Journal of Education and Teaching in Emergency Medicine

ABSTRACT: Audience: The pork belly paracentesis simulator is designed to instruct Emergency Medicine (EM) residents and Emergency Medicine-bound students.

Introduction: Abdominal paracentesis is a common procedure done in the Emergency Department (ED) that must be mastered by EM residents and students. The purpose of a paracentesis is to remove accumulating ascites from the peritoneum. Diagnostic paracentesis is indicated with new cases of ascites or to detect the presence of infection in patients with already known or suspected ascites.1 Therapeutic paracentesis is often conducted in the ED setting to relieve any cardiorespiratory and gastrointestinal manifestations of tense ascites.2 While this procedure has been described in modern medical literature for over a hundred years, the addition of ultrasound can enhance the safety of the procedure and can help detect as little as 100 ml of fluid.3

Objectives: By the end of this instructional session learners should be able to: 1) Discuss the indications, contraindications, and complications associated with abdominal paracentesis; and 2) competently perform an ultrasound-guided abdominal paracentesis on a simulator and remove fluid.

Methods: This paracentesis simulator uses a porcine skin with underlying muscle and fascia to replicate the feel of human tissue undergoing this procedure. A gallon water jug is used to simulate the peritoneal cavity filled with ascites. Placing a small hand towel or sterile blue towel in the water jug acts as a wonderful mimic of bowel loops “floating” in the peritoneal fluid when ultrasound is used. A layer of ultrasound gel is placed liberally on one side of the water jug, and then the pork belly is layered on top of that. This tissue is secured to the jug with 3M microfoam surgical tape (or other adhesive-like duct tape). This model has a realistic feel and can be used with ultrasound to replicate intraperitoneal contents. The thickness of the plastic jug will give a realistic “pop” into the peritoneum with the paracentesis needle. Also, this trainer can be used multiple times by different learners before being replaced. This model will allow the learner to conduct a realistic paracentesis procedure while removing actual fluid.

Topics: Paracentesis, ascites, ultrasound-guided procedure, simulation.