User Manual - Kyoto Kagaku America Inc.
Contents
1. O Please contact manufacturer with any discrepancies typos or mistakes in this manual or product feedback Your cooperation is greatly appreciated Table of Contents WEICON Sii Lila P3 Derore Toblini P3 Table of Contents seen PA ONS AAD NES uae e mtem RE PA SCLC P5 Before TalNiNE c P6 10 FP P 9 EOI a NPAC m P10 While Your Training SESSION P6 10 PIAN P12 13 FAQs DOS and DON Ts es P14 Lumbar Puncture Five Steps for proficiency P 15 2 1 roduct Code Mark PartName o 1348 090 1348 110 O Normal Obesity CSF Puncture Block 11348 130 SO Senior Obesity CSF Puncture Block 11348 140 EP Epidural Puncture Block 11348 150 Skin Cover For inquiries and service please contact your distributor or TC KYOTO KAGAKU co urp http www kyotokagaku com rw kyoto kyotokagaku co jp Main Office and Factory 15 Kitanekoya cho Fushimi ku Kyoto 612 8388 Japan Telephone 81 75 605 2510 Facsimile 81 75 605 2519 LA Office for USA CANADA and Mexico customers 3109Lomita Boulevard Torrance CA 90505 USA Telephone 1 310 325 8860 Facsimile 1 310 325 8867 Set Includes a Lumbar Region Model b CSF Puncture Blocks 4variation 5 pieces b 1 Normal CSF 2 b 2 Obesity CSF 1 b 3 Senior CSF 1 b 4 Senior Obesity OSF 1 c Epidural Puncture Block d Lumbar Spine Model e Skin Cover ft Syringe g Stand h Irrigat2. Additionally lumbar punctures are contraindicated in the presence of cerebral mass lesions such as large abscesses tumors and intra cranial hemorrhage S ubdural hematomas may also increase the risk of herniation For this reason cerebral CT scans may be performed prior to lumbar puncture Increased intracranial pressure can be seen in trauma or infection Decreased intracranial pressure can be seen with obstructed flow such as due to a spinal cord tumor Cloudy fluid is associated with the presence of white blood cells increased protein or the presence of microorganisms Bloody or reddish fluid is associated with subarachnoid hemorrhage or traumatic puncture Brown orange or yellow fluid is associated with elevated protein or old blood in the CSF Increased protein is seen with blood in the CSF polyneuritis tumors trauma diabetes infection and inflammation Decreased protein is seen with rapid CSF production Increased glucose is seen with hyperglycemia Decreased glucose is seen with hypoglycemia bacterial or fungal infection tuberculosis or carcinomatous meningitis Sometimes gamma globulin levels are measured These are increased with demyelinating diseases such as multiple sclerosis or Guillain Barre syndrome Locations of spinal and medullar structures L4 L5 How to find L4 amp L5 Use both hands to hold just below Bend the knees the knees Puncture are Curl the body forward Curl the body forwa
3. Caution Ink from this manual can stain the Lumbar Puncture Model do not let it touch the model 5A CO vL aAPVyDETIOBI amp IC BIBT UM DICER CIES BROSTSCCDHVOES M43B Lumbar Puncture Simulator Il M43B FEMME RIO Sa VB JILV NI lt A Il Instruction Manual English 3 21 E KYOTO KAGAKU co LTD Today medical professionals have ready access to advanced imaging technologies such as CT MRI and ultrasound scans that clearly enhance the quality of medical care However despite its use for more than 100 years the lumbar puncture remains indispensable for the rapid diagnosis of meningitis encephalitis or fever of unknown origin The lumbar puncture also remains important for the diagnosis and treatment of numerous conditions seen by emergency care primary care neurology oncology and anesthesia services Thus even today medical competency requires skillful performance of this procedure In the past medical students could practice lumbar punctures on live patients in order to develop the requisite technical skills However for good reasons this is no longer the case Although medical schools and residency training programs recognize the need for formal procedural skills training there are limited opportunities for such programs to teach and assess procedural competency This unfortunate situation has now changed Keio University Medical School in partnership with Kyoto Kagaku has created a realistic lumbar puncture simulato
4. water detach the syringe from the connector by turning the syringe counter clockwise hen press close the tube clamp X Keep the clamp closed while the session is not in action Insert the block into the Lumbar Region Model Before Training Noting the marks at the back of the skin cover LiR t attach it to the Lumbar Region Model Put the Lumbar Region Model on a supporter base X The simulator is designed to show an appropriate CSF pressure when it used in lateral position and 200cc water in the irrigator bag Adjust the pressure to fit your training purpose vvhen you use the system in sitting position The sitting position supporter base is designed to come to the front end of the Lumbar Region Model Open the clamp and start the training session Before Training Epidural Block Setting with Epidural Block Drain Pouch Empty the drain pouch completely Connect the tube tip from the drain pouch to the side connector tube Following the steps of CSF block preparation fill the block with water set it to the Lumbar Region Model and cover with the skin cover 10 While your training session For details please refer Lumbar Puncture Five Steps for Proficiency P15 21 on this manual Landmarks can be palpated When the needle tip reaches in the subarachnoild space water simulated CSF can be collected X The simulator is designed to show an appropria
5. ark cool area will keep the manikin skin from fading The manikin skin may be cleaned with a wet cloth and mildly soapy water or diluted detergent DON Ts Please do not let ink from pens newspapers these instructions or other sources come in contact with the manikin as they cannot be cleaned off the manikin skin Never use ethanol or organic solvent like paint thinner to clean the skin as this will cause deterioration of the skin 14 Lumbar Puncture Five Steps for Proficiency CORTIC AL VEINS S UPERIOR SAGCTAL SINUS CORPUS CALLOSUM DURA MATER SUB ARACHNOID SPACE ARACHNOD GRANULATIONS THIRD VENTRICLE FOURTH VENTRICLE ME DULLA Here a spinal tap can be done without damage Diagram c Background Cerebros pinal fluid CSF is a primarily in the choroid plexus in rate of production is approximately 20 day The CSF is found in the s the arachnoid and pia mater layers total volume of less than one third that of the Thus unimpaired fluid circulation is very impor disease The CSF fluid circulates from the lateral ventricles through the interventricular foramina foramina of Monro into the third ventricle From there it passes through the small cerebral aqueduct in the brainstem into the fourth ventricle The CSF then passes through three small foramina central foramen of Magendie which is also known as the median aperture and the two lateral foramina of Luschka into either t
6. cation 1 When sterilizing the lumbar puncture site start at the site of puncture and spiral outwards in a continuous stroke with the cleansing solution betadine or other Repeat twice for a total of three times Maintain strict sterile technique throughout the procedure Wear gloves Key Points for Proper Technique When injecting lidocaine or similar local anesthetic check first to make certain that the needle tip is not in a vessel or in the subdural space by gently pulling back on the syringe s plunger 20 Spine Cauda a Dura a mater Spinosus Subarachnoid process space When performing the lumbar puncture make certain that the patient is positioned so that the back is flexed the airways are not compromised and that the vertical and horizontal axes of the patient remain stable Co When inserting the needle make certain that the inner stylet is in place When withdrawing the spinal Needle Tanter cellecihage ines ua make certain that the inner stylet is not in place Wear gloves Spinal fluid Assistant When using the three way stopcock remember that the handle always points to the port that is closed When collecting the spinal fluid maintain the precise order of the pre numbered tubes Lumbar puncture step by step 21 22
7. he central canal of the spinal cord or into the cisterns of the subarachnoid S pace The CSF both bathes and cushions the brain and spinal cord Its circulation includes flow distally to the lumbar cistern which encloses the cauda equina where the lumbar puncture is performed and then superiorly to the cerebral sagittal sinus where it is reabsorbed via the arachnoid granulations the smaller villi and the larger P acchioni s bodies into the venous Sys tem Impaired CSF flow through the small foramina is associated with increased pressure in the lateral ventricles hydrocephalus or with disrupted intracranial blood flow 15 Step 1 Understand the lumbar puncture s indications contraindications and spinal fluid examination The spinal fluid needs to be examined in cases of suspected meningitis fever of unknown origin central nervous system leukemia or lymphoma and for the evaluation of many neurologic diseases including multiple sclerosis and recurrent seizures Oncologists frequently use a lumbar puncture to administer chemotherapy to the central nervous system Anesthesiologists use a lumbar puncture to administer spinal anesthesia for some types of surgery By lumbar puncture amphotericin B can be infused for treatment of fungal meningitis Lumbar punctures are contraindicated in the presence of in the presence of an injection at the lumbar puncture site papilledema severe thrombocytopenia or uncorrected bleeding disorders
8. or bag i Support Base Lateral Position j Support Base Sitting Position k Support Base Team Teaching e MN i ak i i Carrying Case No Picture Before Training Supporting Base Setting with a CSF block Assembly the stand Hang the irrigator bag to the stand Before Training CSF Puncture Block Block type and the direction are indicated on the side wall of each block N Normal CSF O Obesity CSF NS Senior CSF OS Senior Obesity CSF EP Epidural Connector to Connector to the Syringe the irrigator bag Obesity block Region Model Obesity type has a lumbar spine in deeper position Senior type has different tissue resistance and bone shape Connect the tip of the tube from the irrigator bag to the tube at the head end of the puncture block Insert the tube deeply so that it won t come off during the session Fill the irrigator bag with water until the surface reaches to the 200ml line Before Training CSF Puncture Block Connect the syringe to the plug at the end opposite to that of the tube from the irrigator bag Insert turn clockwise and lock the syringe in place With the clamp opened aspirate a small amount of water into the syringe Should any air bubbles remain in the system tilt the system and aspirate fluid with the syringe until only water remains in the tubing e When the block has filled with
9. proximate clinical reality is illustrated below To conduct actual lumbar practice assemble the model as noted above To approximate normal CSF pressure of 150 180 mm Hg fill the reservoir pouch to 14 18 cm in height After locating L4 L5 place the needle perpendicular to the vertical plane With the bevel pointed toward the ceiling parallel to the direction of the ligamentum flavum and the stylet in place support the needle between you index fingers and stabilize the hub of the needle with your thumbs Advance slowly through the skin in the direction of the umbilicus As the needle enters deeper structures there will be a change of resistance consistent with the presence of the spinous ligaments This continues until the needle reaches the dura at which time a change in resistance will be felt Should the needle hit bone or other resistance the needle with sylet in place should be withdrawn and redirected The change in resistance sometimes felt as a pop indicates that the needle is in the subarachnoid space Remove the stylet and check for flow of the CSF aToTAVATo 0E 1 practice 18 Area About 20 30cm diameter Sterilizing IS Checklist for Risk Management Prior to lumbar puncture assess for Risk of increased intra cranial pressure Presence in the patient chart of valid informed consent Absence of lumbar puncture site infection Allergies to latex betadine lidocaine or similar medi
10. r that allows students and medical professionals to practice frequently and achieve high levels of procedural competence without placing any patients at risk of harm By all means please try this innovative lumbar puncture simulator Through practice on this special equipment students at all levels of training can increase their procedural comport competence and efficiency We wish you and your patients well Takahiro Amano MD Professor and Head Medical Education Center Gregory A Plotnikoff MD MTS Associate Professor Keio University Medical School Before You Begin This lumbar puncture simulator has been developed for the training of medical professionals only Any other use or any use not in accordance with the enclosed instructions is strictly prohibited The manufacturer cannot be held responsible for any accident or damage resulting from such use Please use this model carefully and refrain from subjecting in to any unnecessary stress or wear Should you have any questions on this simulator please feel free to contact our distributor in your area or KYOTOKAGAKU at any time Our contact address is on the next page O The contents of the instruction manual are subject to change without prior notice O No part of this instruction manual may be reproduced or transmitted in any form without permission from the manufacturer Please contact manufacturer for extra copies of this manual which may contain important updates and revisions
11. rd Lateral recumbent position 17 Step 3 Practice the lumbar puncture technique on the simulator This lumbar puncture simulator provides additional equipment to emphasize the importance of spinal flexion as well as lumbar region stabilization The importance of spinal flexion is readily seen with the model of the lumbar spine that is provided for teaching c As the spine flexes forward note that the inferior articular processes of the upper vertebrae move upwards Also note the corresponding remarkable increase in the inter laminar space between the inferior notch of the superior lamina and the superior notch of the inferior lamina This inter laminar space is the route of the needle insertion into the subarachnoid or intradural space This importance of lumbar region stabilization is taught using different bases for the lumbar region model The larger base j puts the model in the correct recumbent position When the model a is attached to this base j students can practice technique by themselves as illustrated below This does not approximate clinical reality however Erect spine The smaller base k requires students to practice as a team for correct positioning and stabilizing of the model The smaller base simulates the instability of a living patient Use of this base allows the assistant to practice keeping the craniospinal and transverse planes stable and the spine flexed This teamwork which does ap
12. te CSF pressure when it used in lateral position and 200ml water in the irrigator bag Adjust the pressure to fit your training purpose when you use the system in sitting position e Make sure that the needle is not in the subarachnoid space no water flows out and then inject water simulated saline or air into the epidural space Successful performance can be confirmed by observing the injected air water fills the drain pouch X Empty the drain pouch after each trial X When the puncture pad gets worn water air may be able to be injected even if the needle tip has not reached the epidural space When this occurs change the puncture site or replace the pad by a new one 11 Remove the model skin cove and remove the puncture block from the Lumber region model holding it with its hard part Pull back the syringe s piston to at least the 50 ml mark Lock the syringe onto the connector on the block by turning clockwise Release the clamp Slowly depress the piston and push air into the water filled block until all the air has been injected 12 Close the clamp Turn the syringe counter clockwise to remove it from the block Disconnect the reservoir tube from the block Disconnect the drain pouch from the epidural block and empty the pouch f you continue the session return to P6 and set a new block When you finish the session for the day empty the irriga
13. tor bag and dry all used components naturally and store them in room temperature avoiding direct sunlight or exposure to elements 13 Q Water does not come out even if the needle tip is surely in the subarachnoid space A ls the clamp released Isn t the tube folded A ls the water surface in the irrigator bag at 200ml or above A 21G is the recommended needle size for CSF collection training with the simulator If you still experience the difficultis try with a larger needle A Isn t your needle clogged Use a needle as new as possible A The fluid comes slowly drop by drop Wait and see for 2 3 seconds Q The soft tissue part of the puncture block is coming off when grab the block A The soft tissue and bone part of the puncture blocks are not adhered The soft part may look like coming off when you grab it strongly this is not faulty However to keep the blocks longer we recommend holding the hard part when you handle them Q Epidural puncture pad Water air can be able to be injected even if the needle tip has not reached the epidural space A the puncture block is worn When this occurs change the puncture site or replace the pad by a new one DOs and DON Ts DOs Handle the manikin and components with care Taleum powder may be used on the manikin after use to preserve suppleness of the skin and prevent oils from staining the surface otore the manikin in its storage case when not in use otorage in a d
Download Pdf Manuals
Related Search