RASCI - Hands-On Simulations

There are three hands-on simulations for delegates to practice on. Simulations are for training in and practicing of components of the technical elements in performing an ultrasound guided nerve block. The simulations have three large benefits: (1) they avoid the inherent risks to human health of teaching during patient care; (2) it is a totally controlled situation for maximum convenience of bringing teachers and students together; and (3) the procedures can be repeated indefinitely as opposed to teaching during patient care where a procedure can only be performed once.

Gel-needle-nerve phantoms. These are clean-smelling in-house manufactured gelatine phantoms of nerves lying in tissue. The delegate practices maneuvering (handling) the transducer under direct tutorship. The effects of various orientations to the nerve and how the needle to the transducer is used are demonstrated. The delegate tests the effects of gliding, sliding, tilting, and rotating the transducer in in-axis and off-axis views of a nerve. The delegate tests the effects of gliding, sliding, tilting, and rotating the transducer in in-plane and off-plane views of the needle. Then the delegate attempts placing a needle onto a phantom nerve using different popular approaches that combines a transducer-nerve view with a transducer-needle view. Examples are off-axis/in-plane (OAIP) approaches or off-axis/off-plane (OAOP) approaches.

Stimulating catheter kit practice phantom. This is simple plastic flesh phantom that allows needles and catheters to be inserted into and tunneled. No stimulation of nerves is done. The objective is to learn how to hold and handle the various components of the peri-neural catheter kit without losing sterility. It is important to know how to hold multiple components all simultaneously so that no piece springs off the sterile field during the procedure. The concept of the "third Tagaderm hand" is taught and the "three point grip" for the styleted catheter.

Anesthetized animal nerve block simulation. This is the big opportunity for the delegate to put all their teaching together. Here they can handle an ultrasound transducer, hold a stimulating needle, seek the image of a real nerve and place the needle into the animal's nerve. Electrical stimulation via the needle and seeing the muscles twitch confirms the correctness of the entire process. The pig's anatomy is similar to humans in some areas and dissimilar in others. Generally this is not a simulation of "human" anatomy. The workshop's objective is to be a real simulation utilizing living biological tissue. The lecturer at hand will provide the necessary porcine anatomy information to find each teaching nerve for the purpose of the exercise.