Designed and manufactured by Limbs & Things Limited,Sussex Street, St. Philips, Bristol, BS2 0RA, UK.Telephone: +44 (0)117 311 0500 Fax: +44 (0)117 311 0501sales@limbsandthings.com www.limbsandthings.com

Chest Drain & NeedleDecompression Trainer

User Guide

For more skills training products visit

www.limbsandthings.comPart No: 065-021

Issue 1, November 2012© 2012 Limbs & Things

Advanced Chest DrainPads (Pack of 2)Part No: 60232

Chest Drain DiaphragmPart No: 00000

Chest Drain Pump:Needle DecompressionPart No: 00000

Components

Standard Chest DrainPads (Pack of 2)Part No: 60234

Chest Drain LungPart No: 00000

Chest Drain Pump:Respiratory SwingPart No: 00000

Torso

Needle DecompressionPads (Pack of 2)Part No: 60231 0295

Chest Drain Ribs (Pack of 12)Part No: 60240

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Chest Drain & Needle DecompressionTrainerPart No: 60230

This brand new Limbs & Things simulator has been designed to meet the specific requirementsof healthcare professionals training in surgical or guidewire assisted thoracostomy andthoracentesis. This product, using interchangeable pads, allows for a variety of chest draininsertion techniques to be performed including ultrasound-guided techniques.

Skills• Needle decompression of tension pneumothorax• Ultrasound-guided chest drain insertion (Seldinger-type), including insertion of needle underdirect vision, and ultrasonic recognition of chest structures

• Open, or cut-down chest drain insertion: recognition of correct position, surgical incision,blunt dissection through chest wall, perforation of pleura, and finger sweep

• Suture of tube to chest wall

Features• Representation of adult male thorax with arms raised• Suitable for supine, sitting, or leaning forwards positions• Bony and soft tissue landmarks: manubriosternal joint, clavicles, ribs, pectoralis major andlatissimus dorsi

• Bilateral chest drain and needle decompression pads• Internal ultrasound anatomy: diaphragmatic structures and collapsed lung• Reservoirs can be filled with fluid or mock blood to represent pleural effusion• Needle decompression air reservoirs provide realistic release of air on insertion of needle• Affordable replaceable pads

Package supplied• 1 Needle Decompression Pads (Pack of 2) Part No: 60231• 1 Advanced Chest Drain Pads (Pack of 2) Part No: 60232• 1 Standard Chest Drain Pads (Pack of 2) Part No: 60234• 1 Chest Drain Ribs (Pack of 12) Part No: 60240• 1 Torso• 1 Carry case

Cleaning• All silicone components can be cleaned using warm water with a small amount ofdetergent

• Remove old pads after use and wipe off any lubricant residue from ribs, clamp, and torso• If fluids have been used, ensure chest cavities have been fully drained at end of session, andpreferably wipe dry

• Flush out chest cavity and tubes with warm water if model has been used with mock blood

Chest Drain RetainingKnobs (Pack of 2)Part No: 00000

Components (continued)

Plastic funnel2.5l Jerry Can

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Needle DecompressionPads

• Needle insertion producesrealistic “hiss” of airescape, or bubbles ifsaline-filled syringe is used

• Use of fresh pad advised where inflation may besome time before use

• Pad life prolonged by useof thinner gauge needleseg 21g

Pad usage information

Standard Chest DrainPads

• For open/surgical techniques

• Can also be used forguide wire techniqueswhere no fluid is required

• Not ultrasoundable• Not suitable for use withliquids

• Tough skin for incisionand suturing

• Foam chest wall for bluntdissection

• Pleural layer, providingrealistic give, or “pop”, onpuncture

• Can be used withadhesive dressings

Advanced Chest DrainPads

• Ultrasoundable• For use with liquids – e.g.effusion, or haemothorax

• Needle, guide-wire,dilator, and drain-tubecan all be realisticallyinserted

• For open/surgicaltechniques where effusionor haemothorax arerequired

• Can be sutured• Guidewire insertions willself-seal allowing multipleuses

• Open/surgical incisionswill not self-seal

• Improved respiratoryswing

• Recommend usage of 12 FG catheter

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2

Push the Rib into the hole.

To ease insertion, rotate therib using a corkscrewmotion whilst pushing.

Note: Make sure that allof the Ribs curve in thesame direction after fullinsertion.

1

The Standard and AdvancedPads are supplied withoutRibs.

Apply lubricant to the Riband the corresponding holein the Pad. Lubricant easesfitting and improves theultrasound picture on theAdvanced Pads (shownhere).

3

The ends of the Ribs shouldbe flush with the ‘ledge’under them.

The bottom image showsthe finished Pad with theouter side at the top andthe inner side (with the ‘lip’)at the bottom. The apex ofthe curve should be on thetop of the Pad.

Important: Remove andretain the Ribs beforedisposing of used Pads

Inserting the Ribs into a Pad

2

2

Undo the upper Knob.

Lift the Backing Plate away

1

Before you can remove theSkin the Backing Plate needsto be removed.

Undo the lower RetainingKnob.

3

Peel off one side of the Skin.

And then the other.

To refit the Skin reverse theprocedure. Make sure thatthe Skin fits snugly aroundthe Pads (especially theNeedle DecompressionPads).

Note: To quickly changethe Pads on one side ofthe Trainer, peel the skinoff from that side only.

Removing the Torso Skin

1

5

Make sure the Pad is pushedall the way into the frame.

Fit the Frame back into thecorrect side of the Trainerand in the correct way up(see stage 2).

4

Push one edge of the Padinto position.

And then the other.

6

Refit the Knobs.

Note: Good finger-tightness should ensurea water-tight seal on theAdvanced Pads.

Note: For speed, and ifno seal is required,Standard Pads can befitted using two Knobsonly.

4

2

Note: Use the descriptionand arrow to correctlyorientate the clampwhen fitting it. The PadFrames are notinterchangeable. Theyare clearly labelled Leftand Right, with an arrowto indicate the topcorner.

1

First remove the Torso Skinto expose the Pad Frameand Retaining Knobs on theside of the model you wantto install a Pad in.

Unscrew the Knobs and setthem safely to one side.

3

Remove the Pad Frame.

Push the Pad (with Ribsfitted) up from theunderside of the Frame.

Make sure the ends of theRibs line up with thecorresponding recesses onthe underside of the Clamp.

Fitting a Pad

3

2

Apply lubricant to the upperedge of the Pad.

Apply lubricant to the loweredge of the Pad hole in thechest.

1

Choose the correct Pad forthe Left or Right side of thechest (the thinnest edge ofthe Pad should be pointingtowards the sternum).

Connect the air supply fromthe Chest to the Pad.

3

Push the Pad fully intoposition...

...so that it fits flush withthe chest.

Fitting the Needle Decompression Pads

6

2

Grip the newly exposed partof the Pad...

... and pull the Pad free.

1

Remove the Torso Skin.

Grip the Pad tightly justbehind the disc and pull itaway from the Chest slightly.

3

Disconnect the air supply.

Ensure that the whiteconnector stays with the airsupply tube on the Trainer.

Removing the Needle Decompression Pads

5

2

Make sure the drain tube islevel.

Place the end of the tubeover a sink or into acontainer (eg the suppliedjerry can).

1

The Left and Right reservoirsare emptied separately.

Remove the Torso Skin.

Undo the reservoir cap andpull out the emptying tube.

3

Release the white clamp andallow the reservoir to fullydrain.

When empty: close theclamp on the tube, push itback into position andreplace the cap.

Note: If fluids have beenused, ensure the chestcavities are fully drainedand wiped dry at the endof a session.

Note: Flush out the chestcavity and tubes withwarm water if MockBlood has been used.

Emptying the Chest reservoirs

8

2

Remove the reservoir cap.

Insert the plastic funnel intothe reservoir.

1

Use water for ultrasoundor effusion. Use dilutedLimbs & ThingsConcentrated VenousBlood Part No: 00021 forhaemothorax.

The Left and Right reservoirsare filled separately.

Remove the Torso Skin,ensure an Advanced Pad isfitted, and the fourRetaining Knobs on the PadFrame are tightened securely.

Ensure the white clamp onthe emptying tube (on thesame side of the fitted Pad)is clipped shut.

3

Fill the jerry can with water(approx. 2.5l), and pour itinto the reservoir. Whilepouring, check the PadFrame for leaks. Tightenthe Knobs on the Frameif required.

Check the fluid level of thereservoir through thetranslucent wall of thethorax. Stop filling at therequired level of effusion.

Replace the reservoir capand the Skin.

For ultrasound, allow the Trainer tostand for 5-10 minutes before useand rock the Trainer to dislodge airbubbles from the wall of the chest.

Filling the Chest reservoirs

7

2

Squeeze the bulb and placeyour thumb over the inleton the top.

Keeping your thumb inposition, allow the bulb toreinflate, which draws fluidinto the down tube in thecollecting bottle.

1

Connect the air line fromthe Respiratory Swing Pump,to the left or right rear portson the top of the torso. Theports are marked:

The left and right systemsfunction independently.

3

To reproduce respiratoryswing: keep your thumb inposition and alternatelysqueeze and release thepump to make the fluidlevel rise and fall.

To reproduce the bubblingeffect of coughing, squeezethe bulb hard while keepingyour thumb over the inlet.

Practice the abovesequences to get the bestresults.

Note: If the fluid levelfalls too low, reprime thesystem by repeatingstage 2.

Using the Respiratory Swing Pump

10

2

Release any residual air inthe system, by turning thebleed valve fullyanticlockwise.

Now close the bleed valveby turning it fully clockwise.

1

Note: A safety valve onthe pump tubingprevents over-pressurisation of thesystem.

Connect the air line fromthe Needle DecompressionPump to the left or rightfront port on the top of thetorso. The ports are marked:

The left and right systemsfunction independently.

3

Pressurise the system withone or two squeezes of thepump.

The Trainer is now ready forneedle decompression.

Note: the system can betested by opening thebleed valve afterinflation and listening forair release. If this fails tohappen, check theNeedle DecompressionPad for damage. Alsocheck that the air supplyconnector is fittedproperly.

Using the Needle Decompression Pump

9

2

Replace the lung the sameway.

Replace the Frame, Pad andTorso Skin.

1

The lung and diaphragmhave different shapedconnectors to ensure theycannot be installedincorrectly.

Replace the diaphragm first.

If necessary, lubricate thelocating lug and the outsideof the diaphragm itself.

3

Wit

Fitting the Lung & Diaphragm

12

2

Remove the lung from thesocket on the back wall ofthe chest cavity by grippingthe harder part of therubber at the back of thelung.

Remove the diaphragm thesame way.

1

Ensure the reservoir on theside with the lung anddiaphragm you want toremove is empty.

Remove the Torso Skin, Padand Pad Frame.

3

Place

Removing the Lung & Diaphragm

11

NotesNotes