Pyng Medical Corp
FASTx Trainer’s Manual April 2010
Trainer’s Manual
26 Pages
Preview
Page 1
Trainer’s Manual April 2010 • www.pyng.com
© 2010 Pyng Medical Corp.
TRAINER’S MANUAL
This Trainer’s Manual is an essential component of the FASTxTM Sternal Intraosseous Device education program. It contains the guidelines and information needed to effectively and efficiently teach emergency personnel how to perform sternal intraosseous (IO) infusion using the FASTx. Although the FASTx can be quickly and easily mastered, this is a SPECIALIZED MEDICAL PROCEDURE WHICH SHOULD NOT BE ATTEMPTED BY UNTRAINED PERSONNEL. Quality education is paramount to ensure users achieve the highest levels of competence and confidence with this lifesaving device. Upon completion of training students will be able to: •
Discuss the principles of intraosseous infusion
•
List indications and precautions for use of the FASTx
•
Demonstrate safe and effective use of the FASTx on a manikin and on training devices
•
Explain and demonstrate the removal procedure for the FASTx
Pyng Medical Corp. is committed to “saving lives in seconds.” Comments and suggestions for improvement of training and use of the FASTx are greatly appreciated. Pyng Medical Corp. 7-13511 Crestwood Place Richmond BC V6V 2E9 Canada Phone: 604-303-7964 1-800-349-7964
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FASTx LESSON PLAN
TABLE OF CONTENTS
INTRODUCTION ... 1 INTRAOSSEOUS INFUSION AND FASTx...2 INDICATIONS AND PRECAUTIONS...5 DEMONSTRATION... 6 STEP-BY-STEP INSTRUCTIONS ... 7 SKILL PRACTICE TO MASTERY ... 9 REMOVAL ... 10 FASTx TRAINING DEVICE INSTRUCTIONS...11 TROUBLESHOOTING ... 16 FASTx SKILLS EVALUATION ... 18 FASTx WRITTEN EVALUATION ... 19 REFERENCES...23
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INTRODUCTION (5 minutes)
1. Introduce yourself and welcome students
2. Display course objectives: By the end of this session you will be able to: •
Discuss the principles of intraosseous infusion
•
List indications and precautions for use of the FASTx
•
Demonstrate safe and effective use of the FASTx on a manikin and training device
•
Explain and demonstrate the procedure for removal of the FASTx
3. Provide overview of training:
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Brief discussion of intraosseous infusion and FASTx device
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Demonstration of FASTx (done in real-time)
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Step-by-step instruction
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Skill practice to mastery
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Troubleshooting
•
Evaluation
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INTRAOSSEOUS INFUSION AND FASTx (10-15 minutes)
1. Have students recall their most recent cardiac arrest patients (codes) or most recent attempt to secure vascular access on a trauma casualty, and then ask these questions: •
Were you able to establish a patent IV?
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How many attempts were required?
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How long did this process take?
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Were chest compressions interrupted to start the IV?
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Would your patients benefit from a faster, more reliable procedure?
Studies show it takes an average of 3-12 minutes to establish an IV with failure rates of 10-40% in the pre-hospital setting. Transport is often delayed due to the difficulty of inserting an IV in a moving vehicle.
2. Ask: •
Who is familiar with IO?
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Who has done IO before?
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How does IO work?
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Fluids and medications infused into the bone marrow are drained into the vascular/circulatory system
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Who has performed this Sternal IO procedure on a patient?
Ask the student to share briefly about the experience.
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3. FASTx: •
Provides vascular access comparable to a central line
The manubrium is the most effective IO site (research shows fluids and medications reach the heart in 20-30 seconds) due to its close proximity to the heart and immediate absorption via internal mammary and azygos veins which empty directly into vena cava. •
Takes about 10 seconds to insert, less than 60 seconds for entire procedure
•
Does not interfere with other procedures and can be used concurrently (compressions, cricothyroidotomy, etc.)
•
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The location of the manubrium insertion site high on the torso is often protected in trauma and military situations, and allows for emergency care from a single area near the patient’s head •
Can be inserted while transporting the patient in moving vehicles
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Fluids and medications can be administered as you would for IV such as slow drip, boluses or pressure infuser
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Fluids and medications have been infused into sternums at 30ml/min by 1m gravity drip, 120ml/min by pressurized source and 250 ml/ min by syringe (infusion rates)
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Safe for patient (penetrates 6mm into the manubrium) and staff
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Is quick to learn and easy to retain
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4. Pass around sample Infusion Tubes •
Note its flexibility – this allows it to move with patient’s skin which prevents it from dislodging
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Look at steel bone portal – it will be inserted just inside marrow space
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Approximately 14 gauge inner diameter tubing
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Approximately 17 gauge inner diameter portal
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See page 3 for system infusion rates
5. Hold up Introducer •
Releases at a depth of 6 mm from the surface of manubrium to place in the marrow space
•
“Muscle-powered” (not battery-dependent, spring-loaded or pneumatic) - Typically approximately 30 pounds into Simstern block - Compare to typical CPR at approximately 90 pounds - Actual force will vary depending on patient anatomy
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INDICATIONS
•
Establish a sternal Intraosseous access route for fluids or drugs
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For patients 12 years of age and older (adolescent to adult)
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Use whenever vascular access is required to facilitate emergency resuscitation
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Can be left in place up to 24 hours
PRECAUTIONS/WARNINGS
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Trauma, infection or burns at insertion site may preclude use
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Safety with very severe osteoporosis has not been proven
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Use in patients with recent sternotomy may prove less effective
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The function of the device may be affected by fracture of the sternum or vascular injury which may compromise the integrity of the manubrium or its vascularization
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Insertion in sites other than the manubrium may result in ineffective infusion and/or serious injury to the patient and are not approved
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Reuse of FASTx is not recommended due to the potential of cross-contamination, which may lead to serious injury or death. The FASTx is unlikely to function after use.
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DEMONSTRATION (Should be less than 1 minute)
1. Be sure the trainer, manikin and other equipment are ready for a speedy, flawless procedure. Practice, practice, practice!
2. Invite someone to time it. Ask students to hold their questions until afterward.
3. Describe a real-life scenario with the manikin as your patient (ex1: “Here’s a 68 year-old male in cardiac arrest – we need to give drugs– I’m going to use the FASTx.”) (ex2: “A 19 year-old male with bilateral lower extremity amputation is in severe pain following tourniquet application, hemorrhage and breathing have been controlled and the airway is secure. There are no visible or palpable peripheral veins because of significant blood loss. I’m going to use the FASTx to secure vascular access.”)
4. Perform procedure.
5. Ask if this appears to be superior to numerous IV attempts, interrupting CPR and/or delaying transport.
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STEP-BY-STEP INSTRUCTIONS (5-10 minutes)
1. Expose sternum and locate sternal notch. Tell students to place finger in the sternal notch. Have them pair up and do the same with their partner. “This is the landmark – it’s easy to find on any patient. That’s where you place the Target Foot.”
2. Clean insertion site.
3. Remove the Adhesive Liner with the Locking Pin. By pulling the Locking Pin off, the Adhesive Liner comes off too.
4. Stand at patient’s head or side, hold Introducer in dominant hand (or as comfortable). Align the Target Foot notch with the patient’s sternal notch. Point out that this is over the midline and perpendicular to the manubrium. Hold Introducer perpendicular to manubrium and PAUSE. Consider the angle of the manubrium. “This position ensures the Infusion Tube tip will be inserted correctly.” Give everyone an opportunity to see what “perpendicular to the manubrium” looks like and also model “NOT” perpendicular. Pyng Medical Corp.
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5. Press down completely with increasing force until you hear and feel Infusion Tube separate from Introducer. Hold this position while you ask a couple of students to describe the pressure you just used. Note: The force used will be less with the FASTx than with the FAST1 (for those with experience with the FAST1). Please see step 5 on page 4. Reinforce that it was smooth and steady. “Don’t stab, jab or twist – just push until it releases.”
6. Withdraw the FASTx Sternal straight back while holding down the Target Foot. Support comes out with the Infusion Tube. Discard the FASTx Sternal following local contaminated sharps protocols.
7. Connect the IV line, or source of fluid or medication, directly to the luer. Clip the Strain Relief Hook on the Infusion Tube luer, to the Target Foot clip. Option: (refer to your protocol) • Flush with fluid to clear • Confirm placement by aspiration
8. Remove the liner from the Protective Dome and apply the Dome over the Target Foot Infusion Site. Use of the FASTx Dome is optional as the Target Foot also provides protection.
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SKILL PRACTICE TO MASTERY (Time variable)
Most medical providers will only need one or two trials to be totally competent and confident however, since everyone achieves mastery of psychomotor skills at a different rate, be sure to plan for and allow plenty of time with this section. Remember, once a medical provider feels comfortable with the FASTx, he/she is more likely to utilize it.
HANDY TEACHING HINT: Put the students who finish first to work: they can quickly be taught to reset the trainer, turn the manikin’s disk, etc., which frees you up to work more closely with anyone who requires more instruction. Reassure those who are struggling that, “I needed to practice that a few times too.”
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REMOVAL of FASTx
Students are taught how to remove the FASTx because there’s a strong possibility the hospital staff may request assistance (or just reassurance) with the procedure.
1. Remove Protective Dome from Target Foot.
2. Turn off the source of fluid and medication and disconnect IV tubing.
3. Grasp Infusion Tube with fingers or clamp and pull perpendicular to the manubrium until entire Infusion Tube (including metal tip) emerges from the patient’s chest. Note: pull in one continuous motion (do not start/ stop) until removed. Use the tube to pull, not the luer connection. It is normal for the tubing to stretch.
4. Peel off the Target Foot and dress the site as per standard protocol. 5. Discard Infusion Tube and Target Foot following local contaminated sharps protocol.
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FASTx TRAINING DEVICE INSTRUCTIONS
DEPLOYMENT
1. Remove the red Locking Pin from the Handle of the FASTx Training Device. Note: The FASTx Training Device does not have the Adhesive Liner on the Target Foot.
2. Place the FASTx Training Device on a Simstern block (yellow foam with plastic over white foam).
3. Ensure to push down completely to deploy the FASTx Training Device into the Simstern block.
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4. Pull the FASTx Training Device straight back while holding down the Target Foot to separate the Handle from the Infusion tube, which is now inserted into the Simstern “bone.”
5. Connect the luer to the IV line or source of fluid or medication. Connect the Infusion Tube Strain Relief Hook to the Target Foot.
6. Place the Dome over the Target Foot. Note: Use of the FASTx Dome is optional as the Target Foot also provides protection.
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REMOVAL
7. To remove, grip as close to the lower end of the Infusion Tube as possible. Pull the Infusion Tube out from the Simstern “bone.” Note: Pull in one continuous motion (do not start/ stop) until removed. Use the tube to pull, not the luer connection. It is normal for the tubing to stretch.
RESETTING THE FASTx TRAINING DEVICE
1. Reset the FASTx Training Device using the Reset Tool. Push the Reset Tool into the hole in the back of the FASTx Handle. Push gently until you hear and feel a ‘click’. Note: You do not need to push hard to reset the FASTx Training Device.
2. Carefully push down on the Needle Cover, and hold it down with your thumb and/or fingers to prepare for the next step.
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3. While holding down the Needle Cover, load the Infusion Tube over the Stylet. Note: Load the Infusion Tube with the Strain Relief Hook towards the side of the Handle (90 degrees from the FASTx logo).
4. Load the blue Anti-Buckle into the slot next to the Stylet with Infusion Tube. Ensure to snap the Anti-Buckle into place.
5. Snap the Target Foot back on the Needle Cover. Ensure that the Target Foot notch is aligned with the Handle notch.
6. Check alignment of the Target Foot on the Needle Cover. Ensure each needle is in its respective separate hole. (If not, repeat step 5.) Pull Needle Cover back out in place.
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7. Snap the red Locking Pin back in the Handle.
8. The FASTx Training Device is now ready for re-use.
Note: The FASTx Training Device needles will get worn with re-use and the device may need to be replaced. The Infusion Tube will stretch after multiple uses and may need to be replaced.
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TROUBLESHOOTING
1. Fluid or medication does not flow through IV line to site. Flush to clear. If fluid or medication does not flow even after flushing, infusion should be discontinued and an alternative method of vascular access should be used.
2. Leakage at Insertion Site (Extravasation). If excessive, use alternative method of vascular access.
3. First attempt to place FASTx fails. Double check insertion site, patient position, medic position, and try again with a new device. Be sure to remind students to save a device if the procedure/attempt with the FASTx was not successful (after protecting the sharps) for shipment back to Pyng for examination.
4. Removing entire Infusion Tube Pull perpendicular to the manubrium until the entire Infusion Tube (including metal tip) emerges from the patient’s chest. Ensure to pull in one smooth continuous motion (do not start/stop) until removed. Use the tube to pull, not the leur connection. It is normal for the tubing to stretch.
5. Introducer does not release. Pull Introducer back, if Infusion Tube remains in patient, verify placement by aspirating marrow, proceed with use. If marrow cannot be withdrawn, remove tube and insert second FASTx.
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TROUBLESHOOTING
6. Introducer releases but Infusion Tube is not secured in patient. Use new FASTx.
7. Force is applied but Introducer does not release. Without pulling back, ensure Introducer is perpendicular to manubrium and force is being applied directly along this line.
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