Newborn Anne Directions for Use Rev A

N ew b o r n A n n e Directions for Use

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o. t. N Ca . Cor .S.A pora in U tion. All Rights Reserved. Produced

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Newborn Anne

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www.laerdal.com

Directions for Use

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TABLE OF CONTENTS

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INTRODUCTION Introduction and Intended Use... 2

SETUP GUIDE Newborn Anne Package Contents... 3 Manikin Connectors... 4

CLINICAL SIMULATION General Handling...5 Airway Simulation Features...7 Drug & IV Administration...10 Manikin Preparation Before Use... 11 MAINTENANCE Maintenance After Use... 12 Periodic Maintenance... 12

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Introduction and Intended Use Newborn Anne Manikin Newborn Anne focuses on training in basic neonatal resuscitation skills.

Newborn Anne Manikin Features Airway Features: • Anatomically accurate, realistic airway • ET tube insertion • LMA insertion • Sellick Maneuver • Positive pressure ventilation • Mainstem intubation • Suctioning • Gastric tube insertion Breathing Features: • Bilateral chest rise and fall with mechanical ventilation Breathing Complications: • Unilateral needle thoracentesis - anterior-axillary Vascular Access: • Patent, cuttable umbilicus with venous and arterial access for bolus or continuous infusion • Intraosseous access – bilateral • Simulated blood flashback upon cannulation Other Features: • Interchangeable pupils with normal, dilated and constricted pupils (optional) • Articulation in all four limbs • Stomach reservoir • Umbilical reservoir • Manual umbilical pulse

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Setup Guide Newborn Anne Package Contents The following parts are included in the Newborn Anne shipping carton.

Newborn Anne Manikin

IV Bag Connector Tube

Umbilical Cord (1) Pulse Bulb Tube

Liquid Soap

Airway Lubricant

Umbilical Clamp

Baby Powder

Red Simulated Blood

Baby Pants

Directions for Use

Not shown: * Laerdal Global Warranty * Carry Case * Meconium Kit

Cat.no. Description 220-03650 Meconium Kit 220-00650 Baby Pants 250-21050 Airway Lubricant 300-00750 Red Simulated Blood 276-15550 Liquid Soap 277-00150 Baby Powder

Cat.no. Description 240-01050 Carry Case 220-05550 Umbilical Pulse Bulb 220-05650 Umbilical Clamp 220-05750 IV Bag Connector Tube 220-19250 Directions for Use CD 5527 Laerdal Global Warrranty

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Cat.no. Description Optional Accessories: (Not shown) 200-03050 Eye Kit 220-00350 Right & Left IO Mandrel and Leg Skin Kit 220-00150 Umbilical Cord (4) 240-00250 Umbi Simulated Blood 220-00250 IV Bag &Tubing Set

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Manikin Connectors The Newborn Anne manikin is shipped ready for use. * To attach an empty IV Bag (not provided), connect the IV Bag Connector Tube (C) to the manikin’s Umbilical Reservoir Tube Connection (D). * To attach the Umbilical Pulse Bulb Tube (B), connect to the manikin’s Umbilical Pulse Bulb Tube Connection (A). Note - To attach the tubes, push the connectors together and quarter turn. To detach, reverse the process.

D

A

C

B

Note - The manikin’s Umbilical Reservoir Tube Connection (D) has a valve to prevent leakage from the tube when not attached to an IV-bag set.

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Clinical Simulation Using the Newborn Anne Manikin 1. General Handling Newborn Anne is the size and weight of a newborn baby girl delivered at term with approximately 3.5 kg (7 lbs) body weight and 51 cm (21 inches) length. The arms, legs and neck articulate realistically and encourage care and proper handling. The manikin can be handled appropriately for care and resuscitation of a normal newborn.

Umbilical Cord: The Newborn Anne manikin has a replaceable umbilical cord which can be clamped, tied, cut, sutured, or catheterized, or palpated for umbilical pulse. IV fluids or medications may be injected into the vein in the umbilical cord up to 40ml if the umbilical reservoir is not filled with fluid to use the manual pulse. Fluids will not flow out to the bag.

Manual Umbilical Pulse: Newborn Anne has a manually generated umbilical pulse. To palpate the umbilical pulse, fill the umbilical reservoir with fluid, clamp the umbilical cord and attach the pulse bulb to the white connector. It is up to the instructor to select the pulse rate by squeezing the hand held bulb accordingly (see photo).

Interchangeable Pupils: The Newborn Anne manikin is delivered with normal pupils installed in the head. A replacement Eye Kit containing 3 sets of plastic pupil inserts (normal, dilated, and constricted) to simulate different patient conditions can be purchased separately (see page 3, Optional Accessories). 5

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Clothing:: The Newborn Anne manikin is delivered with baby pants with snaps at the bottom to allow tubing to pass through. Powdering: Newborn Anne manikin is delivered with powder. When needed, apply light dusting of powder externally to the manikin torso (see page 12).

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2. Airway Simulation Features Opening the Airway The neck of Newborn Anne manikin is realistically flexible, from hyperextension to flexion. The simulation team members may demonstrate correct head position for opening of the airway. Clearing the Upper Airway Simulated meconium may be suctioned from the Newborn Anne manikin's mouth and nose with a suction catheter (see page 11). When using the meconium module, the simulation team members can assume that there is meconium in the trachea, instigating proper procedures for aspiration of meconium matter. The head can be turned to the side as normal.

Clearing the Lower Airway One can dry simulate removal of meconium from the Newborn Anne manikin's mouth and trachea by laryngoscopy, using a suction catheter to clear the mouth.

Securing the Airway The Newborn Anne manikin's neck, jaw and airway are modeled to enable a normal newborn intubation scenario. The airway can be intubated either by direct laryngoscopy (straight blade size #1 recommended) and an uncuffed ET tube (size ID 3.5 mm recommended), or with the LMA (size #1 recommended). Nasal intubation can be done. NOTE: Lubricate the ET tube or LMA with provided Airway Lubricant before insertion.

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The "sniffing" position aligns the trachea for the best view of the glottis and vocal cords when properly using a laryngoscope. Cricoid pressure may be used by the simulation team member. The Newborn Anne manikin jaw is realistically hinged and flexible, for airway and intubation maneuvers. The Newborn Anne manikin vocal cords are realistically shaped and at a depth of 9.5 cm from the upper lip. If the ET tube is inserted too far, it will pass into the right main bronchus, giving only right side chestrise during positive-pressure ventilation. An ET tube may be secured by means suitable for a neonate. Tape residues should be cleaned off the skin with soap and water.

Oropharyngeal or nasopharyngeal airways suitable for neonates may be used. NOTE: Lubricate the oropharyngeal or pharyngeal airways with provided Airway Lubricant before insertion.

Detection of Esophageal Intubation If the esophagus is intubated instead of the trachea, the abdomen will then visibly distend for each positive-pressure ventilation.

Stomach ventilation is detectable with the stethoscope.

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Assisted Breathing The Newborn Anne manikin is designed for airway devices such as face masks, ET tubes (size ID 3.5mm recommended) and LMAs (size #1 recommended). The manikin is suitable for use with self-inflating bags and flowinflating bags. It is not designed for use with automatic ventilators.

A size 0/1 face mask is recommended for mask-ventilation with the Newborn Anne manikin. During mask ventilation with elevated airway pressure, air may realistically leak through the esophagus to the abdomen, visibly distending the stomach. To vent out accumulating air from the stomach, an orogastric tube (size 8 FR recommended) can be in place simultaneously with mask ventilation.

Pneumothorax Decompression The needle decompression procedure can be performed by inserting a needle at the left chest side (fourth intercostal space) into the pleural space. The rib structure can be palpated through the skin. The Newborn Anne manikin's pleural space is enclosed so that the needle cannot damage the inner components of the manikin.

Chest Compressions The Newborn Anne manikin has normal visible chest landmarks (xyphoid process, nipples) and underlying sternum structure. The Newborn Anne's maximum chest compression depth is one third of the AP distance.

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3. Drug & IV Administration IV Access via the Umbilical Vein IV fluids or simulated medications may be injected into the vein in the umbilical cord. The fluids will accumulate in an abdominal fluid reservoir (40 ml capacity) if the reservoir is not filled to use the manual pulse. Fluids will not flow out of the reservoir to the IV bag. Cannulation of the umbilical vein can be performed with an umbilical catheter (size 3.5F or 5F). Artificial blood can be added to the reservoir, so that team members can draw simulated blood when testing the catheter for proper insertion depth.

Intraosseous Access Intraosseous access can be established bilaterally in the lower legs. IV fluids or medications may be injected through the I/O needle. Each leg contains a fluid reservoir of approximately 35 ml. To prevent leakage, it must be emptied after each use (see page 12).

Stomach Catherization A feeding tube (size 8FR) can be inserted into the stomach.

A suction catheter (size 10FR) can be inserted into the stomach for stomach content removal. Suction can be applied to the catheter as normal.

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Manikin Preparation Before Use Inserting Fluids into the Umbilical Reservoir Use a syringe to insert fluid into the abdominal reservoir. Do not fill more than 40 ml.

Attaching the Umbilical Cord Lubricate the end of the umbilical cord to be inserted with liquid soap. Squeeze and press the umbilical cord into the umbilical opening. The cord should be pressed at least 50mm (2 inches) into the opening, but need not be pushed further down. To remove, gently pull on the umbilical cord.

Changing Eye Pupils 1. Open the eyelids wide, taking care not to rip the faceskin. 2. Using the suction cup provided in the Eye Kit (see page 3, Optional Accessories) or the edge of your fingernail, gently remove the pupil from the eye. 3. Replace with the pupil of choice, using the small suction cup provided in the Eye Kit or gently press pupil into place with finger.

Inserting the Meconium Module 1. Insert the module with a finger - do not use force. Note: Do not add lubricant to the module. Note: Do not insert the meconium module past uvula. 2. A suction catheter @ 100 mmHg will remove the meconium module. 3. A tether line has been added to ensure removal of the object. For intubation following the removal of the meconium module, add Aiway Lubricant to the ET-tube before intubation.

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Maintenance After Use The maintenance tasks listed below should be performed after the training session. For other service needs, contact your local Laerdal Technical Service Center. Tucking in the Neck Skin If the manikin’s neck has been extended, the neck skin’s lower edge may need to be tucked in under the body framework’s collar line. To Extend the Cleanliness of Your Manikin Use a small towel and lightly dust the manikin head and chest with a small amount of powder (provided). Wipe away any excess. Apply baby powder beneath the body skin at the neck, shoulder and hip joints to prevent sticking. Emptying the Abdominal Reservoir for Fluid Remove the umbilical cord, rinse and wipe it clean, and let it dry. Suction fluid from the reservoir. Add clear or soapy water and suction until the reservoir is clean. Emptying Legs for Fluid If fluid is present in the legs, open the plug behind the knee and remove fluid with a syringe. NOTE: Always remove fluids from the umbilical and IO reservoirs after use.

Periodic Maintenance Changing Lower Leg Mandrels and Skins After multiple uses with IO needle injections to the lower legs, the lower leg mandrels and skins should be replaced if fluid leakage is prominent during use (see page 3, Optional Accessories). 1. Carefully pull the leg skin off the leg. 2. Unscrew and remove the knee bolt holding the lower leg. 3. Exchange the lower leg with a new one of the same type (right/left foot). 4. Reinsert the knee bolt and tighten carefully. 5. Apply baby powder to the inside surfaces of the leg skin. 6. Pull a new leg skin (same type left/right) over the foot/leg. 12

© 2009 Laerdal Medical Corporation. All rights reserved. Printed in USA Part no. 1005465 Rev A (English language version)