Walking into the SIMPeds Engineering Studio, a few blocks from Boston Children’s Hospital, the first thing you notice is body parts — high-fidelity replicas of human anatomy in various sizes. Some are in a glass display case, while others are laid out in various states of assembly, from a lone finger to the complete abdominal cavity of a newborn, packed with diminutive organs. Six newborn-sized, hollow duodenums, cast in rubber over a plastic mold, hang ready near a workbench.
These aren’t your usual medical mannequins.
In the adjoining InventorSpace, three 3D printers stand ready to fabricate additional custom parts. Some will be used by surgeons to rehearse an upcoming complex operation. Others are used for general training and preparedness purposes. A collaboration with the special effects company Fractured FX helped launch the first trainers; today there are more than 20 in various stages of development. They allow practice of rare or infrequently performed procedures as well as some common ones that pose challenges in children.
Knowing the nose
This Pediatric Nasal Foreign Body Extraction trainer was created to prepare emergency department (ED) clinicians for a common but stressful scenario: Junior has put something up his nose. Crafted from CT images, it replicates the complex, narrow passages of a child’s nasal airway and fits all standard extraction tools. “If you get the muscle memory, you don’t have to worry about getting it right when you have a squirming, crying child,” explains simulation engineer Greg Loan.
Not your average doll arm
Fully articulated arm, wrist and hand bones lie beneath the soft rubber on this Radial Access trainer. Clinicians will be able to feel for a pulse (pump shown at left) and practice positioning the wrist to guide a cannula into the radial artery. “Radial arterial line placement is a technically difficult and often very painful procedure, and is performed on some of our smallest, most fragile patients,” says pediatric hospitalist Debra Hillier, MD, the project’s clinical champion. “Access to an infant-specific, just-in-time ultra-realistic trainer will enable clinicians to practice the procedure as though they were working on a real arm.” The arm can be attached to standard mannequins, replacing their unbendable, doll-like arms. The model also includes the ulnar artery, replicating the arm’s blood circulation pattern.
Zip-on trauma practice
This Gunshot Wound Trainer helps Boston Children’s Trauma Team rehearse emergency care. It zips onto the standard SimJunior mannequin and allows clinicians to practice chest tube placement in the presence of heavy bleeding (enough to require transfusion) and a collapsed lung. A section of ribs underneath the skin (shown at left) enables clinicians to practice finding the correct intercostal space for tube insertion. “Gunshot wounds are an excellent example of a high acuity, low frequency event,” says David P. Mooney, MD, MPH, who co-leads trauma simulations at the hospital. “The level of realism in this trainer puts the clinicians in the mindset that they are working on a live patient.”
This Neonatal Abdominal trainer, still under development, is specifically designed to help surgeons practice treating duodenal atresia. In this congenital malformation, the duodenum (first portion of the small intestine after the stomach) is blocked, causing vomiting and inability to feed. It’s rare enough that most surgeons never have the opportunity to practice the corrective operation. The trainer allows surgeons to identify the duodenal atresia (see the whitish organ in the middle) and perform the operative repair with haptic feedback. It was created in collaboration with surgeons Biren P. Modi, MD, MPH, and Jill Zalieckas, MD, MPH.
Taking the trepidation out of trephination
This Fingernail Trephination and Nailbed Laceration trainer reproduces what happens when a finger is subjected to trauma: Blood pools beneath the nail, causing a bruise, and sometimes the skin under the nail can split. The model enables emergency clinicians to practice nail trephination, a procedure that involves making a hole in the fingernail to drain the pooled blood and then sealing off the wound (which continues to “weep” until closed). The removable fingernail also allows practice in repairing tears in the nailbed.
The thigh bone’s connected
This Pediatric Femur Fracture trainer fits onto the standard SimBaby mannequin. It reproduces the angry bruise that signals fracture of the thigh bone. When you manipulate it, you can feel the crackly sensation that indicates a broken bone.
Cath port confidence
This Wearable Power Port trainer is designed to give nurses confidence inserting needles into children’s implanted Port-a-Caths (housed in the assembly at right) to provide IV medications, fluids and nutrition. Because the trainer can be strapped on, actors or staff members can pose as uncooperative patients during the simulations. “In our environment, the pediatric ED, accessing ports in young patients is stressful both physically and psychologically, not only for the patient and family, but also for the nurse,” explains nurse educator and project champion Denise Downey, RN. “The nurse must follow strict policy guidelines and sterile technique in the setting of an often frightened, uncooperative child along with very close observation by parents under stress.” Downey expects to use the device to train approximately 110 nurses annually; they perform some 50 to 60 port accesses every month.
Fabrication at their fingertips
Each trainer represents a close collaboration between clinicians and SIMPeds simulation engineers Greg Loan, Andrew Hosmer, Katie Livingston, Noah Schulz, Mariah Geritano, Duncan Smith-Freedman and Reimi Yonekura. Maeve Geary, a PhD candidate from Bolton University (U.K.), also contributes to the designs.
Plenty of new trainers are on the drawing board or in the early stages of construction. While priority for custom trainers is given to clinicians at Boston Children’s, outside requests will be entertained. “We have seven engineers and a large capacity for fabrication,” says Melissa Burke, director of Business Development for Boston Children’s Simulator Program.
For more information, to view a trainer or to inquire about making a custom trainer, email Melissa.Burke@childrens.harvard.edu.