Caution Don’t mark on the model and other components
with pen or leave printed materials contacted on
their surface.
Ink marks on the models will be irremovable.

M93UB Landmark puncture padⅡ

Ultrasound puncture padⅡ

CVC Insertion Simulator Ⅱ

Instruction
ManualTable of contents
Before you start
Manufacturer ’s note
Set includes
Dos and Dont ’s

P.1
P.2
P.3

［Ⅰ. Landmark puncture padⅡ ］
Parts names and functions
Preparation
After a session

P.5
P.6-P11
P.12-P13［Ⅱ. Ultrasound puncture pads Ⅱ］
Introductory ultrasound training block“REAL VESSELS”
Parts names and functions
Preparation
After a session
Storage and maintenance

P.15
P.16
P.17-P19
P.20-P22
P.22［Ⅲ. Transparent cannulation block ］

After a session

P24
P.25-P26
P.27

Troubleshooting

P.28

Parts names and functions
Preparation

Before you start

Manufacturer ’s note

Manufacturer’s note
The simulator is designed for training in CVC procedures.
Any other use, or any use not in accordance with the enclosed instructions, is strongly discouraged.
Kyoto Kagaku Co., Ltd. cannot be held responsible for any accident or damage resulting from such use.
Please use this model carefully and refrain from subjecting it to any unnecessary stress or wear.
Should you have any questions or concerns regarding use of this simulator, please contact the
distributor you purchased from or Kyoto Kagaku Co., Ltd.

●Features
The simulator comes with 3 kinds of training pads for relevant area and an introductory ultrasoundtraining block.
■ Landmark puncture padⅡ
Three possible accesses: subclavian, internal jugular and supraclavicular.
Carotid artery pulsation is palpable.
A guide wire can be inserted to SVC.
Success and failure confirmation
Jugular/artery puncture can be known by the color of the fluid you collect.
Pneumothorax: your syringe will collect air only.
Guide wire (catheter) placement and Mislodging can be confirmed by finding the wire in the■ Ultrasound puncture padⅡ
Both internal jugular and axillary veins are accessible under ultrasound scanning.
Anatomically correct vein and artery relationship.
Veins collapse under light pressure of the probe.
■ Transparent cannulation block
Facilitates three-dimensional anatomical understanding.
As an effective training tool for developing guide wire insertion skills.
■ Introductory ultrasound training block REAL VESSELS

An introductory training block to acquire basics of ultrasound-guided puncture.

１

Before you start

Set includes

Set includes
Before your first use, ensure that you have all components listed below.

H

H

Ｂ

G

Ａ

F
I

Ｃ
C

J

K

D

L

I

E

M

A. male upper torso manikin1

H. plastic jar

B. transparent anatomical block1

C. skin for cannulation training

1

I. Cotton Swab for Coloring(red / blue)

D. landmark puncture padⅡ

1

J. air bulb

1

E. ultrasound puncture padⅡ1

K. 50ml syringe

1

F. introductory ultrasound training block“REAL VESSELS”

1

L. sample syringe

1

M. sample needle

1

G. irrigation bottle

1

Instruction Manual22each 1 pack

Before you start

DOs and DON’Ts

DOs and DON’Ts
DOs

DON’TsUse new needles for training.
Recommended needle size: 23G or thinner

Never use the supplied needle foranything other than the simulator.

Durable transparent cannulation pad ishighly recommended for insertion training
in order to maintain the puncture padlonger, although it is possible todemonstrate the full procedure with
puncture pad.

Do not peel the skin from the puncturepads.
Do not push the tube tip at the bottom of
the landmark puncture pad.
Never wipe the simulator with thinner orother organic solvent.

Handle with care.
The materials for the Simulator are a
special composition of soft resin. Handle
them with the utmost care at all times.

Don’t mark on the simulator andcomponents with pen or leave any
printed materials in contact with theirsurface. Ink marks on them will not be
removable.

Clean the surface of the pad with dry or
wet soft cloth and put talcum powder
before storage. Clean the upper torso
manikin by dry cloth.

Do not store the simulator and pads withany water left inside.

Store the training set at room temperature,away from heat, moisture and direct
sunlight.

Caution

Do not use broken or bent needles fortraining.

When you use the puncture pads; after
aspirating do not return the fluid fromsyringe into simulator.
It may damage the vessel tube and maylead to leakage.
3

Landmark puncture padⅡL

landmark

P.5

Parts names and functions
Preparation
1. Attach the air bulb

P.6

2. Set the pad on the torso

P.6

3. Preparation of red fluid

P.7

4. Fill the artery tube with red fluid

P. 7- P.8

5. Preparation of blue fluid

6.Fill the vein tube with blue fluid

P.9
P.9 - P.10

After a session
1. Discharge fluid from the padfrom the artery tube with red fluid
2. Discharge fluid from the padfrom the vein tube with blue fluid
3. Detach the puncture padfrom the simulator

Find the how-to-use video on our website

http://www.kyotokagaku.com

P.11
P.12
P.13

Parts names
and functions
Landmark puncture padⅡ

Artery tube
clamp

Connector for arterial pulsation
unit(on the reverse side)
Skin (do not peel)

Artery tube

Left subclavian vein
tube

Right subclavian vein tube
Vein tube
Connectors

Caution● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ●Do not put the pad on flat surface or push
the connector for arterial pulsation unit,
as this may damage the pad.
Do not try to peel the skin of the pad
especially after once it has received apuncture. This may lead to earlier wearingout of the pad.

5

Artery pulsation
Arterypulsation tube
tube

Attach the air bulb
Place the pad into the torso

Preparation

１

Attach the air bulb

Carotid artery pulsation can be made by grabbing the bulb.
Attach the pulsation unit to the connector tube at
the rear wall of the landmark pad.
Ensure to hold the connector tube by your finger
tips so that the tube is not pushed toward the pad
wall.
Attach the air bulb

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ● ●CautionInsertDo not put the pad on flat surface
or push the connector for arterial
pulsation unit, as this may damage
the pad.

Hold here２

Set the pad on the torso

Putting the pulsation unit through the opening in
the right shoulder of the torso, place the pad in
the cavity.

Put the tubes through the hole of the head side.
Open the cut on the left shoulder and put the
tubes into the cut.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

CautionMake sure that the tubes are not folded or tucked between wallsof the pad and the body torso.
The simulator doesn't work properly when the tubes are folded.

6Preparation３

Preparation of red fluid
Fill the artery tube with red fluid

Preparation of red fluid
Pour 200ml water into the plastic jar.Put the simulated
blood(swab type/red) into the jar and stir the water
sufficiently to prepare the simulated blood.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Caution

４

Take care not to drop simulated blood on clothes as
blood stains can be very difficult to remove.
Don’t drink the simulated blood.

Fill the artery tube with red fluid
Clamp

1. Put the torso upright.

2. Open the Clamp.

Open the clamp

Caution●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Before start filling the fluid. Ensure that the clamp is open.
Otherwise exsessive pressure may cause damage to the pad.

7

Preparation５5Fill the artery tube with red fluid

Fill the artery tube with red fluid

4. Then push the piston slowly until the red
fluid reaches to the height of the clamp.

3. Fill the 50ml syringe with red fluid andconnect the syringe tip to the connector at thelower end of artery tube (upper-back tube
from the right shoulder).
Insert and turn clockwise

Right subclavian artery tube

Syringe

To padDetachClose the clamp

5. Close the clamp.

8Preparation
６

Preparation of blue fluid
Fill the vein tube with blue fluid

Preparation of blue fluid
Pour 200ml water into the plastic jar.Put the simulated
blood(swab type/blue) into the jar and stir the water
sufficiently to prepare the simulated blood.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Caution

７
5

Take care not to drop simulated blood on clothes as
blood stains can be very difficult to remove.
Don’t drink the simulated blood.

Fill the vein tube with blue fluid
Clamp

Put the torso upright.

Open the clamp.

Open the clamp● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ● ● ●Caution

Before start filling the fluid. Ensure that the clamp is open, otherwise
exsessive pressure may cause damage to the pad.

9

Preparation８
5Fill the vein tube with blue fluid

Fill the vein tube with blue fluid

3. Fill the 50ml syringe with blue fluid andconnect the syringe tip to the connector at thelower end of vein tube
(lower-front tube from the right shoulder).

4. Then push the piston slowly until the blue fluid
reaches to the height of the clamp.
Ensure that all tubes are fully filled with thefluid and no air bubbles remain inside.
By tilting the torso carefully, air can beremoved.

Insert and turn clockwise

Right subclavian artery tube

Syringe

To padDetachClose the clamp

5. Close the clamp.

10After a session
１

Discharge fluid from the artery tube

Discharge fluid from the artery tube
clamp

2. Open the Clamp of the artery tube.

1. Place the torso upright.
Connect the empty 50ml syringe to theconnector at the lower end of the artery tube.

Insert and turn clockwise
Right subclavian artery tube

Syringe

To padOpen the clamp

Detach

3. Pull the syringe slowly and drain the fluid.
To clean the tube, fill the tube with uncoloredwater and discharge it again.

11

After a session
２

Discharge fluid from the vein tube

Discharge fluid from the artery tube
Clamp

1. Connect the empty 50ml syringe to theconnector at the lower end of the vein tube.

2. Open the clamp of the vein tube.

Insert and turn clockwise
Right subclavian artery tube

Syringe

To padOpen the clamp
Detach

3. Pull the syringe slowly and drain the fluid.
To clean the tube, fill the tube with
uncolored water and discharge it again.

12After a session

Detach the puncture padfrom the simulator

３ Detach the puncture pad from the simulator

Remove the puncture pad from the torso.

Open the cut of left shoulder and remove thetubes. Pull out the puncture pad from inferiorside.

Attach the air bulb

Pull
Push down the ring
Pad

Disconnect the pulsation unit from the pad. The
tube can be disconnected by pushing the
stopper ring toward the connector.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● ●●●●●●●●

CautionBe careful NOT to push the connector tube tip toward the puncture
pad. The pressure may cause damage to the soft structure of thepuncture pad.

13

Ultrasound puncture padsⅡU
us
Introductory ultrasound training block“REAL VESSELS”

P.15
P.15
P.15

1. General information
2. Preparation
3. Training and after a session
Ultrasound puncture padⅡ
Parts names and functions

P.16

Preparation
1. Place the pad into the torso
2. Fill the artery tube with water
3. Fill the vein tube with water

P.17
P.17-P.18
P.18-P.19

After a session
1. Discharge water from the artery tube
2. Discharge water from the vein tube
3. Detach the puncture pad fromthe simulator
4. Maintenance of the skin of the pad

Find the how-to-use video on our website

http://www.kyotokagaku.com

P.20
P.21
P.22
P.22

REAL VESSELS
1Introductory ultrasound training block“REAL VESSELS”

General information

This block facilitates training in basics of ultrasound guided punctures, before moving onto trainings withthe anatomical type ultrasound pad.
Features
Vessel tube (curve)
2 simulated vessel lines: straight and curving.
Both lines are embedded with slope to represent
from shallow vessel to deep one.
Shallow
Deep
Vessel wall yields under pressure of a needle tip.
Training items
How to get correct ultrasound images.
Probe manipulation.
Vessel tube (straight)
Basics for ultrasound-guided vessel access.

２

Preparation

Peel the protective sheet carefully.

３

Pour water into the wider slit in the container andfill it up to the line on the wall. Ensure thatshallower end of vessels are fully under the water
surface.

Training and after a session

Spread some ultrasound gel on the surface of theblock and start training. When the needle tip is in thevessel, your syringe can collect water.
Add water to the container slit as necessary.

After use, wash off the gel completely withrunning water and dry well. Then, replace
the protective sheet before storage.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Caution

Do not leave paper, cloth or other materials except for the included
protective sheet contact with the block surface. Such items may stick tothe surface and lead to damage the block.

15

Parts names andfunctions
Ultrasound puncture padⅡ

Tube clamp

Internal jugular vein tube

Carotid artery
tube

Skin

Artery tube

Vein tube●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

CautionVein tube embedded in the pad has a soft and thin wall to realize life-likeultrasound image.
Do not push the probe strongly.
Make sure that the tubes are not folded or tucked between walls of the padand the body torso. If fluid or air is injected while the tube is folded or clogged,excessive pressure may cause a breakage or burst of the thin tube.
Fill the vessels with COLORLESS water.
After aspirating, do not return fluid from syringe into simulator.

16

Preparation
1

Place the pad into the torso
Fill the artery tube with water

Place the pad into the torso

1. Put the tubes through the hole of the headside.

2. Open the cut of left shoulder and put throughthe tubes. Place the pad into the torso.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Caution2

Make sure that the tubes are not folded or tucked between walls of the padand the body torso.
The simulator doesn't work properly when the tubes are folded.

First, fill the artery tube with water
Tube clamp

1. Open the tube clamp at the head end of
the artery tube.

2. Fill the jar with 200cc of water (approx,70％of the height）.

●●●●●●●●●●●●●●●●●●●●●●●● ●●●●●

CautionOpen the clamp

17

Put the torso upright.
This is to avoid bubbles beingcaught in the tube,as well as
to prevent the water flows out
from its open end.

Fill the artery tube with water
Fill the vein tube with waterPreparation

２ First, fill the artery tube with water
Tube clamp

2. Connect the water-filled 50ml syringe to theconnector at the lower end of the artery tube
(upper and rear side tube at the shoulder).
Screw in the tip of the syringe to the connector.
Advance the piston slowly until the water surface
reaches height of the tube clamp.

Syringe

3. When the tube has been filled by water, close
the tube clamp.
Take off the syringe from the tube.

Right subclavian artery tube

To padClose the clamp

Insert and turn clockwise

３ Then, Fill the vein tube with water

1. Put some water (around 5cm height) in theirrigation bottle.
Connect the tip of the tube from the bottle
to the head end of the vein tube.

2. Connect the syringe filled with water to theconnector at the lower end of the vein tube.
Screw in the tip of the syringe clockwise to theconnector until it locks.

18

Preparation
３

Fill the vein tube

Then, Fill the vein tube with water

3. Push the piston of the syringe slowly until the water flows out into the bottle.
Take off the syringe from the tube. Keep the bottle connected while thesimulator

4. Lay the simulator and start your training session.
●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

CautionWhen the vessel tube is empty, ultrasound image will not be shown properly.

19After a session

Discharge water from the pad

1 Discharge water from the artery tube
Tube clamp

2. Open the tube clamp.

1. Put the torso upright and connect the empty
50ml syringe to the lower end of the arterytube.
SyringeRight subclavian artery tube

To padDetachOpen the clamp

3. Drain water by pulling the piston of the syringe. Detach the syringe from the tube and discharge
the collected water.
SyringeRight subclavian artery tube
To padInsert and turn clockwise

Caution●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Ensure that all the water is discharged from the pad after use.
Do not store the pad while any water remains inside as it may lead to malfunction or damage the pad.

20

After a session

Discharge water from the pad

２ Discharge water from the vein tube

1.Put the torso upright and disconnect the tip of
the tube from the irrigation bottle.
Connect the empty 50ml syringe to the lower
end of the vein tube.
Drain water by pulling with the syringe.

2.Detach the syringe and discharge the water.

SyringeRight subclavian artery tube

To padDetach

3.Tilt the body torso toward the syringe to aspirate
remaining water in the tubings.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● ●●●●●●●●●●●●●●●●●●●

CautionEnsure that all the water is discharged from the pad after use.
Do not store the pad while any water remains inside as it may lead to malfunction or damage the pad.

21

After a session

Detach the puncture pad fromthe simulator
Maintenance of the skin of the pad

３ Detach the puncture pad from the simulator

1. Open the cut of left shoulder and remove the tubes.
Pull out the puncture pad from inferior side.

2. Remove the puncture pad from the torso.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● ●●●●●●●●●●●●●●

Caution

Do not lift the pad by pulling the vessel tubes as this may cause breakage in theembedded tube walls.

４ Maintenance of the skin of the pad

1. To remove the ultrasound gel on the skin, wipe
the skin surface gently by soft cloth, or soft wet
close. If stickiness persists, wipe with soft clothwith small amount of alcohol for disinfection.

2. The skin of the ultrasound pad is not fixed andmay come off if you hold the pad by skin only.
In such case, replace the skin not to leave air
bubbles under it. Air bubble or layer between
skin and soft tissue will impair the quality ofscanning image.

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ● ● ● ● ● ● ●Caution

Never use thinner or organic solvent for cleaning. It may cause breakage inthe simulator skin. Do not touch the surface of the skinless pad, or expose
the surface to air for a long time. Dust attached to the surface may weaken
its adhesion and lead to deterioration in scanning images.

22Transparent cannulation block
C

CLEAR

Parts names and functions

P.24

General information

P.25

Preparation

Remove the pad currently set on the torso

P.25

Set up the cannulation blockP.26

Detach the pad from the torso

P.27

Find the how-to-use video on our website

http://www.kyotokagaku.com

Parts names andfunctions
Transparent cannulation block
Carotid artery

Internal jugular vein

Holes for catheter
insertion
Clavicle

Subclavian arteryLeft Subclavian vein

Subclavian veinlung

Holes for catheter
insertion

Skin

24

SVC

Preparation

General information
Remove the pad currently set
on the torso

General information
The transparent cannulation block is an effective educational model to facilitate
understanding of the relevant anatomical structures and is applicable to trainings incannulation by interchanging with the puncture pads.
Training items
Anatomical understanding● Learn the appropriate depth and angle of the needle for each approach.
● Handling and manipulation of the catheter (guide wire).
● Simulate the steps of the procedures.
●● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● ● ● ● ● ● ● ● ● ● ●Caution１

Do not make any puncture at any site besides the prepared openings.
● The transparent block is not designed to be filled with fluid.
● Do not pour any fluid or water to the openings on the cannulation block.
● Please handle the skin sheet with utmost care. Excessive strain may cause
breakage.
●

Remove the pad currently set on the torso
If other puncture pad is already set on the torso, take it out following
the instruction on:

Remove the landmark puncture pad

Ｐ.13

Remove the ultrasound puncture pad

Ｐ.22

25

Preparation

Set up the cannulation block

２ Set up the cannulation block

Place the transparent cannulation block to thecavity.

Now you can practice cannulation by observing
the catheter through the transparent block.

Cover the pad with the skin sheet

Cover the cannulation block with the skin sheet.
Put the skin sheet over the pad so that the slits ofthe skin sheet fit with the openings on the pad.

Now, the simulator is ready for cannulation
training. The slits in the skin sheet allow trainees
to remove it with the catheter inserted in thepad.

●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Caution

Do not make any puncture at any site besides the prepared openings.
The transparent block is not designed to be filled with fluid.
Do not pour any fluid or water to the openings on the cannulation block.
Please handle the skin sheet with utmost care. Excessive strain may
cause breakage.

26

After a session

Detach the pad from the torso

３ Detach the pad from the torso

Remove all needles and catheters from thesimulator.
Remove the skin.

Remove the pad holding its frame.

＊ If you are moving onto next training session using other kind of training pad, set up the new padfollowing the instruction on :Set up the landmark puncture pad

P.6

Set up the ultrasound puncture pad

P.17

27

TroubleshootingLlandmark

Quick check-up before calling the customer service. Use the table if you have problems using
the simulator. Look in this section for a description of the problem to find a possible solution.
（TEL ＋81-75-605-2510)

U
us

TroubleI cannot fill/discharge
the fluid to/from thevessel tubes properly.

Heavy leakage frompuncture area.

Possible Reason

What to Do

The body torso with the pad is laid
down.

Put the torso upright.

One or some vessel tubes from thepad are folded.

Straighten the tubes.

The puncture pad is worn out.

Order new pads for replacement.

The puncture pad is worn out.

Order new pads for replacement.

Pool of fluid is formed in the pad.

Straighten the tubes. Withdraw all
fluid from the tubes and squeeze
the remaining fluid from the soft
tissue. Dry the pad naturally.

The pulsation unit (air bulb andtube) is not connected to the pad.

Connect the pulsation unit to theconnector at the bottom of thelandmark pad.

The tube of the pulsation unit isfolded in the pit.

Make the tube straight.

The vessel tubes are not filled bywater/fluid.
Or, air bubbles are formed in thevessels.

Fully fill the vessels with water.

Air layer is formed under the skinsheet.

Reattach the skin sheet removing
air bubbled and layers.

The puncture pad is worn out.
Order new pads for replacement.

Order new pads for replacement.

Llandmark

Carotid pulsation
does not work.

U
us

Ultrasound image
is unclear.

28

Ink from this manual can stain the model - do not let it touch the model and its
components.
For inquiries and service, please contact your distributor or KYOTO KAGAKU CO., LTD.

Consumables
andreplacement
parts

■

Part number

Description

11347-280

Landmark puncture padⅡ (a set of 2)11347-170

Ultrasound puncture pad Ⅱ (a set of 2)11347-190

Transparent cannulation block

11347-210

Introductory ultrasound training block (a set of 2)11347-320

Irrigation bottle for ultrasound puncture pad

11347-270

Airbulb for landmark puncture pad(World Wide)■

The contents of the instruction manual are subject to change without prior notice.
No part of this instruction manual may be reproduced or transmitted in any form without permission from the manufacturer.
Please contact manufacturer for extra copies of this manual which may contain important updates and revisions.
Please contact manufacturer with any discrepancies, typos, or mistakes in this manual or product feedback. Your cooperation isgreatly appreciated.
2020.08

Instruction manual is in the inside pocket of the carrying case.

PLEASE READ THE MANUAL CAREFULLY BEFORE USE.

●

clamp

The rear surface of the landmark pad

Artery tube

Hold here with finger tip

Skin (do not peel)

Connector for arterial pulsation unit
(on the reverse side)
Artery pulse tube

DO NOT PUSH THE TUBE

InsertLeft subclavian vein tube

Artery tube

Right subclavian vein tube
Connectors

Vein tube

IMPORTANTIMPORTANT
Make sure to open/ close theclumps properly,following the
instructions of the manual.
Open the clamp

Close the clamp

Do not push the artery pulse tube toward
the rear surface of the puncture pad.
Excessive pressure may cause breakage.