S550.100 NOELLE Instruction Manual

PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY PRIOR TO STARTING TRAINING EXERCISES ON YOUR NEW SIMULATOR. HANDLE YOUR SIMULATOR IN THE SAME MANNER AS YOU WOULD HANDLE YOUR PATIENT – WITH CARE AND CONSIDERATION. SHOULD YOU HAVE ANY QUESTIONS AFTER READING THIS INSTRUCTION MANUAL, CALL OR E-MAIL OUR CUSTOMER SERVICE DEPARTMENT.

800-882-6655 USA Toll Free 305-971-3790 Worldwide 305-667-6085 Fax e-mail: [email protected]

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TABLE OF CONTENTS Section 1 – Rapid Assembly and Checkout Introduction Contents Assembly and checkout Birthing Controller Section 2 – NOELLE Patient Care Bandaging Eyes Teeth and tongue Hygienic care Injection sites Range of movement Ears, nose and airway Injection training arm and hand CPR Airway management Section 3 – NOELLE Obstetric Care Overview Automatic Birthing System Dilating Cervix Fetal Palpation using the Articulating Fetus Normal Labor and Delivery Vacuum Augmentation Shoulder Dystocia Cesarean Delivery Prolapse of the Umbilical Cord Placenta Previa Version Breech Birth Delivery of the Placenta Postpartum Activity Fundal Massage Episotomy Repair Section 4 – NOELLE Neonatal Care Introduction Airway management Umbilicus Section 5 – NOELLE care and maintenance Section 6 – References Section 7 – Limited Warranty Section 8 – Technical Support Section 9 – Common Spare Parts List for NOELLE 550.100

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Section 1 – Rapid Assembly and Checkout Introduction – The NOELLE Maternal and Neonatal teaching system permits students to appreciate the complete birthing experience from the onset of labor, to delivery, to treatment of the mother and neonate after delivery. It provides capabilities in ALS, obstetrics and neonatal resuscitation protocols. This is one of five maternal/child learning systems developed at Gaumard. It is supplied with an extensive training guide containing: Specific OB tasks every student must know Discussion questions Quizzes and puzzles Student readings Two basic OB scenarios Seven advanced OB scenarios Additional instructor and student OB training guides can be purchased by contacting Gaumard Scientific.

Your NOELLE S550.100 Maternal and Neonatal Birthing System includes the following: Quantity

Item

One One One One One Two One Three Two Three Three Three Two One One One One One One One One

Instruction demo on CD-ROM Head and torso assembly with IV arm Abdomen cover with speaker attached Automatic birthing system with mounting flange Birthing controller with fetal heart tones and power supply Mechanical adaptors Elevating “cushion” for Leopold Maneuvers Dilating cervices Placentas Vulvas – fully dilated Vulva for postpartum repair of episotomies Umbilical cords Umbilical clamps Postpartum perineal insert 48 hour postpartum uterine assembly Silicone lubricant Articulating birthing fetus with patent mouth and nose Resuscitation neonate with intubatable airway and umbilicus Carrying bag for neonate Instructions for use NOELLE Training Guide with both basic and advanced scenarios

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Assembly and checkout NOELLE™ is shipped partially assembled. The preterm fetus and full term neonate are fully assembled. Place NOELLE on a flat surface. Remove the abdominal cover, remove the fetus, elevating pillow and other materials packed within the abdomen. Note that the automatic birthing mechanism secures the upper and lower torsos using four (4) tee-nuts. Also note that the speaker in the abdominal cover is connected to the birthing mechanism providing the fetal tones. Now connect NOELLE’s legs as outlined below.

NOELLE’s birthing mechanism is secured to the upper and lower torsos with four (4) tee-nuts

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Remove the wingnuts, washers and springs from both hips

Remove IM site from each leg and slide bolt through hole. Reach through the IM site and attach the first washer, then spring, the second washer and finally the wingnut. Tighten nut until the spring is compressed slightly.

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Birthing Controller The birthing controller is powered by 100-240 VAC and 50-60 Hertz. Connect the power cord provided to the Birthing Controller. In certain countries, the customer may have to supply an electrical wall adapter to connect between NOELLE’s power cord to your wall outlet. The Birthing controller has four (4) switches: Fetal heart rate Birthing speed Pause/Resume On/Off

The Birthing Controller operates 100-240VAC and regulates the speed of delivery as well as fetal heart rate. Delivery can be paused at any point to extend delivery time or to simulate certain complications.

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To begin, observe the movement of the automatic birthing mechanism without the fetus in place. This “test run” will be done without the “tummy cover” in place. Choose a fetal heart rate of say 140, and a delivery speed of “1” which is the fastest birthing speed. Select “On” and press “Resume”. A small motor located in the birthing mechanism will start which provides internal rotation, movement down the birth canal, and finally external rotation so that the fetal shoulders may align with the long axis of the vulval insert. Observe that the motor will stop from time to time in order to more realistically simulate the birthing process. Note that the fetal heart tones may be heard during delivery. Select “Pause” at any time and the mechanism will stop. Select “Resume” when ready. Note that two adapters are attached to the birthing mechanism. Select one adapter and the fetus will be birthed to about the shoulders; select two adapters and the entire head and upper torso will be birthed before the mechanism stops. Allow the birthing mechanism to reach the limit of its travel where it will stop. Select “Pause” and the mechanism will return to its original position. Now select a different delivery speed , a different fetal heart rate, and select “Resume” to begin another birthing process.

Section 2 – NOELLE Patient Care Bandaging - the fingers and toes of NOELLE are separated to permit bandaging exercises. The surface of the simulator is smooth and resistant to water, oil and liniments. Eyes/Ophthalmologic Exercises – The head has separately inset and removable eyes, permitting: Administration of orbital medicines, including drops/ointments into the conjunctival sac. Removal of foreign bodies Eye irrigation

Teeth and tongue – Noelle is supplied with fixed upper and lower dentures. The tongue may be moved gently from side to side. Hygienic Care – NOELLE’s head is supplied with a wig for instruction in combing, shampooing and head draping. Bathing exercises may also be practiced. Injection Sites – Sites on the upper left and right arms and legs permit IM injections. An IV training arm provides an extensive venous network to start IVs or infuse fluids.

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Range of Movement – NOELLE’s head and jaw articulate. The legs and arm articulate in the normal fashion. Ear, Nose and Airway – The ear cavity may be filled with about 10 mL of fluid. The nose is patent permitting feeding exercises or passage of a nasal/tracheal catheter. The airway contains nominal landmarks permitting either BVM or intubation exercises. The trachea extends to the bronchi and lungs. Lungs expand normally permitting realistic chest rise. Injection Training Arm and Hand – IV, IM or subQ exercises can be performed. Always use needle sets sized #22 or thinner to extend the life of the veins and skin. Always use clean water in the veins and drain after use. CPR – Since NOELLE contains a realisitic airway we do not recommend mouth to mouth ventilation since the airway would be difficult to clean afterward. Instead use a normal size adult BVM which will seal around the mouth and nose. The ribs have normal anatomic landmarks and the lungs permit an adequate chest rise. NOELLE has three tubes extending from beneath her left arm. One has a squeeze bulb used to pulse the bilateral carotids. Another tube has a blue marking which may be used to monitor airway ventilation. A third tube has a red marking used to measure the depth of cardiac compression. These two tubes may be connected to an optional CPR monitor supplied by Gaumard Scientific. Contact Customer Service for details.

Squeeze bulb is used to generate carotid pulses

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Tubes labeled with red and blue markers are used with the optional monitor shown to teach and test airway ventilation and chest compression

The more advanced CPR Link shown above may be used with your computer to record ventilation and compression waveforms

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Airway Management – Most airway management techniques can be practiced on NOELLE including BVM, nasal/oral intubation, and suctioning. For intubation we suggest a Miller 3 or MAC 4 blade as well as a Fr 7 or 7.5 ETT. Use the Sellick maneuver if needed to bring the vocal folds into view. Remember to lubricate the distal end of any airway device before inserting it into NOELLE.

BVM using mask with wide seal to assure an easily seen chest rise

Lubricate the distal tip of the ETT prior to intubation

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Section 3 - NOELLE™ Obstetric Care Overview NOELLE is supplied with a detailed Instructor and Student guide describing what students really need to know as well as quizzes and nine scenarios. Extra copies of the Instructor and/or Student Guides are available from Gaumard Scientific.

The NOELLE birthing mechanism offers the ability to demonstrate a variety of obstetric techniques including: Fetal palpation Vaginal delivery Shoulder dystocia Cesarean section delivery Complete, frank and footling breech deliveries External version Cord prolapse Placenta previa Vacuum delivery

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Automatic Birthing Mechanism NOELLE is supplied with an electromechanical system to automatically deliver the fetus. The system provides for internal rotation, linear motion to “crowning”, and a second rotation to present the fetal shoulders parallel to the longitudinal axis of the vulva. Placing the fetus in the right occipital anterior (ROA) position will result in a “nose down” crowning followed by shoulder rotation. Placing the fetus in the left occipital posterior (LOP) position will result in a “nose up” presentation which may require some assistance on the part of the student or Instructor. Breech deliveries may also be performed as detailed later in these Instructions.

Dilating Cervix As the fetus proceeds down the birth canal it pushes against a simulated uterus/cervix. It looks like a disc with a small hole in the center and is attached to the entrance of the birth canal using three (3) metal snaps. The device is designed to permit considerable distension. During delivery the presenting part dilates and swells the cervix and swells as the fetus moves down the birth canal. At crowning the head passes through the cervix and through the vulval insert. Students can measure birth descent and cervical dilation which may be used to plot the progress of labor.

Leopold maneuvers using the articulating fetus To perform Leopold Maneuvers, retract the birthing mechanism fully and remove the articulating birthing baby. Place the elevating cushion within the birthing torso. Route the inflation bulb outside NOELLE through any space provided on the left side. Place the birthing baby in the elevating cushion in the vertex, breech, or transverse positions. Install the “tummy cover”. Inflate the elevating cushion until the fetus is felt within the abdomen.

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Place elevating pillow within simulator

Place fetus onto elevating pillow and lift fetus anteriorly using squeeze bulb.

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Snap abdominal cover into place.

Lift fetus anteriorly using squeeze bulb.

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Conduct the four Leopold Maneuvers.

Normal Labor and Delivery To conduct a delivery, remove the “tummy cover” and place the articulating birthing baby on the birthing mechanism. Lubricate the fetal head and shoulders, plus the inside of the vulva using water based silicone. Attach the umbilical cord to the baby, route the cord so it does not bind in the mechanism and attach the placenta to the pelvic cavity using the Velcro® fastener. Note that the fetus has a receptacle at the rectum into which the matching pin located on the birthing mechanism is inserted. Position the baby so that its head faces toward the left side of the simulator. This is the ROA or right occipital anterior position. Note: any other position may be chosen; however, take care that the fetal shoulders are aligned with the long axis of the vulval insert. Caution: if the fetal shoulders are NOT aligned with the vulva, binding may occur.

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Remember to lubricate the inside of the vulva

Also lubricate the inside of the dilating cervix.

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Now thoroughly lubricate the fetal head and shoulders.

Attach the umbilicus to the placenta.

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Attach placenta to one of three positions on the abdominal wall. Orienting the Velcro patches in parallel causes the placenta to be retained; orienting them at right angles causes the placenta to release with modest traction.

Attach umbilicus to fetus.

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Position the fetal arms and legs as shown

Umbilical cord can be wrapped once around the fetal neck

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