CARRYING OUT THE TRAINING
The below example is for one hour of training session.

Preparatory Meeting
Case:

Osaka City University, Faculty of Medicine
Skills Simulation CenterWEB

http://www.med.osaka-cu.ac.jp/ssc/Orientation

15min.

ITEMS TO PREPARE

SPChair□ Manometer* Using a SP for this step allows a closer-to-life demonstration.
The SP lies on his/her side and holds the knees to round the back.

② Puncture, Collecting Cerebrospinal Fluid□ Tray (for hygienic items)

Affix the red seal to the puncture's site on the body.
After advising the patient that the cotton ball is cold, sterilize the puncture area.
● Wear the sterilized gloves and place the drape on the simulator.
●□ Forceps or tweezers (for sterilization)□ Drape（In case that the training time is limited, adjust the time by omitting wearing the gown, etc.）□ Cotton ball for sterilization

On the side table

Demonstration of
the procedure

15min.

Let's explain how to use the utensils.
The training session would advance more smoothly if thetrainees learn beforehand an explanation about how to use thespinal needle with three-way stopcock when measuring initial
CSF pressure and collecting cerebrospinal fluid.

□ Spare supplies (Spinal needles, cup, etc.)□ Sterilized gloves□ Cap●□ Water 1.5L（simulated CSF）
※ In case of using a standardized patient along the simulator topractice the selection of the puncture site on the body,
prepare a bed as shown in the above layout example.

Simulator●□ Cup (for CSF collection)

Chair

Simulator□ Spinal needle with a three-way stopcock□ Red circle seal (for marking)Training table

orThe demonstrator palpates the ilium and findthe Jacoby's line. Then marks L4/5 lumbarintervertebral space.

●□ M43B Lumbar Puncture Simulator IIBedSidetable

The previous studies and experience of the trainees about lumbar puncture arereviewed.
● The trainees receive an explanation about the training's flow.

●① Selection of The Puncture Site
On the training table

LayoutexampleShare the training contents and flow among instructors toadvance the training session more smoothly.

□ 50ml syringe（for cleanup） *Included Simulator set●□ Garbage bags

Carry out the puncture. Demonstrate how to advise the patient when
they are going to apply the puncture, and ask the patients to indicate
if the pain expands to the leg.
Advance the needle 3 to 5cm and verify that CSF outflows. Then measure theinitial pressure and collect the CSF while explaining to the trainees.
Let's study some failure cases as well.
Since the needle is pricked horizontally respect the floor
and perpendicularly to the patient's body, if the patient's
shoulder line is not perpendicular to the bed, the needle
will get diagonally into the body, making easy to occur afailure in the procedure. It's important to keep thepatient in a posture perfectly perpendicular to the bed.

TRAINING TRICKS
Don't teach to thetrainees too soon.

Practice in pairs

Don't give immediate assistance to thetrainees when they are struggling. Wait
to allow them to forge their capability
to solve problems by themselves.

It's recommended to make thetraining session in pairs. One person
performs the procedure, while theother one supports the simulator.

Even if they fail at any task, letting
them thinking back on their failure
and its reason will make them learn
about it.

This way, the person holding the simulator
can watch their partner and imagine howhimself/herself will do next. Also they can
notice rooms for improvement and earn abetter learning experience.

In the actual clinical working place,advice may not always be given at
once. In those moments, the capabilityof thinking and solving problems bythemselves will be important for theirgrown as professionals.

On the other hand, the operating trainee
will feel the mental strain of being
watched by someone else, and bothtrainees will go through the training
session with a higher sense of alertness.

Self-revision using
the simulator
With Lumbar Puncture Simulator II, it's
possible to see the place on thespinal cord where the puncture wasapplied by taking off the skin on thelumbar area.
Also, since the lumbar spine modelthat shows from the 2nd to the 5th
lumbar vertebrae is included, it ispossible to learn the opening andshutting movement of the vertebrae
according to the body's position.

Training in Pairs
Training session

30
min.

● Ten minutes of hands-on training, and three minutes of debriefing per person.
● One person applying the puncture, and the other one holding the simulator. Then take turns.

It's recommended that the instructor doesn't point the trainee's mistakes immediately
on the practice but during the debriefing time.

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