Chapter 1 ■ Educational Principles of Simulation-Based Procedural Training 3

Fig. 1.1. Teaching models (A) A ferret is used to demonstrate endotracheal intubation. (B) An infant intubation

model (Resusci Intubation Model, Laerdal Medical, Armonk, NY) is used to practice endotracheal intubation. A

viewing port in the back of the head allows demonstration of anatomic relationships. (C) A rabbit’s ear has been

shaved to demonstrate vessels for intravenous placement. (D) A resuscitation model (Resusci Baby, Laerdal Medical)

is used to practice bag and mask ventilation. (E) An umbilical cord is used to practice catheter insertion. The cord is

placed in an infant feeding bottle, filled with normal saline, and supported inside a cardboard box. The end of the

cord projects through a cut nipple. (From Neonatology: Pathophysiology and Management of the Newborn, 4th ed.

Philadelphia: JB Lippincott;1994, p. 37.)

perspectives. The educators can facilitate the process

by providing an objective view of the learner’s performance.

3. Abstract conceptualization (thinking): Is the logical analysis of ideas and acting on intellectual understanding of a situation by the learner, and helps provide the educator with the opportunity to clarify the

same. This results in a new mental model and understanding.

4. Active experimentation (doing): This new mental

model and understanding, developed by the learner,

requires immediate testing by active experimentation,

4 Section I ■ Preparation and Support

Table 1.1 Teaching Models Used to Teach Procedures

Manikin (Small Dolls with Soft Vinyl Skin)

To teach tracheotomy care:

Create a hole in the doll’s neck with a sharp instrument—a corkscrew works well.

Insert a size 1 or size 0 tracheotomy tube.

Tie the ties, and use as a model to teach proper suctioning and skin care techniques.

To teach umbilical catheter managements:

Puncture the doll’s anterior abdomen using a 16-gauge Medicut needle.

Insert needle through the doll’s front and back, then remove.

Thread an umbilical catheter through from front to back.

Insert blunt needles onto catheter at both ends. An IV bag containing water tinted with red food coloring can be attached to the posterior end of the catheter

to simulate blood.

To teach technique for drawing samples for blood gases:

Insert a three-way stopcock into the umbilical catheter anteriorly and attach IV bag and tubing.

This system also can be used to teach arterial and venous blood pressure monitoring by transducer.

To simulate arterial pressure, wrap a blood pressure cuff around the partially filled IV bag and inflate to 60–70 torr.

For a venous line, inflate to 5–10 torr.

Resusci Heada

The model head used for endotracheal intubation can be modified to teach orogastric and nasogastric feeding by attaching a reservoir to the esophageal opening.

Rabbits

To teach placement of chest tube:

Anesthetize a rabbit weighing approximately 2 kg using xylazine, 8.8 mg/kg IM. Wait 10 min, then administer ketamine HCI, 50 mg/kg IM.

Place the rabbit on its back and shave or clip the chest hair as closely as possible. Use a commercial depilatory to remove remaining hair.

Restrain the rabbit’s fore- and hindpaws securely.

Surgically drape the rabbit.

Place electrodes on the chest wall for attachment to a cardiorespiratory monitor. Changes in ECG tracing due to the pneumothorax can then be

demonstrated.

Insert chest tube.

Weanling Kittens

To teach endotracheal intubation:

Use kittens weighing 1–1.5 kg.

Withhold food 8 h before intubation; however, allow water intake.

Give ketamine HCI 20 mg/kg IM.

Wait 10 min for full effect of ketamine HCI.

Examine larynx after every four or five attempts at intubation. If the laryngeal area is traumatized, allow 7–10 d for recovery.

Ferrets

To teach endotracheal intubation

Withhold food 8 h before intubation; however, allow water intake.

Give ketamine HCI, 5 mg/kg IM, and acepromazine maleate, 0.55 mg/kg IM, and allow to take effect.

Maintain anesthesia with 40% of original dose IM as needed. If necessary, control sneezing with 0.5 mg/kg IM of diphenhydramine.

Apply bland ophthalmic ointment to eyes to prevent desiccation.

Examine larynx for signs of trauma, as for kittens, and allow recovery between training sessions. Evidence of trauma was noted in 100% of ferrets after 10 intubations.

Placenta and Cord

To teach insertion of IV infusion lines and umbilical vessel catheters:b

Preserve placenta and cord by freezing in individual containers.

Allow 3–4 h for thawing before use.

Use vessels on the fetal surface of the placenta to demonstrate insertion of peripheral IV needles and cannulae. Blood drawing also can be demonstrated.

Cut a 15-cm length of cord to demonstrate the anatomy of the umbilical stump and the technique for arterial and venous catheterization. The cord may be

placed in an infant’s feeding bottle that contains saline. One end of the cord then protrudes through a suitably cut nipple and can be pulled out of the bottle for each attempt at the procedure.

a

Laerdal Medical, Armonk, NY.

b

Use of this model is not recommended unless HIV and hepatitis B virus status of source is known.

From: Avery GB, Neonatology: Pathophysiology and Management of the Newborn, 4th ed. Philadelphia: JB Lippincott; 1994.