Low Cost Alternative for Abscess I&D (1090-003889)
CE Hours: 0.25 Session Type: SimVentors
Annually, our simulation center has over 100 students who need to learn and be tested on incision, drainage, and packing of abscesses. Factoring in learning, self-guided practice, and testing for each student, we need in excess of 300 abscesses per year to meet our needs. The cheapest commercial trainers found are about $30 for two abscesses leading to over $4,000 annually. We needed a more cost efficient way to train this skill. To do this, we experimented with modifying our method of making silicone suture. We quickly discovered that we could not simply inject simulated pus (mayonnaise and yellow mustard) into a gel layer. This meant we needed to create spaces we could then fill with the “pus”. Working with the silicone manufacturer we settled on using clay to create the spaces that would become the abscess and fill in the silicone around the clay. Prior to the clay, we tried using other materials including nitrile gloves, latex gloves and balloons, and plastic beads. These materials prevented the silicone from curing correctly. Finally, to create the appearance of a raised abscess lesion, we decided to use escargot trays. Each escargot tray has six wells which lead to each I&D pad having six independent abscesses. Working upside down, the first layer is poured using a fast curing silicone which allows our epidermis layer to have the raised abscess appearance. Next, we place wads of clay into each of the wells as space holders for the “pus” later. We add a second layer of gel silicone which can accept injection of fluids from simulated anesthetics, filling the trays with this layer. The clay is not completely covered during this step, allowing for its removal later. Once that layer is set, we remove the clay and place the trays on a flat surface onto which has been poured the final layer of rubber. That layer cures to the previous layer creating the spaces we subsequently fill with “pus” by injecting the mold from the side. This process proved to be reproducible and efficient. With multiple trays we are able to produce enough abscesses in about 2 weeks to meet our annual need. These pads are produced at a cost of less than $10 per pad including material and labor. Each pad contains six abscesses leading to an overall cost of approximately $1.50 per abscess. These meet the need of being able to inject simulated anesthetic, incise and drain the abscess, pack the abscess with iodoform packing material, and suture the incision closed. The center's student workers are taught how to do this and are the ones who produce the pads.