Virtual Phlebotomy
Contents
1. To select a multisample needle click on the multisample needle with tube holder icon in the toolbar A selection of 3 different gauge needles will appear Select the appropriate gauge needle and move cursor over site A target will appear Click to locate needle insertion point The bevel position will be displayed in a circular inset at the top right of the screen www laerdal com Virtual Phlebotomy Directions for Use Training Sequence To select and use a label click on the label icon in the toolbar A selection of all labels available for this case will appear Select the label to apply A menu will appear allowing you to mark the label with dif ferent handling and labelling instructions Mark the label as appropriate for the case by clicking in the circle next to the corresponding text Click the check mark once you have marked the label The label will then attach to your cursor Click the label on the corresponding collection tube to apply To apply tape or dressing click on the corresponding icon move to site and click on desired location To apply a warm compress to the arm click on the corresponding icon in the toolbar and click on a location on the arm The warm compress will take a few seconds to have any effect To use gauze and apply pressure to the site click on the gauze icon in the tool tray If a needle is on the arm the gauze will appear above the puncture site If no needle is on the arm then click at t2. Select site and advance to next screen www laerdal com Equipment Selection This screen presents the inventory of equipment that can be used in the simulation Holding the mouse over an item will present the trainee with a brief description of the corresponding piece of equipment To select an item click on that item and it will appear on the Equipment toolbar on the left hand side of the screen The trainee may click on an item multiple times and the quantity of that piece of equipment will appear in parentheses after the item on the Selection list To deselect an item click on the x at the upper right of the equipment in the tray After choosing the equipment click on the right arrow to advance to the Simulation screen It is pos sible to return to the Equipment Selection screen at any time during the procedure Equipment Selection Om i _ o O 10 mi ec ed 50050 n Reference Chart 2 0 09 0 eo Select required equipment and advance to next screen A reference chart for proper specimen tube selection can be accessed by clicking the Reference Chart ICON www laerdal com Simulation Screen and Performance of the Intravenous Procedure The Simulation component of the Virtual Phlebotomy Self Directed Learning System allows the train ee to perform the specimen acquisition procedure by interacting with the software and using the hap tic device All of the items chosen from
3. Practice Case Emergent No Chest Pain Practice Case Emergent No Post heparin Therapy Case Scenario In Patient Yes Possible Heart Attack Case Scenario Test Emergent Yes Level One Novice Cognitive Test Hide Selecting the number and types of cases for review Select the number of cases to display by clicking on one of the buttons under the Show Cases heading on the left of the screen Viewing average user scores and progress There are different ways to review the user s general progress If the administrator has configured the Virtual Phlebotomy system to save practice cases then addi tional filters will be presented to view competency training and practice cases independently or together Clicking on the Level Averages tab will display a graph of the cognitive test and skills case scenario averages at each level of difficulty LASJVAJNAS n awral AA WWW aerda com Clicking on the Average Skill Scores tab will display a list of critical and non critical assessment errors the ratio of the times you performed that category correctly and a list of specific skill errors and how frequently they were performed in correctly Clicking on the Progress graph tab will display a graph of the score on all of the selected cases and cognitive tests in a scatter plot Viewing specific case scenario and cognitive test debriefings Click on the specific case scenario or cognitive test at the bottom of the scr
4. insertion is www laerdal com Information Box At the bottom of many screens there is a rectangular box that prompts the trainee on how to proceed An example Is presented here Equipment Selection na e p eee 0 0 eee n ea D eee Reference Chart ka L eee Select required equipment and advance to next screen T Select required equipment and advance to next screen www laerdal com Help Screens Most screens in the Virtual Phlebotomy Self Directed Learning System have help screens that explain the functionality of the screen The help screen is activated by clicking on the help button question mark located on the lower right coi al une saresni An example help screen is shown here with call outs showing the various components of the menu screen Use the scroll bar or scroll the middle mouse button to view the complete help screen Equipment Selection Help Overview I Based on the information given in the Case Scenario select as many pieces of equipment as you might need to complete the procedure Krr fori a 3 Da Mi www laerdal com Virtual Phlebotomy Directions for Use System Overview Main Menu screen This screen presents a menu of options including e Competency Training A progressive tiered hierarchy of case studies cognitive tests and required skills that ranges from novice Level to expert Level 3 e Practice Cases Individual cases c
5. screen Back arrow Return to Previous screen Help for Current Screen Inactive Icon Icons that appear grey are not available Exit the application to the Virtual Products Boot Screen Return to the Main Menu www laerdal com Virtual Phlebotomy Directions for Use System Overview Log Off the current user or Instructor Information about Virtual Phlebotomy Interface Icons Yes Accept Save No cancel Make Active Inactive Haptic Device Available Haptic Device is Not Available Insert Needle into Haptic Device Indicator Palpate Haptic Device Indicator Specimen Tube Attachment www laerdal com Virtual Phlebotomy Directions for Use System Overview oce00 View case scenario Learn how to orient the site Select equipment Case scenario level indicator Movie available Change site for insertion Click to play movie Wash Hands Inform Patient Palpate Site Make Fist Patient Status Warn of Stick Patient Identification www laerdal com 6 3 Navigation and Training Aids Tool Tips By moving the mouse over any navigation or administration icon a small pop up Tool Tip will appear providing a brief explanation of that item An example is presented here x Cognitive Test R Ul Leamer demouseri Score 80 Leve O0 6 Continued bleeding from a venipuncture site beyond 5 minutes T The correct angle of needle
6. the Equipment Selection screen will appear on the left side of the screen and be available for use in the procedure You can review the case scenario select more equipment or change sites by clicking on the three icons at the top of the screen Note you will not be allowed to perform venous access outside the SEleCled sie lO Dello Venous access OUlsIde Wie cuen seleqled site select a cdilerenusite a clicking the Site Selection button If not already done remove the needle from the haptic device and completely detach the specimen tube from the multi sample needle before beginning the procedure To zoom in and out of the arm model scroll the middle mouse button To orient the arm differently click and hold the middle mouse button and move the mouse around Messages will appear in a box at the lower left of the screen to guide you in the use of the system To select a piece of equipment click on the toolbar on the left side of the screen Most items must either be placed on the arm or disposed of in either the metal trashcan bio hazard bag or sharps container Specimen tubes can be placed into the specimen tray Specimen labels must be attached to specimen tubes in the tray or disposed Certain items such as the tourniquet gauze needle specimen tube etc can be removed by clicking on them Case Scenario Q Equipment Q Site Selection Palpation Q Patient Identification S L Wash Hands Pd A atan Sta
7. Virtual Phlebotomy Directions for Use System Overview 6 1 Software Overview The Virtual Phlebotomy Self Directed Learning System software consists of two distinct parts 1 The basic menus screens which present the case scenario provide assessment of performance and support many other functions and 2 The simulation training sequence that enables interaction between the trainee inserting the needle and the three dimensional 3D model of the arm Described in the Quick Start Chapter The following section describes the Basic menu screens Section 6 2 while the Training Sequence is covered in Chapter WARNING Precautions when using the simulation software e The Virtual Phlebotomy Self Directed Learning System has been designed to work on the com puter supplied with the product The computer is an integral part of the system It will not work on other computer platforms because of its requirements for very specific high speed graphics capabilities Do not attempt to install and run this software on any other computer other than that which has been provided by the manufacturer e No software should be installed on the computer supplied with the Virtual Phlebotomy Self Directed Learning System except for those products supplied by the manufacturer of the software e Running any program such as anti virus software on the computer supplied with the simulator may cause the Virtual Phlebotomy Self Directed Learnin
8. an be tried from all of the levels e Anatomical Viewer This module presents a three dimensional 3D model of the arm that can be used to identify structures and learn anatomy e Procedure Training This video introduces the beginning student to the techniques and skills required for venous specimen acquisition e System Tutorial This video shows the trainee how to use the Virtual Phlebotomy simulator system Competency Review This module shows that trainee record of performance Main Menu 7 Le AN N S SF i SS dy a A e For the beginning trainee it is important to view both the Procedure Training and System Overview videos to understand how to perform both proper venous specimen collection and to best use the Virtual Phlebotomy Self Directed Learning System www laerdal com Procedure Training video This screen presents the procedural video demonstrating Introduction to Phlebotomy Standard Precautions and Patient Assessment Factors Affecting Laboratory Results Environment and Equipment Tube Selection and Specimen Collection Vein Selection and Site Preparation Venipuncture Procedure Complications and Difficult Draws This video is divided into chapters allowing the learner to select the section they wish to view by clicking on the appropriate section There Is also a video slider allowing the trainee to choose a spe cific place in the video for review It is highly recommend that th
9. cated in the middle of the haptic device A slight tug will be felt as the needle is engaged by the haptic device After engage ment the transparent needle on the screen will be highlighted The position of the bevel will also poss In une ele meto ine Er Case Scenario Q Equipment Site Selection Palpation O L Patient Identification gt 4 f Wash Hands JO Patient Status Inform Patient O Relax Fist 4 Warn of Stick P Orientation S Select a tube and attach to begin draw To palpate the arm select the Palpation button on the top left of the Simulation Screen Move the palpation fingers to a location on the arm click the mouse and feel the vein using the top part of the haptic device To palpate a new location on the arm move the cursor and click a new location The palpation fingers are automatically removed when you select another piece of equipment or click the palpation button a second time All Body Substance Isolation BSI techniques should be followed These may include the use of gloves and goggles which can be selected and deselected by clicking on the corresponding icon The insertion site can be prepared using the cleansing supplies in the inventory All items must be dis posed of properly erther in the trashcan biohazard bag or the sharps container www laerdal com Depending on the patient case It may be more or less difficult to correctly insert the needle D
10. e In either case the learner will be presented a case scenario Case Scenario screen The patient scenario contains information vital to the trainee s successful performance of the subse quent venous specimen acquisition procedure Read the paragraph required tests and look at the bul leted hints below to ensure that you select the correct equipment specific to the case presented The cases become more difficult as you progress in Competency Training Mode from Level to Level 3 Highlights marked as yellow text are not provided at advanced levels Flu Ilike Symptoms Level ORE Procedure Time 00 05 00 A 70 year old man came into the Emergency Department complaining of fatigue and flu like symptoms He appeared mildly jaundiced with icteric sclera You have been notified of tha STAT blood work ordered Required Tests Test 1 Liver Profile Test 2 Complete Blood Count Test 3 Hepatitis Serum Panel Review case and advance to next screen AAA A www laerdal com Site Selection This screen allows you to select the specific venous access site First select from left or right arms then select between the antecubital fossa or pronated wrist Based on the information presented in the preceding Case Scenario choose the site which is most suitable for venipuncture Once the trainee has chosen a site click on the right arrow to advance to the Equipment Selection Screen
11. e Scenario is presented here Case Scenario d Routine Blood Tests Level o y Procedure Time 00 06 00 An 18 year old female has been sent to the out patient drawing center with a prescription for her blood work Required Tests Test 1 Complete Metabolic Profile Test 2 Fasting Lipid Profile Test 3 Liver Function Test Test4 Complete Blood Count Review case and advance to next screen www laerdal com
12. e beginning student watch the video in its entirety before attempting the simulation There are play pause and stop buttons in the video player SSeS O O S 5 Entire Video 1 Introduction to Phlebotomy o 2 Standard Precautions and Patient Assessment 3 Factors Affecting Laboratory Results O 4 Environment and Equipment O 5 Tube Selection and Specimen Collection D 6 Vein Selection and Site Preparation D 7 Venipuncture Procedure 8 Complications and Difficult Draws www laerdal com System Tutorial video This screen presents the System Tutorial video which Is divided into the following chapters I Introduction to Virtual Phlebotomy System Overview Training Types Performing the Procedure Debriefing Competency Review Se E A ee Conclusion 8 For the Instructor This video allows the learner to select the section of the video they wish to view by clicking on the appropriate section There is also a slider allowing the trainee to choose specific place in the video they would like to review There are also play pause and stop buttons in the video player System Tutorial 5 1 Introduction t Virtual Phlebotomy O 2 System Overview O 2 Learning Types Da Performing the Procedure O 5 Debriefing pa _ 6 Competency Review 9 9 Fo A K 7 Conclusion _ For the Instructor ge Ad E www laerdal com Anatomical Viewer The Anatomical Viewer allows the l
13. earner to view and identify anatomical structures in the arm and hand The arm can be positioned in either a pronated or supinated position by selecting the corre sponding buttons To zoom in and out of the arm model roll the middle mouse button To re orient the arm in a different position click and hold the middle mouse button and move the mouse Structures can be revealed through the selection and de selection of different tissues including e Skin e Arteries e Veins e Nerves e Bones e Muscles and Connective Tissue Anatomical Viewer Anatomical Filters EH Show Bone Show Arteries 1 Show Muscle and Connective Tissue E Show Ligaments iT Show Nerves P Show Veins _ Show Skin gt Orientation 900 Agi Po For identification move the mouse cursor over the anatomic structure and Its name will appear in the ted beat tre lower lent of de Screen www laerdal com Competency Review screen The Competency Review screen presents your competency accomplishments in a concise and intul tive format Competency Review Learner demouseri Level Averages show Cases Cognitive be AJ Skill Last 10 Last 25 Last 50 Last 100 Competency le Show Hide Level 1 Novice Level 2 Intermediate Level 3 Advanced Practice Case Title Type Medical Condition Level Scora Passed Show Flulike Symptoms Practice Case Emergent 20 No Flu like Symptoms Practice Case Emergent 20 No Flu like Symptoms
14. een to view the associ ated debriefing Once the specific case scenario Is accessed the trainee Is able to display the assessment in html for mat for printing by clicking on the print icon at the bottom of the case scenario pop up Routine Blood Tests Score 80 Procedure Time 00 07 59 Learner lisa Tourniquet Time 00 00 49 Level o o Unsuccessful Completion of Procedure Venous Access Events Vain Puncturad Critical Errors Procedure Completed in Appropriate Time Standard Precautions Performed Correctly Tourniquet Usage Correct Venous Access Attempted Venous Access Performed Correctly site Preparation Incorrect 41 Sile cleansing time too short No Site Contamination Equipment Disposed Corractly Insertion Made at Allowable Site Patient Identification Performed Correctly Incorrect Specimens Acquired 4 1 Required samples not obtained Acquired specimen not filed completely Correct Specimen Handling Specimen Not Labeled Correctly 4 Labels not applied to specimens before moving on to assessment Dressings Not Correctly Applied 4 1 Dressing not applied to all puncture sites Tape applied to puncture site without gauze Pressure Applied Correctly Sorting The case scenarios and cognitive tests can be sorted by clicking the column headings www laerdal com 7 TRAINING SEQUENCE Mie temes as the opten o seleccin sins Hadas Cases see Section OMG Sire Guide tera rapid run through or Competency Training Mod
15. g System to crash or slow the simulation to an unstable condition This is a dedicated computer and should not be used for other purposes except those explicitly stated by the software manufacturer www laerdal com 6 2 Basic menu screens To start the application click on the Virtual Phlebotomy section of the boot screen This will initially bring up a loading screen immediately followed by the Introductory Screen see below and prompt the trainee to enter their user name and password Please note that these accounts need to be created by the System Administrator usually the Instructor see section called Administration below Login This screen prompts the trainee to enter user name and password Click the check button to move to the next screen or the No button to remove the Login pop up screen Press the Virtual Products button to return to the Boot screen to Virtual IV and Infant Virtual LV www laerdal com Virtual Phlebotomy Directions for Use System Overview System Icons There are a number of navigation icons that are found at the bottom right of the screen The icon will change color when activated by a mouse click In other cases icons will become grey if they are not available See the System Tutorial video within the application for more detailed information Examples of these icons and their definitions are shown on the pages below Navigation Icons Right arrow Proceed to the next
16. h vacuum tube holder from the toolbar Move the needle cursor to the desired location on the site and click Then insert the real needle with vacuum tube holder into the haptic device Note Before performing the needle insertion it Is necessary to engage the haptic device needle in the haptic device Insert the needle into the Needle Insertion Point on the haptic device until the nee die on the screen lights up You will feel a small tug and hear a sound when the haptic device engages Applying Pressure Once you have selected the gauze and applied it to the arm you can apply pres sure to it by pressing the palpation pressure application area of the haptic device Click on the palpation icon to turn palpation on A palpation finger will attach to the cursor Move fingers to the simulation window click on the site to locate the palpation point To turn palpation off click on palpation or select another piece of equipment Equipment Use Specific To select a specimen tube click on the specimen tube icon in the toolbar A selection of 6 long draw and 6 short draw tubes will appear Click to select the specific tube Once selected the tube can be placed in the tube tray at the right of the simulation window or directly into the multisample needle with tube holder If automatic tube selection Is configured by the administrator empty tubes in the tube tray will be automatically attached to the multisample needle starting with the left most tube
17. he location you wish to apply the gauze Apply pressure to the gauze pad by pressing down in the palpa tion pressure application area of the haptic device To place the tourniquet click on the corresponding tool bar icon move to arm and click on desired location To use an alcohol wipe povidon iodine swab or chlorhexidine wipe click on the corresponding icon on the toolbar and move to the desired site on the arm Once at the desired site click hold and move the mouse to cleanse the site Release mouse button when cleansing Is complete Procedure Tasks Specific To palpate identify the patient wash your hands confirm that the patient followed physicians orders ask the patient to make a fist inform the patient of the procedure warn the patient of the stick or view a video about site orientation click on the corresponding icon on the left edge of the simulation window Once you have completed the procedure advance to the next screen to review your performance www laerdal com Debriefing Following the procedure the learner will be assessed as to how well he or she performed the pro cedures lor e une cen nel screen push une acvance DUO nte E ming te procedures line assessment Is divided into Venous Access Events Critical and Non Critical errors Critical errors are vital to proper performance of the procedure Depending on the configuration chosen by the administra tion under Training Simulation Options a quantitative sc
18. ical Errore Procedure Completed in Appropriate Time standard Precautions Mot Performed Correctly 4 1 Hands not washed Tourniquet Usage Incorect 4 Toumiquet not removed Venous Access Attempted Venous Access Performed Correctly Site Preparation incorrect 4 1 Site preparation not attempted Equipment Disposed Incorectiy lt 4 Gloves not disposed Insertion Made at Allowable Site Patient Identification Not Performed Correct 4 1 Patient was not identified Incerect Specimens Acquired 4 Required samples not obtained Acquired specimen not filled completely Corect Specimen Handling Specimen Not Labeled Correctiy 4 1 Labels not applied to specimens before moving onto assessment Drassings Not Correctiy Applied 4 1 firassina BA ananla ba all miiashisa sbav www laerdal com Cannulation Event Animations These generic animations display a record of the learner s performance in terms of the angle of needle insertion lateral or direct needle placement vein behavior rolling nerve involvement and vein punc ture vein present vein punctured through etc and whether the trainee performed the venous access correctly The animation Is controlled using standard video control buttons Ames E e DIET E www laerdal com Remediation Case Scenario If the student fails the procedure a remediation case with red hints may appear following advance ment from the Debriefing screen An example Remediation Cas
19. ore may be displayed This Overall Rating may be high but the trainee can still fail the procedure if Critical errors were made The total time of the procedure as well as the time the constricting band was placed on the arm Is timed For some Critical and Non Critical errors a movie icon will appear next to the error Clicking on that error will display a video showing the proper way to perform that sub task of the procedure Clicking on the Venous Access event video shows the trainee an under the skin view of what occurred during cannulation For example if the angle of insertion was too steep the video will dis play the consequences of a steep insertion From the debriefing screen the learner is able to display the assessment in html format for printing by clicking on the print icon at the bottom of the screen If the trainee is in Competency Training Mode and succeeds at the procedure then the next case or a qualification test will be automatically pre sented when the trainee advances to the next screen If the trainee fails the procedure he or she may be presented with the same case scenario a different case scenario the procedure training screen or with a remedial case scenario with hints to help the trainee better understand proper procedure Routine Blood Tests Score 52 Procedure Time 00 03 37 Leamer lisa Toumiquet Time Level To O Unsuccessful Completion of Procedure Venous Access Events Vein Punctured Crit
20. tus G Inform Patient O Make Fist O ek Wam of Stick Orientation ES Choose procedural steps around window or equipment from toolbar www laerdal com Virtual Phlebotomy Directions for Use Training Sequence The haptic device contains three 3 separate regions 1 The top of the device is for vein palpation and pressure application 2 The middle of the device is for needle insertion and 3 The bottom of the device is for skin stretch An icon of the haptic device appears in the upper right corner and will show you when and how to Interact with he haptic device To begin the procedure the specimen tube must be completely removed from the multi sample needle Special note Under no circumstances should any needle other than those supplied with the Virtual Phlebotomy Self Directed Learning System ever be used with the haptic device The tourniquet can be placed on the arm to enhance vein engorgement However be aware that the trainee is negatively assessed if the constricting band is left on the arm for too long www laerdal com To use a multi sample needle and tube holder select the appropriate gauge from the inventory on the left side of the screen and move it to the arm A target cursor will appear on the arm Locate the insertion point on the arm with the target cursor click and the needle will appear Insert the multi sample needle tube holder combination into the needle insertion receptacle lo
21. uring needle insertion stretching the skin at the bottom part of the haptic device should assist in securing the vein for insertion 29 different arms supplied with the Virtual Phlebotomy Self Directed Learning System ranging from pediatric to geriatric and including rolling veins fragile veins and arms and hands with difficult to penetrate skin The appropriate angle for needle insertion is 10 30 degrees In some cases the learner will perform the procedure in an incorrect fashion resulting in bleeding bruising or swelling that will appear on the arm O Case Scenario Q Equipment Site Selection Palpation O Patient Identification U Wash Hands Patient Status E Inform Patient O Make Fist O Warn of Stick Y Orientation 23 Insert collection tube into needle with tube holder to begin draw es Use equipment by clicking on the equipment toolbar at the left All pieces of equipment are prepared and ready to use A number of procedure tasks appear along the left edge of the round window It is necessary to perform some of these tasks to successfully complete the procedure Using the Haptic Device To insert the needle palpate apply pressure or stretch the skin perform the function on the haptic device in the corresponding area www laerdal com Virtual Phlebotomy Directions for Use Training Sequence Needle insertion To perform the needle insertion select a needle wit
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