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SimMan3G Chest Tube Adaptation

  Submitted by: Dustin Hicks MSN, RN on April 24, 2017
  HomeGrown Solution Number: 288
Identification of the Problem
In nursing education we are often required to teach skills and concepts that our students rarely get to practice in the clinical setting. One such skill that can be rare for students to perform and difficult to duplicate in the lab setting is care of a chest tube. Current manikins allow for participants to insert chest tubes but are limited in their ability to control the amount of drainage from the tube and to replicate the tidaling that is seen in the system as a patient breathes.
Unique Idea
After completing a simple modification to a few spare parts for the SimMan3G and common medical supplies we can simulate a functioning chest tube that will allow for the collection of variable amounts of drainage in a chest drainage system while mimicking the tidaling that occurs in the drainage system as a patient breathes.
Objectives
To expand the use of the SimMan3G by providing a solution allowing for the replication of chest tube drainage and tidaling within a chest drainage system. Participants will be able to measure chest drainage output and practice basic chest tube management techniques.
Supplies/Ingredients
1. Chest drainage collection system
2. 100cc Jackson-Pratt Drain
3. 30" tubing with connectors from SimMan3G Wound kit
4. One connector from SimMan3G Wound kit
5. Spare nasal cannula tubing (cut 24" from connection end)
6. One pair of hemostats
Steps to Creating the Solution
1. Create small opening approximately 2 inches from the end of the 30" wound kit tubing. Allow just enough space for the extra wound kit connector to fit snugly inside. Insert connector into created opening.
2. Connect cut end of nasal cannula tubing onto the added wound kit connector. You may need to use your hemostats to widen the opening of the cut end of tubing to allow it to fit onto the wound kit connector.
3. Connect the other end of the nasal cannula tubing to the output side (where the plug goes) of the Jackson-Pratt (JP) drain.
4. Unzip the skin on the left side of the manikin and run the wound care tubing underneath, exiting the skin through the opening made for the defibrillator connection. Allow the opposite end to exit the skin around the arm at the shoulder where it can be connected to the left shoulder bleeding port.
5. Place JP drain with tubing connected underneath the distal end of the chest plate along-side manikins left chest rise bladder with tubing pointed towards the left side of the chest.
6. Zip up the left side of the manikin leaving the tubing exposed only where it connects to the bleeding port and where it exits the manikin as the "chest tube".
7. Prepare chest drainage collection system per manufacturer instructions. Connect and secure the "chest tube" to the chest drainage collection system. Apply dressing as desired to the chest tube site.
8. Turn on the SimMan3G manikin and fill with simulated blood. Once filled with blood you can utilize the controls within the software to control the flow of bleeding. Allow as much drainage into the system as you desire. As the manikin breathes the JP drain should act as a bellows, changing the air pressure in the system just enough to provide for tidaling in the water seal chamber and in the drainage tubing.
9. Attach to suction and adjust the level of suction as desired or leave to water seal. Any bubbling in the water seal chamber will provide an opportunity to discuss the detection and correction of air leaks in the collection system and/or the resolution of pneumothorax after chest tube placement.