Mar
26
2013

Building a Nasal Secretions Simulator

Do you have a simulation that calls for suctioning nasal secretions from an infant?  Here’s an inexpensive device you can make yourself. We call it the Secretion-based Nasal Obstruction Trainer or SNOT, for short.

Why SNOT?

Supplies for Making Simulated MucusInfants are dedicated nose-breathers. For this reason, caregivers must always keep nasal passages open. But, how do you emphasize that with a simulator?  Today’s simulation devices can do many things, but having a runny nose on command is not one of them.

I was recently approached by one of our Jump faculty members, Dr. Trina Croland, a pediatric hospitalist, who asked me to create a moulage effect that would reinforce the need for continued nasal suctioning. This request presented two challenges: creating a convincing simulated mucus that was safe to use on a mannequin and building an instructor-controlled delivery device that would provide continuous nasal secretions.

Making Simulated Mucus

There are several methods for making fairly realistic simulated mucus. Some of those “recipes” call for using food products, such as baby food. The following recipe is free of food-based products.

 Reeves Watercolor PaintsIngredients

Reeves Watercolor Paint for MixingDirections

  1. Gradually add the water to the lubricating jelly while mixing thoroughly until the jelly is completely dissolved in the water.

  2. After the water and jelly are mixed, blend the colors by first mixing the white and yellow together.

  3. Stir in the green and burnt umber one at a time in very small amounts until the desired pigmentation is achieved, then blend into the water and jelly solution. The solution will look a little thin, but mixing it any thicker will make it hard to push through the tubing.

Building the SNOT Device

 Supplies

  • 10 mL syringe

  • 1 infant-sized nasal cannula

  • 14-gauge IV catheter

  • Lock Tite 401 Adhesive (Only available online)

  • Smooth-On Skin Tite silicone rubber mixture (available through reynoldsam.com)

  • Scissors

Directions

  1. Attaching the Catheter to the Nasal CannulaCut the tip of the 14-gauge catheter down to approximately a quarter inch long. Cut the end off the nasal cannula tubing where it connects to the oxygen source.

  2. Apply a small amount of the Lock Tite 401 around the catheter and insert it into the end of the cannula tubing. The adhesive will set rapidly, so use precautions to avoid skin contact.

  3. Remove the head skin from the Laerdal SimBaby simulator. Turn the skin inside out and stuff it with washcloths for stability. Tape the skin to a tabletop. Insert the cannula prongs into the nares from the inside pointing outwards until the prongs are seated.

  4. Mix a small amount (approximately 3 mL) of the Skin Tite silicone rubber until completely blended. Pot life of the mixture is approximately 5 minutes, so you’ll need to work quickly. Completely cover the nasal cannula with the silicone mixture, working the silicone around and under the cannula. Once set, mix up additional silicone and apply it generously over the tubing to create a secure attachment.

  5. Covering the Nasal Canula with SiliconeOnce the second silicone application is completely set, fill the 10 mL syringe with the simulated mucus, prime the tube and test for leakage. Reapply the head skin, guiding the cannula tubing around each side of the head.

  6. Grasp the ends of the cannula prongs with hemostats and pull gently to stretch the prongs. Trim them as close to the base as possible. Guide the tubing down the back of the head and neck and out under the neck skin. The tubing can then be hidden under the blankets and fed down to the foot of the bed.

Cleaning & Maintenance

Once properly installed, this device is very secure and can be left in place. If you decide to remove the device after each use, use extra care removing and replacing the head skin. Repeatedly removing and reapplying the skin can cause stress and tears in the neck area.

Be sure to clear and clean the tubing after each use. To do this, turn the simulator head to the side and flush the tubing with water. Purge the line with air and flush it again with isopropyl alcohol. Purge again and allow the line to dry thoroughly.

Categories: Innovation