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HomeGrown Solution: Creating a Postpartum Hemorrhage

Title

Creating a Postpartum Hemorrhage

Submitted By

Nevada LeCounte and Jeff Garrett

HomeGrown Solution Number

384

Identification of the Problem

Postpartum hemorrhage is a common obstetrical emergency, requiring rapid assessment of blood loss and signs of clinical deterioration to allow for early identification and intervention. Many high-fidelity obstetrical manikins have built-in features to simulate a postpartum hemorrhage; however, the reservoirs used for this feature may limit the amount of blood loss that can be utilized for a simulation. Additionally, functionality issues with these features, such as incomplete emptying of the reservoir and pooling within the manikin rather than visible drainage, can lead to both underestimation of blood loss by simulation participants and can make cleaning the manikin difficult, further impacting functionality.

Unique Idea

A cost-effective, realistic, and easy to manage postpartum hemorrhage can be simulated by placing IV fluid bags mixed with simulated blood inside of a pressure bag and spiking them with a secondary line. Up to 2 liters can be placed within the manikin and fed through the cervix and out of the manikin. The roller clamps on the secondary line allow for control of blood flow, and the pressure bags will allow for a continuous flow even if the lines become slightly kinked within the manikin. This method also allows for a fast turn-around time in between simulation runs.

Objectives

Reviewing this solution should lead to:

  • Development and implementation of a realistic postpartum hemorrhage simulation scenario
  • An ability to create a mild, moderate, or severe postpartum hemorrhage based on the simulation needs

Supplies/Ingredients

  • One to two 0.5-1L bags of IV fluid* or simulated blood
  • 20-40 mL of simulated blood to mix with IV fluids*
  • One to two IV pressure bags
  • One to two secondary lines
  • Obstetrical manikin with abdominal or uterine cavity
  • Disposable underpads

Steps to Creating the Solution

  1. Determine the severity of the postpartum hemorrhage and set-up a pre-determined amount of IV fluid bags by mixing them with 20-40 mL of simulated blood; may skip mixing if using pre-mixed simulated blood bags.
  2. Spike the IV bag(s) with a secondary line and prime the line, clamping when done.
  3. Place the bag(s) within a pressure bag and inflate the pressure bag to max volume.
  4. Open the abdominal or uterine cavity of the manikin and feed the secondary lines down through the cervix and towards the vagina of the manikin. These can be adjusted so that they are loosely looped or sutured into place within the cavity. Make sure the end of the secondary line is not directly visible from outside of the manikin.
  5. Place the pressure bag(s) within the abdominal or uterine cavity of the manikin. These can lie side-by-side, or hang from a small hook within the manikin if a hook is available.
  6. Place several disposable underpads outside and under the manikin. The number of these pads will be determined by the volume of blood used.
  7. Close the cavity of the manikin.
  8. When ready for the manikin to bleed, unclamp the secondary line. Use the roller clamp to determine the rate of blood flow. You may desire a slow continuous bleed from the beginning of your scenario, or may have a scenario in which a standardized participant uses the clamp to start the flow of blood.

Images

one IV pressure bag and one bag of simulated blood on top of a disposable underpad simulated blood in IV pressure bag on top of a disposable underpad open uterine cavity of an obstetrical manikin with a line being fed inside and a white towel placed beside the cavity open abdominal cavity of an obstetrical manikin with an IV pressure bag containing simulated blood in cavity Obstetrical manikin draped above the vulva with disposable underpad underneath. Simulated blood draining from the vaginal opening onto the disposable underpad.

Video

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