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Design and Evaluation of a More Realistic Tube Thoracostomy Task Trainer ( T-4 )

  Submitted by: Mark Williams on April 14, 2018
  HomeGrown Solution Number: 297
Identification of the Problem
Tube thoracostomy, or chest tube insertion, is a procedure that is taught to physicians during Advanced Trauma Life Support Courses and other procedure labs. Commercial task trainers are available for this procedure. The most widely used task trainer is called Trauma ManTM, which is shown here. It is used for the thoracostomy, cricothyrotomy, and peritoneal lavage stations in the ATLS course. The problems with this model, and other available models, is that they lack tactile and visual realism, and that replacement skins are expensive. The skin is extremely moist, and it doesn’t feel real when making incisions. The trainer is headless.
Unique Idea
A chest tube task trainer model was created using inexpensive materials and spare parts from the Simulation Center. A window was cut into the side of the 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 rigs with bolts, washers, and wing nuts. This process was repeated on the opposite side. For added realism, and 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 mannequin head used already had the ability to perform surgical cricothyrotomy’s.] The chest tube task trainer was designed to allow 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 model was informally evaluated by learners, instructors, and course directors after each use. This task trainer was christened the “T4 model” based on the number of versions that were tested during the pilot-testing phase.
The objective of this study was to develop a tube thoracostomy task trainer with readily available materials that has enhanced realism and lower cost than existing, commercial trainers.
1. Spare hollowed out manikin chest
2. Spare simulator head
3. 8- 4 inch long rods
4. 8 - bolts
5. 8 - wing nuts
6. 1 Ventilator
7. 2 racks of pork ribs
8. 2 sections of pig skin
9. Nebulizer tubing
10. BLS lungs cut and sealed to size
Steps to Creating the Solution
1. Take the hollowed out spare manikin chest piece and draw out sections to be cut away on each side of the chest.
2. Drill out all holes for the pieces of rod. (Note: you must file down end of rod to a point to pierce the skin and ribs during installation).
3. Make lungs for the simulator head if it doesn't already have them. To do this, simply take an adult lung from a BLS Anne and heat seal it down the middle. Insert nebulizer tubing into each section and seal with tap. Take the constructed lungs and secure those to the airway of the manikin head.
4. Connect manikin head to torso.
5. Intubate manikin head using 7.0 ETT tube.
6. Connect vent to ETT tube to allow the lungs to inflate and deflate.
7. Connect one rack of ribs to each side of the torso.
8. Measure out the length of skin needed for each side of the chest and cut pig skin to fit.
9. Secure pig skin over the ribs and tighten with wing nuts.
10. Place gown over simulator and dress each side of the chest to only expose where the procedure should be done.