Venous Cannulation Simulator

Assembly Instructions

 

The process for assembling and installing a venous cannulation simulator is outlined below. First, the parts are prepared. Next, the parts are assembled. Two assembly options are provided; the first option is somewhat quicker, but can be very messy. After assembly, the device is installed into the mannequin. Last, operation of the device during usage is described. The necessary parts are listed below.

 

 

Parts List:

1-7.0mm Nasopharyngeal Airway

1-5cc syringe

1- four-way Large Bore Stopcock with Rotating Male Luer Lock adapter

1- small squeeze tube of clear RTV (Caulk)

1-60ml syringe

1-80 cm length of ˝ inches outside diameter X 3/8 inches inside diameter clear low-pressure vinyl tubing.

                The external diameter is important as it must fit within the 5cc syringe. 

1-IV bag with tubing; filled with commercial stage blood

1-IV bag with tubing, empty

clear tape (supplied with the HPS mannequin)

4x4 absorbent gauze pads

latex free HY Tape

 

 

Parts Preparation:

  1. Cut the “bell” off of a 7.0mm Nasopharyngeal Airway. Discard the “bell”.  This part of the device simulates the vein.
  2. Fill the cut end of the nasal airway tube with approximately 1 cm of clear RTV (Caulk). Allow to cure for at least 24 hours.
  3. Cut to length 80cm of ˝ inches outside diameter X 3/8 inches inside diameter clear low-pressure vinyl tubing. 
  4. Remove the plunger from a 5cc syringe; discard the plunger.
  5. Place a thin ring of caulk around one end of the vinyl tubing and insert into the open syringe.  

 

 

Assembly and Filling procedure:

Note: Two procedures are described below. The first procedure requires more time, but is relatively “risk free”. The second procedure is quicker, but can create a serious mess if care is not taken during the steps. Specific steps for both procedures are as follows.

 

Procedure #1

1.        Attach a four-way Large Bore Stopcock with Rotating Male Luer Lock adapter on the end of the 5cc syringe.

2.        Place the beveled end of the nasopharyngeal airway into the free end of the vinyl tubing. Do not seal the joint between the nasopharyngeal Airway and the vinyl tubing. The nasopharyngeal airway piece is designed to be replaceable, and is disposed after several uses.

3.       Attach an IV bag filled with stage blood to the simulated vein via the Luer lock adapter.

4.       Attach a 60ml syringe to the stopcock.

5.        Rotate the stopcock so that only the 60ml syringe is “connected” to the simulated vein. Using the syringe, draw some of the air out of the simulated vein, creating a slight vacuum.

6.        While maintaining the vacuum, rotate the stopcock so that the IV bag is “connected” to the vein. Blood should flow into the vein.

7.        When the blood stops flowing into the vein, turn the stopcock back to the syringe.

8.        Repeat steps 5-7 until the vein is completely full of simulated blood, and no air bubbles are present. The distal, “syringe,” end of the vein must be kept elevated during this entire procedure for this to work correctly.

9.        Remove the 60ml syringe and the IV bag from the stopcock.

 

Procedure #2

  1. Attach a four-way Large Bore Stopcock with Rotating Male Luer Lock adapter on the end of the 5cc syringe.
  2. Attach an IV bag filled with stage blood to the simulated vein via the Luer lock adapter.
  3. Attach a 60ml syringe to the stopcock.
  4. Elevate the open end of the tubing above the IV bag, and open the stopcock to “connect” the IV bag to the tubing. Slowly lower the tubing until the blood is two or three inches from the end of the tubing. Do not allow any blood to touch the end of the tubing. Close the stopcock.
  5. Insert the nasopharyngeal airway piece into the clear tubing. This should form a secure, watertight seal. There will be a bubble of air at the end of the tube; this is to be expected.
  6. Raise the syringe end of the device, to allow the trapped air bubble to migrate to that end of the device.
  7. Rotate the stopcock so that only the 60ml syringe is “connected” to the simulated vein. Using the syringe, draw some of the air out of the simulated vein, creating a slight vacuum.
  8. While maintaining the vacuum, rotate the stopcock so that the IV bag is “connected” to the vein. Blood should flow into the vein.
  9. When the blood stops flowing into the vein, turn the stopcock back to the syringe.
  10. Repeat steps 7-9 until the vein is completely full of simulated blood, and no air bubbles are present. The distal, “syringe,” end of the vein must be kept elevated during this entire procedure for this to work correctly.

10.     Remove the 60ml syringe and the IV bag from the stopcock.

 

 

Installation:

The Venous Cannulation Simulator can be installed in either the HPS model C or model D mannequin. (It might also be compatible with the ECS mannequin.) It can be used to simulate either the internal jugular vein, or the sub-clavian (SC) vein.

 

Note: extreme care must be exercised to avoid pulling the nasopharyngeal airway out of the tubing, which would result in a spill into the mannequin.

 

Internal Jugular vein

1.        To simulate the internal jugular (IJ) vein place the proximal end of the simulated vein under the disposable neck skin, at a location where the IJ would normally be found, slightly lateral to the carotid artery.

2.        Carefully run the rest of the vein under the skin of the right shoulder, keeping the vein outside of the chest cavity (figure 2). The syringe/stopcock portion should extend beyond the chest skin of the mannequin.

3.        Using several 4x4 gauze pads, pack the area around the vein where it will be punctured. These pads will protect the interior of the mannequin by absorbing any spillage that may occur during operation of the device.

4.        Tape the caulked end of the vein in place, using the clear tape supplied with the mannequin. This will prevent it from from rolling or sliding during the procedure.

5.        Cover the vein with the removable neck skin.

6.        Attach the IV bag containing the simulated blood to the stopcock.

7.        Attach the empty IV bag to the stopcock, and place it on the floor.

 

The IJ vein can be simulated in the HPS “C” mannequin, and in the “D” mannequin with the “Chip” head. The original “D” head does not have the removable neck skin or the underlying structure necessary to support this device. Although we have not attempted this, it should also work on the ECS mannequin.

 

Subclavian vein

1.        To simulate the left subclavian vein, place the “vein” under the chest skin immediately posterior to the location used for simulation of needle decompression of a pneumothorax. (fig. 3)  The caulked end should be at the left of the mannequin. 

2.        Carefully run the tubing across the chest wall (underneath the skin) and hide underneath the right side of the mannequin. The syringe/stopcock portion should extend beyond the chest skin of the mannequin (figure 4).

3.        Using several 4x4 gauze pads, pack the area around the vein where it will be punctured. These pads will absorb any spillage that may occur during operation of the device.

4.        Tape the caulked end of the vein in place, using the clear tape supplied with the mannequin. This will prevent it from from rolling or sliding during the procedure.

5.        Cover the vein with the removable skin piece.

6.        Attach the IV bag containing the simulated blood to the stopcock.

7.        Attach the empty IV bag to the stopcock, and place it on the floor.

 

It is possible to fill the device after placement in the mannequin. However, our experience is that it is significantly more difficult to fill the tube and to evacuate all of the bubbles. This required an unreasonable amount of movement and manipulation of the mannequin to get all of the bubbles out. This increased the danger of accidentally pulling out the nasopharyngeal airway part of the device.

 

 

Operation:

The operation of the venous cannulation simulator can be divided into two separate sections, device insertion and usage. For realistic effects during insertion of a device, perform the following steps.

 

1.        Hang the blood IV bag about 1 foot above the patient. This will create sufficient pressure to generate realistic blood loss during the procedure.

2.        Set the stopcock so the simulated blood bag is open to the vein.

 

The vein simulator can also be used for certain activities, such as cardiac output injections or fluid bolus injection (figure 5). To realistically represent these activities, set the stopcock so that the empty IV bag is open to the vein and that the blood bag is closed to the vein. This will provide a reservoir for the injected fluids to enter.

 

For simulating the passage of a pulmonary artery catheter, the catheter balloon must be punctured with a small pin hole.  The reason for this is the internal diameter of the vinyl tubing will not accommodate both a fully inflated balloon and the fluid inside.

 

Both the simulated vein and the neck skin may be used for more than one simulation. To reuse the vein after each simulation, reseal the vein with the latex free HY Tape. We have run three simulations with the same vein, covering it with tape each time.  Despite three punctures there was insignificant leakage. We typically replace each “vein” after one day of usage.