Abdominal Aortic Aneurysm (AAA) Repair

Trainer User Guide

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Part No: 065-025

Issue 1, June 2005© 2005 Limbs & Things

Abdominal Aortic Aneurysm (AAA) Repair TrainerPart No: 60610

For practising open techniques associated with AAA surgery. Designed in collaboration with St Mary’s Hospital Vascular Unit, London, UK for use by Higher Surgical Trainees (HST).

Skills• AAA Repair Trainer enables practise of the following: common iliac aneurysm, internal iliac

aneurysm and juxtarenal repair• Management of pre-incised skin & soft tissue using the correct surgical instruments to

provide adequate access to the relevant vessel• Identification of the internal structures around the vessel• Maintaining access and conducting delicate manoeuvres within a confined space• Anastomosis of arterial grafts• Fluid flush test

Features• Anatomically accurate vessels with relevant soft tissue landmarks• Realistic tissue response• Aorta includes 3 aneurysms: aortic, iliac and internal iliac• Vessels will withstand a fluid flush test to demonstrate the integrity of the repair• Internal ‘organs’ supplied. When filled with water they replicate the obstructive mobility of

organs within the abdominal cavity accurately• Lightweight and portable• Mock Blood Flow System supplied to allow user to connect AAA to Mock Blood Flow Kit

(Available separately. Part No: 60650. Consists of Mock Blood Giving Set and Mock Blood)

Package supplied• 1 AAA Trainer Skin 60612• 1 AAA Trainer Base & Anatomical Insert 60615• 1 AAA Trainer Vena Cava 60614• 3 AAA Trainer Internal Organs 60613• 2 Replacement AAA 60611• 2 AAA Bifurcated Graft (18mm dia) 60616• 1 Mock Blood Flow System• 1 bag of clips

IMPORTANT Use only Limbs & Things Mock Blood with the AAA Repair Trainer: it has a neutral water base enablingeasy flushing and stain removal. Blood from other manufacturers will compromise the model if used.

Contents

Product overview 1

Components 2

Mock Blood Flow SystemOverview 3

Connectors 5

Preparing the AAA TrainerWet simulation (fluid) 6Use this if you have access to a sink and running water in your training environment

Dry simulation (air) 13Use this if you do not have access to a sink and running water in your training environment

Setting up the AAA Trainer Skin 19

Removing the AAA 21

Cleaning the Mock Blood Flow System 22

Surgical Setup 24

1

Components

AAA Trainer BasePart No: 60615

AAA Trainer InternalOrgansPart No: 60613

Mock Blood FlowSystem

AAA Trainer SkinPart No: 60612

Vena Cava(attaches to Anatomical Insert)Part No: 60614

AAA Bifurcated Graft Part No: 60616

AAA Anatomical Insert(fits in AAA Trainer Base)

Replacement AAA Part No: 60611

2

The Pump consists of:

- syringe - valve- primary tube

(with connector forattaching to Flow Tubing)

- secondary tube

1

The Mock Blood FlowSystem consists of:

- Flow Tubing (connectsvessels to the Pump and Mock Blood Giving Set)

- Pump (for managingMock Blood within theFlow Tubing and attachedvessel)

3

To manage Mock Blooddirectly to and from theFlow Tubing (and the vessel),align the ‘OFF’ arm of thevalve with the secondarytube. (Red cross indicatestube which is closed off.)

The direction of flow iscontrolled by the syringe.

Mock Blood Flow System: Overview

3

Xa

b

d

c

ab

d

c

b

2

5

The maximum capacity ofthe syringe is 60ml so stages3 & 4 will need to becombined several timeswhen managing largeamounts of Mock Blood.

4

To manage Mock Blood toand from the secondarytube align the ‘OFF’ arm ofthe valve with the primarytube. (Red cross indicatestube which is closed off.)

The direction of flow iscontrolled by the syringe.

4

X1

Connector in the lockedposition, preventing itemsfrom being attached to it.

3

Should any of the MockBlood Flow Systemconnectors fail to attachthey will need to be ‘reset’.

2

Unlock the connector bydepressing the metal clip.

The connector is reset andready to use when the pinpops out.

Mock Blood Flow System: Connectors

5

2

Fill the Internal Organ withapproximately 3 litres (5pints) of water.

Close end cap of nozzle.

1

Open the nozzle at the endof the Internal Organ.

Insert the funnel firmly intothe nozzle. Ensure that it fitssnugly to avoid any fluidleaking during filling.

3

Push down gently on theend of the Internal Organ toprovide enough space forthe nozzle to be hiddenwithin.

Push the nozzle downwardsensuring that the end cap isflush with the surface of theInternal Organ.

Preparing AAA Trainer: Wet simulation (fluid)

6

4

Place AAA Trainer Base onthe work surface. Remove allcontents except for:Anatomical Insert, VenaCava and AAA.

Ensure the AnatomicalInsert, Vena Cava and AAAare in position. Ensure theAAA is securely attached tothe blood flow connectors.

Velcro straps are used forsecuring certain parts of theTrainer in position:- black straps retain Internal

Organs- white straps retract the

Trainer Skin

7

5

Before the Internal Organscan be fitted the whitestraps need to berepositioned. Lift up thestraps from either side ofthe Base.

Pull the straps entirelythrough the holes.

6

Pull the straps up and overthe top edge of the Base,attaching them to theircorresponding Velcro dots.

Finally, secure the ends ofthe straps back on the sidesof the Base.

9

Repeat stages 1 to 8 whenpreparing and fittinganother Internal Organ onthe other side of the Base.Ensure that the short part ofthe Internal Organ fits in theproximal end.

8

7

To fit the Internal Organsthe black retaining strapsneed to be undone. Lift upthe straps from one side ofthe Base.

Pull the straps entirelythrough the holes.

8

Drape the three strapsacross the top of the Base,as shown.

Fold the Internal Organ intoan L shape ensuring that thelong part fits the long sideof the base. (Short part fitson the distal end.)Secure the Internal Organ inposition by feeding thestraps back over andthrough their correspondingholes in the Base.

9

10

A third Internal Organ canbe added to one side tosimulate a greater degree ofbowel obstruction whenperforming the procedure.

11

Place the Flow Tubing onthe work surface, next tothe Trainer Base, as shown.

Attach the dual Flow Tubingconnectors to the distal(lower) end of the Base.

12

Ensure both connectors arefirmly attached: they should‘click’ when properlyengaged. See page 5 if theconnectors fail to attach.

Then attach the singleconnector to the proximal(upper) end of the base.

14

Engage the white clamp onthe tube leading from thebottom of the blood bag.

The AAA requires primingbefore Mock Blood can beintroduced. This involvescreating a vacuum inside theAAA so that it fills moreeasily and less air isintroduced into it.

13

NB: Please note that if youpurchased the AAA Trainerby itself you will need topurchase a Limbs & ThingsMock Blood Flow Kit (Part No: 60650) to connectthe Trainer to a bloodsupply. (The Mock BloodFlow Kit is supplied asstandard with the ArterialProcedures Trainer.)

Introduce the Mock BloodFlow Kit.

Attach the white plasticconnector on the end of theblood bag tube to the openend of the Flow Tubing.

15

Attach the Pump to theremaining connector on theFlow Tubing.

Ensure it is firmly attached.

10

17

Align the ‘OFF’ arm of thevalve with the primary tube.The red cross indicates thetube which is closed off.

Slowly push the plungerexpelling air from thesyringe.

Repeat stages 16 & 17 untilthe AAA has collapsed.

NB: Leave the Pumpattached, align the ‘OFF’arm of the valve with theprimary tube and ensurethe plunger of the syringeis fully depressed.

16

Now align the ‘OFF’ arm ofthe valve with the secondarytube. The red cross indicatesthe tube which is closed off.

Slowly pull the plungerallowing air to fill thesyringe.

11

18

Open the cap on top of theblood bag.

Insert the large funnel.

NB: Use only Limbs &Things Mock Blood withthe AAA Repair Trainer: ithas a neutral water baseenabling easy flushing andstain removal. Blood from othermanufacturers willcompromise the model if used.

X X

20

Release the white clamp onthe tube at the bottom ofthe blood bag and allow theAAA to fill.

This will take severalminutes. To speed up theprocess, the Base can beplaced on the floor whilstleaving the blood bag andstand on the work surface.

You may find that a smallamount of air is trapped inthe AAA and the FlowSystem.

19

Support the funnel and neckof the blood bag carefullywith one hand.

Slowly pour 500ml (0.8pints) of Mock Blood intothe blood bag.

21

To facilitate air removal,raise the proximal end ofthe Base by approximately45 degrees. This allows theair to rise up through theAAA and collect at thehighest point.

To remove the air carry outthe instructions in stages 16& 17. Repeat as necessary.

Disconnect the Pump andattach the Trainer Skin. See‘Setting up AAA TrainerSkin’ page 19.

12

1

Place AAA Trainer Base onthe work surface. Remove allcontents except for:Anatomical Insert, VenaCava and AAA.

Ensure the AnatomicalInsert, Vena Cava and AAAare in position. Ensure theAAA is securely attached tothe blood flow connectors.

Velcro straps are used forsecuring certain parts of theTrainer in position:- black straps retain Internal

Organs- white straps retract the

Trainer Skin

Preparing AAA Trainer: Dry simulation (air only)

13

2

Before the Internal Organscan be fitted the whitestraps need to berepositioned. Lift up thestraps from either side ofthe Base.

Pull the straps entirelythrough the holes.

3

Pull the straps up and overthe top edge of the Base,attaching them to theircorresponding Velcro dots.

Finally, secure the ends ofthe straps back on the sidesof the Base.

14

6

Inflate each Internal Organby blowing through thenozzle. Squeeze the base ofthe nozzle whilst inflating tokeep the valve open.

Do not over fill. As a guide,lay them flat on the worksurface and press downevenly with both hands. Agap of about 2 cm betweenyour hands and the worksurface is ideal.

4

To fit the Internal Organsthe black retaining strapsneed to be undone. Lift upthe straps from one side ofthe Base.

Pull the straps entirelythrough the holes.

5

Drape the three strapsacross the Base, as shown.

The Internal Organs cannow be inflated andpositioned. Three aresupplied but only two willbe used for the drysimulation.

9

Pull the straps through theholes.

Tighten the central strapfirst, allowing it to gentlysqueeze the Internal Organ.

7

Once correctly filled closethe cap and push the nozzlefully into the Internal Organ.

Fold the Internal Organ intoan L shape ensuring that thelong part fits the long sideof the base. (Short part fitson the distal end.)

8

Push the Internal Organcarefully down against theinside wall of the Base,ensuring that all three strapsare supporting its underside.

Secure the Internal Organ inposition by feeding thestraps back through theircorresponding holes in theBase.

15

10

Secure this position byfastening the strap to theoutside of the Base. Repeatthis process for the otherstraps.

Ensure each strap isengaged along the entirelength of the correspondingvelcro strip.

16

12

For added visual realism theAAA can be filled with air.Place the Flow Tubing onthe work surface so that theblood flow connectorsmatch up with those on theTrainer Base.

Attach the dual Flow Tubingconnectors to the distal endof the Base.

11

Repeat stages 4 to 10 onthe opposite side of theBase, ensuring that the shortpart of the Internal Organfits in the proximal end

Check that the InternalOrgans are obscuring theblood flow connectors onthe AAA.

15

Attach the Pump to theremaining connector on theFlow Tubing.

Ensure it is firmly attached.

14

For the purposes of a drysimulation, the open end ofthe Flow Tubing should beclamped off using the blueclip provided.

13

Ensure both connectors arefirmly attached: they should‘click’ when properlyengaged. See page 5 if theconnectors fail to attach.

Then attach the singleconnector to the upper(proximal) end of base.

17

16

Align the ‘OFF’ arm of thevalve with the primary tube.The red cross indicates thetube which is closed off.(See pages 3 & 4)

Slowly draw back theplunger allowing air to fillthe syringe.

18

17

Now align the ‘OFF’ arm ofthe valve with the secondarytube. The red cross indicatesthe tube which is closed off.(See pages 3 & 4)

Slowly push the plungerallowing air into the FlowTubing and the AAA.

X X

18

Repeat stages 16 & 17several times until the AAAlooks realistically distended.

Attach the AAA Trainer Skin.See page 19.

2

Pull back the Skin andretrieve one of the retractingstraps.

Locate the white Velcro® doton the underside of theSkin.

1

Having set up the InternalOrgans and filled the AAA,ensure the white retractingstraps are inside the Base.

Place the Skin on top of theBase ensuring correctorientation (rib plate andcostal margins placed atproximal end).

3

Pull the retracting straptightly, fastening it to theVelcro® dot.

Pull the strap carefully upand away from the Base.

Setting up the AAA Trainer Skin

19

4

Fasten the retractor strap tothe outside of the Trainer.

Repeat this process for theother side. The Trainer isnow ready for use.

20

2

Carefully detach the AAAfrom the blood flowconnectors inside the Base.

Remove the AnatomicalInsert from the Base andpush out the four AAAretaining clips from theunderside.

1

Detach the Flow Tubingfrom the Base.

Clamp the distal andproximal ends of the AAAusing the blue clipsprovided.

2

Empty any remaining MockBlood from the AAA intothe Mock Blood bottle.Remove and keep the blueclips and discard the AAA.

Removing the AAA

21

44

Any remaining Mock Bloodcan be removed from theFlow Tubing by using thePump. See stages 3 & 4 of‘Mock Blood Flow System:Overview’ page 3. Repeatstages as necessary.

Excess Mock Blood can bepoured back into the bottlefor storage. Rinse out theblood bag and the Base.Wipe the base dry andhange the blood bag up todry. Rinse out the Pump andallow to dry.

23

2

Pour any remaining MockBlood back into the bottlefor storage. Rehang theblood bag and fill with500ml (0.8 pints) of water.

Attach the Flow Tubing tothe Base allowing the waterto flush through.

NB. Ensure the whiteclamp on the tube at thebottom of the blood baghas been released.

1

Remove the AnatomicalInsert ensuring that the AAAand Internal Organs havebeen removed first.

Pull all the straps throughtheir holes and fasten themtightly to the outside of thebase.

3

When the two distal ends ofthe Mock Blood FlowSystem run completely clearof blood, disconnect them.

This provides greaterpressure to the proximal endwhich is still connected.Once the fluid is cleardisconnect this end.

Cleaning the Mock Blood Flow System

22

Notes

25

1

For enhanced realism allLimbs & Things arterialtrainers can be covered withsurgical drapes.

Surgical setup

24