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Researchers Create Equine Jugular Vein Injection Simulator

German researchers have presented a jugular vein injection simulator designed to help promote equine welfare while helping veterinary students master injection skills before working with a live horse.

Photo: Courtesy Uta Delling, DrMedVet., MS, Dipl. ACVS, ECVS Veterinary school is going high-tech. First, we showed you the simulator designed to help veterinary students learn where to place the needle when administering joint injections. Now, German researchers have presented a jugular vein injection simulator designed to help promote equine welfare while helping veterinary students master injection skills before working with a live horse. Using a life-size, lifelike model of a horse head and neck with blood running through one of its jugular veins, veterinary students can now practice jugular vein puncture repeatedly without causing pain to a living horse, said Uta Delling, DrMedVet., MS, Dipl. ACVS, ECVS, associate surgeon at the University of Leipzig's Large Animal Clinic for Surgery. Until now, veterinary students have had to practice jugular vein injection on living horses starting with the very first try, Delling said. It isn't possible to practice inject ing jugular veins on cadavers because the veins have no blood and are therefore deflated. The horses wiggle and jump; it hurts a little bit, she said. Some of the horses are very patient and will stand still through several trials. But after a while ev en the quietest ones wont tolerate it anymore. Practicing with live horses has become an increasingly more significant welfare issue as fewer horses are available to veterinary hospitals, said Delling. In some parts of Europe, as many as 14 to 15 students might need to practice on a single horse. But getting jugular vein injections right is very important, she said, as many common veterinary medicines are injected into the jugular vein. If the veterinarian misses the vein and injects the medicine into the surrounding tissue, it can create a really nasty inflammation, Delling said. Jugular vein puncture is also used to draw blood for analyses and for administering sedatives and euthanasia drugs. With euthanasia in particular, a veterinarians injection skills are especially important. Its very important to really hit the vein, because if you inject it in the muscle, its really not a nice death, she said. Inaccurate aim can also cause the vein to occlude (meaning it develops a clot) which is sometimes associated with inflammation of the vein's wall, she said. Certain types of inflammation require surgical

correction, and in some cases a vein can remain permanently occluded, leaving the horse with only one usable jugular vein for therapy.

The Leipzig simulator features 3-cm-diameter tubingabout the size of a real jugular veinthat has a transparent liquid running through it to simulate blood. If the students inject the vein correctly, the "blood" will flow through the needle.

Photo: Courtesy Uta Delling, DrMedVet., MS, Dipl. ACVS, ECVS The Leipzig simulator features 3-cm-diameter tubingabout the size of a real jugular veinthat has a transparent liquid running through it to simulate blood. If the students inject the vein correctly, the "blood" will flow through the needle. The tubing has a special design that allows it to be pierced hundreds of times without leaking. When it does finally start to leak, the tubing can be replaced without having to replace the entire model. Although red liquid would have been more realistic, Delling said they chose to use transparent fluid so as not to stain the model after the repeated uses. Artist and study co-author Antje Schlenker, visual arts graduate, also of Lepzig University, spent about a year designing and perfecting the model, Delling said. This pioneer project cost the group several thousand euros, she said. But future models would probably cost less perhaps 2,000 to 3,000 (about $4,000)now that the model has been designed. Schlenkers website shows a photographic journal of the simulator's design. The study, "Evaluation of a training model to teach veterinary students a technique for injecting the jugular vein in horses," was published in the Journal of Veterinary Medical Education 's fall edition. J Vet Med Educ. 2013 Fall;40(3):288-95. doi: 10.3138/jvme.1012-09R1.

Evaluation of a training model to teach veterinary students a technique for injecting the jugular vein in horses.
Eichel JC, Korb W, Schlenker A, Bausch G, Brehm W, Delling U.

Abstract
In this study, a newly-developed model for training veterinary students to inject the jugular vein in horses was evaluated as an additional tool to supplement the current method of teaching. The model was first validated by 19 experienced equine veterinarians, who judged the model to be a realistic and valuable tool for learning the technique. Subsequently, it was assessed using 24 students who were divided randomly into two groups. The injection technique was taught conventionally in a classroom lecture and a live demonstration to both groups, but only group 1 received additional training on the new model. All participants filled out self-assessment questionnaires before and after group 1 received training on the model. Finally, the proficiency of both groups was assessed using an objective structured clinical evaluation (OSCE) on live horses. Students from group 1 showed significantly improved confidence after their additional training on the model and also showed greater confidence when compared to group 2 students. In the OSCE, group 1 had a significantly better score compared to group 2: the median (with inter-quartile range) was 15 (0.7) vs. 11.5 (2.8) points out of 15, respectively. The training model proved to be a useful tool to teach veterinary students how to perform jugular vein injections in horses in a controlled environment, without time limitations or animal welfare concerns. The newly developed training model offers an inexpensive, efficient, animalsparing way to teach this clinical skill to veterinary students.