Assembly and use of a low-cost paracentesis simulator for the teaching of puncture and drainage of ascites

SILVEIRA, BRENO WELLINGTON MESQUITA; ARAÚJO, LUANA AKEMI ALVES; ALBUQUERQUE, LUCAS DE SOUZA; VASCONCELOS, FELIPE DE OLIVEIRA; LIMA, ERICK BATISTA DE MEDEIROS; GÓES, ANNYA COSTA ARAÚJO DE MACEDO; VERAS, LARA BURLAMAQUI

doi:10.1590/0100-6991e-20223099

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Education • Rev. Col. Bras. Cir. 49 • 2022 • https://doi.org/10.1590/0100-6991e-20223099 copy

Assembly and use of a low-cost paracentesis simulator for the teaching of puncture and drainage of ascites

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students.

Methodology:

a paracentesis simulator was built using a mannequin and materials such as plastic bottles, Velcro, polyvinyl chloride sheets and silicone were used. A cross-sectional and experimental study was carried out with undergraduate medical students without previous practical experience with paracentesis, which sought to validate the model, evaluating its benefits in learning and obtaining technical skills.

Results:

after using the simulator there was an increase of 82.4% in the level of confidence in performing paracentesis in a patient, with 98% of respondents considering that the model fulfilled the simulator function with satisfaction, and 100% considering it useful as a teaching tool.

Conclusion:

the built simulator was effective as an educational resource, serving as an alternative to high-cost commercial models, allowing for greater accessibility in the use of this tool in medical education.

Keywords:
Simulation Training; Low-cost Technology; Paracentesis; Ascites; Education; Medical

Stage		RC	RI
I	Presentation and explanation of the procedure for the patient	The participant must say the name and title, ask the patient's name and explain the procedure to be performed in intelligible language	Absence of any of these steps, but not all
II	Questioning about full bladder and request for voiding	The participant must ask if the patient is in the mood to urinate and, if so, must ask him to urinate before the procedure	Absence of any of these steps, but not all
III	Identification of the puncture site	The participant must locate the puncture point, at the intersection between the middle and distal third of the imaginary line between the umbilical scar and the left anterior superior iliac spine	Identification of a site more proximal or distal to the desired point or any other non-matching anatomical site
IV	Wearing gloves	The participant must wear sterilized gloves immediately before antisepsis	He wore gloves only after antisepsis, before locating the puncture point, or he wore them and kept them on inappropriately
V	Antisepsis	With gloves on, dip gauze into the tub with antiseptic and apply antiseptic in circular and centrifugal movements in relation to the puncture point	Apply antiseptic degloved, in non-circular or centripetal movements, breaking the antiseptic technique due to contamination of the gloves
VI	field cloth	With gloves on, the participant must open the field cloth and position the fenestra to isolate the puncture point. This step must be performed between antisepsis and anesthesia	Placement of the field cloth before antisepsis or after anesthesia or degloved
VII	Anesthesia	Apply infiltrative local anesthetic at the puncture point, penetrate at an acute angle with a 5mL syringe coupled to a 22G intravenous catheter with a bevel oriented upwards, then penetrate into the deep planes at a more perpendicular angulation and anesthetize the path, always aspirating before the applications	No aspiration before applications, penetration with downward bevel orientation, no anesthesia of the dermis or puncture path, penetration with incorrect angulation and no puncture pressure control
VIII	Puncture technique	Perform Z-traction technique or skin traction with catheter, puncture at the appropriate point with a 20mL syringe coupled to a 14G intravenous catheter, with bevel oriented upwards, always aspirating and performing penetration force control	Absence of skin traction, excessive penetration or incorrect angulation, multiple superficial penetrations
IX	Ascitic fluid aspiration	Aspirate 20mL of ascitic fluid after reaching the peritoneal cavity	Insufficient aspiration, return the aspirated liquid back to the peritoneal cavity

	Not			Yes
	MINS	MEINS	PINS	PSEG	MESEG	MUSEG
Before the Simulation	54,9%	31,3%	3,9%	3,9%	5,9%	0%
After Simulation	3,9%	0%	3,9%	23,5%	62,7%	5,9%

	N	Mean	Median	SD	SE
pre-simulation	51	1,75	1	1,11	0,16
post-simulation	51	4,59	5	0,96	0,13

	DT	DP	I	CP	CT
Did the created model fulfill the role of simulator with satisfaction?	0%	0%	1 (1,9%)	13 (25,5%)	37 (72,6%)
Is the simulator useful as an educational tool?	0%	0%	0%	3 (5,9%)	48 (94,1%)
Does the simulation consolidate theoretical learning?	0%	0%	0%	4 (7,8%)	47 (92,2%)
Should the simulator be used as a training method before the real situation?	0%	0%	0%	1 (1,9%)	50 (98,1%)
Should the simulator be enhanced during medical graduation?	0%	0%	0%	1 (1,9%)	50 (98,1%)

STAGE	NR	RI	RC
I	17,6%	3,9%	78,4%
II	58,8%	0%	41,2%
III	31,4%	0%	68,6%
IV	1,9%	70,6%	27,5%
V	15,7%	4,0%	80,3%
VI	17,6%	11,8%	70,6%
VII	3,9%	51,0%	45,1%
VIII	3,9%	47,0%	49,0%
IX	21,6%	7,8%	70,6%

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