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Manual muñeca materna Manual muñeca materna Document Transcript

  • S550.100 NOELLE™ Maternal and Neonatal Simulation System INSTRUCTION MANUALGaumard® Scientific Company, Inc.14700 SW 136th StreetMiami, FL 33196e-mail:©2004-5 Gaumard® Scientific Company, Inc.All Rights ReservedThe NOELLE simulation system is protected by patents,including US 6,503,087 and 6,758,676.
  • TABLE OF CONTENTSSection 1 – Rapid Assembly and Checkout Introduction Contents Assembly and checkout Birthing ControllerSection 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 managementSection 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 RepairSection 4 – NOELLE Neonatal Care Introduction Airway management UmbilicusSection 5 – NOELLE care and maintenanceSection 6 – ReferencesSection 7 – Limited WarrantySection 8 – Technical SupportSection 9 – Common Spare Parts List for NOELLE 550.100 3
  • Section 1 – Rapid Assembly and CheckoutIntroduction – The NOELLE Maternal and Neonatal teaching system permits studentsto appreciate the complete birthing experience from the onset of labor, to delivery, totreatment of the mother and neonate after delivery. It provides capabilities in ALS,obstetrics and neonatal resuscitation protocols. This is one of five maternal/child learningsystems 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 scenariosAdditional instructor and student OB training guides can be purchased by contactingGaumard Scientific.Your NOELLE S550.100 Maternal and Neonatal Birthing System includes the following:Quantity ItemOne Instruction demo on CD-ROMOne Head and torso assembly with IV armOne Abdomen cover with speaker attachedOne Automatic birthing system with mounting flangeOne Birthing controller with fetal heart tones and power supplyTwo Mechanical adaptorsOne Elevating “cushion” for Leopold ManeuversThree Dilating cervicesTwo PlacentasThree Vulvas – fully dilatedThree Vulva for postpartum repair of episotomiesThree Umbilical cordsTwo Umbilical clampsOne Postpartum perineal insertOne 48 hour postpartum uterine assemblyOne Silicone lubricantOne Articulating birthing fetus with patent mouth and noseOne Resuscitation neonate with intubatable airway and umbilicusOne Carrying bag for neonateOne Instructions for useOne NOELLE Training Guide with both basic and advanced scenarios 4
  • Assembly and checkoutNOELLE™ is shipped partially assembled. The preterm fetus and full term neonate arefully 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 automaticbirthing mechanism secures the upper and lower torsos using four (4) tee-nuts. Also notethat the speaker in the abdominal cover is connected to the birthing mechanism providingthe 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 5
  • Remove the wingnuts, washers and springs from both hipsRemove IM site from each leg and slide bolt through hole. Reach through the IMsite and attach the first washer, then spring, the second washer and finally thewingnut. Tighten nut until the spring is compressed slightly. 6
  • Birthing ControllerThe birthing controller is powered by 100-240 VAC and 50-60 Hertz. Connect the powercord provided to the Birthing Controller. In certain countries, the customer may have tosupply an electrical wall adapter to connect between NOELLE’s power cord to your walloutlet. The Birthing controller has four (4) switches: Fetal heart rate Birthing speed Pause/Resume On/OffThe Birthing Controller operates 100-240VAC and regulates the speed of deliveryas well as fetal heart rate. Delivery can be paused at any point to extend deliverytime or to simulate certain complications. 7
  • To begin, observe the movement of the automatic birthing mechanism without the fetusin place. This “test run” will be done without the “tummy cover” in place. Choose a fetalheart 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 willstart which provides internal rotation, movement down the birth canal, and finallyexternal rotation so that the fetal shoulders may align with the long axis of the vulvalinsert. Observe that the motor will stop from time to time in order to more realisticallysimulate the birthing process. Note that the fetal heart tones may be heard duringdelivery.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 thefetus will be birthed to about the shoulders; select two adapters and the entire head andupper 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 differentdelivery speed , a different fetal heart rate, and select “Resume” to begin another birthingprocess.Section 2 – NOELLE Patient CareBandaging - the fingers and toes of NOELLE are separated to permit bandagingexercises. 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 irrigationTeeth and tongue – Noelle is supplied with fixed upper and lower dentures. The tonguemay 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. AnIV training arm provides an extensive venous network to start IVs or infuse fluids. 8
  • Range of Movement – NOELLE’s head and jaw articulate. The legs and arm articulatein the normal fashion.Ear, Nose and Airway – The ear cavity may be filled with about 10 mL of fluid. Thenose is patent permitting feeding exercises or passage of a nasal/tracheal catheter. Theairway contains nominal landmarks permitting either BVM or intubation exercises. Thetrachea extends to the bronchi and lungs. Lungs expand normally permitting realisticchest 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 tomouth ventilation since the airway would be difficult to clean afterward. Instead use anormal size adult BVM which will seal around the mouth and nose. The ribs have normalanatomic landmarks and the lungs permit an adequate chest rise. NOELLE has threetubes extending from beneath her left arm. One has a squeeze bulb used to pulse thebilateral carotids. Another tube has a blue marking which may be used to monitor airwayventilation. A third tube has a red marking used to measure the depth of cardiaccompression. These two tubes may be connected to an optional CPR monitor supplied byGaumard Scientific. Contact Customer Service for details.Squeeze bulb is used to generate carotid pulses 9
  • Tubes labeled with red and blue markers are used with the optional monitor shownto teach and test airway ventilation and chest compressionThe more advanced CPR Link shown above may be used with your computer torecord ventilation and compression waveforms 10
  • Airway Management – Most airway management techniques can be practiced onNOELLE including BVM, nasal/oral intubation, and suctioning. For intubation wesuggest a Miller 3 or MAC 4 blade as well as a Fr 7 or 7.5 ETT. Use the Sellickmaneuver if needed to bring the vocal folds into view. Remember to lubricate thedistal end of any airway device before inserting it into NOELLE.BVM using mask with wide seal to assure an easily seen chest riseLubricate the distal tip of the ETT prior to intubation 11
  • Section 3 - NOELLE™ Obstetric CareOverviewNOELLE is supplied with a detailed Instructor and Student guide describing whatstudents really need to know as well as quizzes and nine scenarios. Extra copies of theInstructor and/or Student Guides are available from Gaumard Scientific.The NOELLE birthing mechanism offers the ability to demonstrate a variety of obstetrictechniques including: Fetal palpation Vaginal delivery Shoulder dystocia Cesarean section delivery Complete, frank and footling breech deliveries External version Cord prolapse Placenta previa Vacuum delivery 12
  • Automatic Birthing MechanismNOELLE is supplied with an electromechanical system to automatically deliver the fetus.The system provides for internal rotation, linear motion to “crowning”, and a secondrotation 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 “nosedown” crowning followed by shoulder rotation. Placing the fetus in the left occipitalposterior (LOP) position will result in a “nose up” presentation which may require someassistance on the part of the student or Instructor. Breech deliveries may also beperformed as detailed later in these Instructions.Dilating CervixAs the fetus proceeds down the birth canal it pushes against a simulated uterus/cervix. Itlooks like a disc with a small hole in the center and is attached to the entrance of the birthcanal using three (3) metal snaps. The device is designed to permit considerabledistension. During delivery the presenting part dilates and swells the cervix and swells asthe fetus moves down the birth canal. At crowning the head passes through the cervixand through the vulval insert. Students can measure birth descent and cervical dilationwhich may be used to plot the progress of labor.Leopold maneuvers using the articulating fetusTo perform Leopold Maneuvers, retract the birthing mechanism fully and remove thearticulating birthing baby. Place the elevating cushion within the birthing torso. Routethe inflation bulb outside NOELLE through any space provided on the left side. Placethe 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 theabdomen. 13
  • Place elevating pillow within simulatorPlace fetus onto elevating pillow and lift fetus anteriorly using squeeze bulb. 14
  • Snap abdominal cover into place.Lift fetus anteriorly using squeeze bulb. 15
  • Conduct the four Leopold Maneuvers.Normal Labor and DeliveryTo conduct a delivery, remove the “tummy cover” and place the articulating birthingbaby on the birthing mechanism. Lubricate the fetal head and shoulders, plus theinside 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 pelviccavity using the Velcro® fastener. Note that the fetus has a receptacle at the rectum intowhich 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 theROA 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 vulvalinsert. Caution: if the fetal shoulders are NOT aligned with the vulva, binding mayoccur. 16
  • Remember to lubricate the inside of the vulvaAlso lubricate the inside of the dilating cervix. 17
  • Now thoroughly lubricate the fetal head and shoulders.Attach the umbilicus to the placenta. 18
  • Attach placenta to one of three positions on the abdominal wall. Orienting theVelcro patches in parallel causes the placenta to be retained; orienting them at rightangles causes the placenta to release with modest traction.Attach umbilicus to fetus. 19
  • Position the fetal arms and legs as shownUmbilical cord can be wrapped once around the fetal neck 20
  • Attach fetus to birthing mechanism using one or two birthing adaptersTurn on the monitor and select a fetal heart rate from 60 to 200 beats per minute. Youmay adjust the heartrate at any time during delivery to simulate episodes of bradycardiaor tachycardia. Now select one of four delivery speeds. Speed “1” is the fastest and canbe used to demonstrate a precipitous delivery. Speed “4” requires about 25 minutes tocomplete. You may lengthen delivery time in any of the four speeds by pressing thePAUSE and then RESUME button. 21
  • The first few centimeters of movement normally take about half the total delivery time.Note that the baby rotates internally as it moves forward and that the baby turns after thehead is delivered and before the shoulders are delivered. The student or instructor mayhelp the fetal head and shoulders through the vulva as in real life. Once the shouldersare delivered, the student can remove the baby from the mother in the normal manner.The birthing cycle can be paused at any point and then resumed. The sound produced bythe small motor is an excellent indicator whether the fetal movement is being slowed byundue friction. In the event the birthing baby binds in the birth canal, the mechanism willpause and back up. It will automatically try a second time. If this occurs, remove theabdominal cover and determine the cause. In most cases, binding can be prevented bythoroughly lubricating the fetus, the dilating cervix and the vulva.During delivery, fetal heart tones can be heard by placing the bell of a conventionalstethoscope on the abdomen. Move it around until the tones are clearly heard. Tones aresupplied via a small speaker which can be located in three areas depending upon the fetallie. The amplitude of the fetal heart tones is set at Gaumard. To adjust the amplitude, lookfor a small hole on the bottom of the Birthing Controller. Insert a small screwdriver,engage the adjusting screw and turn clockwise or counter clockwise. 22
  • Cervix dilates as fetal head moves down birth canalFetal head at crowning 23
  • Mouth and nose suctioning can be simulated.External fetal rotation aligns shoulders with the longitudinal axis of the vulva 24
  • Vacuum-assisted DeliveryVacuum-assisted delivery is a technique for the management of arrest during the secondstage of labor. Criteria for successful delivery include: (1) cervical dilation iscomplete;(2) cephalic presentation is confirmed ;(3) the fetal head is no more than 1/5palpable above the pubic bone; (4) effective uterine contractions continue; (5) maternalexpulsive efforts continue.Vacuum-assisted delivery may be practiced with the NOELLE simulator using a vacuumcup supplied by a number of suppliers. 25
  • Lubricate the fetus supplied with NOELLE and place it onto the delivery system in thenormal ROA position. Note: NOELLE models supplied since Jan 2005 include a softscalp you may place over the skull providing a better vacuum seal between the fetalhead and the vacuum cup. Activate the delivery mechanism and the fetus will movedown the birth canal. Select “Pause” as soon as the cervix is fully dilated. This is beforecrowning and “pausing” will stop the delivery mechanism. Insert a lubricated vacuumcup into the vagina and place the cup onto the flexion point of the skull located betweenthe fontanelles. Use the manual vacuum pump supplied with such devices to cause theattachment of the cup to the skull. Wait a few minutes for the “chignon” to form.Vacuum assist device attached to fetal scalp between fontanellesAwait the next contraction that may be simulated by asking NOELLE to bear down, andhaving the student apply steady traction perpendicular to the plane of the cup. Select the“Resume” key, then the “Pause” key again to move the fetus slightly down the birthcanal. Some vacuum-assisted delivery devices are equipped with a means for measuringthe amount of traction which may be on the order of about 15 pounds. The student muststop traction when the simulated contraction ceases. Repeat this procedure of waiting forthe simulated contraction and providing traction during the contraction if and only if thefetus is moving down the birth canal with each contraction. The student may also assessthe potential need for an episiotomy to facilitate delivery. In the event delivery progressis not being made, NOELLE must be immediately referred as a potential “C”section candidate. 26
  • Shoulder DystociaShoulder dystocia is a dangerous conditions defined in the NOELLE Guide as the “arrestof delivery of the fetal body after the successful delivery of the fetal head”. It may becharacterized by the so-called “turtle-sign” wherein the fetal head moves forward andthen retracts. During dystocia, the fetal shoulders become wedged behind the symphysis.NOELLE may be used to practice the resolution of dystocia using episiotomy techniques,the McRobert’s maneuver, suprapubic pressure, posterior arm sweep or elbow-kneedelivery.The McRoberts maneuver causes pelvic tilt that mayrelease the fetal shoulder from behind the pubic boneSuprapubic pressure may also release the fetal shoulder 27
  • To demonstrate shoulder dystocia, place the fetal baby in the ROA position. Locate asmall squeeze bulb at the lower left side of NOELLE and note it is attached to aninflatable bag near the dilating cervix. Inflate the bag using the manual squeeze bulbnoting that the fetal head and shoulders will rise toward the symphysis. Note that the fetalhead is palpable beneath the stomach cover. Activate the delivery mechanism moving thefetus down the birth canal until the fetal head is delivered. Simulate dystocia by pausingthe delivery mechanism. Students must use the various maneuvers attempting to deliverthe baby. If the fetus can not be delivered the Instructor can press the “Resume” keywhich will cause the fetus to resume it movement down the birth canal and the studentsshould try again. Note: NOELLE models produced after March 10, 2005 incorporatea “fifth speed” on the controller which delivers the fetus and produces the turtlesign”. This is followed be a three (3) minute pause during which time the studentsmust attempt to deliver the baby. When time expires the mechanism resumesdelivery and the students must start over.Manual squeeze bulb expands inflatable bag beneath fetus lifting it anteriorly,simulating locking the shoulder behind pubic bone.Note: do not place the fetus onto the delivery mechanism in the LOA position it willattempt to birth with its shoulders at right angles to the axis of the vulva causingundo stress on the delivery mechanism. At any time the Instructor may completelyretract the delivery mechanism by toggling the power switch first to the “off “position and then to the “on” position. 28
  • Cesarean DeliveryCesarean birth is the delivery of the fetus through an abdominal and uterine incision ACesarean delivery, also called a C-section may be performed as a result of breechpresentation, pre-term or dysfunctional labor, fetal distress, prolapsed umbilical cord,placenta previa, abruption placenta, or a variety of other abnormalities. Demonstrate a C-section using NOELLE by removing the metal snaps just above the pubic bone andbirthing the baby between the stomach cover and the pubic bone. An optionalabdominal cover is available if the Instructor wishes to demonstrate midline or“bikini” incisions.Delivery mechanism fully retracted and inflatable cushion insertedNOELLE “C” section delivery using optional abdominal 29
  • cover with “bikini” incision. Specify P/N S560.029Prolapse of the Umbilical CordProlapse of the umbilical cord is a dangerous complication which involves the presenceof the umbilical cord in the birth canal in front of the presenting part. This condition mayoccur as a result of breech presentation, transverse lies, a small fetus, an overly long cord,a placenta placed low in the uterus, or other abnormalities.Prolapse of the umbilical cordIf the cord is observed in the birth canal ahead of the presenting part, gloved fingersshould be inserted and the presenting part lifted off the cord to relieve pressure on thecord. This procedure must be maintained until the prolapse has been solved, either by atermination to the compression of the cord, or until delivery of the fetus by C-section.Placenta PreviaPlacenta previa is a condition in which the placenta is located in the lower half of theuterus, located near or covering the cervical os. There are three types of placenta previa:total, partial and marginal. Total placenta previa is when the placenta completely coversthe cervical os. Partial placenta previa is when the cervical os is partially covered by theplacenta. Marginal placenta previa is when the edge of the placenta extends to theinternal os, where the uterus opens into the vaginal canal.To simulate placenta previa with NOELLE, place the placenta in the desired position tosimulate the condition, with the maternal side against the uterine wall or the cervical os. 30
  • Then place the fetus within the uterine cavity with the presenting part closest to theplacenta.Total placenta previa in which the placenta completely coversthe well effaced cervical osExternal VersionVersion may be attempted to rotate the fetus from a breech position into one permittingnormal vertex presentation. To practice “version” remove the abdominal cover and thefetus, retract the delivery mechanism fully and insert the inflatable cushion. Next, removethe foam in the abdominal cover. Thoroughly lubricate the inside surface of theabdominal cover, the fetus, and the inflatable cushion. 31
  • Place the lubricated fetus onto the lubricated inflatable cushion and snap thelubricated abdominal cover into place. Inflate the cushion lifting the fetusanteriorly. Inflate the cushion at the base of the pelvic cavity to position fetus.Confirm the breech position and attempt to manually turn the fetus within theuterus by transabdominal manipulationBreech BirthBreech birth occurs when either the buttocks or lower extremities of the fetus are thepresenting part. There are three types of breech birth: frank, complete and incomplete orfootling. Frank breech occurs when the buttocks are the presenting part and the legs ofthe fetus are extended up toward the baby’s head. Complete breech occurs when thebuttocks are the presenting part and the baby’s legs are flexed along the lower torso.Footling or incomplete breech occurs when one of both of the legs are the presenting part.There are many differences in labor between the breech presentation and the vertexpresentation. With the descent, the posterior hip encounters the pelvic floor and internalrotation takes place, allowing the anterior hip to move beneath the pubic arch. Theanterior hip then delivers, followed by the posterior hip, the legs and the feet. Externalrotation allows the shoulders to move into the maternal pelvic and internal rotation allowsthe shoulders to deliver. Downward traction allows the delivery of the anterior shoulder,with a finger inserted into the birth canal to free the arm. Upward traction allows theposterior shoulder to deliver and the posterior arm is freed in the same manner. After thedelivery of the shoulders, the fetal head delivers in a flexed or heads up position. 32
  • Although it is possible for a vaginal delivery of breech presentations, once a breechpresentation has been confirmed, a Cesarean is often performed to lower the risk of infantmortality due to cord prolapse or birth asphyxia.To simulate breech presentations with the NOELLE, retract the birthing mechanism fully,remove the cover in the fetal head, insert the birthing mechanism into the fetal head usingeither one or two adapters and place the fetal legs in either an extended position tosimulate “footling” delivery or retract the legs for a “frank” delivery.Remove plug in fetal head for breech delivery 33
  • Removing plug reveals aperture for birthing mechanismOne way of not losing the plug is to insert it into the rectum.Also remember to lubricate the lower torso and legs of the fetus 34
  • Attach the fetal head to the birthing mechanism using one or two adaptersAssisting a frank delivery 35
  • The Pinard or leg-flip maneuver frees one leg then another.The fetal arms may also require a similar maneuver during delivery. 36
  • The fetal arms are delivered and the fetus rotated anteriorly to birth the head.Delivery of the PlacentaThe placenta supplied with NOELLE may be positioned so that it births spontaneously orrequires either modest cord traction or manual removal. In addition, note that the placentais designed with two removable placental fragments. These fragments are attached to thebody of the placenta with Velcro. You may reverse one or both fragments causing one orboth to birth with the placenta or remain affixed to the uterine wall.Students must carefully inspect the birthed placenta to make sure it is complete and thatno fragments remain internally. If retained fragments are noted the student must retrievethem using a gloved hand under appropriate sterile conditions. 37
  • Postpartum ActivityFundal MassageAfter delivery the uterus normally contracts reducing postpartum bleeding. Under certainconditions contraction does not occur and extensive bleeding may continue. If thiscondition is not recognized and treated in a timely manner the new mother may go intoshock and die. Inadequate uterine contraction may present as a “boggy” or soft uterusassessed through abdominal palpation. Uterine contraction may be augmented usingcertain drugs and/or uterine massage.To simulate pharmacologic intervention, access NOELLE’s bilateral injection sites. Topractice uterine massage, remove NOELLE’s fully dilated vulval insert and snap thepostpartum perineal insert into place. Attach the large postpartum uterine assembly to thedistal end of the vagina using the locking ring assembly. Note that the postpartum uterineassembly consists of a thin outer uterine skin and a smaller, harder inner uterus.Use the squeeze bulb attached to the postpartum uterine assembly to inflate the spacebetween the two uteri expanding the soft external skin sufficient to simulate a “boggy”uterine condition. Bimanual massage will cause air to leak from the thumb screw in thesqueeze bulb causing the outer skin to contract. When sufficient air is released the studentwill begin to feel the harder inner uterus which simulates the well contracted postpartumstate.Remove the vulva and cervix, and insert the uterine assembly 38
  • Retract the delivery mechanism, place the elevating cushion,and insert the uterine assembly from the side shownSnap the uterine assembly into place and use the squeeze bulbto produce the uterine tone desired. Lift the uterus anteriorlyusing the elevating pillow. The white Velcro patch on the fundusmay be used to position the uterus at various orientationswithin the abdominal cavity 39
  • Use bimanual massage to shrink the “boggy” uterus into a smallerand firm condition.Episotomy RepairRemove the fully dilated vulva used during delivery and select one of the three episotomyrepair modules. Snap a repair module into place. Use a “000” size suture and smallcurved needle to repair the surgical incision or repair.Episotomy repair modules snap into birth canal 40
  • “000” sized sutures are recommendedto extend the life of the repair modules 41
  • Section 4 - NOELLE™ Neonatal CareThe full size neonate supplied with the NOELLE S550.100 is a resuscitation baby havinga patent umbilicus and the ability to change color with airway ventrilation: Realistic airway with tongue, vocal folds, trachea, and esophagus Articulating head, neck, jaw, arms and legs Heart, lungs, ribs, stomach and liver Perform BVM or CPR Conduct oral or nasal intubation plus suctioning Crico prominence permits the Sellick maneuver Bilateral lung expansion with realistic chest rise Patent umbilicusAirway Management – Be sure to treat the simulator as you would treat a real newbornwith care and consideration. Before inserting ET, NP, or OP tubes always lubricate thedistal end of the tube. Failure to do so will damage the tiny airway. When intubating wesuggest a Miller 1 blade and an uncuffed 2.5 mm ETT with appropriate stylet.Practice BVM techniques using an “infant” sized mask having a thick seal 42
  • Intubate using a Miller 1 blade and well lubricated 2.5 ETT with stiffening stylet.Color ChangeThe neonate has devices in its forearms and lower legs to cause the skin to turn from anormal healthy color to a blue color indicative of peripheral cyanosis. It also has devicesin the cheeks which cause the skin to turn from a normal color to an ominous blue colorindicative of central cyanosis. These devices are controlled by a monitor that starts theneonatal simulator in one of three selectable states: central, peripheral, or healthy. Themonitor observes ventilations and compressions performed on the neonate anddetermines whether they meet or exceed conventional standards. If acceptable, themonitor causes the skin to turn to a more healthy color; if inadequate or non-existent, themonitor causes the skin to turn toward an ominous blue color.The rate of improvement and deterioration is selectable and is defined as the timebetween each of the three selectable states. The monitor also has a “coach” and “test”mode. In “coach” the student will hear sounds indicating that it is the correct time forventilations and compressions. In “test” the sounds are silenced. The monitor alsofeatures a visual display to see whether the rescue efforts are judged as being too high,too low, or just right. 43
  • To get started attach the red chest compression and blue airway ventilation tubes to themonitor. Attach both the cable from the neonate and the power supply to the monitor.Switch the monitor on and observe the color of the neonate. Perform BVM or CPR in thenormal manner. The condition of the neonate will progressively worsen if appropriatetreatment is not received.UmbilicusThe umbilicus remains patent for several hours after birth and may be used to infusemedications in a critically ill neonate. The neonate supplied with NOELLE has a patentumbilicus for use in such training.The umbilicus is connected to an internal reservoir that can be filled with fluid using thesyringe provided. Students can insert a lubricated standard umbilical catheter, verifycatheter placement by removal of fluid, and add medications as needed for the trainingexercise. Both the filling and drainage tube are located on the right side of the neonate.Generate palpable umbilical pulses using manual squeeze bulb 44
  • Lubricate distal tip before inserting umbilical catheterSection 5 – NOELLE Care and MaintenanceTreat NOELLE, the birthing fetus, and full term neonate with care, as you would in adelivery environment.After use, clean the simulators with a mild detergent or with soap and water. Remove alltraces of any lubricant. Do not clean with harsh abrasives. Dry thoroughly.* Store the simulators in a cool area in the packing carton provided.* Do not stack or store heavy materials on top of the carton.* Indelible marks made with ballpoint pens, ink or marker cannot be removed.* Do not wrap the simulator in newsprint.* Do not use povidone iodine on the simulator.* Replacement parts are available from Gaumard Scientific or from your Distributor. 45
  • Section 6 – ReferencesNOELLE™ Training Guide with basic and advanced interactive scenarios. GaumardScientific Company, Inc. Published 2003. (Instructor and Student Guides available.)NOELLE™ Perinatal Monitor. Gaumard Scientific Company, 2003Managing Complications in Pregnancy and Childbirth WHO/RHR/00.7Myles Textbook for Midwives. Edited by Bennett and BrownSection 7 – Limited WarrantyGaumard® Scientific Company (Gaumard) warrants that if the accompanying productproves to be defective in material or workmanship within one (1) year from the date ofthe original purchase, Gaumard will, at Gaumard’s option, either repair or replace samewithout charge. This limited warranty may be enforced only by the first consumer user.All subsequent purchasers acquire the product “as is” without this limited warranty.This warranty covers all defects in material or workmanship, except: 1. Damage resulting from accident, misuse, neglect, or from other than normal and ordinary use of the product. 2. Damage resulting from failure to clean or use the product in accordance with the instructions. 3. Damage resulting from repair or attempted repair by anyone other than Gaumard.When repair is indicated, the user must: 1. Contact Gaumard and request service authorization. 2. At the customer’s expense, ship the product with a copy of the bill of sale to Gaumard.Gaumard disclaims liability for incidental and consequential damages for breach of anyexpress or implied warranty, including any implied warranty of merchantability withrespect to this product. This writing constitutes the entire agreement of the parties withrespect to the subject matter hereof, no waiver or amendment shall be valid unless inwriting signed by Gaumard. 46
  • Section 8 – Technical SupportContact us if you have any questions or if your system requires repair.Toll Free USA 800-882-6655Worldwide 305-971-3790Fax 305-667-6085e-mail sima@gaumard.comOffice hours 8:30 a.m. – 4:30 p.m. ET, Monday-FridayInternet catalog www.gaumard.comGaumard® Scientific Company, Inc.14700 SW 136 StreetMiami, FL 33196-5691 47
  • Section 9 – Common Spare Parts List for NOELLE™ S550.100NOELLEPart # Description Price ($US)550.008 Stomach cover 50.00550.009 Speaker with cable assembly 25.00550.010 NOELLE Controller 195.00550.011 Power supply 100/240VAC; 4 Amps 75.00550.012 Automatic Birthing Mechanism 595.00550.013 same as 550.012 but an exchange 200.00550.014 Four (4) tee nuts to mount Birthing Mechanism 4.00550.015 Dilating cervices (set of 4) 80.00550.016 Replaceable vulval inserts (set of 4) 80.00550.018 Elevating pillow for Leopold maneuvers 75.00550.019 Placenta with Velcro retainers 25.00550.020 Umbilical cords and clamps (set of 4) 50.00550.030 Postpartum perineal insert 50.00550.031 48 hour postpartum uterine activity 75.00550.032 Episiotomy trainer (set of 3) 115.00550.033 Water based silicone lubricant 5.00560.029 Stomach cover for “C” section 100.00Articulating Fetus550.017 Articulating baby 225.00Neonate550.320.101 Resuscitation baby 900.00550.320.102 Controller and power supply 600.00 48