Name: creation of a high-fidelity, low-cost, intraosseous line placement task trainer via 3d printing
Uploaded: 2022-08-17T12:40:00
Description: Watch this Scientific Journal Video about Creation of a High-Fidelity, Low-Cost, Intraosseous Line Placement Task Trainer via 3D Printing at JoVE.com

The funding for this project was provided solely from institutional or departmental resources.

NOTE: The University of Nebraska Medical Center Institutional Review Board determined that our study did not constitute human subject research. The local IRB obtained ethical approval and waiver of informed consent. Complete anonymization of imaging data was done before analysis per the hospital de-identification protocol.
1. Data
<ol>
	<li>Obtain a CT scan capturing the anatomy of interest for the planned task trainer. Be careful to take into consideration the working volume limitations of ...

<ol>
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In this protocol we detail a 3D task trainer's development process to train the infrequently performed and life-saving procedure of IO line placement. This self-guided protocol uses 3D printing to produce the bulk of the model structures, while the remainder of the components used to assemble the task trainer are ubiquitous, easily obtainable, and non-toxic materials that may be reclaimed and reused. The 3D task trainer is low-cost and requires minimum expertise to create and assemble. We have successfully used our 3D IO...

Patient care competency of procedural skills is a critical component for developing trainees in civilian and military healthcare1,2 environments. Procedural skills development is particularly important for procedure-intensive specialties such as anesthesiology3 and front-line medical personnel. Task trainers may be used to rehearse numerous procedures with skill levels ranging from those of a first-year medical student or medical technician to a senior resident or fellow. While many medical procedures require significant training to complete, the task presented here-placement of an interosseous (IO) line-is straightforward and requires less technical skill. Successful placement of an IO line can be accomplished after a relatively short period of training. The use of simulation during medical training, which includes the use of task trainers, is recognized as a tool to gain technical procedural skills through the repetition and the rehearsal of a clinical procedure in a safe, low-stress environment, before ultimately performing the procedure on patients2,4,5.
Understandably so, simulation training in medical education environments has become widely accepted and appears to be a mainstay, despite the paucity of data regarding any impact on patient outcomes6,7. Additionally, recent publications demonstrate that simulation improves team performance and patient outcomes as the result of improved team dynamics and decision-making. Still, there is little data to suggest that simulation improves the time or success rate to perform critical, life-saving procedures8,9 suggesting that simulation is complex and multifaceted in the education of health care providers. In patients where standard intravenous access is not possible or indicated, IO line placement may be used to achieve vascular access quickly, requiring minimal skill. Timely and successful performance of this procedure is critical, particularly in the perioperative environment or a trauma scenario10,11,12. Because IO line placement is an infrequently performed procedure in the perioperative area and can be a life-saving procedure, training in a non-clinical environment is critical. An anatomically accurate task trainer specific to IO line placement is an ideal tool for offering predictable training frequency and skills development for this procedure.
Although widely used, currently available commercial task trainers suffer from several significant drawbacks. First, task trainers that allow for multiple attempts of a procedure are costly, not only for the initial purchase of the task trainer but also for replenishing the replaceable parts such as silicone skin patches. The result is often infrequently replaced parts, leaving prominent landmarks that provide the trainee a suboptimal training experience; patients will not come pre-marked where one should do the procedure. Another drawback is that the high cost of traditional task trainers can result in limited access by users when the devices are &#39;locked up&#39; in protected storage locations to prevent loss or damage to the devices. The result is requiring more rigorously and less available scheduled practice time, limiting their use can certainly make unscheduled training difficult. Finally, most trainers are considered low-fidelity5,13,14 and use only representative anatomy, potentially leading to inappropriate psychomotor skills development or training scars. Low-fidelity trainers also make the thorough assessment of skill acquisition, mastery, and degradation very difficult as training on a low-fidelity device may not adequately mimic the actual real-world procedure.
Representative anatomy also impedes the proper evaluation of the acquisition and mastery of psychomotor skills. Moreover, assessing the transfer of psychomotor skills between simulated medical environments to patient care becomes nearly impossible if some of the psychomotor skills are not reflected in the clinical task. This results in the prevention of consensus on the ability of medical simulation and training to affect patient outcomes. To overcome the challenges of cost, anatomical accuracy, and access, we have developed a low-cost, high-fidelity IO line task trainer. The task trainer is designed from an actual patient&#39;s CT scan, resulting in accurate anatomy (Figure 1). The materials used are ubiquitous and easy to obtain, with components that are relatively easy to reclaim. Compared to many other commercially available trainers, the modest cost of the task trainer design described here dramatically reduces the desire to sequester the trainers in a less accessible, protected location and makes multiple repetitions without leading landmarks possible.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>3D printer filament, poly-lactic acid (PLA), 1.75 mm</td>
			<td>N/A / Hatchbox</td>
			<td></td>
			<td>Base for 3D printing molds, bone structures, and bone / mold hardware</td>
		</tr>
		<tr>
			<td>3D printer, Original Prusa i3 MK3</td>
			<td>Prusa</td>
			<td></td>
			<td>To print molds, bone structures, and bone / mold hardware</td>
		</tr>
		<tr>
			<td>bleach, household (6% sodium hypochlorite)</td>
			<td>Clorox</td>
			<td></td>
			<td>Animicrobial additive for tissue media</td>
		</tr>
		<tr>
			<td>bolts, 1/4&#8221;, flat / countersunk or round head, various lengths</td>
			<td>N/A</td>
			<td></td>
			<td>Hardware used to hold mold casing halves together during casting</td>
		</tr>
		<tr>
			<td>Bucket, 5 gallon, plastic</td>
			<td>N/A</td>
			<td></td>
			<td>To hold tissue media during media preparation</td>
		</tr>
		<tr>
			<td>chlorhexidine, 4% solution w/v</td>
			<td></td>
			<td></td>
			<td>Animicrobial additive for tissue media</td>
		</tr>
		<tr>
			<td>drill, household 3/8&#8217; chuck</td>
			<td>N/A</td>
			<td></td>
			<td>To stir tissue media during media preparation</td>
		</tr>
		<tr>
			<td>food coloring, red (optional)</td>
			<td>N/A</td>
			<td></td>
			<td>Coloring additive for simulated bone marrow</td>
		</tr>
		<tr>
			<td>gelatin, unflavored</td>
			<td>Knox</td>
			<td></td>
			<td>Base for tissue media</td>
		</tr>
		<tr>
			<td>hex nuts, 1/4&#8221;</td>
			<td>N/A</td>
			<td></td>
			<td>Hardware used to hold mold casing halves together during casting</td>
		</tr>
		<tr>
			<td>Non-stick cooking spray</td>
			<td>N/A</td>
			<td></td>
			<td>Mold releasing agent</td>
		</tr>
		<tr>
			<td>plastic bags, ziplock</td>
			<td>Ziplock</td>
			<td></td>
			<td>To store tissue media</td>
		</tr>
		<tr>
			<td>psyllium husk fiber, finely ground, orange flavored, sugar free (optional)</td>
			<td>Procter &#38; Gamble</td>
			<td>Metamucil</td>
			<td>Opacity / Echogenicity additive for tissue media</td>
		</tr>
		<tr>
			<td>screwdriver, flat / Phillips (matching bolt hardware)</td>
			<td>N/A</td>
			<td></td>
			<td>To tighten mold casing hardware</td>
		</tr>
		<tr>
			<td>silicone gasket cord stock, 3mm, round, various lengths</td>
			<td>N/A</td>
			<td></td>
			<td>Gasket media for mold casings</td>
		</tr>
		<tr>
			<td>spray adhesive, Super 77 (optional)</td>
			<td>3M</td>
			<td></td>
			<td>Agent used to improve bed adhesion during 3D printing</td>
		</tr>
		<tr>
			<td>stirring paddle / rod</td>
			<td></td>
			<td></td>
			<td>To stir tissue media during media preparation</td>
		</tr>
		<tr>
			<td>turkey baster, household, ## mL</td>
			<td>N/A</td>
			<td></td>
			<td>To inject simulated bone marrow into bone marrow cavity</td>
		</tr>
		<tr>
			<td>ultrasound gel</td>
			<td></td>
			<td></td>
			<td>Base for simulated bone marrow</td>
		</tr>
		<tr>
			<td>water, tap</td>
			<td></td>
			<td></td>
			<td>Used in both tissue media and simulated bone marrow</td>
		</tr>
	</tbody>
</table>

creation of a high-fidelity, low-cost, intraosseous line placement task trainer via 3d printing

The description of procedural task trainers includes their use as a training tool to hone technical skills through repetition and rehearsal of procedures in a safe environment before ultimately performing the procedure on a patient. Many procedural task trainers available to date suffer from several drawbacks, including unrealistic anatomy and the tendency to develop user-created &#39;landmarks&#39; after the trainer tissue undergoes repeated manipulations, potentially leading to inappropriate psychomotor skill development. To ameliorate these drawbacks, a process was created to produce a high-fidelity procedural task trainer, created from anatomy obtained from computed tomography (CT) scans, that utilize ubiquitous three-dimensional (3D) printing technology and off-the-shelf commodity supplies.
This method includes creating a 3D printed tissue mold capturing the tissue structure surrounding the skeletal element of interest to encase the bony skeletal structure suspended within the tissue, which is also 3D printed. A tissue medium mixture, which approximates tissue in both high-fidelity geometry and tissue density, is then poured into a mold and allowed to set. After a task trainer has been used to practice a procedure, such as intraosseous line placement, the tissue media, molds, and bones are reclaimable and may be reused to create a fresh task trainer, free of puncture sites and manipulation defects, for use in subsequent training sessions.

Following the protocol, the modeling of the task trainer utilized a CT scan of a de-identified patient. Segmentation of the CT images utilized 3D Slicer software and Auto Meshmixer for 3D modeling. For 3D printing, both 3D Simplify and the Prusa i3 MK3 were used (Figure 1). Subsequently, we completed the assembly of the 3D-printed parts, prepared the tissue media mixture, and poured the media mixture into the assembled task trainer mold. Following a training period with the task trainer, the...

Watch this Scientific Journal Video about Creation of a High-Fidelity, Low-Cost, Intraosseous Line Placement Task Trainer via 3D Printing at JoVE.com

Creation of a High-Fidelity, Low-Cost, Intraosseous Line Placement Task Trainer via 3D Printing

We describe a procedure to process computed tomography (CT) scans into high-fidelity, reclaimable, and low-cost procedural task trainers. The CT scan identification processes, export, segmentation, modeling, and 3D printing are all described, along with the issues and lessons learned in the process.

The description of procedural task trainers includes their use as a training tool to hone technical skills through repetition and rehearsal of procedures ...

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