Using Simulation Models to Train Clinicians in the Use of Point-of-Care Ultrasound
August 9th, 2024
The present protocol describes an ideal solution to train novices in the use of point-of-care ultrasound devices for the practical clinical skill of visually assessing distinct individual anatomical vascular conditions prior to and during an intended venous vascular cannulation using point-of-care ultrasound in a patient.
This experiment tried to answer the question of clinicians unfamiliar with the use of ultrasound for vascular cannulation who may be able to learn and practice the skill of ultrasound guided cannulation in a simulation model and are subsequently able to apply this skill in the clinical setting. Portable ultrasound devices are increasingly available in clinically areas because they are more affordable today than in the past, but clinicians need to be trained on how to use them successfully. Novices can learn the technique of ultrasound-guided cannulation fast when they have the opportunity to train on simulation models and make multiple attempts before they apply the same technique in their clinical setting.
The use of ultrasound during the cannulation has the advantage of providing information about the depth, size, and direction of vascular structure before the actual cannulation occurs. Further, it provides a clear vision of the needle tip being observable during the cannulation process. We are planning on performing a survey amongst senior clinicians to determine their views and perspectives on the use of this technique and what kind of barriers in the clinical space may exist.
To begin, cut a regular raw chicken breast horizontally with a sharp kitchen knife to allow for the insertion of three or more fluid-filled artificial blood vessels. Fill a 50-milliliter catheter-tipped syringe with cold rose hip tea. Push the fluid in the balloon and remove any air bubbles at the same time by repeatedly pushing the syringe in and out of the modeling balloon.
At the end, ensure the balloon is free of air bubbles and slightly pressurized. Tighten the modeling balloon with a knot to avoid any fluid leaks. Place the fluid-filled modeling balloon on the lower half of the chicken breast.
Fold the other half of the chicken breast over the balloon. Wrap this chicken breast simulation model with a transparent film and place it on a tray. To begin, place a point-of-care ultrasound or POCUS device with a linear probe and a probe cover onto the prepared simulation model.
Apply ultrasound gel to the area of interest in the simulation model. In a transverse view, visualize a simulated vessel in the simulation model. Place the ultrasound probe on top of the simulation model and center the view of the vessel in the middle of the screen of the ultrasound device where vessels appear as a black circular structure.
Move the ultrasound probe across the simulation model to place the vessel in the center of the screen of the POCUS device so that the whole vascular structure is visible. Adjust the image size and contrast settings to obtain optimal vision of the vessel and surrounding tissue. Press the Freeze function button to freeze the image.
Next, place digital markers to indicate the depth of the center of the vessel and to measure the diameter of the vessel. Rotate the ultrasound probe by 90 degrees to obtain a longitudinal view of the blood vessel. Observe the direction of the vessel being aligned with the probe.
Place the linear probe in a transverse view of the vessel. Remove the protective needle cover of the peripheral intravenous catheter cannula to commence the cannulation procedure. Place the transverse vision of the vessel centrally on the screen of the POCUS device.
Slowly and carefully cannulate in the middle of the linear probe, the simulation model, at an angle of around 40 degrees, aiming for the top of the vessel. Advance the needle tip into the tissue of the simulation model, aiming for the vessel. While advancing through the tissue, visually identify the needle tip on the screen of the POCUS device.
Further advance the needle through the tissue towards the vessel, following the needle tip with the ultrasound probe simultaneously. Visualize the needle tip entering the intravascular space. Then level the needle to a shallower angle and advance it to rest in the center of the vessel.
To validate the position of the needle tip, change the angle of the ultrasound probe or move it in small increments back and forth until the needle tip visually disappears and reappears on the screen. Observe the opposite end of the peripheral intravenous catheter for some evidence of red-colored fluid to confirm correct placement. Finally, remove the stylet from the peripheral intravenous catheter.
Overview
This protocol outlines a method for training novices in the use of point-of-care ultrasound devices for assessing anatomical vascular conditions. It emphasizes the importance of simulation training prior to clinical application.
Key Study Components
Area of Science
- Ultrasound technology
- Vascular cannulation
- Clinical training
Background
- Portable ultrasound devices are becoming more accessible in clinical settings.
- Training is essential for effective use of ultrasound in vascular procedures.
- Simulation models provide a safe environment for practice.
- Ultrasound aids in visualizing vascular structures before cannulation.
Purpose of Study
- To evaluate the effectiveness of simulation training for ultrasound-guided cannulation.
- To assess the ability of novices to apply learned skills in clinical settings.
- To identify barriers to the use of ultrasound in clinical practice.
Methods Used
- Training novices on simulation models.
- Assessing skill acquisition through practice attempts.
- Surveying senior clinicians for insights on ultrasound use.
- Evaluating the advantages of ultrasound during cannulation.
Main Results
- Novices can quickly learn ultrasound-guided cannulation techniques.
- Simulation training enhances confidence and skill retention.
- Ultrasound provides critical information about vascular structures.
- Barriers to clinical application will be explored through surveys.
Conclusions
- Training on simulation models is effective for skill development.
- Ultrasound-guided techniques improve clinical outcomes.
- Further research is needed to address barriers in clinical settings.
Frequently Asked Questions
Executive Industry Relevance
Simulation-based training for point-of-care ultrasound (POCUS) in vascular access addresses a critical skill gap in clinical practice, enabling rapid upskilling of clinicians in non-invasive vascular assessment. By integrating simulation models with POCUS devices, organizations can standardize skill acquisition and improve procedural confidence before patient-facing application. This approach supports scalable workforce development and reduces procedural variability at key clinical inflection points.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables controlled evaluation of device usability and operator learning curves in simulated environments.
- Supports objective assessment of procedural steps and measurement accuracy for translational device validation.
- Facilitates mechanistic de-risking by isolating operator-dependent variables in vascular access workflows.
Screening & Assay Development
- Provides a reproducible platform for evaluating new ultrasound-guided vascular access tools or protocols.
- Standardizes measurement of vessel depth, diameter, and direction for quantitative comparison across devices.
- Enables iterative optimization of device settings and procedural parameters before clinical deployment.
Translational & Preclinical Research
- Aligns simulation outputs with clinical endpoints such as first-attempt cannulation success.
- Supports continuity from device prototyping to preclinical usability testing in disease-relevant models.
- Reduces translational risk by validating operator proficiency and measurement reliability prior to patient studies.
Pipeline & Workflow Integration
This simulation-based POCUS training model fits within the translational continuum from device development through clinical implementation, supporting both early usability studies and preclinical validation.
- Discovery Biology: Isolates operator technique as a variable, enabling hypothesis testing around device efficacy and procedural outcomes.
- Screening: Delivers standardized, quantitative readouts of vessel characteristics and cannulation success rates.
- Analytics: Provides measurable outputs such as vessel depth, diameter, and needle visualization for comparative analysis.
- Translational Research: Bridges simulation-based skill acquisition with real-world clinical performance metrics.
- Enterprise Reuse: Establishes a scalable, reusable training and validation platform for future device or protocol iterations.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in operator performance and device usability.
- Operational Value: Standardizes training, reduces procedural variability, and accelerates onboarding.
- Strategic Value: Improves go/no-go decisions for device deployment and protocol adoption.
- Portfolio Impact: Enables risk-adjusted advancement of vascular access technologies and training programs.
Implementation Considerations
- Requires expertise in ultrasound imaging and simulation model preparation.
- Needs access to POCUS devices, simulation materials, and measurement tools.
- Demands cross-team alignment on training protocols and assessment criteria.
- Adaptation may be needed for different vascular models or device types.
- Limitations include simulation fidelity and transferability to complex patient anatomies.
