The Feasibility of Ultrasound-Guided Knee Arthrocentesis Training Using Formalin-Embalmed Cadavers

Abstract

Background: The use of ultrasound guidance during knee arthrocentesis has proven to increase operator confidence and accuracy, particularly in novice healthcare providers. Realistic and practical means of teaching this procedure to medical trainees are needed. This study is intended to assess the feasibility and efficacy of using formalin-embalmed human cadavers in the instruction of ultrasound-guided knee arthrocentesis to medical trainees. Methods: Twenty participants received a 30-minute didactic orientation detailing the principles of ultrasound-guided knee arthrocentesis, followed by a training practicum performed on human cadavers. The practicum included a 25-minute training period, followed by a 15-minute assessment period. Participants were objectively assessed on their ability to independently aspirate synovial fluid from the suprapatellar bursa using ultrasound guidance. Digital pretraining and posttraining questionnaires were administered to evaluate each participant’s confidence in their ability to independently locate the site of optimal needle placement and successfully aspirate synovial fluid with the guidance of ultrasound imaging. Results: An analysis via the Wilcoxon rank sum testing revealed that participant self-confidence increased significantly after training across all assessment items (p < 0.0001). Fifteen participants (75%) successfully aspirated 1 mL of synovial fluid on their first attempt, whereas 3 participants (15%) were successful on their second attempt. Two participants (10%) failed to perform a successful aspiration within the 15-minute time limit. The average time required to aspirate 1 mL of synovial fluid was 41 seconds. Conclusions: Ultrasound images of the formalin-embalmed suprapatellar bursa are of sufficient quality to use in the instruction of arthrocentesis to medical trainees. Brief instruction using formalin-embalmed cadaver models significantly increases trainee confidence and prepares first-year medical students to successfully and independently perform ultrasound-guided knee arthrocentesis.

Implementation of Ultrasound in Preclinical Education at Osteopathic Medical Schools: A Scoping Review

“…Embalmed cadavers were also utilized to teach needle-guided procedures such as knee arthrocentesis, subclavian vein access, PICC line insertions, central line insertions, and identification of fractures using US [ 14 , 16 , 19 - 22 ]. To verify the technical skills of students in US, examinations and assessments were also given [ 11 , 13 , 20 - 23 ].…”

Comparing the Utility of Palpation-Based and Ultrasound-Guided Teaching Methodologies for Subclavian Central Venous Access Using Formalin-Embalmed Cadavers

“…Formalin-embalmed cadavers had not been utilized to teach subclavian central venous access until our prior publication (34) due to perceived barriers to their use in training programs related to tissue desiccation and blood coagulation during the embalming process (22,23). The sonographic clarity of these images (Fig.…”

“…However, cost and inaccessibility have proven to be challenging impediments to in their widespread adaptation (19,20,21). Formalin-embalmed cadavers, which are widely used for anatomical education, may provide a useful alternative to synthetic models and other types of cadaveric specimens while preserving anatomic, tactile, and sonographic accuracy (22).…”

“…Although there are many bene ts to using formalin-embalmed cadavers in medical education, there exist some obstacles to using them in US-guided procedure training. The desiccated nature of formalinembalmed tissue often negatively impacts sonographic image quality (22,23). When considering vascular access in a formalin-based cadaver, the embalming process causes uid to form inside the vessels that is a different consistency than blood would be in a live patient.…”

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

“…[21][22][23] Formalin-embalmed cadavers, which are widely used for anatomical education, may provide a useful alternative to synthetic models and other types of cadaveric specimens while preserving anatomic, tactile, and sonographic accuracy. 24 Although there are many benefits to using formalin-embalmed cadavers in medical education, there exist some obstacles to using them in US-guided procedure training. The desiccated nature of formalin-embalmed tissue often negatively impacts sonographic image quality.…”