Traditional Poster Round

Poster

Infant Arterial Access Trainer: Promoting Successful Procedural Learning on our Tiniest Patients

Tuesday, May 15
09:45 - 10:45
Location: The Gate, Atrium Level

Context: : Pediatric arterial blood sampling and catheterization are important and difficult-to-master skills. Traditionally, pediatric arterial access has been taught on live patients, who are seriously ill, often have poor perfusion, and whose family members are under duress. Multiple unsuccessful attempts lead to undue pain in patients, distress in family members, and potentially more invasive means to obtain further access. Currently, no task-trainer model exists for deliberate practice on patients for whom this procedure is the most technically difficult: infants and toddlers.

Description: : The simulator is a novel educational task trainer developed by SIMPeds at Boston Children’s Hospital. It is composed of a 3D-printed (SLS nylon) skeleton featuring the full range of anatomic motion; silicone musculature and soft tissue; self-healing silicone radial and ulnar arteries; silicone skin; a 3D-printed hand-operated pump; and a 3D-printed tabletop mount. The simulator resembles an infant arm and features circulating, pulsatile flow with palpable radial and ulnar pulses. The arteries are anatomically accurate in diameter and location, and the trainer arm can be manipulated in the same manner as that of a human infant. The radial artery can be accessed using standard needles and catheters, and once accessed, will give a needle flash as would be expected during a live procedure.

The authors intend this simulator to be used in conjunction with a skills curriculum. Goals of using the arterial trainer and skills curriculum bundle include: decreasing number of arterial access attempts per patient; decreasing the number of live patient procedures needed to achieve procedural competency; decreasing provider stress and cognitive load while performing the task; and providing educators with a means to assess learners’ performance gaps prior to live patient approach.

Observation/Evaluation: : The simulator has been described as “appropriately frustrating” by novice participants in a skills session held in June of 2017. Fifty-six pediatric interns used the trainer during this course, and each learner required several attempts to access the artery. By contrast, more senior clinicians have achieved access within the first attempt, suggesting construct validity of the design. Formal analysis of the bundle and IRB submission will be forthcoming.

Discussion: : The prototype simulator allows users to perform radial access on a simulated patient with a satisfactory level of realism. Once the trainer has been validated and undergone testing for durability, the authors intend to study educational effectiveness of the bundled curriculum, and explore opportunities for further use of the device within the broader pediatric healthcare simulation community.





Debra Hillier, MD

Attending Physician, Intermediate Care Program, Boston Children's Hospital
Harvard Medical School
Winchester, Massachusetts

Debra Hillier, MD, is an Instructor in Pediatrics at Harvard Medical School and an Attending Hospitalist at Boston Children's Hospital, in the Division of Medicine Critical Care. Her clinical work has spanned the fields of pediatric inpatient medicine, pediatric critical care, pediatric emergency medicine, and pediatric sedation medicine. Her area of academic expertise is medical education, with a focus on simulation-based learning. She has developed multiple curricula for a broad range of learner levels and disciplines, including medical students at the undergraduate level, general and categorical pediatric residents, pediatric fellows, nurses, nurse practitioners, and attending physicians. Her teaching sessions can range from small group simulations, to didactic lectures, to large audience skills seminars. In addition to an interest in interprofessional education and team-based learning through simulation, Dr. Hillier has cultivated a passion for simulation-based procedural skills learning and assessment, and the determination of procedural competency.

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Kristen Leeman, MD

Associate Medical Director, NICU, Boston Children's Hospital
Harvard Medical School
Boston, Massachusetts

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Gregory Loan, ALM

Simulation Engineer
Boston Children's Hospital Simulator Program
Boston, Massachusetts

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Peter Weinstock, MD, PhD

Director - Simulator Program
Boston Children's Hospital, MA

PETER WEINSTOCK MD PhD
Chair and Executive Director, Boston Children's Hospital Simulator Program (SIMPeds)
Senior Assoc. Critical Care Medicine
Associate Professor of Anesthesia, Harvard Medical School


A practicing pediatric intensive care unit physician, Dr. Weinstock combines >20 years in surgery, medicine, education and innovation to lead the Boston Children's Simulator Program (SIMPeds) to one of largest most integrated "return on investment" simulator enterprises world-wide. Dr. Weinstock has weaved sustainable medical simulation ecosystems into the fabric of medical centers and regional health care systems on 6 continents and is founding president of the International Pediatric Simulation Society (IPSS). He serves on multiple advisory boards including education, simulation, social robotics and AI, and lectures internationally including "TED" on combining simulation, human factors, 3DP and special effects -- all to prepare world-class clinicians and healthcare systems to perform at their best, as well as to reduce fear and anxiety in patients and families.

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