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
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.
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.
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.
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.
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.
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.