TissueDB/Simulators/Multipurpose Thoracic Simulator (Carter)
General Information
The Multipurpose Thoracic Simulator is a bench-top model for practising two fundamental invasive thoracic procedures — thoracentesis and thoracostomy (chest-tube) insertion. A single modular chest-wall segment — porcine rib rack, taut one-litre IV-fluid bag with 150 mL of air, headliner-foam layer and Ioban2 antimicrobial drape — serves both stations. The module mounts inside an upright Resusci Anne manikin for thoracentesis and transfers into a separate simulated thorax for chest-tube insertion.[1]
| Field | Details |
|---|---|
| General Information | Bench-top thoracic simulator for practising two invasive procedures — thoracentesis and chest-tube (thoracostomy) insertion. A single modular chest-wall segment (porcine rib rack, IV-fluid bag with ~150 mL air, headliner foam, Ioban2 drape) serves both stations. |
| Features and Basic Operation | A single modular chest-wall segment serves two stations. At Station 1 the module sits in an upright Resusci Anne manikin for thoracentesis; at Station 2 it transfers into a simulated thorax for chest-tube placement. The trainee first reads a chest radiograph to choose the correct intervention, then performs the procedure under live supervision. |
| Current Development Status | Validated. Built and tested, with published evidence of improved skill among junior trainees.[1] |
| Estimated Build Time and Cost | Not stated in source, ~US$30 |
| Specialized Tools and Equipment | Thoracentesis kit (Seldinger-compatible); chest-tube insertion set (scalpel, blunt clamp, 28 French chest tube, suture); upright Resusci Anne manikin; a separately published simulated thorax model for the chest-tube station; paired teaching chest radiographs. |
| Version | Not stated in source |
| Development Team Contact Information | Yvonne M. Carter, Brette M. Wilson, Erin Hall and M. Blair Marshall, Division of Thoracic Surgery, Georgetown University Medical Center, Washington, DC. Corresponding author: Y. M. Carter (per the 2010 publication). |
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Bone (ribs) | 1 rack (4–5 rib segment) | Pork Ribs (ex vivo porcine) | ~US$10 | Supplies bone density and intercostal spaces so the needle and chest tube pass above a rib, as in the patient. Shared by both stations. |
| Subcutaneous tissue | 1 sheet (1/4 in. / ~6 mm) | Polyurethane Foam (headliner foam) | ~US$5 | Soft-tissue plane over the ribs; gives the needle and blade realistic resistance on the way in. The source figure caption calls it "thin felt" while the body text says headliner foam — the body text governs: one foam component, not two. |
| Pleura | 1 | One-litre IV-fluid bag with ~150 mL air (not a TissueDB-catalogued material) | ~US$2 | Taut air–fluid bag stands in for the pleural cavity — an effusion at the thoracentesis station, or a pneumothorax-versus-bulla decision at the chest-tube station. A fluid-mechanics substrate rather than a tissue analogue, so the row is intentionally unlinked. |
| Skin | 1 per module | Ioban2 antimicrobial drape | ~US$15 | Iodophor-impregnated adhesive drape forms the sealed outer surface the needle and chest tube pass through, and holds the module together. The source calls it a "sealant" rather than a skin analogue as such. |
Structural Parts
| Part Name | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Resusci Anne manikin (Station 1 host) | 1 | Upright patient-simulator manikin with an 8 cm × 8 cm lateral chest-wall defect | Reusable lab equipment | Holds the chest-wall module at the thoracentesis station; the upright pose mirrors seated-patient positioning. A standing lab asset, not a per-build consumable. Model version not stated in source. |
| Simulated thorax model (Station 2 host) | 1 | Separately published open-lobectomy thorax model (Carter & Marshall, Ann Thorac Surg 2009;87:1546); not yet a TissueDB page | Reusable lab equipment | Receives the same chest-wall module for the chest-tube station. Distinct from the Resusci Anne host used at Station 1. |
| Thoracentesis kit (Station 1 instrument) | 1 per session | Clinical Seldinger-compatible thoracentesis kit from institutional stores | Clinical supply kit | The thoracentesis instrument kit the trainee works with at Station 1. Sourced from clinical stores rather than fabricated. |
| Chest-tube insertion set (Station 2 instruments) | 1 per session | Scalpel, blunt clamp, 28 French chest tube, suture material | Clinical supply kit | The chest-tube instrument kit for Station 2, built around a 28 French tube. Sourced from clinical stores. |
| Chest radiographs (two per station) | 4 films total | Teaching-collection radiographs — Station 1: effusion vs. lobar collapse; Station 2: pneumothorax vs. giant bulla | Teaching material | Decision stimulus: the trainee picks the film matching the procedure before beginning. Drawn from a teaching collection. |
| Procedure-specific checklist (Fig 2) | 1 rubric per procedure | Five-item OSATS-style checklist per procedure; 0/1 per item, max 5. Modified from Martin et al. 1997 | Assessment rubric | A board-certified thoracic surgeon scores each attempt live. Items span radiograph reading, intercostal-space choice, instrument position relative to the rib, and technique. |
| Global assessment scale (Fig 3) | 1 rubric per procedure | Six categories on a 5-point Likert scale (max 30), with a PASS/FAIL overall call. Modified from Martin et al. 1997 | Assessment rubric | Scored live alongside the checklist by the supervising surgeon. Categories: tissue respect, time and motion, instrument handling, instrument knowledge, procedure flow and planning, and procedure knowledge. |
Build Instructions
The assessment protocol (OSATS-modified checklist + global scale, administered by a board-certified thoracic surgeon) and the training arc (three weekly supervised sessions per participant) are Carter 2010's central methodological contribution and are documented here because they constitute the simulator's own evaluation apparatus.
Phase 1: Prepare the chest wall module materials
- Obtain a 4–5 rib porcine rib segment from a butcher or wholesale meat vendor. A rack covering the lateral chest wall area is appropriate (Carter 2010, Fig 1 caption).
- Obtain a 1 litre intravenous-fluid bag (saline, Ringer's solution, or equivalent) from clinical stores. Expired stock is acceptable.
- Obtain a 1/4 in. (approximately 6 mm) sheet of headliner foam (automotive upholstery grade polyurethane foam), cut to approximately the footprint of the IV bag.
- Obtain one roll of Ioban2 antimicrobial drape (3M Health Care, St. Paul, MN). One roll yields multiple module builds.
Phase 2: Assemble the chest wall module
- Inject approximately 150 mL of air into the 1 L IV bag using a large-bore needle or hypodermic syringe, then seal the puncture site. The bag should be taut with a visible air–fluid level (Carter 2010, lines 186–187).
- Place the porcine rib segment on top of the air-filled IV bag, oriented so that the intercostal spaces face upward (Carter 2010, line 187).
- Cover the rib segment with the 1/4 in. headliner foam (Carter 2010, line 188).
- Wrap the rib-bag-foam assembly together with Ioban2 drape, enveloping all components so that the drape holds the stack as a single sealed unit (Carter 2010, lines 188–189; compare Fig 1).
Phase 3: Install the module for Station 1 — Thoracentesis
- Cut an 8 cm × 8 cm defect in the lateral chest of an upright Resusci Anne manikin, then place the chest wall module inside the defect so the Ioban2-wrapped surface is flush with the manikin's exterior chest wall (Carter 2010, lines 195–197). Present the trainee with two chest radiographs (pleural effusion vs. severe atelectasis with lobar collapse) before supplying the thoracentesis kit.
Phase 4: Install the module for Station 2 — Thoracostomy
- Transfer the chest wall module into the Carter 2009 open-lobectomy thorax model (Carter YM, Marshall MB. Ann Thorac Surg 2009;87:1546; not yet staged as a dedicated TissueDB simulator page). The module substitutes for the lateral chest wall of the lobectomy thorax (Carter 2010, lines 183–185). Present the trainee with two chest radiographs (pneumothorax vs. giant bullous) before supplying the chest-tube insertion instrument set with a 28 French chest tube.
Success criteria
- Station 1 (thoracentesis): correct intercostal-space selection, needle inserted above the selected rib, aspiration confirmed during insertion, catheter advanced via Seldinger technique, and chest-radiograph interpretation correctly differentiating pleural effusion from lobar collapse (Carter 2010, Fig 2 checklist).
- Station 2 (thoracostomy): 28 French chest tube placed through an appropriate intercostal space, entering above the selected rib and secured with suture, and chest-radiograph interpretation correctly differentiating pneumothorax from giant bullous (Carter 2010, Fig 2 checklist + line 187).
References
- Carter YM, Marshall MB (2009). "Open lobectomy simulator is an effective tool for teaching thoracic surgical skills." Annals of Thoracic Surgery 87:1546. Referenced as the Station 2 thorax model (ref [4] of Carter 2010). Not yet staged as a dedicated TissueDB simulator page.
- Martin JA, Regehr G, Reznick R, et al. (1997). "Objective structured assessment of technical skill (OSATS) for surgical residents." British Journal of Surgery 84:273. Referenced as the basis for the procedure-specific checklist (Fig 2) and global assessment scale (Fig 3) used by Carter 2010 (ref [5] of Carter 2010).
- ↑ 1.0 1.1 1.2 Carter YM, Wilson BM, Hall E, Marshall MB (2010). "Multipurpose Simulator for Technical Skill Development in Thoracic Surgery." Journal of Surgical Research 163(2):186–191. DOI: 10.1016/j.jss.2010.04.051. PMID: 20691997.
| Alternative names | Carter thoracic simulator multipurpose thoracic trainer |
|---|
| Authors | Arturopelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturopelayo (2026). "TissueDB/Simulators/Multipurpose Thoracic Simulator (Carter)". Appropedia. Retrieved June 4, 2026. |