The Development and Evaluation of a Low-Cost, High-Fidelity Ultrasound-Guided Abdominal Paracentesis Simulator

Introduction Paracentesis is a vital procedure for diagnosing and managing ascites, yet hands-on training opportunities are limited due to issues related to patient availability and procedural risks. Simulation-based training helps develop skills and confidence, but high-fidelity commercial models remain expensive and scarce. To address this gap, we created a novel, low-cost, high-fidelity ultrasound-guided abdominal paracentesis (USGAP) simulation model. Designed for affordability and realism, this model aims to improve trainee confidence and integrate ultrasound guidance to enhance procedural safety and precision. Methods A 3-litre saline bag was modified to simulate the abdominal cavity, incorporating aqueous dietary fibre antifreeze mix gel for liver tissue, fluid-filled sausage casing for the bowel, and dyed water for ascitic fluid. The model was sealed and coated with latex for self-sealing properties, with a total cost of £25. Assessment took place over two sessions (January-February 2025) involving 19 participants (senior house officers (SHOs), registrars, and consultants). Pre- and post-training questionnaires assessed training opportunities, confidence, and model effectiveness using a five-point Likert scale. Data was analysed using IBM SPSS Statistics (IBM Corp., Armonk, NY) (Wilcoxon signed-rank test, p<0.05). Ethics approval was not required as this study was registered as a quality improvement project. Consent was obtained, and all responses were anonymised. Results Pre-training data revealed significant gaps in USGAP training, with only 31.6% of participants reporting adequate exposure (median Likert 2/5). However, all participants (100%) recognised the importance of high-quality simulation. Following model use, confidence in performing USGAP significantly improved from 47.3% to 78.9% (p = 0.005). The model received unanimous positive feedback (100%) with participants praising its affordability, realism, and procedural accuracy. Conclusions This study demonstrated that a cost-effective, high-fidelity USGAP model significantly enhances trainees' confidence while providing a sustainable and accessible alternative to expensive commercial models. The realistic anatomical structures, ultrasound capability, and self-sealing properties make it a valuable training tool. While the sample size was limited, the findings strongly support broader implementation into medical training. Future research should assess long-term skill retention and multi-centre adoption.