Tricks of the Trade sneak peak: Teaching procedures

Teaching procedural skills in medical school is increasing falling on the shoulders of emergency physicians. Two common problems that arise are the equipment expenses and simulation of realism. Working with my colleague Dr. Jeff Tabas, we came up some creative ideas around the teaching of (1) the Seldinger technique for central line placement and (2) saphenous vein cutdown.

Seldinger technique
The concept of "keeping the wire in the vein" is often a difficult concept to explain and visualize when walking through the steps. One can demonstrate and practice the procedure by using a transparent foley catheter tubing (ideally an unused one!), which substitutes as the vein. The transparent tubing allows the learner to view the wire, resting in the vein at all times.

Saphenous vein cutdown

A saphenous vein cutdown kit can be quite pricey. Alternatively, all you really need to gather are:

• Scalpel
• 3-0 silk ties without needles
• 18-gauge angiocatheter
• Dental floss pick

The 90-degree pointed end of the dental floss pick functions exactly as a saphenous vein elevator/hook, as seen in this medical student volunteer. (Just kidding, this was at a cadaver procedural lab.) I bought a pack of 50 dental floss picks for $5.