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.

M43B。

Lumbar Puncture Simulator ⅡＡ
11348-600 / 600-D

Instruction
ManualContents／目 次● English Manual

P.2〜P.13

Lumbar Puncture SimulatorⅡA Light
ⅡA Light tone

Lumbar Puncture SimulatorⅡA Dark
ⅡA Dark tone

M43B

Lumbar Puncture SimulatorⅡA
Instruction ManualContents
Before you start
Before you start
Set includes/Dos and Don’ts

Before training
Preparation for spinal tap
Preparation with epidural block

P.2P.3
P.4〜P.7
P.8

Training
During your training session

After training
Trouble shooting

P.9〜P.10
P.11〜P.12
P.13● Before You Begin

This lumbar puncture simulator has been developed for the training of medical professionals only.
Any other use, or any use not in accordance with the enclosed instructions, is strongly discouraged.
The manufacturer cannot be held responsible for any accident or damage resulting from such use.
Please use this model carefully and refrain from any unnecessary stress or wear.
Should you have any questions regarding this simulator, please feel free to contact our distributor in your area
or KYOTOKAGAKU at any time. (Our contact address is on the back cover of this manual)● Features

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 themanufacturer. Please contact the manufacturer for extra copies of this manual which may contain important
updates and revisions.
Please contact the manufacturer for any discrepancies, typos, or mistakes in this manual or product feedback.
Your cooperation is greatly appreciated.

Before you start

Today, medical professionals have ready access to advanced imaging technologies such as CT,
MRI and ultrasound scans that clearly enhance the quality of medical care. However, despite its use
for more than 100 years, the lumbar puncture remains indispensable for the rapid diagnosis ofmeningitis, encephalitis or fever of unknown origin. The lumbar puncture also remains important
for the diagnosis and treatment of numerous conditions seen by emergency care, primary care,neurology, oncology and anesthesia services.
Thus, even today, medical competency requires skillful performance of this procedure.
In the past, medical students could practice lumbar punctures on live patients in order to develop
the requisite technical skills. However, for good reasons, this is no longer the case. Although
medical schools and residency training programs recognize the need for formal procedural skills
training, there are limited opportunities for such programs to teach and assess proceduralcompetency.
This unfortunate situation has now changed. Keio University Medical School, in partnership with Kyoto
Kagaku, has created a realistic lumbar puncture simulator that allows students and medical
professionals to practice frequently and achieve high levels of procedural competence without
placing any patients at risk of harm.
By all means, please try this innovative lumbar puncture simulator. Through practice on this special
equipment, students at all levels of training can increase their procedural comport, competence
and efficiency.
We wish you, and your patients, well.
Takahiro Amano, MD
Professor and Head,
Medical Education Center
Gregory A. Plotnikoff, MD, MTS
Associate Professor
Keio University Medical School２Before you start

Set includes/Dos and Don’ts

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

b-1
faib-1ehdb-4

jb-2

cb-3

ga. Lumbar Region Model
1b. CSF Puncture Blocks（4 variations 5 pieces）
2b-1. Normal CSF
1b-2. Obesity CSF
1b-3. Senior CSF
1
b-4. Senior Obesity OSF
1c. Epidural Puncture Blockd. Lumbar Spine Model
1e. Skin Coverf. Syringe
g. Irrigator Poleh. Irrigator Bag
i. Supporting Stand (Two Way)j. Support Base（Team Teaching）

111111DOs and DON’Ts
DOs

DON’TsHandle the manikin and components with care.
Talcum powder may be used on the manikin after
use to preserve suppleness of the skin and prevent
oils from staining the surface.
Store the manikin in its storage case when not in use.
Storing in a dark, cool area will keep the manikin
skin from fading.
The manikin skin may be cleaned with a wet clothand mildly soapy water or diluted detergent.

Please do not let ink from pens, newspapers orother sources come in contact with the manikin,as they cannot be cleaned off the manikin skin.
Never use ethanol or organic solvent such as paintthinner to clean the skin, as this will cause
deterioration of the skin.

３Before Training

Preparation for spinal tap

１ Prepare the stand

1. Assemble the stand.

2. Hang the irrigator bag to the stand.

２ Variation of puncture pads
NOSO

NS

N: Normal CSF O: Obesity CSF

OS: Senior Obesity CSF NS: Senior CSF*Obesity type has the lumbar spine in a deeper position.
Senior type has a different tissue resistance and bone shape.

Pad type and its orientation are indicated on the side.

NConnector tothe syringe

Connector tothe irrigator bag

The arrow indicates the head side of the Lumbar
Region Model.

EP: Epidural

４

Before Training

Preparation for spinal tap

３ Preparation of a CSF block

1. Connect the puncture block with the irrigator bag.
Connect the tip of the tube from the irrigator bag to the connector
at the head-end of the puncture block.
Insert the tube completely to secure it into position.

Put the tube tipup to here.

200cc

3. Connect the syringe to the block.

2. Fill the irrigator bag.

Connect the syringe to the plug at the opposite
end. Insert, turn clockwise
and lock the syringe in place.

Fill the irrigator bag with water until the surface
reaches to the 200ml line.

4. Release the clamp.

5. Fill the puncture block with water.
Tilt the puncture block and aspirate water withthe syringe until only water remains in the tubing.

ReleaseCaution5●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

If bubbles are in the tubing, the water may not
flow out even when the puncture is successful.

Before Training

Preparation for spinal tap

３ Preparation of a CSF block
CloseCaution●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Keep the clamp closed while thesession is NOT in action.

6. Close the clamp.

４ Set the puncture block in the model
Removing the block holder from the Lumbar
Region Model helps smooth fitting.

Insert the block into the Lumbar Region Model.

ＲL

Noting the marks at the back of the skin cover(L,R,↑ ) attach it to the Lumbar Region Model.

The setting process is the same for the sitting
position.

Skin CoverSkin Cover

Caution●●●●●●●●●●●●●●●●●●

Caution

Do not fold the tube.

６●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●The orientation marks come on the innerside of the skin cover.

Before Training

Preparation for spinal tap

５ Ready●The simulator is ready for training (with the normal CSF block).

Stand
Irrigator Bag

Lumbar Region Model

Clamp
Skin CoverSupporting Stand
Lateral position

Stand
Irrigator Bag

Lumbar Region Model

Clamp

Supporting Stand

Skin Cover

Sitting position*In the photos, the skin cover is opened to show internal components.
●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

CautionCSF pressure can be adjusted by changing the height of the irrigator pole.

7

Before Training

Preparation with epidural block

１ Preparation of the epidural block

Empty the drain pouch completely.

Connect the tube tip from the drain pouch to theside connector tube.
Then set the block to the simulator with the sameprocess as the CSF block.

Hold here

InsertHold here

PadInsert

TubeIrrigator Bag

Drain Pouch
Hold here

PadHold hereConnector●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●

Caution

Hold the tube at the end of the pad as shown above and connect it with the tube
from the irrigator bag.

２ ReadyThe simulator is ready for training (with the epidural puncture block)StandIrrigator Bag
Lumbar Region Model

Clamp
Skin CoverSupporting Base
Drain Pouch８Training

During your training session

１ During your training session
Release the clamp

Find the landmarks

Landmarks can be palpated.

Epidural puncture

CSF collectiondrain pouch
Make sure that the needle is not in the subarachnoid
space (no water flows out), and then inject water(simulated saline) or air into the epidural space.
Successful performance can be confirmed by observing
the injected air/water flows into the drain pouch.

When the needle tip reaches the subarachnoid
space, water (simulated CSF) can be collected.

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

CautionEmpty the drain pouch after each trial.
When the puncture pad Is worn out, water/air may be able to be injected even if the needle tip has
not reached the epidural space. When this occurs, change the puncture site or replace the pad with anew unit.

９Training

During your training session

１ During your training session
Two people training

The support base for team teaching simulates
the instability of a live patient.

Remove the lumbar region model from the supporting stand.

Place the stand in the sitting position and put yourfingers under the lumbar region model.
Then draw the model to disengage it from thestand.

The dismounted stand and the lumbar region model.

10After Training
１ Remove the block from the model

Remove the model skin cover and remove thepuncture block from the Lumber Region Model,
holding it by its base.

Caution●●●●●●●●●●●●●●●●●●●●●●Do not pull on the tube.

２ Drain the water

2. Release the clamp.

1. Connect the syringe to the puncture block.
Pull back the syringe's piston toat least the 50ml mark. Lock thesyringe onto the connector on
the block by turning clockwise.

4. Close the clamp.

3. Inject air into the tubing.
Slowly depress the piston and push air into thewater-filled block until all the air has been injected.

11After Training
３ Take out the syringe and the drain pouch

Hold here

Remove the syringe.
Turn the syringe counter-clockwise to remove
it from the block.
Disconnect the reservoir tube from the block.
Take out the irrigator Bag
Hold here

Pulls

PadIrrigator Bag
Hold here

Connector

Take out the drain pouch
Pulls

Hold here

Pad
Drain Pouch
Hold hereTube●●●●●●●●●●●●●●●●●●●●●●●●●●●●

CautionTake out the drain pouch.
Disconnect the drain pouch from the epiduralblock and empty the pouch.

Hold the tube at the end of the pad
as shown above and connect itwith the tube from the irrigatorbag.

* If you wish to continue the session, return to P6 and set a new block.

When your session is finished, empty the irrigator bag and dry all used components naturally
and store them in room temperature, avoiding direct sunlight or exposure to elements.

12Troubleshooting
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.

FAQs
Q, Water does not come out even if the needle tip is surely in thesubarachnoid space.
A, Is the clamp released ? Is the tube folded ?
A, Is the water surface in the irrigator bag at 200ml or above ?
A, 21G is the recommended needle size for CSF collection training with thesimulator.
If you still experience the difficulties, please try with a larger needle.
A, Is your needle clogged ? Please try using a new needle.
A, Are there bubbles in the tubing? Remove the bubbles. (see P5.5) A,The fluid comes slowly, drop by drop. Wait and see for 2-3 seconds.

Q, The soft tissue part of the puncture block is coming off when I grab theblock.
A, The soft tissue and bone part of the puncture blocks are not adhered.
The soft part may look like it is coming off when you grab it too tightly.
To make the blocks last longer, we recommend holding the hard part at
the base when handling them.

Q, (Epidural puncture pad) Water/air can be injected even if the needle tip
has not reached the epidural space.
A, The puncture block is worn out. When this occurs, change the puncturesite or replace the pad with a new unit.

13Caution

Do not let ink from pens, newspapers, product manual or other sources
contact the manikin. Ink marks on the manikin will be irremovable.

・For inquiries and service, please contact your distributor or KYOTO KAGAKU CO., LTD.

Consumablesandreplacement
parts

■

Product Code11348-090
11348-11011348-120
11348-13011348-140
11348-15011348-150-D(World Wide)

MarkNONSOSEPPart Name
Normal CSF Puncture Block
Normal Obesity CSF Puncture Block
Senior CSF Puncture Block
Senior Obesity CSF Puncture Block
Epidural Puncture Blockskin cover Light tone for M43B/BB/PH51
skin cover Dark tone for M43B/M43BB■

本書の内容は、予告なしに変更することがあります。本書の内容の一部もしくは全部を当社に無断で複写・転載することを禁じます。
本書の内容に、万一不審な点や誤りなど、お気づきの点がございましたら、当社もしくは販売店にご連絡ください。
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 in this manual or product feedback. Your cooperation is greatly appreciated.
2021.09

M43B/ M43B-B

Quick ManualLumbar Puncture Simulator ⅡA
Read the full instruction manual carefully before use.

１ Connect the block to the tube
N : Normal CSF Puncture Block
O : Obesity CSF Puncture Block
NS: Senior CSF Puncture Block
OS: Senior Obesity CFS Puncture Block
EP: Epidural Puncture BlockThis way comes to the head-side of the lumbar model.

Connector to the Syringe

Connector to the irrigator bag① Puncture block variations
Block type is indicated on the side of each pad.

② Connect the puncture block with the irrigator bag.
Connect the tip of the tube from the irrigator bag to theconnector at the head-end of the puncture block.

３ Set the puncture blok in the Model

２ Fill the puncture block

RL
Aspirate fluid with the syringe until only water remains in the tubing.

Insert the block into the Lumbar Region Model.

４ Ready

Setting of Epidural block
Irrigator Bag
Water surface
at 200cc level.

Orient the pad's direction.

Lumbar Region
ModelOpen the clamp
before training.

Connect a drainage pouch to the side tubeof the block.
Skin CoverHold here

InsertPad

Drain Pouch
Hold here■(World Wide)■Tube

2020/11