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

Summary

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.

Abstract

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€. 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.

Introduction

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 'cannot ventilate, cannot intubate' 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 int....

Protocol

The animal anatomic segments, normally intended for human consumption, were purchased at a local butcher'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

1. 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 cutting and dissecting.
2. Remove tissue until the larynx cartilages are almost exposed and the tracheal rings are easy to palpate.
3. Rem....

Results

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. suit.......

Discussion

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.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Foam	BRICOSELF ITALIA, vercelli	na	Used to stabilyze the model on the wooden tablet
Insuline Syringe	na	na	Used to draw linea alba with india ink
Pig Esophagus	Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)	na	Wet material used to build the simulated muscular layers and fascia
Pig skin	Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)	na	Wet material used to obtain the simulated skin
Pig thymus	Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)	na	Wet material used to build the simulated thyroid
SILK suture - Vetsuture SILK 2/0 (Metric 3) Ago 3/8 30mm Reverse Cutting (12 pz)	Sanitalia Care Srl	SILK2CN	Sutures to tight all the parts of the model
Surgical instruments scissors, forceps, knife, needle holder	na	na	na
Swine upper airways	Butcher shop (Il mercato carni, di Dutto Srl. - 28100, Novara (Italy)	na	Wet material used to build the model
white india ink - pelikan 10ml	Cartoleria Manzoni di Lo Monaco Rosaria s.a.s. 97019 Vittoria, Italy	36340	Ink used to mark the linea alba on the esophagus
Wood stapler	BRICOSELF ITALIA, vercelli	na	Used to staple on the model
Wooden tablet	BRICOSELF ITALIA, vercelli	na	Used to stabilyze the model with the stapler