Intraosseous access is one of those skills that is rarely used but can be a lifesaver. In the critically ill child IV access can be challenging. You get tunnel vision and try to insert a cannula whilst losing focus on the reason for access – circulatory support. In order to achieve mastery in any skill one must undertake deliberate practice, using both mental and physical simulation.
Here’s how you can produce your own IO trainer for a few cents:
|1. You are going to need a couple of delicious chocolate bars, some gloves and a roll of 15cm wide plaster of Paris.|
|2. Keeping the wrapper on the chocolate (you may want to eat it later after all) apply six to eight layers of plaster and allow to dry.|
|3. Here is the completed product.|
|4. One of the trainers has been wrapped in an attempt to simulate skin. I have found that a looser glove works best. It also makes the trainer easier to transport without – you no longer cover your clothes in plaster dust.|
|5. Unlike the more traditional chicken bones you can have one or two of these trainers made up in advance for just-in-time teaching.|
This is not a new technique. It’s even been written up in the literature here.
Bateman ED, Bateman A. Intraosseus access simulation: the Crunchie solution. Emerg Med J. 2010 Dec;27(12):961
I’ll have to give that a go next time I’m at work. Thanks, Angela
Last time i trained my juniors we used raw eggs – I’ve had numerous occasions in real life where Ive seen the IO go right through the tibia – i think this is probably due to the anxiety of the moment and people push too hard. The raw egg approach means they learn to drill steadily but carefully. – and the eggs don’t smash! and you can put multiple holes in them – not as tasty as crunchy bars though!
Nice idea. For many years, I have been using a Crunchie or Violet Crumble with two tongue depressors superficial to the wrapper and then encased in Sleek Tape. In a non-randomised, anecdotal “study” I have found two tongue depressors are more “realistic” than one, and that Sleek is more “realistic” than Elastoplast.
I tried to use gloves to simulate skin, to encourage fixing it in place, but they just split and fly off. They do make it easier to carry them without getting plaster dust all over your scrubs though. I keep a couple of them in the office for that ‘teaching moment’. I think it’s probably more acceptable to my colleagues than keeping chicken thighs in there.