Postpartum hemorrhage (PPH) is still one of the leading causes of maternal mortality in the U.S and worldwide. It is defined as the loss of more than 500 mL of blood after vaginal delivery or 1,000 mL after a cesarean section. The condition, if not promptly recognized and treated, can lead to significant complications or death due to severe blood loss.

There are currently limited low fidelity simulation task trainers available that can demonstrate an active postpartum hemorrhage. High fidelity simulators with these capabilities are costly and may not be a feasible option for simulation centers that lack funding to purchase and maintain them.

Urinary task trainers are often used to teach urinary catherization skills. These are more cost-effective options than purchasing a full-size patient simulator. This solution aims to provide a cost-effective option using a unique task trainer would give its learners the opportunity to practice the appropriate interventions needed to effectively manage a patient experiencing postpartum hemorrhage. It is an inexpensive training solution while still maintaining the high-fidelity component of a more expensive simulator.

This solution provides a flexible option that allows educators to set up a realistic simulated environment for a postpartum hemorrhage using a urinary task trainer. The presence of active bleeding from the task trainer will create a sense of urgency with the learners that mimics a real clinical environment. The functionality of the urinary task trainer gives learners the option to practice common nursing interventions to teach PPH including straight catheterization, intramuscular medication administration, and fundal massage. This option can be paired with other modalities (IV task trainers) to allow additional interventions to be implemented during the training session. This solution is ideal for training novice learners. It can also be used as a quick refresher for experienced nurses and allows them to experience the urgency required to manage a PPH patient.

This submission builds on Creating a Postpartum Hemorrhage completed by Nevada LaCounte and Jeff Garrett that offers alternative solutions for demonstrating a postpartum solution. Their solution uses a patient simulator or standardized patient. These options may not be feasible for low resource simulation programs. This solution offers an alternative for programs that may require a low resource solution for demonstrating a postpartum hemorrhage as they work to build their simulation program.

1. Design a cost-effective simulation scenario that effectively replicates postpartum hemorrhage, including active bleeding, to enhance clinical training and decision-making skills.

2. Develop a flexible, high-quality training solution for healthcare professionals focused on the comprehensive management of postpartum hemorrhage, adaptable to various learning environments and resource levels.

1. urinary task trainer with detachable genitalia

2. absorbent disposable pads

3. simulated blood

4. IV fluid bags (500 or 1000) depending on how long the patient will bleed

5. secondary IV tubing

6. scissors or a scalpel

7. blood bag stand or IV pole

8. small hand towel or ABD pads

9. supplies for interventions required as dictated by the simulation design

1. Spike the IV bag and remove the tubing. Save the stopper. Draw up 10cc of simulated blood and inject it into the IV bag through the opening created from spiking the bag.

2. Replug the IV fluids with the stopper and vigorously shake the bag. Prime the IV bag with secondary tubing. Longer tubing may be needed depending on the height of the pole compared to the location of the task trainer.

3. Remove the female genitalia and abdomen. Create a small hole on the inner extension of the vaginal canal using scissors or a scalpel to create a slit. This should impact the ability to utilize the vagina cannula for other options (e.g. suppository administration).

4. Feed the tubing through the vaginal opening created until the tip touches the vaginal opening. Do not advance the tubing past the vaginal opening.

5. Place multiple absorbent pads on the work surface. Lay the task trainer on top. Place a postpartum pad between the patient’s legs. Place a few ABD pads or a small towel in the abdominal cavity.

6. Place female genitalia back into place allowing the tubing to go into the abdominal cavity. Gently replace the abdominal pad with the tubing coming out from the side. Ensure the roller clamp is out. Hang the IV bag on IV stand.

7. Add additional blood and clots to increase realism. To begin the activity, simply release the roller clamp to begin the hemorrhage. Tighten or release the clamp to control the rate of bleeding. Students may complete a fundal massage, administer IM uterotonic medications (if IM pads are in place), and complete a straight catherization.

8. Remove the abdomen pad once the activity is complete. Any blood that has dripped into the trainer should be absorbed by the towel or pads. Remove these items and wipe the abdominal cavity clean. Remove the tubing and genitalia and thoroughly rinse with warm water. Allow to air dry. Wipe any excess blood from the back of the trainer and dispose of the wet pads.