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High Fidelity Low Cost Transvenous Pacing Simulator (1090-003480)
CE Hours: 0.25 Cost: $0.00
Description:
Transvenous Pacemaker Insertion (TV) is technically challenging procedure that, while within the scope of an emergency provider’s practice, is infrequently encountered. Emergency medicine residents across the country must learn this procedure but rarely have the opportunity to perform in a real world setting. Many high fidelity training models either utilize live animals (costly, ethically complicated) or expensive simulation mannequins. In 2014, Dr Luber and colleagues from UT Houston Health Sciences Center designed a low cost, hi-fidelity mannequin to facilitate EKG guided placement of a transvenous pacing wire using an open source Arduino microcontroller, open source Processing software, and inexpensive infrared speed sensors. This design could be replicated with only minor electronics knowledge for under $50, allowing residency programs and other instructors to recreate the simulator themselves. This design was expanded by creating open source software in Processing to display animated EKG waveforms that change as pacing wire is inserted into different depths of the mannequin. A virtual pacing control box was created inside this software allowing learners to manipulate parameters to achieve pacing capture of the mannequin. A hollow body mannequin is the base of the model. Inside are 5 infrared speed sensors that act as checkpoints connected in series along hollow tubing, attached to an introducer sheath pre-installed into mannequin. These sensors interface with an Arduino nano, connected to a computer running the Processing software. As the pacing wire passes the sensors in the tubing, the Arduino triggers changes to the animated EKG display. Once the wire reaches the last sensor, the program allows learners to manipulate the controller box and successfully pace the mannequin, as the wire is in the correct position to pace. The Processing software displays the EKG waveform, controller box, and wiring diagram. Learners must decide whether to hook up the negative and positive leads of the pacing wire to the controller box, virtual “bedside monitor”, or leave unconnected to perform EKG guided wire placement, “blind” wire placement, or to attempt rhythm capture. The learners interact with the wiring diagram, and the program displays accurate, realistic EKG waveforms depending on these connections. When the learners have placed wire to depth and are ready to attempt rhythm capture, they manipulate output, rate, and sensitivity on virtual controller box to successfully pace the mannequin as they would in real life. This virtual interface provides a lifelike depiction of transvenous cardiac pacing allowing learners to participate in the full clinical workflow. This model can be a useful tool for instructors seeking to teach emergency medicine residents or other learners how to setup and perform external transvenous pacing. All code for Arduino, Processing, and assembly instructions are available online. The model is simple enough to be replicated by an instructor for approximately $50. Not included in these costs are a soldering iron, computer, and disposable TV pacing kit (5fr introducer sheath, pacing wire, alligator clips, dressing, etc). TV controller box (controls rate, sensitivity, current) is not required, as the controller box is simulated in the software.