Simulation Case Library: The Case of the Coiled Cardiac Catheter.

Many medical disciplines participate in the acute care of hemodynamically unstable patients. At WVU we have many opportunities for multidisciplinary critical care group instruction in our simulation facility. The main educational goals of this session are the recognition and management of a pulmonary artery catheter that is coiled in the right ventricle. Recognition of waveforms and identification of catheter malposition are a priority in our critical care education programs. We present the scenario using the METI model C manikin with system 5.5 software. The target audiences for this scenario at WVU include junior house staff from assorted disciplines, masters level physician assistant students, and medical students during the second and fourth years of training. This scenario has also been included in a critical care medicine CME course for a variety of health care practitioners. We present a variety of the manufacturer's pre-packaged hemodynamic instability scenarios. Standard man awake or relaxed with the hypotension-hemorrhage scenario is described in detail. The focus is on catheter misplacement rather than on disease state. Despite prior preparation from lecture with slides, textbook review, ordemonstration without patient context, most students do not recognize a right ventricular waveform when it is simulated in the context of a patient care scenario. Debriefing occurs immediately in the simulation laboratory and includes a review of typical waveform and pressure transitions as the catheter passes from the introducer to the wedge position. Measurement of cardiac output is demonstrated. A variety of electronic resources are suggested for further self-study and more complete review of invasive monitoring principles and techniques. Students over the past 4 years have had an overwhelmingly positive response to this simulation experience.