Advancing Point-of-Care Ultrasound Training in Medical Schools: Ultrasound-Guided Subclavian Vein Access Training Using Formalin-Embalmed Cadavers

Abstract

OBJECTIVES: This brief report examines the feasibility of using formalin-embalmed cadavers in training medical students to use ultrasound guidance to access the subclavian. This novel educational approach is discussed in the context of the ongoing integration of point-of-care ultrasound training into medical education. Additionally, this report explores how cadavers can provide practical, effective, and hands-on skills training opportunities for medical students to learn to perform common clinical procedures under ultrasound guidance. DESIGN: This report presents subjective and objective data evaluating the utility of teaching medical students to perform ultrasound-guided subclavian vein access on formalin-embalmed cadavers. SETTING: Rocky Vista University College of Osteopathic Medicine in Ivins, UT. SUBJECTS: Twenty-five first-year medical students at Rocky Vista University. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pre and posttraining questionnaires were administered to assess each participant’s self-confidence in using ultrasonography to access the subclavian vein of a cadaver. A statistically significant increase in participant self-confidence was observed across all questionnaire items from pre to posttraining. Objective evaluation consisted of a supervised skills test. Participants were evaluated on their ability to visualize the subclavian vein with ultrasound and achieve flashback of blood/embalming fluid into a syringe. During skills testing, the number of needle sticks and the time taken to achieve flashback were recorded for each participant. Twenty-three of the 25 participants were able to successfully complete the skills testing assessment. CONCLUSIONS: The formalin-embalmed cadaver can be a readily available and effective learning tool for medical education programs seeking to provide training opportunities in ultrasound-guided clinical procedures. The use of cadavers allows learners to train in a low stress and anatomically authentic environment without risk of patient discomfort.

Comparing the Utility of Landmark-Palpation Guided to Ultrasound-Guided Teaching Methodologies for Subclavian Central Venous Access Using a Formalin-Embalmed Cadaver Model

“…The purpose of this study is to compare the utility of the formalin-embalmed cadaver as a training tool for teaching novice trainees to use palpation-landmark guided techniques to access the subclavian vein and provide a comparison to US-guided training methods reported in our prior study. 27 The palpation group took longer to successfully canulate (approximately 36 seconds more), with more failures and more needlesticks required for success than the US group which may translate to increased patient discomfort and increased infection rates in live patients. Another significant advantage the US group had was that they were able to visualize the needle while advancing, a practice which decreases the risk of pleural injury, which is a common complication of this procedure.…”

“…Data from the remaining 25 participants was accessed from a prior study and served as our US group. 27 US and palpation-related data were collected and analyzed over one year.…”

“…Participants in the US group described in previous work 27 received ten minutes of individual instruction from an Associate Professor of US using a formalin-embalmed cadaver. Participants were instructed to locate the subclavian vein in a short-axis view (Figure 1A) and use a dynamic approach to access the subclavian vein with the introducer needle (Figure 1C).…”

“…Formalin-embalmed cadavers have not been utilized to teach subclavian central venous access until our prior publication 27 due to perceived barriers to their use in training programs related to tissue desiccation and blood coagulation during the embalming process. 24,25 The sonographic clarity of these images (Figure 1) and the patent status of these veins illustrate the utility of formalin-embalmed cadavers in subclavian vein access training using either US-guided or palpation-based techniques.…”

“…26 This follow-up study presents data that builds upon our prior work that shows that formalin-embalmed cadavers are a useful tool in teaching US-guided subclavian venous access. 27 This present study compares the relative utility of palpation-based and US-guided training techniques to teach central venous catheterizations in the subclavian vein. This study aims to determine if formalin-embalmed cadavers are an effective training tool for teaching trainees using both types of central venous access techniques.…”