Creation of an Affordable and Realistic Ultrasound Pericardiocentesis Model

Purpose The pericardium is a protective fluid filled sac that surrounds the heart. In cardiac tamponade, the pericardium fills with excess fluid (blood, pus, etc.) resulting in decreased cardiac output. Ultrasound guided pericardiocentesis is a dangerous, but potentially lifesaving procedure that can be performed to relieve cardiac tamponade. Teaching institutions often obtain lifelike trainers that cost upwards of $20,000. More cost-effective models using balloons or Styrofoam eggs have been created but lack realism and durability. Our objective was to develop an affordable model utilizing a 3D printed heart for ultrasound-guided pericardiocentesis. Methods Models of the heart and pericardium were created using Mimics 3D software (Materialise) and printed on a Stratasys J750 printer utilizing Digital Anatomy materials. An alternative model was created utilizing a cup and saline IV bag. Gel wax was then melted at 220 degrees Fahrenheit and the two models were submerged to simulate the acoustic properties of surrounding thoracic tissues. Results The 3D model and alternative model were successfully created and ultrasound-guided pericardiocentesis was attempted. The echogenicity of the 3D printed pericardium was sufficient for visualization; however, the material was too thick to penetrate. In the alternative model, the saline IV bag was amenable to needle puncture, but was anechoic preventing sufficient visualization and did not sufficiently reseal after needle removal. Conclusion While gel wax has appropriate ultrasound properties, a material that can reseal after needle insertion is needed to make plastic bags and cups viable alternatives. Additional trials need to be done to identify a material for the 3D printed pericardium that is compatible with both ultrasound and repeat procedure attempts. Overall, 3D printing offers the most promising results and with future attempts, after fine-tuning the thickness of the pericardial sac, we anticipate a successful model will be produced.