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:
Get your ballistics gel
Cut your gel into small cubes
Place them into a recepticle
Place gel cubes in crockpot. Put the heat setting on high
Mark the depth you want the “vessel” to be on either side
Drill holes on either side
Use countersink bit to smoothen edges
Be sure to get inside and out
File the edges
Measure out the tubing. Give yourself about 6 inches on each side
Cut it
Tie one end off-
Fill your syringe from your Thomas cup. 
Fill the tube
Tie off the other end
Pull it through the holes
Cut the end of funnels off, get your dowels.
Tie the tube to the dowel, place flask between dowel and pan
Do it on the other side as well.
Check on your gel. It should be syrupy.
Begin pouring
Pour to your hearts content
After its hardened, take out the dowels and funnels
Use your hands and a spatula to take the phantom out of pan
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
- Kendall JL, Faragher JP. Ultrasound-guided central venous access: a homemade phantom for simulation. CJEM. 2007;9:(5)371-3. [pubmed]
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
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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
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.
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
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
Penrose drains in my attempt burst (from the heat of the melted ballistics gel, possibly) and did not work after two tries. Metamucil added and stirred in did make it more echogenic and less transparent to the naked eye, but do note this can’t be filtered out later on. Also note that water soluble coloring (like most food dyes) will not work in melted ballistics gel, for those trying.
Thanks! Making a few of these for ECMO simulators. Can you clarify- can you use Metamucil and still reuse the ballistic gel again? Thanks,
Erik
Probably not. I typically don’t use the Metamucil, but it’s an option if you need it to be opaque