ATLA 39, 257–260, 2011 257

Validation of the Educational Potential of a Simulator to

Develop Abilities and Skills for the Creation and
Maintenance of an Intravenous Cannula

Juan J. Perez-Rivero and Emilio Rendón-Franco

Departamento de Producción Agrícola y Animal, Universidad Autónoma Metropolitana Unidad Xochimilco,

Mexico City, Mexico

Summary — Historically, the method used in veterinary medicine to teach technical procedures which are
to be performed on live animals, has taken the form of an apprenticeship. However, in the last decade,
there have been several new developments in technologies oriented toward the development of such abil-
ities and skills by students — for example, manuals, videos, pictures, and virtual reality simulators.
Unfortunately, these simulators are inaccessible to many, due to their high cost. For this reason, it is nec-
essary to create simulators that are easy to manufacture at low cost, and that are also portable. These sim-
ulators also need to be validated with regard to their ability to fulfil the required educational objectives.
The validation of a venous simulator is described in this study. Fifty-two veterinary students, with no pre-
vious experience in the creation and maintenance of an indwelling venous cannula, were selected at ran-
dom. They were divided into two groups: one experimental group (n = 35), who had training practice on
the simulator, and the remainder (n = 17), who acted as the control group (i.e. they had no training prac-
tice on the simulator). The outcome measure was the number of attempts required to successfully cannu-
late the cephalic vein of an anaesthetised rabbit. The students in the experimental group showed more skill
in cannulating the vein, with 45% effectiveness, as compared to 20% effectiveness in the control group.
The difference between the groups was statistically significant (p < 0.05).

Key words: intravenous injections, teaching model.

Address for correspondence: Juan J. Perez-Rivero, Departamento de Producción Agrícola y Animal,

Universidad Autónoma Metropolitana Unidad Xochimilco, Calzada del Hueso 1100, Colonia Villa Quietud
Delegación, Coyoacán 04969, Mexico City, Mexico.
E-mail: jjperez1_1999@yahoo.com

Introduction ities and skills necessary to create and maintain an

Students usually learn to carry out many of the tech-
nical procedures performed on live animals under
initial close supervision. However, during the last
decade, this trend has been modified, with the devel-
opment of videos, pictures and other materials, to
teach common handling techniques and other proce-
dural methods for small mammals (1). Where possi-
ble, this is complemented by the use of simulators
(2). In 2003, Engum et al. (3) showed that the edu-
cational use of simulators allowed students to
acquire knowledge (‘to know what it is’), to develop
abilities and skills (‘to know how to do’) and to adopt
appropriate attitudes (‘to know how to be’). The
achievement of all three of these learning objectives
is necessary for the successful creation and mainte-
nance of an intravenous cannula (IVC; 3). Students
should also understand that the knowledge and
skills acquired with the simulators will be useful for
solving real problems in live animals.
Simulators permit students to repeat procedures
several times and in different contexts, i.e. in the
classroom, in the simulation laboratory, or at home,
if it is portable. This enables them to acquire the abil-
IVC, without causing injury, infection and suffering
in live animals (2, 4, 5). One disadvantage of some of
these simulators is their high cost, which means
there are often not enough simulators available to
meet the training needs of the students. Due to an
increase in the use of simulators, it is necessary to
create simulators that are easy to manufacture at
low cost, and that are also portable. These simulators
must also be validated with regard to their ability to
fulfil the required educational objectives.
Therefore, the objective of this study was to val-
idate the educational potential of a low-cost venous
simulator for teaching students how to create and
maintain an IVC. This is compared to the teaching
method of directly using live animals, without
prior simulator training practice.
Materials and Methods
Simulator design
The simulator was made from a length of 15cm-
wide cotton bandage, rolled up on itself, wrapping
258
a 15cm-length of 3mm-diameter hollow latex
tubing (Grupo Holy, Naucalpan de Juárez, Estado
de México, Mexico) under the last two external
layers of the bandage wrapping. The tubing was
filled with water, which was coloured red with a
vegetable dye (Herdez SA de CV, San Luis Potosi,
Mexico), to simulate the blood content of a vein.
The tubing was sealed by knotting each end
(Figure 1).
The experimental group
A prospective longitudinal study was performed
with 52 third-year veterinary students, all of
whom had no previous experience in the creation
and maintenance of an IVC. All the students
received theoretical and visual information about
IVC for 1 hour. Thirty-five randomly-chosen stu-
dents were trained on the simulator, under the
direct supervision of two instructors, for 2 hours.
The simulated intravenous cannulation was con-
sidered to be successful when the simulated blood
flowed freely into the visual chamber of the can-
nula, the trocar guide was removed, the cannula
was fixed in place correctly (Figure 2), and a 0.5ml
sample of the simulated blood was obtained.
The control group
The control group consisted of 17 students, who
were given the same instructions as the experi-
mental group, but did not have training practice on
the simulator.
In vivo practice
The students from both groups were each required
to place an IVC (Punzocat®; Equipos Médicos
Vizcarra, Mexico City, Mexico) in the cephalic vein
Figure 1: The venous simulator
This model was used by veterinary students to practice
vein puncture and the placing of an IVC.
J.J. Perez-Rivero & E. Rendón-Franco
of an anaesthetised rabbit, as described below:
Fifty-two physically healthy New Zealand rab-
bits (each weighing approximately 4kg), were
anaesthetised by intramuscular injection of a com-
bination of acetyl promazine (Vétoquinol, Lure,
France; 0.5mg/kg), butorfanol (Pfizer, New York,
NY, USA; 0.5mg/kg) and ketamine (Pisa
Farmacéutica, Mexico City, Mexico; 40mg/kg). The
region of the cephalic vein was clipped and disin-
fected, and a tourniquet was placed over the
humerus-cubit-radial joint. The availability of a
vein to be punctured was verified by the instruc-
tors, then the students were instructed to create an
IVC without any leakage of blood, with a maxi-
mum allowance of three attempts per student. The
proficiency of the two groups was compared by
using the Mann-Whitney test (6, 7) with the SAS
statistical software program (8).
The Internal Committee for the Care and Use of
Laboratory Animals at the Universidad Autónoma
Metropolitana Unidad Xochimilco (CICUAL-UAM-
X), approved the procedures performed on the ani-
mals.
Results
The students in the experimental group (n = 35)
performed 65 attempts in total during the creation
and maintenance of IVCs in vivo, and were suc-
cessful in 29 (45%) of these attempts. Fourteen
(40%) of the simulator-trained participants were
successful on the first attempt, seven (20%) on the
Figure 2: The placing of an IVC into the
venous simulator
It can be noted that the visual flow chamber and the
cannula connection piece both contain simulated blood.
Creation and maintenance of an intravenous cannula
Figure 3: A comparison of the efficency of
the simulator-trained group and
the control group, in creating and
maintaining an IVC in vivo
60
50
40
per cent
30
20
10
0
simulator- control
trained
= First attempt; = second attempt;
= third attempt; = not able.
second attempt, and eight (23%) on the third
attempt (Figure 3). Six participants (17%) were
unable to successfully create an IVC.
The untrained control group performed 41
attempts, and succeeded in eight (20%) of them.
Two students (12%) from this group were able to
create and maintain an IVC on the first attempt,
four (24%) on the second, and two (12%) on the
third attempt (Figure 3). Nine participants (52%)
were unable to create an IVC.
The statistical difference between the experi-
mental group and the control group, in their rela-
tive effectiveness of creating and maintaining an
IVC, was significant (p < 0.05).
Discussion
One of the main priorities for the organisers of vet-
erinary science study programmes, is to consider
whether training practice with simulators could
improve technical performance, before a procedure
is attempted in a real-life context with live ani-
mals. This question also applies to the training of
medical clinicians to perform procedures on their
patients (9). There are a number of published stud-
ies which describe the use of simulators and their
educational potential, specifically in the area of
technical competence. For example, Engum et al.
(3) compared two teaching methods for placing an
IVC. The first was the traditional method, in which
a video is shown and then followed-up with a
259
demonstration by an instructor, after which a
mannequin simulating a human arm is used by the
students for training practice. This was compared
with the alternative method of using computer
simulators. The study found that the teaching out-
come results were similar with the two methods.
However, the students preferred the traditional
teaching method, because it helped them to
improve their practical skills (3). Britt et al. (10)
reported the use of a simulator for placing a cen-
tral cannula, comparing it with the traditional
method, in which the students practice on real
patients. In the latter case, adverse events, such as
infection, are unfortunately frequent. The students
that used the simulator acquired abilities and
skills for the correct placing of the cannula, with
the advantage of not potentially introducing infec-
tion or otherwise generating additional costs for
the teaching hospital (10). A further example is the
use of simulators by first-year cardio-thoracic sur-
gery students, for practice prior to performing coro-
nary anastomoses in the pig model (4). The use of
the simulator for four hours improved the profi-
ciency of the students in performance of the proce-
dure (4).
The outcome of our study was clear ― the use of
the venous simulator for two hours of training
practice, resulted in the development of appropri-
ate skills by the students, for the creation and
maintenance of IVCs in the real-life context.
Acknowledgements
We thank Yvonne M. Heuze de Icaza at the
Universidad Autónoma Metropolitana, for her sup-
port in developing this research and for the
humane care of the animals used. We also thank
Jorge Salvador León Dousset for his advice and
pedagogical review of this paper.
Received 24.01.11; received in final form 13.04.11;
accepted for publication 04.05.11.
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