P437 A low-cost, sustainable ascitic tap/drain simulator to improve procedural training access, trainee confidence, and patient safety

Introduction Abdominal paracentesis (ascitic tap/drain) is a core medical competency and a common requirement in the management of decompensated liver disease, yet training opportunities can be limited by access to commercial simulation models. We aimed to develop and implement a low-cost, reusable paracentesis simulator to improve trainee access to training and confidence, supporting patient safety.Methods A multidisciplinary team (medical education simulation team with senior clinical oversight from the local college tutor and gastroenterology consultants) designed a reusable paracentesis trainer using an unused birthing mannequin as the base. Layered materials were used to replicate abdominal wall ‘feel’: an EVA foam ‘skin’ layer, soft foam to mimic subcutaneous tissue, and a second EVA layer to simulate peritoneal ‘give.’ Ascitic fluid was simulated using a fluid-filled internal bag system, with silicone used to support repeated puncture and reduce leakage. Bowel was represented by differently coloured fluid layers beneath the ascitic compartments, and inferior epigastric vessels were simulated using re-purposed drip tubing filled with red fluid positioned bilaterally relative to the umbilicus to reinforce safe-site selection. The model was used in facilitated teaching sessions for trainees learning diagnostic and therapeutic paracentesis. Trainee feedback was collected following sessions to assess realism and self-reported confidence.Results A functional, low-cost paracentesis simulator was successfully constructed from repurposed materials and integrated into local training. Trainees reported that the model felt realistic and improved their confidence in performing ascitic tap/drain, with particular perceived benefit in understanding safe approach and avoidance of vascular injury. The model was considered feasible and sustainable for repeated use within the trust, addressing prior access barriers to commercial trainers.Conclusions A low-cost, locally built paracentesis simulator can provide realistic, sustainable procedural training where commercial models are unavailable or unaffordable. Early trainee feedback suggests improved confidence and acceptability. Wider roll-out with structured pre/post measures of confidence and competence (and incorporation into a formal teaching pathway) may further strengthen training quality and patient safety.