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UGIV_Simulator

Vascular access is such an important component of the treatment of ED patients.  Our nurses, paramedics and techs do an amazing job placing IV’s, but sometimes there’s that “difficult stick”.  I’ve found ultrasound to be immensely beneficial in situations in which vascular access is unable to be obtained by standard methods.  I’ve used it on numerous occasions when placing central lines, and over the past few years, I’ve found myself placing more and more US-guided peripheral IV’s.

One of the physicians at my shop (Jacob Hennings) went to the ACEP teaching fellowship a few weeks back and emailed me about this product called “Clear Ballistics.”  He stated that one of the other people there had been using it to make a DIY ultrasound-guided vascular access simulator.  As soon as I heard about this, I ordered a block of this ballistics gel, and started experimenting.  Here’s how I made it:

Items you’ll need to get started:
1. Ballistics gel
2. Small bread loaf pan
3. Drill bits
4. Countersink bit
5. Latex tubing
6. 2 flask funnels
7. Dowels
8. Drill
9. Safety goggles
10. Crock Pot
11. Knife
12. Syringe

(this video has been updated as of 12/23/15)

If you don’t feel like watching this video, here are the steps:

  1. _Ballistic   Get your ballistics gel
  2. 1.0 Cut_Cubes Cut your gel into small cubes
  3. 2 Cubes Place them into a recepticle
  4. 3 Melting_Cubes Place gel cubes in crockpot.  Put the heat setting on high
  5. 3.5 Measure_Pan Mark the depth you want the “vessel” to be on either side
  6. 4.0 Drill_Pan Drill holes on either side
  7. 5.0 Countersink_Outside Use countersink bit to smoothen edges
  8. 6.0 Countersink_Inside Be sure to get inside and out
  9. 6.5 Sand_Hole File the edges
  10. 7.0 Measure_Tubing Measure out the tubing. Give yourself about 6 inches on each side
  11. 8 Cut_Tubing Cut it
  12. 9 Tie_Tubing1 Tie one end off
  13.  10 Fill_Syringe Fill your syringe from your Thomas cup.
  14. 11. Filling_Tubing Fill the tube
  15. 12.0 Tying_Tubing Tie off the other end
  16. 12.5 Tubing_Inside_pan Pull it through the holes
  17. 13 Stick_Funnel Cut the end of funnels off, get your dowels.
  18. 14 Placing_stick_and_Funnel2 Tie the tube to the dowel, place flask between dowel and pan
  19. Tubing Do it on the other side as well.
  20. 15.0 Stiring_Gel Check on your gel.  It should be syrupy.
  21. 16.0 Pouring_Gel_1 Begin pouring
  22. 17.0 Pouring_Gel Pour to your hearts content
  23. 18.0 Removing_Funnel After its hardened, take out the dowels and funnels
  24. 20.0 Spatula_for_removing_Phantom Use your hands and a spatula to take the phantom out of pan
  25. 21.0 Phantom_completed Et voilà!

The beauty of using this instead of a gelatin (the one with food) US-guided vascular access simulator is that this one is much more durable, and when you’re done, you can just take the tubing out, melt it down, and start over.   Of course, if you want your gel mold to be opaque (although we haven’t tried it) you can add sugar free Metamucil ( 1TBS/250mL gel)1 or dark food coloring.  Let me know how it works for you.

 

REFERENCES

  1. Kendall JL, Faragher JP. Ultrasound-guided central venous access: a homemade phantom for simulation. CJEM. 2007;9:(5)371-3. [pubmed]

7 Responses to UGIV_Simulator

  1. Thanks, Jacob! As you know, we used this phantom for our ECMO cannulation simulation lab at Castlefest 2015. I was, hands down, the best gel I’ve ever used for simulation. And the fact that you can melt this down and reuse it over and over again is pure bonus.

    EDECMO-endorsed.

    BTW, great blog and resource.

    ~Joe
    The EDECMO Podcast

  2. Pingback: The BEST Vascular Access Phantom for ECPR Simulation

  3. Pingback: Home Made IV Access Ultrasound Phantom - INJECTABLE ORANGE

  4. Adam O'Brien says:

    Hi Jacob,

    Thanks for this recipe using ballistic gel. It has many advantages over other phantoms for teaching ultrasound guided vascular access. However, I’ve found that the echogenic tracks left by previous attempts cause confusion about where the needle tip is – have you found this? Despite this, I’m about to heat the gel and re-make several phantoms.

    Cheers,
    Adam

    • Jacob.Avila says:

      Hey Adam,

      Thanks for the comment! Yes, the tracks are a common issue. I’ve found that using a smaller gauge needle decreases the size of that track. Also, I tell learners to start on one end of the phantom and when the next learner tries it, I tell them to go distal to the last puncture. That way the previous needle track does not get in the way of the current one.

  5. April Starr says:

    Hello Jacob,
    Thank you for the tutorial, I placed an order for the ballistic gel today! I am curious if you have had a chance to use the Metamucil or food coloring yet? If so how did it turn out and were you able to reuse it?
    Thank you for your help!
    April

  6. Jacob says:

    Hi Jacob!

    I´ve made a similar home made ultrasound phantom using the forumla from this article:

    https://deepblue.lib.umich.edu/bitstream/handle/2027.42/38198/1870230413_ftp.pdf?sequence=1

    Adding some preservative to the gelatine makes it more long lived. Metamucil makes it more tissue like on ultrasound and less opaque and is highly recommended. Food coloring makes it look better. Creating the phantom i 3 layers (the midlayer for trapping the vessels which will otherwise float) allows for full inclusion of the vessel in the phantom.

    /Jacob Rosén

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Jacob Avila