A Novel Task Trainer for Penile Corpus Cavernosa Aspiration.

INTRODUCTION: Priapism is a rare yet time sensitive emergency with potentially significant morbidity. A novel task trainer was developed for corpus cavernosa aspiration and phenylephrine injection. The primary aim of this study was to assess model realism and usefulness for emergency medicine resident procedural education. Secondarily, an assessment of comfort level with the procedure before and after intervention was performed. METHODS: A priapism model containing corpus cavernosa and spongiosum analogs was constructed. The models and evaluation forms were pilot tested by faculty and then tested for realism and usefulness in a sample of 49 residents after a brief training session. Secondary end points included resident comfort with cavernosa aspiration before and after the session of the model on a visual analog scale. RESULTS: Eight faculty pilot tested the procedure model and evaluated it based on a 5-point scale. They unanimously felt that the model was realistic [mean = 4.4, 95% confidence interval (CI) = 3.8-5.0] and useful for resident education (mean = 4.8, 95% CI = 4.4-5.0). The model was then evaluated for realism and usefulness in 49 residents. The model was felt to be realistic (mean = 4.3, 95% CI = 4.0-4.5) and useful for resident education (mean = 4.6, 95% CI = 4.4-4.8). Residents also noted an improvement in comfort performing the procedure before and after simulation session with the mean visual analog scale rating increasing from 34.3 to 83.8 (P < 0.001). CONCLUSIONS: An easily constructed priapism task trainer was felt to be realistic and useful for resident education. Secondarily, use of the model in a simulation session can improve resident comfort in an important and infrequent procedure.

What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access.

OBJECTIVES: Ultrasound (US) has been shown to facilitate peripheral intravenous (IV) placement in emergency department (ED) patients with difficult IV access (DIVA). This study sought to define patient and vein characteristics that affect successful US-guided peripheral IV placement. METHODS: This was a prospective observational study of US-guided IV placement in a convenience sample of DIVA patients in an urban, tertiary care ED. DIVA patients were defined as having any of the following: at least two failed IV attempts or a history of difficult access plus the inability to visualize or palpate any veins on physical exam. Patient characteristics (demographic information, vital signs, and medical history) were collected on enrolled patients. The relationships between patient characteristics, vein depth and diameter, US probe orientation, and successful IV placement were analyzed. RESULTS: A total of 169 patients were enrolled, with 236 attempts at access. Increasing vessel diameter was associated with a higher likelihood of success (odds ratio [OR] = 1.79 per 0.1-cm increase in vessel diameter, 95% confidence interval [CI] = 1.37 to 2.34). Increasing vessel depth did not affect success rates (OR = 0.96 per 0.1-cm increase of depth, 95% CI = 0.89 to 1.04) until a threshold depth of 1.6 cm, beyond which no vessels were successfully cannulated. Probe orientation and patient characteristics were unrelated to success. CONCLUSIONS: Success was solely related to vessel characteristics detected with US and not influenced by patient characteristics or probe orientation. Successful DIVA was primarily associated with larger vessel, while vessel depth up to >1.6 cm and patient characteristics were unrelated to success. Clinically, if two vessels are identified at a depth of <1.6 cm, the larger diameter vessel, even if comparatively deeper, should yield the greatest likelihood of success.