Development and Evaluation of a Low-Cost Phantom Model for Ultrasound-Guided Intercostal Chest Drain Insertion

Introduction Intercostal chest drain (ICD) insertion is a key procedure across multiple specialties within the NHS, used primarily to manage pleural effusions and pneumothoraces. Despite its importance, ICD insertion carries a significant complication rate, including injury to surrounding structures, infection, and bleeding. Ultrasound (US) guidance reduces complication and failure rates and is recommended by the British Thoracic Society for pleural procedures. However, many clinicians report low confidence in US-guided ICD insertion, partly due to limited access to training. Existing training models are often costly or limited by realism and ethical concerns. This study aimed to develop and evaluate a low-cost, realistic phantom model for simulation-based training in US-guided ICD insertion. Methods The model, SONIC (SONographic Intercostal Chest drain phantom), was developed using inexpensive, readily available materials, with a final cost of less than £50. The model incorporates anatomically and sonographically realistic ribs, intercostal muscles, and internal organs (lung and liver). SONIC was evaluated during two simulation sessions (February and May 2025) led by Emergency Medicine consultants. A total of 17 participants (including 10 trainees) completed an online questionnaire, with trainees completing additional pre- and post-intervention assessments. Outcomes included self-reported confidence, perceived realism and usefulness, and an informal comparison with commercial models. Data were analysed using Wilcoxon signed-rank tests. Results Trainees demonstrated improvements in all pre- and post-intervention measures, with significant improvements in understanding of US-guided ICD insertion (p = 0.033) and equipment use (p = 0.015). All participants considered SONIC a useful training tool, with 92% agreeing that trainees should practise on the model prior to performing the procedure on patients. Most participants reported realistic US (88%) and tactile (77%) experiences. Among those with prior experience of commercial models, 100% rated SONIC as non-inferior. Conclusions Findings from this pilot study suggest that SONIC could represent a low-cost, scalable alternative to existing simulation models for US-guided ICD insertion. Despite a small sample size, the results indicate that the model improves trainee confidence and provides a realistic training experience. Wider adoption of such models may enhance access to simulation training and improve procedural safety.