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SimMan3G NG Tube Modification

  Submitted by: Dustin Hicks on January 08, 2016
  HomeGrown Solution Number: 273
Identification of the Problem
While Laerdal's SImMan 3G mannequin is a great tool for learning through simulation it is limited on how it can be utilized for training on a patient with a nasogastric tube, a common tool for administering medications, feedings, and emptying/decompressing the stomach. Currently there have been no published solutions for how to utilize a nasogastric tube in the SimMan 3G mannequin while preventing any damage to the electrical parts inside the mannequin.
Unique Idea
This simple and reversible modification to the inner parts of the mannequin allow for a nasogastric tube to be utilized in the mannequin while keeping any fluids separated from the inner electronic components of the mannequin.
Objectives
Supplies/Ingredients
1. One 14 Fr. Salem Sump Nasogastric Tube (or similar)
2. One emptied 500ml IV bag
3. One large zip lock bag (big enough to place your IV bag inside)
4. Nasogastric securing supplies (tape, NG strip, safety pin, etc)
5. Food coloring of choice for gastric content
6. Hemostats
7. Mannequin airway lubricant
8. Modeling clay or plumbers putty
9. Catheter syringe
10. Water
Steps to Creating the Solution
1. Unzip the torso skin on the mannequin, obtaining access to the inside of the Laerdal SimMan 3G mannequin. Expose the inner chest by lifting the abdominal foam and placing it to the side.
2. Disconnect the esophageal tube (larger clear tubing) from the abdominal padding (it will be attached to a white connector affixed to the padding)
3. Lubricate your nasogastric tube or the nasal airway with the mannequin airway lubricant. Insert the nasogastric tube into the nare of choice and continue to push it in until you see it poke out of the end of the esophageal tubing. If you have trouble getting it to move all the way through the tubing you may use forceps to grab the nasogastric tube and pull it through.
4. Once the tube is pulled through, guide it through the hole that is located on the left lateral chest area on the mannequin. This will bring the nasogastric tube outside of the inner workings of the mannequin, protecting the electronics.
5. Using hemostats, dilate the opening to the emptied IV bag so that the tip of the nasogastric tube fits snugly inside the IV bag. Be sure to insert the tube far enough into the bag that the holes in the end of the nasogastric tube are inside the IV bag. Form a gasket around the NGT as it enters the IV bag using the plumbers putty or modeling clay to give an extra layer of protection from leaking (this may not be necessary) Place the IV bag inside your zip-lock style bag and close it.
6. Prepare your gastric contents using food coloring and water (or liquid of choice, Coca-cola mixed with water allows you to adjust gastric pH) to get the color of gastric content you want. Using your catheter tip syringe, fill the IV bag through the NGT as full as necessary and remove any excess air that may have entered the IV bag. The more fluid you need the larger IV bag I would use so that it can be as flat as possible between the outer shell of the mannequin and the external skin. If planning on introducing much fluid into the NGT I would keep the bag as empty as you can while allowing for aspiration of gastric content as needed.
7. Replace the abdominal foam and tuck the bags between the hard plastic shell of the mannequin and the external skin. Then, zip the skin back up on the mannequin.
8. Secure the NGT to the nose as desired and you are ready to go!