Patent Publication Number: US-2021183267-A1

Title: Self-contained multipurpose medical training system and components

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is related to, and claims priority from, co-pending U.S. patent application Ser. No. 16/046,724 filed on Jul. 26, 2018 which claims priority from U.S. provisional application 62/537,841 filed Jul. 27, 2017 which is incorporated herein by reference. 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     Not Applicable. 
     FIELD 
     The present teachings generally relate to medical training devices, and more particularly to novel improvements to a self-contained multipurpose medical training system and associated components for the same. 
     BACKGROUND 
     The statements in this section merely provide background information related to the present disclosure and may not constitute prior art. 
     Learning the proper skill and precision for safely and effectively inserting a catheter needle, particularly intravenously or for decompression purposes, is a difficult and tedious process. Such training becomes more complex and complicated when the training must occur under field conditions, i.e., at locations other than established medical training facilities such as temporary and/or mobile military medical facilities or bases. 
     Unfortunately, traditional medical needle insertion training devices are designed for classroom settings. They typically include a replicated human body part (e.g., a leg, arm or torso), and focus on anatomical correctness—not convenience. Most require support components (e.g., pumps and monitors) that link to the anatomical component with tubes and wires. Moreover, all of the training components require separate storage—even the needles (a/k/a “Sharps”). Hence, traditional training devices are large and unwieldy, not very durable, and not very portable. Up until recently, the prevailing attitude in the medical community had been that the student would learn and practice needle insertion techniques at an institution or facility supplied with a traditional training device. As a consequence, training, certification and recertification efforts have been traditionally focused on classroom training, with few options for home or other out-of-classroom practice. 
     In recent years, a few “portable” or “personal” devices have been introduced, including for example the self-contained needle insertion training system disclosed in U.S. Pat. No. 8,556,634 (the “&#39;634 patent”). These devices, and in particular the device disclosed and claimed in the &#39;634 patent (the “&#39;634 Trainer”), provide a readily available compact training platform for personal use that can be accessed and utilized at virtually any time and place. Although the &#39;634 Trainer has substantial benefits over other needle insertion training devices, it has been found that the device would benefit from improvements. 
     In particular, the preferred embodiment of the &#39;634 Trainer is elongated and substantially tubular. This can at times result in an unstable practice platform in that the device may shift or roll during needle insertion training. This potential problem can be moderated by positioning of the device and/or the particular grip applied to the device during training or practice procedures. For example, the device can be held firmly at one end with one hand while using the other hand to conduct the needle insertions. Alternately, the device can be placed in the user&#39;s lap or on a cushion or other similar surface to hold the device in place during training. However, it would be desirable to have a configuration for the &#39;634 Trainer that would be relatively stable, without rolling, and that would not require such external constraints to impose such stability. 
     Further, the &#39;634 Trainer is designed to provide at least two different practice areas upon which to train—e.g., one for intravenous insertions and one for chest needle decompression insertions. Although these training areas have a somewhat curved topography because they run along the outer surface of a tubular body, they nonetheless provide an overall relatively flat upward facing surface for the practice of needle insertion. Yet, because each of the practice areas is oriented on a different plane relative to each other (and relative to the central axis of the trainer), the trainer must be rotated or oriented for use such that the desired training area is facing upward. It would therefore be desirable for the trainer to be configured such that the trainer will be stable when placed upon a relatively flat surface when either of the practice areas is positioned in an upward facing orientation. 
     In addition, in the &#39;634 Trainer, the synthetic skin is disclosed as a “jacket” that slips over the synthetic or simulated blood vessels and underlying flesh pad on the outer surface of the body. While this is a very functional design, during use the synthetic skin must frequently be replaced, and the jacket or tubular design of the simulated skin in the &#39;634 Trainer can require undue time to replace. This same problem exists for other needle insertion training devices, where the synthetic skin requires excessive time to replace. It would therefore be desirable to have a synthetic skin component designed for needle insertion training devices that is readily and rapidly replaceable. It would further be desirable for the synthetic skin to integrate in some manner with the body of the training device in order to streamline and improve the efficiency of the product design and function. 
     Further, in certain embodiments, applicant&#39;s trainer is configured for the threading of simulated blood vessels through orifices in the body of the trainer with the use of clips on the interior of the trainer to secure the simulated blood vessels in place on the outer surface of the trainer. While functional, the threading of the simulated blood vessels can be somewhat difficult and time consuming. It would therefore be desirable for the trainer to be configured to enable a less demanding method to thread and secure the simulated blood vessels for attachment to the outer surface of the trainer. 
     In yet other embodiments, applicant&#39;s trainer is configured to accommodate the attachment of simulated blood vessel strips or segments on the outer surface of the device. The disclosed configurations require that each end of each simulated blood vessel strip or segment be secured to protrusions on each end of the outer surface of the trainer. While functional, it has since been learned that this configuration lends itself to the potential for inadvertent dislodging of the simulated blood vessel strips or segments from the protrusions. It would therefore be desirable for the trainer to be configured to secure the simulated blood vessel strips or segments to the outer surface of the trainer in a manner that would minimize the potential for the inadvertent dislodging of the simulated blood vessel strips or segments from the trainer. 
    
    
     
       DRAWINGS 
       The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present teachings in any way. 
         FIG. 1  is an exploded isometric view of the body, endcaps and other various components of a first embodiment of a multipurpose medical training system in accordance with and incorporating various features of the present disclosure. 
         FIG. 2  is a perspective view of the multipurpose medical training system of  FIG. 1  showing the decompression slot as a phantom image, with the body resting on a first set of feet to stably position the system with the decompression slot facing upward. 
         FIG. 3  is a perspective view of the multipurpose medical training system of  FIG. 1  showing the decompression slot as a phantom image, with the body resting on a second set of feet to stably position the system with a single training simulated blood vessel facing upward and the decompression slot facing to the side. 
         FIG. 4  is a cross-sectional plan view of the multipurpose medical training system of  FIG. 1 , sectioned along the centerline of the body and endcaps with the decompression aperture oriented upward, showing various representative needle insertion training components stored within the body of the training system. 
         FIG. 5  is a cross-sectional plan view of the multipurpose medical training system of  FIG. 1 , sectioned along the centerline of the body and endcaps with one of the simulated blood vessels oriented along the top of the outer surface of the system, showing various representative needle insertion training components stored within the body of the training system. 
         FIG. 6  is an end view of the body of the multipurpose medical training system of  FIG. 1 . 
         FIG. 7  is a perspective view of the underside of the body of the multipurpose medical training system of  FIG. 1 . 
         FIG. 8  is a perspective view of the body of the multipurpose medical training system of  FIG. 1  oriented with the decompression partially visible. 
         FIG. 9  is a perspective view of the body of the multipurpose medical training system of  FIG. 1  oriented with the decompression slot fully visible. 
         FIG. 10  is a side or plan view of a second embodiment of the body and endcaps of a multipurpose medical training system in accordance with and incorporating various features of the present disclosure, and showing a sectional line  11 - 11 . 
         FIG. 11  is a lateral cross-sectional view of the body and endcaps of the multipurpose medical training system of  FIG. 10  along the sectional line  11 - 11 . 
         FIG. 12  is a perspective view of the lateral cross-sectional view in  FIG. 11  of the body and endcaps of the multipurpose medical training system of  FIG. 10 . 
         FIG. 13  is an end view of the body of multipurpose medical training system of  FIG. 10 , showing representative legs oriented for insertion into corresponding orifices in the body. 
         FIG. 14  is a top view of a synthetic skin patch for use with multipurpose medical training systems of including the system of the present disclosure, in accordance with various embodiments of the present disclosure, and showing a sectional line  15 - 15 . 
         FIG. 15  is a cross-sectional view of the synthetic skin patch of  FIG. 14  along sectional line  15 - 15 . 
     
    
    
     Corresponding reference numerals indicate corresponding parts throughout the several views of drawings. 
     DETAILED DESCRIPTION 
     The following description is merely exemplary in nature and is in no way intended to limit the present teachings, application, or uses. Throughout this specification, like reference numerals will be used to refer to like elements. 
     Referring to  FIG. 1 , the present disclosure provides an improved self-contained catheter intravenous needle insertion training system (“ITS”)  10  that is structured and operable to provide an instrument or tool for users to practice various needle insertion techniques. 
     Generally, the improved ITS  10  provides expedient and precise skills training for intravenous (“IV”) and needle decompression education. The improved ITS  10  is structured and functional to be a total self-contained training device, whereby everything that is needed to conduct critical hands on lifesaving IV and needle decompression training can be stored within the unit, although various components are at times attached to the exterior surface of the device to enable practice and training functionality. It is envisioned that the improved ITS  10  can be used, for example, in the field by the U.S. military to instruct critical combat lifesaver skills to soldiers and host nation forces, as well as providing an excellent training tool for civilians and as a tool in, for example, the classroom setting or away from the classroom. 
     Referring now to  FIGS. 1, 2 and 3 , a first embodiment of the improved ITS  10  includes a hollow tubular body  12  of approximately 6¼ inch length by approximately 2 inch outer diameter, and having at least one sidewall  14  of approximately ⅛ inch thickness, a first externally threaded open end  16  having an approximate length of one inch, an opposing second externally threaded open end  18  having an approximate length of one inch, and an interior cavity  20  formed by the sidewall  14  and the open ends  16  and  18 . Of course, the improved ITS  10  could be configured with a single open end with an opposing closed end. That is, in various embodiments, the body can have a square, rectangular, triangular, etc., cross-section, such that the body  12  includes a plurality of sidewalls  14 , or in various other embodiments, the body can have a circular, oval, elliptical, etc., cross-section, such that the body  12  includes one or more circumferential sidewalls  14 . However, although the body  12  can include more than one sidewall  14  and/or more than one cavity  20 , for clarity and simplicity, the one or more sidewall(s)  14  will be referred to herein in the singular, e.g., sidewall  14  with a single cavity  20 . The outer diameter of the sidewall  14  is slightly less than the outer diameter of the open end  16  and open end  18 . Consequently, a small lip  15   a  of approximately ⅛ inch width is formed at the junction between the sidewall  14  and the open end  16 , and a matching small lip  15   b  of approximately ⅛ inch width is formed at the junction between the sidewall  14  and the open end  18 . 
     The improved ITS  10  additionally includes two closure devices or endcaps  22  that are structured and operable with interior threads to engage or mate with the exterior treads of the first and second open ends  16  and  18  as shown. When secured to the body  12 , the endcaps  22  thereby substantially close the open ends  16  and  18  of the body  12  to close off the interior cavity  20  such that at least one of a variety of components, to be used in association with the improved ITS  10 , can be removably stored within the interior cavity  20 . Such components can be any device, mechanism, substance, applicator, accessory, component, tablet, capsule, caplet, etc. to be used in association with the improved ITS  10 , including, e.g., a hypodermic syringe and associated needle assemblies, an intravenous catheter device and associated needle assembly, decompression device and associated needle assembly for evacuating air from a wound, alcohol or iodine swaps, scissors, a knife, tweezers, suture implements, simulated blood vessels, tissue and skin, synthetic blood, various clips, and a syringe and stopcock or valve, etc. (collectively, the “Storable Trainer Components”). 
     In various embodiments, the improved ITS  10  can include an annular collar that is fixed to the body  12  at a first end to configure one of the open ends  16  or  18  to be matable with an endcap  22 . In other embodiments, the open ends  16  and  18  can be configured to removably mate with the endcaps  22  without an annular collar. Further, while the endcaps  22  are depicted in  FIGS. 1-3  as caps with lateral ridges on their outer surfaces that are used as a grip surface to effectuate the turning of the endcap  22  to open and close the improved ITS  10 , other closure configurations will provide the same function. For example, the endcap  22  can be configured with a knurled outer surface in place of the lateral ridges to provide a grip surface. Likewise, the endcaps  22  may alternatively be configured, for example, with tabs, lugs or other protrusions to provide a grip. 
     Of course, the endcaps  22  can be any device structured and operable to allow the open ends  16  and  18  of the body  12  to be securely covered when it is desired to close off the interior cavity  20 , and be readily removed from, or disengaged with, the respective open end  16  or  18  to allow access to the interior cavity  20 . That is, the endcap  22  can be any device structured and operable to allow the improved ITS  10  to be opened and closed as desired to respectively allow or prevent access to the interior cavity  20 . For example, in various embodiments, the endcap  22  can be a plug that is structured and operable to threadingly or frictionally engage the body  12  at or near the open end  16 . Alternatively, in various embodiments, the endcap  22  can be a lid, door or any other structure, device or mechanism that pivotally, rotatingly, hingedly or removably connect to the body  12  at or near the open end  16  such that the structure, device or mechanism can be secured or latched in a closed position, via any suitable latching device, and pivotally, rotatingly or hingedly moved to an open position upon release or uncoupling of the securing or latching device or mechanism. 
     Hence, any one or more of the Storable Trainer Components can be placed in the interior cavity  20  and stored therein by placing the endcaps  22  in a closed position, wherein the endcaps  22  securely engage the body  12  at or near the open ends  16  and  18 . Subsequently, the stored Storable Trainer Components can be removed from the interior cavity  20  by placing one or more of the endcaps  22  in an open position, wherein the endcap  22  is disengaged from one of the body open ends  16  or  18 , i.e., removed from or moved away from that open end, thereby allowing access to the interior cavity  20 . 
     Referring again to  FIGS. 1-3 , and  FIG. 6 , in various embodiments, the improved ITS  10  further includes a needle decompression training orifice  24  extending through the sidewall  14 . The needle decompression training orifice  24  is structured and functional to allow a user to practice inserting the catheterized decompression needle into the chest of a patient to evacuate air from the patient&#39;s chest cavity, as described further below. The orifice  24  is formed in the shape of an elongated slot with rounded ends, and runs laterally on the side of the body  12 . The orifice  24  is centered lengthwise between the first and second open ends  16  and  18 , with a length of approximately two inches and a width of approximately ⅜ inch. The outer edges of the orifice  24  are rounded to provide a more anatomically correct opening and to promote the advance of the decompression needle into the orifice  24  during training. 
     Three open-ended, approximately ¼ inch wide, uniform slots  25  are formed in the open end  16  and extend entirely through the sidewall  14 . The slots  25  are all the same size and shape, and extend parallel to one another laterally inward a distance of approximately one inch from the rim of the open end  16  toward the middle of the body  12 . The inner ends and outer edges of each of the slots  25  are rounded to eliminate sharp edges. 
     Similarly, three open-ended, approximately ⅜″ wide, uniform slots  28  are formed in the open end  18  and extend entirely through the sidewall  14 . The slots  28  are all the same size and shape, and extend parallel to one another laterally inward a distance of approximately one inch from the rim of the open end  16  toward the middle of the body  12 . The inner ends and outer edges of each of the slots  28  are rounded to eliminate sharp edges. 
     Each of the open ends  16  and  18  also has a set of three bases in the form of legs that protrude radially from the body  12  just inside the threads of said open ends. Referring to  FIG. 4 , it can be seen that a first leg  30  extends from the body  12  substantially opposite the middle of the three slots  25  proximate the open end  16 . The first leg  30  extends approximately ½ inch radially from the outer surface of the sidewall  14  to a tip  32 . Flat edges  34  and  36  descend in mirror fashion from each side of the tip  32  approximately ¼ inch at an angle of approximately 45 degrees, while concave arcs  38  and  40  extend approximately ⅜ inch from the body  12  upward to join the edges  34  and  36 , respectively, and form the leg  30 . 
     A second leg  42  extends outward from the body  12  at an orientation of approximately 40 degrees away from the first leg  30 . The second leg  42  extends approximately ½ inch radially from the outer surface of the sidewall  14  to form a flat edge  44  that is parallel to the flat edge  34  of the first leg  30 . 
     Similarly, a third leg  46  extends outward from the body  12  at an orientation of approximately 40 degrees away from the first leg  30  opposite the second leg  42 . The third leg  46  extends approximately ½ inch radially from the outer surface of the sidewall  14  to form a flat edge  48  that is parallel to the flat edge  36  of the first leg  30 . 
     All of the legs  30 ,  42  and  46  are flat and coplanar on both lateral sides and approximately ¼ inch wide. Moreover, in order to enable the legs to function without interference from the body  12  when the ITS  10  is positioned on a substantially flat surface, a gap G 1  of approximately ⅛ inch exists between the outer surface of the sidewall  14  and the line defined by the flat edge  44  of the second leg  42  and the flat edge  34  of the first leg  30 , and a gap G 2  of approximately ⅛ inch exists between the outer surface of the sidewall  14  and the line defined by the flat edge  48  of the third leg  46  to the flat edge  36  of the first leg  30 . Of course, these gaps G 1  and G 2  can vary so long as the legs extend far enough from the body  12  to create a separation or a flush fit between the lines and the body. Referring to the  FIGS. 5-7 , it can be seen that the body  12  has a second set of legs  31 ,  43  and  47 , proximate the open end  18  that mirror the legs  30 ,  42  and  46  proximate the open end  16 . 
     As can be appreciated, the unique configuration of the legs  30 ,  31 ,  42 ,  43 ,  46  and  47 , enables the user to selectively orient either of the two training regions facing upward when the ITS  10  on a relatively flat surface, and rapidly switch to the other training region merely by rotating the ITS  10  so that it rests on a different four of the six legs. That is, when the legs  30 ,  31 ,  42  and  43  are positioned on a relatively flat surface, the needle decompression orifice  24  and its associated training region face upward and the ITS  10  is in a first orientation ready for decompression needle insertion training use. By simply rotating the ITS  10  so that the legs  30 ,  31 ,  46  and  47  are resting on the same flat surface, a single simulated blood vessel  54  not adjacent the decompression orifice  24  is facing upward along with its associated training region and the ITS  10  is in a second orientation ready for IV needle insertion training use. Notably, the ITS  10  shares the legs  30  and  31  between the first and second training orientations. 
     Referring again to  FIGS. 1-3 , in various implementations, a clavicle simulation pad  50  is positioned on the outer surface of the hollow body atop the needle depression training orifice  24 . The clavicle simulation pad  50  is structured to simulate the characteristics of human clavicle tissue. In the embodiment of the ITS  10 , the clavicle simulation pad  50  is a generally rectangle shape that is sized to completely cover the orifice  24  and extend out radially from the orifice  24  approximately one inch in all directions so as to lay flush against the outer surface of the sidewall  14  proximate the orifice  24 . The clavicle simulation pad  50  is formed from an elastic material, such as for example a TPE plastic or a latex or a silicone-based material, which is approximately three inches long, 1½ inches wide and a uniform thickness of approximately 0.060 inches. Of course, the dimensions of the clavicle simulation pad  50  can vary so long as the pad  50  maintains its similarity to human clavicle tissue and can be held in place over the orifice  24 , particularly during needle decompression insertion training using the ITS  10 . Adhesives or other bonding agents may be used to secure the clavicle simulation pad  50  to the outer surface of the sidewall  14 . 
     In various embodiments, the improved ITS  10  further includes a generally rectangular simulated flesh pad  52  disposed on the outer surface of the body sidewall  14 , over the clavicle simulation pad  50  and between the plane defined by the legs  30 ,  42  and  46  at one end of the body  12  and the plane defined by the legs  31 ,  43  and  47  at the other end of the body  12 . The simulated flesh pad  52  is structured and functional to simulate the density and pliability of human flesh adjacent, for example, the simulated blood vessel in a human forearm or hand, and in particular subcutaneous tissue. The flesh pad  52  is formed from an elastic material, such as for example a foam, neoprene or rubber, and is sized to fit between the lips  15   a  and  15   b  of the body  12  with a length of approximately four inches, a width of approximately three inches, and a uniform thickness of approximately ⅜ inches. Adhesives or other bonding agents may be used to secure the flesh pad  52  to the outer surface of the sidewall  14 . Of course, the dimensions of the flesh pad  52  can vary so long as the flesh pad  52  maintains its similarity to human subcutaneous tissue and can be held in place over the orifice  24 , particularly during needle insertion training using the ITS  10 . Adhesives or other bonding agents may be used to secure the flesh pad  52  to the outer surface of the sidewall  14 . 
     With further reference to  FIGS. 1, 2, and 3 , the improved ITS  10  further includes one or more simulated blood vessels such as the simulated blood vessel strip or segment  54   a  or the simulated blood vessel tubing  54   b  (collectively,  54 ) disposed over the outer surface of the body  12 . Each simulated blood vessel  54  is an elastomeric tube, or tubing, constructed of a suitable material, e.g., rubber or other elastic polymer or compound, sized and structured to simulate the feel, density, thickness and pliability of a human blood vessel. As described further below, each simulated blood vessel  54  is structured and operable to simulate a human blood vessel such that a user of the improved ITS  10  can practice the proper technique of inserting a catheter intravenous needle into an actual human blood vessel. Each simulated blood vessel  54  positioned on the ITS  10  is oriented laterally across the length of the sidewall  14  atop the flesh pad  52 , with one end held in place in one of the slots  25  and at the other end held in place in the corresponding slot  28 , as shown. The simulated blood vessels  54  can be of different configurations. 
     Where the simulated blood vessel  54  is an open-ended length of tubing (such as is shown by way of example at  54   b  in  FIG. 1 ), a pair of clamps or clips  55  (preferably tube clips such as those shown by way of example in  FIG. 1 ) are firmly attached along the length of the simulated blood vessel  54   b  such that the clips  55  will not slip. Alternatively, a portion of the simulated blood vessel  54   b  can be utilized by forming a knot along the length of the tubing at one or more desired locations. Preferably, however, the clips  55  are utilized and are separated by a section of the simulated blood vessel  54   b  that is somewhat less than the length between the slots  25  and  28  such that the section of the simulated blood vessel  54   b  between the clips  55  can be stretched, positioned over the flesh pad  52 , and the clips  55  situated in the cavity  20  of the body  12  adjacent the slots  25  and  28 . Methodically, one of the clips  55  is positioned in the cavity  20  adjacent one of the slots  25  or  28  with the section of the simulated blood vessel  54   b  between the clips  55  extending through the slot. The section of the simulated blood vessel  54   b  between the clips  55  is stretched over the flesh pad  52  and extended to allow the second clip  55  to slide into the open end of the opposing slot  25  or  28 . The simulated blood vessel  54   b  is then allowed to snap into place over the flesh pad  52  with one of the clips  55  in the cavity  20  adjacent the slot  25 , the other clip  55  in the cavity  20  adjacent the slot  28 , and the simulated blood vessel  54   b  pulled taut through the closed ends of the slots  25  and  28 . 
     Where the simulated blood vessel  54  is a simulated blood vessel strip or segment (such as is shown by way of example at  54   a  in  FIGS. 1 and 5 ), each of the simulated blood vessels  54   a  comprises a length of elastomeric tubing having a length that is the same as or somewhat less than the length between the slots  25  and  28 , and having enlarged ends  80  formed by the insertion of a plug  82  into each end of the simulated blood vessels  54   a  such that the elastic tubing stretches tightly over the plugs  82  to hold them securely in place. (See  FIG. 5 ). To secure a simulated blood vessel  54   a  to the ITS  10 , one of the enlarged ends  80  of the simulated blood vessel  54   a  is positioned in the cavity  20  adjacent one of the slots  25  or  28  with the section of the greater length of the simulated blood vessel  54   a  extending through the slot. The simulated blood vessel  54   a  is then stretched over the flesh pad  52  and extended to allow the other enlarged end  80  to slide into the open end of the opposing slot  25  or  28 , the slot  25  or  28  thereby cinching and securing the enlarged end  80  of the simulated blood vessel  54   a . The simulated blood vessel  54   a  is then allowed to snap into place over the flesh pad  52  with one of the enlarged ends  80  in the cavity  20  adjacent the slot  25 , the other enlarged end  80  in the cavity  20  adjacent the slot  28 , and the simulated blood vessel  54   a  pulled taut through the closed ends of the slots  25  and  28 . One of ordinary skill in the art will recognize that the enlarged ends  80  of the simulated blood vessels  54   a  must each be of sufficient size to prevent the enlarged end  80  from passing through its corresponding slot  25  or  28 . 
     Each of the simulated blood vessels  54 , whether  54   a  or  54   b  or other configuration of the simulated blood vessels  54 , can be empty or filled with either unpressurized or pressurized fluid, such as for example simulated blood. A simulated blood vessel  54  that is filled with a fluid is sometimes referred to as a “charged” vein or vessel. Therefore, if a user properly inserts a needle into an unpressurized charged simulated blood vessel  54 , the user can draw, or extract, some or all of the liquid from the simulated blood vessel  54 . Further, if a user properly inserts an intravenous needle into a pressurized charged simulated blood vessel  54 , the simulated blood vessel  54  will provide a “flash” of simulated blood into the housing of the intravenous needle to indicate a proper wet vein insertion or “wet stick” for training purposes. 
     In a preferred configuration, for example, the ITS  10  includes two empty simulated blood vessels  54  positioned generally adjacent and on each of the long sides of the orifice  24  to act as touch indicators to simulate human ribs on either side of the intercostal tissue pad  50  for needle decompression insertion training, and a single charged simulated blood vessel  54  in the third position of the ITS  10  for wet-stick training (see  FIGS. 2 and 3 ). For example, in various implementations, the simulated blood vessels  54  adjacent the orifice  24  can simulate the second and third ribs of a human torso skeletal structure. Still further, in various embodiments, the improved ITS  10  can include an inflatable air sack (not shown) structured and operable to be inflated and placed into the cavity  20  adjacent the needle decompression training orifice  24 . Therefore, if a user properly inserts the needle of a decompression syringe into the needle decompression training orifice  24 , simulating proper insertion of the needle into the chest cavity of a patient, the air sack will be pierced and the air can be evacuated via the decompression syringe, as described in detail below. 
     Additionally, in various embodiments, the improved ITS  10  includes an improved simulated skin patch  56  disposed over the outer surface of the body sidewall  14  over the simulated blood vessel(s)  54  and the flesh pad  52  ( FIGS. 1-3 ). The simulated skin patch  56  is structured and functional to simulate the characteristics of human skin adjacent or in close proximity to the simulated blood vessels in a human forearm or hand. The skin patch  56  is formed from a supple elastic material, such as for example a TPE plastic or a latex or a silicone-based material, and is sized to fit substantially taut over the flesh pad  52  and between the legs  42 ,  43 ,  46  and  47  when slightly stretched (see  FIGS. 2 and 3 ). 
     Referring to  FIGS. 12 and 13 , it can be seen that when laid flat in a relaxed state (i.e., not stretched), the improved skin patch  56  is substantially rectangular, having a central portion  58  with dimensions of approximately 4½ inches in length, 3 inches in width and 0.020-0.040 inches in thickness. The central portion has a first face  60  and a second face  62  opposite the first face  60 . The first face  60  is textured to replicate the surface texture of human skin. A generally uniform ⅜ inch wide border  64  extends from and surrounds the central portion  58 . The border  64  has a ⅛ inch wide flat portion  66  and a tapered portion  68  positioned between the flat portion  66  and the central portion  58  of the skin patch  56 . At its interface with the central portion  58 , the tapered portion  68  has a thickness approximately the same thickness as the central portion  58 . The tapered portion  68  uniformly expands in thickness to its interface with the flat portion  66  of the border  64 , where the thickness of the tapered portion  68  matches that of the flat portion  66 . 
     A substantially flat and circular tab  70  extends at a 45 degree angle away from each of the four corners of the flat portion  66  of the border  64 . The tab  70  has the same width and thickness as the flat portion  58 , and defines a ⅛ inch wide circular aperture  72  in the center of the tab  70 . The tabs  70  provide strengthened attachment loops that releasably secure the skin patch  56  to the legs  42  and  43  at one end and the legs  46  and  47  at the other end when the skin  56  is stretched over the flesh pad  52  atop the sidewall  14  ( FIGS. 1-3 ). Hence, in addition to providing multiple bases for operation and use of the improved ITS  10 , the legs  30 ,  31 ,  42 ,  43 ,  46  and  47 , also provide mounting sites or positions for the skin patch  56 . That is, the legs  30 ,  31 ,  42 ,  43 ,  46  and  47 , simultaneously act as both legs for the stable utilization of the ITS  10 , and also provide mounts for the skin patch  56 . 
     In various alternate embodiments, including for example the ITS  100  in  FIGS. 8-11 , each simulated blood vessel  54   b  has opposing ends that are inserted through a respective pair of circular orifices or apertures  102  and  104  formed in the sidewall  14  near the closed and open ends  16  and  18  of the body  12 . More particularly, the ends of the each simulated blood vessel  54   b  extend through the respective apertures  102  and  104  into the interior cavity  20  where the ends are secured, via any suitable securing means, e.g., a clamp or clip or knot, such that at least a portion of each simulated blood vessel  54   b  between the respective ends is disposed along the outside of the outer surface of the body sidewall  14 . Accordingly, the portion of each simulated blood vessel  54   b  disposed along the outside of the outer surface of the body sidewall  14  is accessible by the user for use in practicing the proper technique of inserting a catheter intravenous needle into an actual human blood vessel, as described further below. 
     In various embodiments, each simulated blood vessel  54  has a length such that a supplementary portion of each simulated blood vessel  54   b  is disposed within the interior cavity  20  to provide additional simulated vein material for replacing the portion of each simulated blood vessel  54   b  disposed along the outside of the outer surface of the body sidewall  14 . That is, as the portion of each simulated blood vessel  54   b  disposed along the outside of the outer surface of the body sidewall  14  deteriorates from use or is otherwise damaged, the securing means of one end of the respective simulated blood vessel  54   b  can be released and the deteriorated portion can be pulled into the interior cavity  20  or alternatively removed and discarded. Simultaneously, the supplementary portion of the respective simulated blood vessel  54   b  can be pulled to the outside of the body  12  and disposed along the outer surface of the body sidewall  14 , thereby replacing the deteriorated portion. 
     The ITS  100  also incorporates a set of six removable pegs  106  that snap securely into orifices  108  to form legs for the device. This may be desirable on a number of levels. For example, when the body  12  is machined, such as for example from a rigid materials such as for example aluminum or a plastic, constructing integrated legs into the body  12  as part of the machining process would be difficult and expensive. In addition, it may prove advantageous to be able to remove the legs from the body  12  for shipping or storage. The orifices  108  correspond to the same positions and orientations as, that is to say they mimic, the positions and orientations of the legs  30 ,  31 ,  42 ,  43 ,  46  and  47 , with respect to the body  12 . The pegs  106  are formed of a generally rigid, yet pliant plastic, with a plaint prong  110  at one end that has a diameter that is slightly greater than the diameter of the orifices  108  for secure insertion into the orifices  108 , and a bulbous knob  112  at the opposite end to hold the tabs  70  onto the pegs  106  when the skin patch  56  is stretched into place on the ITS  100 . 
     Operation and use of the improved ITS  10  will now be described. As described above, the improved ITS  10  can be utilized to simulate “dry stick” intravenous needle insertion. For example, in various embodiments, one or more of the simulated blood vessels  54  of the improved ITS  10  can be utilized to practice inserting an IV needle and advancing an associated catheter into any of the empty simulated blood vessels  54  properly mounted to the outer surface of the ITS  10 . To perform such a dry intravenous needle insertion training procedure utilizing the improved ITS  10 , the user removes at least one of the endcaps  22  from the body  12  and removes the desired Storable Trainer Component, e.g., an 18 gauge catheter needle, saline lock and custom IV line, from the interior cavity  20 . The user may then re-secure the endcap  22  to body  12  to close the improved ITS  10 . 
     Next, the user chooses which of the practice faces will be used for training and positions the appropriate legs (i.e.,  30 ,  31 ,  42  and  43 ; or alternatively,  30 ,  31 ,  46  and  47 ) of the improved ITS  10  on an upward facing surface so that the desired training orientation of the ITS  10  is achieved and the desired training area or region is facing upward. The user will then complete a pre-execution check of the IV supplies, e.g., the 18 gauge catheter needle, saline lock and custom IV line, to ensure good serviceability, and place them within reach. 
     Subsequently, the user can employ one or more of the proper needle insertion techniques, such as follows: the user holds the needle between his/her index finger and thumb and removes a safety cap from the needle. With the opposite hand, using his/her thumb and index finger, the user forms the letter “C” and positions his/her index finger over the selected simulated blood vessel  54  and above the injection site, (this will keep the simulated blood vessel  54  from rolling and act as a pressure point to slow blood loss from an actual needle insertion, once the needle is removed). The user then positions his/her thumb below the injection site and applies a small amount of downward tension pulling the simulated skin patch  56  taunt. The thumb may also be used as a support for the needle to ensure a 45° angle. Next, the user positions the needle at approximately a 45° angle with the bevel edge of the needle facing upward and slowly inserts the needle into the simulated blood vessel  54 . Due to the construction of the simulated blood vessels  54 , the user will feel a small amount of resistance as the needle advances through the simulated skin patch  56  and the wall of the simulated blood vessel  54 . Once the needle is properly inserted, the user repositions his/her thumb to allow the needle to drop down to above the skin level. Next, the user slowly advances the needle approximately another ¼ of an inch into the simulated blood vessel  54 . Without moving the needle, the user slowly advances the catheter into the simulated blood vessel  54 . Next, while continuing to apply pressure with his/her index finger above the injection site, the user removes the needle, leaving the catheter in place. 
     As also described above, the improved ITS  10  can be utilized to simulate “wet stick” intravenous needle insertion. For example, in various embodiments, one or more of the simulated blood vessels  54  of the improved ITS  10  can be filled with a liquid, as described above, and be utilized to practice inserting an IV needle and obtaining an actual “flash” of blood in the needle chamber. Using a charged simulated blood vessel  54 , the user will employ the same steps as described above for dry stick intravenous needle insertion training. However, if the needle is properly inserted into the liquid filled simulated blood vessel  54 , the user will see a “flash” of liquid in the chamber of the intravenous needle chamber (or associated syringe if a syringe is being used), simulating a “flash” of blood into the needle chamber during an actual wet intravenous needle insertion. 
     As further described above, the improved ITS  10  can be utilized to perform needle decompression training. To perform such needle decompression training, the user places the endcap  22  in the open position and removes the desired Storable Trainer Components, e.g., a decompression syringe and a 14 gauge catheter needle, from the interior cavity  20 , as described above. In various implementations, the user can next inflate an air sack and insert the air sack into the interior cavity  20  beneath the needle depression training orifice  24 . The user may then resecure the endcap  22  to close the body  12  of the improved ITS  10 . 
     Next, the user positions the appropriate legs (i.e.,  30 ,  31 ,  42  and  43 ) of the improved ITS  10  on an upward facing surface so that the desired training orientation of the ITS  10  is achieved with the needle decompression training area or region is facing upward. The user will then complete a pre-execution check of the IV supplies, e.g., the 14 gauge catheter needle, air sack, etc., to ensure good serviceability, and place them within reach. Using his/her fingers to feel along the skin patch  56  and flesh pad  52  at each side of the orifice  24 , the user then identifies the proper insertion site between the two adjacent simulated blood vessel  54  adjacent the orifice  24 , to simulate locating the middle of a human clavicle between the second and third ribs. Subsequently, the user removes the safety cap from the 14 gauge needle and holds the needle at approximately a 90° angle to the injection site, i.e., above the needle depression training orifice  24 . Then, applying firm, but gentle, pressure the user advances the needle through the simulated skin patch  56  and flesh pad  52 . The user continues to advance the needle until the catheter hub is against the simulated skin patch  56 . Then, while holding the catheter needle in place, the user removes the needle, and can optionally secure the catheter hub in place with tape and attach a small flutter valve to the hub of the catheter. Decompression can then be verified by checking the air sack to determine whether the air from within the air sack has been evacuated. 
     While I have described in the detailed description several configurations that may be encompassed within the disclosed embodiments of this invention, numerous other alternative configurations, that would now be apparent to one of ordinary skill in the art, may be designed and constructed within the bounds of my invention as set forth in the claims. Moreover, the above-described novel mechanisms of the present invention, shown by way of example at  10  can be arranged in a number of other and related varieties of configurations without departing from or expanding beyond the scope of my invention as set forth in the claims. Thus, the description herein is merely exemplary in nature and, thus, variations that do not depart from the gist of that which is described are intended to be within the scope of the teachings. Such variations are not to be regarded as a departure from the spirit and scope of the teachings. 
     For example, the improved ITS  10  is not limited to two training areas as depicted by representation in the Figs. Rather, the improved ITS  10  may incorporate three or more such training areas and the legs may be modified or the number increased to provide an opposing stable base, oriented on the opposite side of the body  12 , for at least two of the three or more training areas. Similarly, the improved ITS  10  is not restricted to an exact count of six legs. Rather, the number of legs and their shapes and sizes may vary substantially so long as the legs collectively provide an opposing stable base, oriented on the opposite side of the body  12 , for each of the training areas, and preferably share at least one common support or leg for at least two training areas. 
     The slots  25  and  28  may be of various shapes and dimensions, need not be uniform and need not be open-ended, so long as the slots can readily allow for the insertion of the enlarged end  80  of the simulated blood vessel strip or segment  54   a  into the slot such that the enlarged end  80  will remain secure in the slot once both ends of the simulated blood vessel  54   a  are in opposing slots and the simulated blood vessel  54   a  is released. For example, the slot may be closed and have a keyhole shape in which the enlarged end  80  of the simulated blood vessel  54   a  can pass through the large opening in the keyhole slot but not the reduced or cinched opening in the slot. 
     The skin patch  56  may have alternate shapes and sizes so long as the skin patch  56  reasonably simulates at least in part human skin in region of the training area, and can be secured to the body  12  by attachment to one or more of the legs or upward supports for the body  12 , such as for example one or more of the legs  30 ,  31 ,  42 ,  43 ,  46  and/or  47 . For example, the perimeter of the skin patch  56  may be oval, round, square, or randomly shaped; the circular tab  70  and circular aperture  72  need not be circular nor the exact size described above, but can rather be any of a variety of other shapes and sizes so long as the skin patch  56  can be secured to the body  12  by attachment to one or more of the legs or upward supports for the body  12 . Further, the skin patch  56  does not require a border, nor a uniformly dimensioned border, nor a border identical to the border  64 . Instead, the border  64  of the skin patch  56  may be configured to have one or more of a variety of shapes and sizes, or the skin patch  56  may have no border at all. The central portion of the skin patch  56  need not be entirely uniform in thickness as described above, but may vary in thickness substantially, particularly in light of the potential use of different materials and processes to form the skin patch  56 , so long as the skin patch  56  reasonably simulates at least in part human skin in region of the training area and provides reasonable durability. 
     Moreover, each of the features of the improved ITS  10  described herein may be utilized in conjunction with or incorporated into various medical insertion training devices and systems that are not self-contained as claimed in the &#39;634 Trainer. 
     Additional variations or modifications to the configuration of the novel mechanism of the present invention, shown by way of example at  10 , may occur to those skilled in the art upon reviewing the subject matter of this invention. Such variations, if within the spirit of this disclosure, are intended to be encompassed within the scope of this invention. The description of the embodiments as set forth herein, and as shown in the drawings, is provided for illustrative purposes only and, unless otherwise expressly set forth, is not intended to limit the scope of the claims, which set forth the metes and bounds of my invention. Accordingly, all matter contained in the above description or shown in the accompanying drawings should be interpreted as illustrative and not in a limiting sense.