Task Trainer for Ultrasound-Guided Lumbar Puncture in Obese Patients (1090-004190)
CE Hours: 0.25 Session Type: SimVentors
As the prevalence of obesity continues to rise, the traditional anatomy-based approach to performing lumbar punctures (LPs) has become increasingly difficult. Bedside ultrasound can significantly improve LP success in patients with difficult anatomy. We developed a low-cost model to train learners to perform LPs on obese patients with the help of ultrasound guidance. To construct the task trainer, we purchased an anatomically correct spine model and isolated the relevant spinal segment (T12-L5 vertebrae). The spine was shaped to minimize lumbar lordosis to simulate the inability of many obese patients to adequately flex the spine. An 18-inch by 0.25-inch Penrose drain was threaded through the spinal column to simulate the dural sac. The distal end of the Penrose drain was clamped using a binder clip, just below the L5 vertebra. A 16-gauge angiocatheter was affixed with epoxy to the proximal end of the Penrose drain to allow for fluid instillation. The angiocather end of the drain was glued to the perpendicular metal rod connecting all the vertebrae to ensure easy access for fluid instillation following mold formation. Once the glue was dried, a saline flush was used to fill the Penrose drain reservoir with normal saline to simulate cerebrospinal fluid. After completing the modifications of the spine model, a box with inner dimensions of 12”x6”x7” was constructed from MDF wrapped in aluminum foil to be used as a mold. An 18”x4”x4” block of ballistics gel was melted in a commercial crock pot at 250 degrees Fahrenheit. The spine model was placed in the mold and the ballistics gel was carefully poured over the spine to a depth of 6 inches. The model was allowed to cool overnight. After cooling, the mold was deconstructed, leaving the spine encased by a 12”x6”x6” block of ultrasound-ready, transparent gel. To opacify the model for testing purposes, a layer of commercially available silicone rubber was dyed flesh-tone and placed over the transparent trainer.