency Medicine. 12 (1), 99-102 (2017).</li><li>Aho, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Every+surgical+resident+should+know+how+to+perform+a+cricothyrotomy:+an+inexpensive+cricothyrotomy+task+trainer+for+teaching+and+assessing+surgical+trainees.">Every surgical resident should know how to perform a cricothyrotomy: an inexpensive cricothyrotomy task trainer for teaching and assessing surgical trainees.</a> Journal of Surgical Education. 72 (4), 658-661 (2015).</li><li>Holak, E. J., Kaslow, O., Pagel, P. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Who+teaches+surgical+airway+management+and+how+do+they+teach+it?+A+survey+of+United+States+anesthesiology+training+programme.">Who teaches surgical airway management and how do they teach it? A survey of United States anesthesiology training programme.</a> Journal of Clinical Anesthesia. 23 (4), 275-279 (2011).</li><li>Makowski, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Survey+of+Graduating+Emergency+Medicine+Residents'+Experience+with+Cricothyrotomy.">A Survey of Graduating Emergency Medicine Residents' Experience with Cricothyrotomy.</a> The Western Journal of Emergency Medicine. 14 (6), 654-661 (2013).</li><li>Tonui, P. M., Nish, A. D., Smith, H. L., Letendre, P. V., Portela, D. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasound+Imaging+for+Endotracheal+Tube+Repositioning+During+Percutaneous+Tracheostomy+in+a+Cadaver+Model:+A+Potential+Teaching+Modality.">Ultrasound Imaging for Endotracheal Tube Repositioning During Percutaneous Tracheostomy in a Cadaver Model: A Potential Teaching Modality.</a> Ochsner Journal. 14 (3), 335-338 (2014).</li><li>Netto, F. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+porcine+model+for+teaching+surgical+cricothyridootomy.">A porcine model for teaching surgical cricothyridootomy.</a> The journal of the Brasilian College of Surgeons. 42 (3), 193-196 (2015).</li><li>Varaday, S. S., Yentis, S. M., Clarke, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+homemade+model+for+training+in+cricothyrotomy.">A homemade model for training in cricothyrotomy.</a> Anaesthesia. 59, 1012-1015 (2004).</li><li>Bryant, R. J., Morgan, M. H., Youngquist, S. T., Fix, M. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Edible+Cricothyrotomy+Model:+A+Low-Cost+Alternative+to+Pig+Tracheas+and+Plastic+Models+for+Teaching+Cricothyrotomy.">Edible Cricothyrotomy Model: A Low-Cost Alternative to Pig Tracheas and Plastic Models for Teaching Cricothyrotomy.</a> Journal of Education and Teaching Emergency Medicine. 2 (1), (2017).</li><li>Fikkers, B. G., van Vugt, S., van der Hoeven, J. G., van den Hoogen, F. J., Marres, H. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Emergency+cricothyrotomy:+a+randomised+crossover+trial+comparing+the+wire-guided+and+catheter-over-needle+techniques.">Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques.</a> Anaesthesia. 59 (10), 1008-1011 (2004).</li><li>Fiorelli, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+home-made+animal+model+in+comparison+with+a+standard+manikin+for+teaching+percutaneous+dilatational+tracheostomy.">A home-made animal model in comparison with a standard manikin for teaching percutaneous dilatational tracheostomy.</a> Interactive Cardiovascular and Thoracic Surgery. 20, 248-253 (2015).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Cricotracheotomy Trainer Manikin - Global Technologies &amp;#34;Simulators for Education&amp;#34;. , (2019).</li></ol>

The manufactured low-cost and high-fidelity bench-model simulated the human neck and enabled practice of cricothyrotomy, percutaneous and surgical tracheostomy. The designed survey filled by senior ENT physicians and anesthesiologists evaluated the extent to which the model replicates the physical characteristics of the neck and its suitability for training the given subglottic airway access procedures.
Several home-made models or simulators have been reported and we tried to overcome their li...

Difficult airway management is a critical skill for every physician dealing with critical, ill, and emergency patients. A review published in 2013 estimates that the incidence numbers of &#39;cannot ventilate, cannot intubate&#39; situations with the use of surgical airway techniques vary from 0 to 18.5%1.
Tracheostomy is one of the oldest surgical procedures and is extensively used as the method of choice for subglottic airway access for patients requiring prolonged artificial ventilation. Originally performed in the operating theater, it has become a routine practice bedside at many hospitals, especially in the intensive care unit (ICU)2. Several types of techniques have been described, including surgical (ST) and percutaneous tracheostomy (PCT). Tracheostomy has been widely reported to have high complication rates.A national audit reports that 50% of airway-related deaths or brain damage in critical care are caused by tracheostomy complications3.&#160;Often, the high complication rates reflect lack of familiarity with the technique and inadequate training.
Another way to subglottically access the airways is to perform a cricothyrotomy (CT), which has been broadly recommended as a strategy to deal with &#39;cannot ventilate, cannot intubate&#39;&#160;&#160;situations in both prehospital and intra-hospital care4. Being a fast and potentially lifesaving fallback maneuver in the patients with a failed airway, clinicians responsible for airway management must be familiar with the technique. Practice and training therefore play a pivotal role since its success is dependent on the operator&#39;s dexterity5. However, due to improvements in airway management in the past decades, a decline in the need for tracheotomy and emergency surgical airways was observed. This has resulted in a lack of clinical experience and decreased exposure to this life-saving technique, which may negatively affect the quality of procedures and ultimately the safety of patients6,7.
Nowadays, simulation is a common and effective teaching method to train medical and surgical skills, especially for novices who are learning new abilities8,9. Simulation allows to recreate a clinical procedure or situation, providing trainees with first-hand exposure to clinical scenario and complex techniques while eliminating the risk for patients10.
A broad variety of simulators, from virtual reality to animal models, have been used in training surgical airway management11,12,13,14. Practice on models and mannequins is reported to be the most common form of instruction for Anesthesiology and Emergency Medicine residents15,16. Cadavers have also been used to teach neck anatomy and the procedural skills17. However, the cost of all these options are sometimes prohibitive and can pose ethical and moral constrains and challenges. Low cost simulators have also been described and suggested for educational purposes but have not been used to train all the subglottic airway access procedures.
In this manuscript, we describe how to manufacture an easily-made, low-cost and high-fidelity bench-model that simulates the human neck to perform cricothyrotomy, percutaneous and surgical tracheostomy and its evaluation. The main aim was to design an easy-to-make model with readily and regularly available materials so that anyone can simply emulate and reproduce it. The overall time to assemble the model was about 15 minutes and the cost estimate was approximately of 10&#8364; including resources and manufacturing (20&#8364;/h).

<table border="0" cellpadding="0" cellspacing="0" style="width:1171px;" width="1168">
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:223px;">Foam&#160;</td>
			<td style="width:475px;">BRICOSELF ITALIA, vercelli&#160;</td>
			<td style="width:123px;">na</td>
			<td style="width:351px;">Used to stabilyze the model on the wooden tablet</td>
		</tr>
		<tr height="18">
			<td height="18" style="height:19px;width:223px;">Insuline Syringe</td>
			<td style="width:475px;">na</td>
			<td style="width:123px;">na</td>
			<td>Used to draw linea alba with india ink</td>
		</tr>
		<tr height="18">
			<td height="18" style="height:19px;width:223px;">Pig Esophagus</td>
			<td style="width:475px;">Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)</td>
			<td style="width:123px;">na</td>
			<td>Wet material used to build the simulated muscular layers and fascia</td>
		</tr>
		<tr height="18">
			<td height="18" style="height:18px;width:223px;">Pig skin</td>
			<td style="width:475px;">Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)</td>
			<td style="width:123px;">na</td>
			<td>Wet material used to obtain the simulated skin&#160;</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:223px;">Pig thymus</td>
			<td style="width:475px;">Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)</td>
			<td style="width:123px;">na</td>
			<td>Wet material used to build the simulated thyroid</td>
		</tr>
		<tr height="62">
			<td height="62" style="height:62px;width:223px;">SILK suture - Vetsuture SILK 2/0 (Metric 3) Ago 3/8 30mm Reverse Cutting (12 pz)</td>
			<td style="width:475px;">Sanitalia Care Srl</td>
			<td style="width:123px;">SILK2CN</td>
			<td>Sutures to tight all the parts of the model</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:223px;">Surgical instruments scissors, forceps, knife, needle holder&#160;</td>
			<td style="width:475px;">na</td>
			<td style="width:123px;">na</td>
			<td>na</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:223px;">Swine upper airways</td>
			<td style="width:475px;">Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)</td>
			<td style="width:123px;">na</td>
			<td>Wet material used to build the model</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:223px;">white india ink -&#160; pelikan 10ml</td>
			<td>Cartoleria Manzoni di Lo Monaco Rosaria s.a.s. 97019 Vittoria, Italy</td>
			<td align="right">36340</td>
			<td>Ink used to mark the linea alba on the esophagus</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:223px;">Wood stapler</td>
			<td style="width:475px;">BRICOSELF ITALIA, vercelli&#160;</td>
			<td style="width:123px;">na</td>
			<td>Used to staple on the model</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:223px;">Wooden tablet</td>
			<td style="width:475px;">BRICOSELF ITALIA, vercelli&#160;</td>
			<td style="width:123px;">na</td>
			<td>Used to stabilyze the model with the stapler</td>
		</tr>
	</tbody>
</table>

manufacture of a multi-purpose low-cost animal bench-model for teaching tracheostomy

Tracheostomy is one of the most frequent procedures, performed through various techniques in the intensive care unit and emergency situations. Despite this, there is a lack of training on this procedure that affects its outcome, which is also dependent on operator's dexterity. Here, we take the specific training and simulation into consideration. This article aims to describe every step of the manufacture of a new multi-purpose low-cost animal bench-model, with the support of video and images, and to obtain an opinion about the quality of this model by administering a questionnaire to professionals with experience in the procedures. 
Ten experts in the technique were enrolled. The model scored an average of 3.45/5 for its anatomical realism; 4.75/5 for its usefulness as a training tool for simulation courses and assessments. The time necessary to build the model was 15 minutes, and the cost amounted to 10&#8364;. The animal bench-model was considered a very useful simulator for tracheostomy training and assessments. Therefore, it could be used as a tool for medical courses and residencies.

We assessed the feasibility and acceptability of the easily-made, low-cost and high-fidelity bench-model that simulates the human neck as a tool for cricothyrotomy, percutaneous and surgical tracheostomy training. After a review of current literature about simulation in surgical education, a survey instrument was designed. The questionnaire consisted of the following content sessions: 
a. general data and demographics of the participants; 
b. fidelity of the bench-model; 
c...

Watch this Scientific Journal Video about Manufacture of a Multi-Purpose Low-Cost Animal Bench-Model for Teaching Tracheostomy at JoVE.com

Manufacture of a Multi-Purpose Low-Cost Animal Bench-Model for Teaching Tracheostomy

This article illustrates every step of the manufacture of a new multi-purpose low-cost animal bench-model for subglottic airway access management. All the procedures are shown in the video. The model's realism and its suitability for training the given clinical maneuvers were assessed by independent senior otolaryngologists and anesthesiologists.

Tracheostomy is one of the most frequent procedures, performed through various techniques in the intensive care unit and emergency situations. Despite ...

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