Prolapsed Umbilical Cord Management Trainer
by Dr. Sally Byford, Dr. Sarah Jahnssens, Michael Blunt and Zachary Buxton
The Mater Education Simulation Team was tasked by our Clinical Director Dr. Sarah Janssens and Simulation Fellow Dr. Sally Byford to design a low cost, but highly functional part task trainer to help train Midwifery staff, O&G Registrars and other healthcare team members as a part of our Advanced Maternity Emergency Management (AMEM) program to recognize and manage umbilical cord prolapse. While this can be simulated with some high fidelity manikins the substantial cost and limited availability of these manikins in many simulation centres can make it very difficult to realistically train staff to manage this serious complication. Our very own Michael Blunt (Simulation Coordinator) showed that he was more than equal to the challenge of designing this low cost, highly functional trainer.
For our AMEM program we also needed our participants to be able to practice catheterisation and bladder filling to lift the presenting part to maintain adequate perfusion of the fetus. For this another of our team members, Zachary Buxton (Simulation Coordinator), designed a trainer to modify an existing part task trainer by making a urethra and bladder which offers a high degree of functional fidelity and allows participants to practice the emergency procedure of bladder catheterisation and filling with the added complexity of a participant manipulating the fetus to ensure the umbilical cord is not compressed and perfusion is maintained.
|Cut tubing from either end of hand pump and hand-pump chamber with ball valves to two lengths of non-distensible oxygen tubing with zip ties. *See Notes Section|
|Attach distensible central line trainer tubing of appropriate length to non-distensible oxygen tubing. * See Notes Section|
|This can now be inserted into any part task trainer or manikin and looped around baby training manikins’ legs, arms, head etc. for a highly functional fidelity umbilical cord prolapse trainer. This can be easily sized up to allow for the operator to use their foot to operate and allow for the operator to have both hands available to demonstrate techniques or control the birthing trainer manikins.|
|Two thin sheets of silicone are created by spreading silicone mixture to a thickness of roughly 2-3mm. These sheets of silicone are affixed to each other with a small amount of silicone and a nasopharyngeal airway (NPA) is inserted through and secured between these sheets of silicone with silicone glue to ensure a secure, waterproof seal. This NPA is then secured to an indwelling catheter leg bag and filled with a small amount of water with yellow food die to simulate the “flash” of urine obtained on catheterisation. We found this method improved fidelity by giving users the expected visual cue for successful catheterisation while also allowing participants to instil the appropriate volume of normal saline required to fill the “bladder” leg bag and achieve the objective of maintaining perfusion through the prolapsed umbilicus by filling the bladder to lift the presenting portion of the manikin.|
|After this urethra and bladder modification is secured together it can then be affixed to the frame of any part task trainer or internal aspects of your manikin as shown using zip ties, trachy tape or velcro pads.|
Future use and improvements:
While this part task trainer demonstrates excellent functional fidelity in that the expansion/contraction of the distensible tubing simulates the pulsation of an umbilicus it could be improved with minimal cost to improve visual fidelity by adding a thin silicone sheath over the distensible tubing with appropriate colouring for the appearance of the umbilical vein and arteries. Furthermore, the silicone insert to modify the part task trainer to allow for realistic catheterisation could be improved in colouring and appearance of urethra. However, these improvements need to be considered in the context of your goals, outcomes, and the additional time and material needed to do so.
Notes: Important Information for Consideration
Step 1 Notes: It is very important that the tubing is non distensible or the volume of the hand pump does not produce an appreciable pulsatile motion to simulate the umbilical cord. We used oxygen tubing with a tapering end as it was easy to cut the tapered end to fit the ball valve on the hand pump.
Step 2 Note: We used central line trainer tubing as it was readily available but any tubing which is strong enough for the pressures achieved but able to expand and contract readily to achieve simulation of a pulsatile umbilical cord would work well. It is however VERY important that you consider the volume of this length of tubing as the hand pump holds roughly 30-50 mL of fluid. Therefore, if your length of tubing is too long or the bore too large the pulsation will be less appreciable to participants.
Step 4 Note: We recommend using a vacuum pump to remove air from the silicone mixture as it improves the density and strength of the silicone. If you plan to use a vacuum pump you will need to add a retarder to the silicone mixture to prolong the setting time of the mix. We used Barnes’ Platsil 71R retarder. This step is not a necessity, but if completed the end product has a better look, texture and strength. During the mixing phase of the silicone, we add red acrylic paint, which can be sourced from any art shop, and Fuse Fx silicone pigment. This is mixed to give the silicone a flesh like look.
Step 5 Note: It is very important that you test the integrity of your “bladder” prior to use. This is particularly important when using in a manikin as there is always the risk of fluid leakage. The manikin electronics we use are well protected from liquids but not all manikins are designed this way. Use at your own discretion and risk.
Dr. Sally Byford
Dr. Sarah Jahnssens
Clinical Simulation Director