Virtual I.V.
Contents
1. de Ez 1 Anatomical MU ec Y nicae q Ls 1 y Competency Review For the beginning learner it is important to view both the Procedure Training and System Tutorial videos to understand how to perform both proper peripheral intravenous access and to best use the Virtual Self Directed Learning System www laerdal com Procedure Training video This screen presents the procedural video demonstrating Equipment Proper choice and use of equipment e Standard Precautions e Needle Insertion Performance of needle insertion 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 learner to choose spe cific place in the video for review It is highly recommend that the beginning student watch the video in its entirety before attempting the simulation There are play pause and stop buttons in the video player N Procedure Video O O Entire Wideo gt 1 Equipmant 2 Standard precautions Q 3 Needle insertion www laerdal com System Tutorial video This screen presents the System Tutorial video which is divided into the following chapters Introduction to Virtual 2 0 System Overview Training Types Debriefing Competency Review2. TRAINING SEQUENCE The learner has the option of selecting either Practice Cases see Section 4 Quick Start Trainee Reference Guide for a rapid run through or Competency Training Mode In either case the learner will be presented a case scenario Case Scenario screen The patient scenario contains information vital to the learner s successful performance of the subse quent venous cannulation Read the paragraph review the vital signs and look at the yellow bulleted highlights below to ensure that you select the correct equipment and cannulation site for the case presented The cases become more difficult as you progress in Competency Training Mode from Student 5 to Practitioner P levels In the P levels yellow highlights are not provided Food Poisoning Level Procedure Time 00 10 00 You respond to the company mess hall for a 56 year old woman who has been vomiting for the past hour She complains of abdominal pain which began shortly ater eating Her skin is and clammy She has a history of hypertension and high cholesterol for which she takes medication She is allergic to penicillin and bee stings Respiration Breaths Per Minute 20 Blood Pressure Systolic Dystolic 146 90 Heart Rate Beats Per Minute 96 Temperature C NA Review case and advance to next screen www laerdal com Site Selection This screen shows four 4 views of each arm that corresponds to the patient presented in th
3. 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 messem eee cursor to the desired location on the site and click Then insert the real needle 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 dle on the screen lights up You will feel a small tug and hear a sound when the haptic device engages Applying Pressure you can apply pressure 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 IMove 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 apply tape or dressing click on the corresponding icon move to site and click on desired location To place the tourniquet click on the corresponding tool bar icon move to arm and click on desired location To use an alcohol wipe chlorhexidine wipe or povidone iodine swab click on the corresponding icon on the toolbar and move to the desired site on the arm Once at the desired site clic
4. avoided 2 Which of the following is not true regarding constricting bands teurniquets 3 Which of the following is not a complication of peripheral IV insertion IeesILLLULULLOLLGLULLULLIGULALLLLILLILOEODLULULULLLLLCLLLLLL LLLLLLL AL ILESCL GIR www laerdal com Virtual Directions for Use System Overview Information Box At the bottom of many screens there is a rectangular box that prompts the trainee how to proceed Equipment Selection o EE Select required equipment and advance to next screen Select required equipment and advance to next screen www laerdal com Help Screens Most screens in the Virtual 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 Gore or dme same An example help screen is shown here with call outs showing the various components of the menu 9 S 5 Equipment Selection Help Overview Based on the information given in the Case Scenario select as many pieces of equipment as you might need to complete the procedure 3 Pe fee aed AAE bo Pa www laerdal com Virtual Directions for Use System Overview Ca
5. device www laerdal com There are over forty 40 different arms supplied with the Virtual Self Directed Learning System ranging from pediatric to geriatric and include rolling veins fragile veins and arms and hands with dif ficult to penetrate skin The appropriate angle for needle insertion depends on the patient scenario and insertion site but is generally between 10 and 30 degrees A flash of red will appear in the needle if the stylet penetrates a vein or an artery After needle insertion the needle should be withdrawn and the catheter secured in place with the appropriate equipment such as tape Catheter lock syringe flush and LV tubing can be placed on the catheter 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 Case Scenario Q Equipment o Site Selection Palpation Patient Identification e Wash Hands e Inform Patient C2 Warn of Stick Orientation e Choose procedural steps around window or equipment from toolbar 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 is necessary to per form some of these tasks to successfully complete the procedure www laerdal com Virtual Directions for Use Training Sequence
6. engagement the transparent needle on the screen will be highlighted The position of the bevel will also appear in the circle next to the arm 5 Equipment Site Selection Palpation e Patient Identification Wash Hands 3 Inform Patient 9 Warn of Stick Orientation 357 Click at desired insertion location To palpate the arm select the Palpation button Move the palpation fingers to a location on the arm click 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 select the palpation button a second time All Body Substance Isolation BSI techniques should be followed These may include gloves and gog gles 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 either in the trashcan biohazard bag or the sharps container Depending on the patient case it may be more or less difficult to correctly insert the needle During needle insertion stretching the skin at the bottom part of the haptic device should assist in securing the vein for insertion Similarly vein occlusion can be performed using the top part of the haptic
7. Conclusion For the Instructor EO e M m This video allows the learner to select whatever section they wish to view by clicking on the appropri ate section There is also a slider allowing the learner to choose specific place in the video they would like to review There are also play pause and stop buttons in the video player l Entire Video Introduction to Virtual 2 0 2 System Overview 4 3 Training Types gt 4 Performing the Procedure 5 Debriefing 6 Competency Review 7 Conclusion For the Instructor www laerdal com Anatomical Viewer The Anatomical Viewer allows the learner to view and identify anatomical structures in the arm and hand The arm can be positioned in either pronated or supinated position by selecting the corre sponding buttons To zoom in and out of the arm model roll the middle mouse wheel To re orient the arm in a different position click and hold the middle mouse wheel and move the mouse Structures can be revealed through the selection and de selection of different tissues including Skin e Arteries e Veins e Nerves Bones Muscles and Connective Tissue Pronated Anatomical Filters iy show Bone Show Arteries Show Muscle and Connective Tissue Lu Show Ligaments Show Nerves Show Veins Show Skin e Orientation Anatomical Names For identification move the mouse cursor o
8. Virtual Directions for Use System overview www laerdal com Virtual Directions for Use System Overview 6 1 Software Overview The Virtual Self Directed Learning System software consists of two distinct parts 1 The basic menus screens which present the training videos practice cases review competencies and sup bort other functions and 2 The simulation training sequence that enables interaction between the trainee inserting the needle and the three dimensional 30 model of the arm The following section describes the Basic menu screens Section 6 2 while the Training Sequence is covered in Chapter 7 WARNING Precautions when using the simulation software The Virtual LV Self Directed Learning System has been designed to work on the computer 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 No software should be installed on the computer supplied with the Virtual LV 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 LV Self Directed Learn
9. e Case Scenario Two 2 images are with the arm in the supinated position and two 2 images are with the arm in the pronated position Based on the information presented in the preceding Case Scenario choose the site which is most suitable for intravenous cannulation Select the site by clicking in the box associated with the anatomi cal descriptor of the best site At any time during the procedure you can change sites review the case scenario or obtain more equipment Click on the right arrow to advance to the Equipment Selection Screen Site Selection right antecubital fossa right pronated forearm right upper arm 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 learner with a brief description of the corresponding piece of equipment select an item click on that item and it will appear on the Equipment toolbar on the left hand side of the screen The learner may click on an item multiple times and the quantity of that piece of equipment will appear on the item in the equipment toolbar To deselect an item click on the x at the upper right of the item in the equipment 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 p
10. formation Examples of these icons and their definitions are shown on the pages below Navigation Icons Right arrow Proceed to the next 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 l V Directions for Use System Overview Log Off the current user or Instructor Information about Virtual I V 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 View case scenario www laerdal com Virtual Directions for Use System Overview Select equipment Change site for insertion Wash Hands Inform Patient Palpate Site Warn of Stick Learn how to orient the site Case scenario level indicator Movie available Click to play movie www laerdal com 6 3 Navigation and Learning Aids Tool Tips By moving the mouse over any navigation or administration icon a small pop up Tool will appear providing a brief explanation of that item An example is presented here N Cognitive 9 Test Resul Learner demouser Level 1 When selecting peripheral sites for insertion which of the following should be
11. ing 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 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 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 mark to move to the next screen or the No button to remove the Login pop up screen Click the Virtual Products button to return to the boot screen to Virtual Phlebotomy amp Infant Virtual www laerdal com Virtual l V Directions for Use System Overview The following section describes the Icons and Buttons Basic menu screens and the Training Sequence also covered briefly in the Quick Start Guide 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 in
12. k 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 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 proce dure view the debriefing screen click the right arrow after performing the procedure The assess ment is divided into Critical and Non Critical errors Critical errors are vital to proper performance of the procedure Depending on the configuration chosen by the administration a quantitative score may be displayed This Overall Rating may be high but the learner can still fail the procedure if Critical errors were made total time of the procedure as well as the time the constricting band was placed on the arm is displayed 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 the procedure Clicking on the cannulation event video shows the learner an under the skin view of what occurred during cannulation For example if the angle of insertio
13. n was too steep the video will display the con Cl Hr doe v Tren 506595 cc rie nis cass GP a qualification test will be automatically presented when the learner advances to the next screen If the learner 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 remediation case scenario to help the learner better understand proper procedure Debriefing 1 Pedestrian Struck Score 96 Procedure Time 00 01 03 Learner Mil C Band Time 00 00 30 Level amp Unsuccessful Completion of Procedure Cannulation Events Correct Cannulation Vein Punctured Catheter Buckling Critical Errors Procedure Completed in Appropriate Time Standard Precautions Performed Correctly C Band Usage Correct Catheterization Attempted Catheter Cannulation Error 4 Catheter buckled Flash Chamber Observed Correctly Flush Successful Site Preparation Correct No Site Contamination Equipment Disposed Correctly Insertion Made at Allowable Site Patient identification performed correctly Non Critical Errors Appropriate Site Selected Patient Informed at Appropriate Time Extension tubing Used Correctly Correct Bevel Angle 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
14. ng 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 the specific case scenario or cognitive test at the bottom of the screen to view the associ ated debriefing Once the specific case scenario 15 accessed the learner 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 Chast Pain Seore 24 Procedure Time 00 01 38 Leamer C Band Time 00 00 31 Level Unsuccessful Completion of Procedure DIS Ta TIE iD 5 Correct Cannulation Vein Puncturad Errors Procedure Completed in Appropriate Time Standard Precautions Performed Correctly C Band Usage Conect Cathetenzaton Attempted Cannulated and Correctly Threaded Flash Chamber Observed Conmectty Flush Successful Site Preparation Incorrect 4 Site cleansing time too short Site Contamination Equipment Disposed Correctly Insertion Made at Allowable Site Patent identification perfomed Non Critical Errors Appropriate Site Selected Patient Not Property Informed 4 Patiant mot informed Extension tubing Used Correctly Correct Bevel Angle Sorting The case scenarios and cognitive tests can be sorted by clicking the column headings www laerdal com 7
15. or direct needle placement vein behavior rolling needle catheter behavior buckling re cannulation vein puncture vein present vein punctured through etc and whether the learner cannulated the vein correctly animation is controlled using standard video control buttons Ane mme www laerdal com Remediation Case Scenario If the student fails the procedure a remediation case with red hints may appear following advance MOnt mein ST example remediation case scenario 15 presented here Case Scenario Pedestrian Struck Level 53 Procedure Time 00 06 00 You receive by basic unit 41 year old female who has been struck by a car She was found in the parking lot of a shopping mall with abrasions to her face left arm and shoulder and left leg which is significantly deformed She is alert and oriented without loss of consciousness and is complaining of pain in both her left shoulder and left leg She has no pulses in her left arm Upon assessment you find her lungs clear and her abdomen soft She has no known drug allergies and takes no medication of any kind Vitals Respiration Breaths Per Minute 24 Blood Pressure Systolic Diastolic 100 70 Heart Rate Beats Per Minute 108 Temperature NA Oxygen Saturation NA Review case and advance to next screen www laerdal com
16. reer Selection screen This screen offers the trainee the choice of three 3 different career modules Move the mouse over the different career choices to identify the career chosen for you by your instructor Click on the cho sen module to begin training Career Selection a S Pre Hospital Main Menu screen This screen presents a menu of options including Competency Training A progressive tiered hierarchy of case studies cognitive tests and required skills that ranges from beginning student 51 to advanced practitioner P3 Practice Cases Individual cases can be tried from all of the levels for practicing skills with or without recording assessment as this is configurable www laerdal com Virtual l V Directions for Use System Overview e Anatomical Viewer This module presents a three dimensional 3D model of the arm that can be used to identify structures and learn anatomy Procedure Training This video introduces the beginning student to the techniques and skills required for intravenous access System Tutorial This video shows the learner how to use the Virtual LV simulator system Competency Review This module shows achieved learner competencies during competency training a complete review of student performance Main Menu 24 Py 4 dog ME m Gre ul Competency Training System Tutorial XQ 4
17. rocedure Select required equipment and advance to next screen p www laerdal com Simulation Screen and Performance of the Intravenous Procedure The Simulation component of the Virtual Self Directed Learning System allows the learner to per form the LV insertion procedure using the haptic device All of the items chosen from the Equipment Selection screen will appear on the left side of the screen and be available for use in the procedure If not already done remove the needle from the haptic device and completely attach the catheter to the needle before beginning the procedure To zoom in and out of the arm model roll the middle mouse wheel To orient the arm differently click and hold the middle mouse wheel and move the mouse around To select a piece of equipment click on the inventory on the left side of the screen Once an item is chosen it must either be placed on the arm or disposed of in the trashcan biohazard bag or sharps container Certain items such as the tourniquet catheter needle pump flush extension tubing lock and tubing be removed by clicking on them Case Scenario Equipment I Site Selection Palpation Patient Identification e ral b Inform Patient C2 Warn of Stick Orientation Choose procedural steps around window equipment from toolbar www laerdal com Virtual l V Directions for Use Training Sequence The hap
18. tic device contains three 3 separate regions 1 The top of the device is for vein palpation and occlusion 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 the Haptic Device To begin the procedure the catheter must be attached to the needle Align the ridge located on the needle with the groove on the catheter to ensure proper configuration of the needle catheter combination insertion Palpation and Occlusion Skin Stretch Special note Under no circumstances should any needle or catheter other than those supplied with the Virtual 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 learner is negatively assessed if the constricting band is left on the arm for too long www laerdal com To use a needle select the appropriate gauge from the toolbar 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 needle catheter combination into the needle insertion receptacle located in the middle of the haptic device A slight tug will be felt as the needle is engaged by the haptic device After
19. ver the anatomic structure and its name will appear in the text box at the lower left of the screen www laerdal com Competency Review screen The Competency Review screen presents your competency accomplishments a concise and intui tive format Leamer demouserl Show Cases amp All Last 10 Last 25 Last 50 Last 100 Competency Show Hide Practice Case Title Medical Condition Laval ScorePassed Show Pedestrian Struck Case Scenario Trauma 96 Yes gt Selecting the number of cases to 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 system to save practice cases then additional 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 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 incorrectly unina WWW Clicki
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