gms | German Medical Science

For significant urine analysis the sample has to be devoid of contamination. Ultrasonic based puncture of the urinary bladder (cystocentesis) is a standardised procedure to collect such a sample [1]. Relocation of bacteria from the lower urinary tract into the bladder as found after catheter placement can be avoided [2]. The opportunities to practice cystocentesis are limited during study. To improve training of this skill a simple urinary bladder simulator for “cystocentesis” was created at the Clinical Skills Lab of the University of Veterinary Medicine Hannover. The intention was to create a cost effective simulator to train and assess students sample collection of urine under ultrasonic control.

A stuffed toy dog (IKEA) was used as the external cover of the simulator (Figure 1 [Fig. 1]). The abdomen is represented by a compact multilayer silicon package. Inside the silicon package a fluid filled cavity simulates the “urinary bladder”. Using an attached drip infusion set (e.g. NaCl-solution) the cavity can be refilled. In contrast to a real abdomen the simulator shows no other abdominal structures than the “bladder”. During the last year of study, students participating in ultrasound examinations at a traineeship in the clinic for mall animals. At the end of the traineeship students have to perform ultrasonic based “cystocentesis” in an objective structured clinical examination (OSCE) on the simulator. At the OSCE station binary checklists (yes/no) and an ultrasound device (M5Vet, Mindray) with ultrasound probe (5-8 MHz) were used.

Results of the OSCE station “cystocentesis” showed 80% (n=68) of the students passed this OSCE station. 82% could display the needle during puncture and about 74% of students successfully punctured the bladder and collected a sample. 25% were not able to demonstrate the “urinary bladder”. Almost no one modified the frequency (to 8 MHz) on the ultrasonic device to adjust the depiction. The simulators production takes about four hours, including the sewing of the stuffed dog and manufacturing the silicon package. The costs of material are approximately 50 €.

Students get immediate feedback for the performance of a “cystocentesis” under ultrasound control. The simulator can be easily produced on low-cost level. Due to the use of a stuffed toy dog, one limitation of the simulator is the correct anatomical location of the target region. Therefore, some students were confused about the correlation of the “urinary bladder” to other anatomic landmarks of the simulator. In the future this simulator will be improved and evaluated by medical specialists for diagnostic imaging and other clinicians.