Development and Evaluation of a 3D-Printed Adult Proximal Tibia Model for Simulation Training in Intraosseous Access

Abstract

Intraosseous infusion remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients and those presenting to the emergency department. There is a scarcity of cost-effective, anatomically correct trainers to improve physician confidence and competency in this skill. The purpose of this report is to describe the development and evaluation of a three-dimensional (3D) printed Adult Proximal Intraosseous (IO) Tibia task trainer for simulation-based medical education. The proposed trainer was designed by combining open-source models of a human skeleton and a lower leg surface scan in Blender (Blender Foundation - www.blender.org) and manipulating them further using a JavaScript program. Polylactic acid was used to simulate bone while cured silicone moulds were used to replicate skin and soft tissue. Two trainers were produced and tested by 15 rural family medicine residents, six rural emergency medicine physicians, and six registered nurses. Participants evaluated the realism of the trainer and its efficacy as a training tool through a structured survey. The trainer received overall positive feedback from all participants, and most participants felt that no improvements were required to use the trainer for medical education. Notable suggestions for improvement included adding an infusion component, increasing the size of the tibial tubercle for better landmarking, and creating a variety of sizes for different patient body types. Residents and emergency medicine physicians practising in rural Newfoundland and Labrador found the 3D-printed trainer to be a practical tool for practising intraosseous technique. The outcome of this report supports the use of this cost-effective trainer for simulation-based medical education.

Keywords: emergency medicine and trauma; intraosseous; simulation in medical education; task-trainer; three-dimensional (3d) printing.

Figure 1. Components of the Adult Proximal Tibia IO Trainer

A) Base; B) bone and muscle tissue; C) skin attachment; D) replaceable tibial cartridge

Figure 2. Screenshots of model rendering in Meshmixer

A) Rendering of cured silicone muscle mould with bones; B) rendering of base unit with recessed shapes from boolean subtraction of bones

Figure 3. Equipment setup showing two Adult Proximal Tibia IO Trainers, EZ-IO power driver and needle sets, and cordless drill

Figure 4. Testing of Adult Proximal Tibia IO Trainer

A) Testing with cordless drill and custom drill-bit; B) testing with EZ-IO Power Driver; C) trainer following needle insertion

Figure 5. Photos showing wear of the Adult Proximal Tibia IO Trainer following data collection

A) Skin attachment; B) tibial cartridge

Figure 6. Frequency of FM resident responses to questions 3, 4, and 8 of the product evaluation survey (N=15)

Q3: In your opinion, how effective is this new Adult IO Trainer in increasing trainees’ skills-based competency in IO insertion? Q4: In your opinion, how effective is this new Adult IO Trainer in increasing trainees’ confidence to perform IO insertion? Q8: Please rate the value of the Adult IO Trainer as a training tool. Likert scale: 1 = Not at all effective; 3 = Effective; 5 = Very effective. FM- family medicine

Figure 7. Frequency of responses by FM residents (N=15) and ED physicians (N=6) to Question 9 of the product evaluation survey

FM- Family Medicine; ED- Emergency Department;