WO2005122105A2 - Medical teaching aid - Google Patents

Medical teaching aid Download PDF

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Publication number
WO2005122105A2
WO2005122105A2 PCT/GB2005/002157 GB2005002157W WO2005122105A2 WO 2005122105 A2 WO2005122105 A2 WO 2005122105A2 GB 2005002157 W GB2005002157 W GB 2005002157W WO 2005122105 A2 WO2005122105 A2 WO 2005122105A2
Authority
WO
WIPO (PCT)
Prior art keywords
teaching aid
foot
fluid filled
flexible member
pressure
Prior art date
Application number
PCT/GB2005/002157
Other languages
French (fr)
Other versions
WO2005122105A3 (en
Inventor
Vincent Paul Choudhery
Esther Hannah Johnson
Original Assignee
Greater Glasgow Nhs Board
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Greater Glasgow Nhs Board filed Critical Greater Glasgow Nhs Board
Publication of WO2005122105A2 publication Critical patent/WO2005122105A2/en
Publication of WO2005122105A3 publication Critical patent/WO2005122105A3/en

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Classifications

    • GPHYSICS
    • G09EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09BEDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/285Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine for injections, endoscopy, bronchoscopy, sigmoidscopy, insertion of contraceptive devices or enemas
    • GPHYSICS
    • G09EDUCATION; CRYPTOGRAPHY; DISPLAY; ADVERTISING; SEALS
    • G09BEDUCATIONAL OR DEMONSTRATION APPLIANCES; APPLIANCES FOR TEACHING, OR COMMUNICATING WITH, THE BLIND, DEAF OR MUTE; MODELS; PLANETARIA; GLOBES; MAPS; DIAGRAMS
    • G09B23/00Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes
    • G09B23/28Models for scientific, medical, or mathematical purposes, e.g. full-sized devices for demonstration purposes for medicine
    • G09B23/30Anatomical models
    • G09B23/34Anatomical models with removable parts

Definitions

  • the present invention relates to a medical teaching aid for practising the taking of blood samples.
  • the Guthrie Test which is a routine blood test carried out on all newborns, involves the collection of a capillary blood sample obtained by a heel prick. Up to 1 ml of blood can be sampled from this method. Blood is collected on a blotting paper card with a number of circles which, for a sufficient sample, must be permeated on both sides with the blood. The test is usually carried out with automatic incision devices which ensure a prick depth of around 2.0mm to 2.4mm. This optimum depth produces the most blood (for a sufficient sample) whilst maintaining the safety of the baby.
  • the incision device does not touch the calcaneous (heel) bone, arteries or nerves.
  • Medical staff are currently instructed to puncture the plantar surface (sole) of the foot on the most medial or lateral portion (edges of the sole) .
  • Staff should also avoid the posterior curvature of the heel (as this is where the bone is close to the skin) and previous puncture sites, as this can lead to infection and damage to the heel.
  • Newborn heel puncture blood sampling is recognised as a difficult procedure, which requires a number of attempts before the technique is perfected.
  • One of the few teaching aids on the market is a foam baby foot which is used as a teaching aid for the heel stick technique.
  • Brochures and videos are also available which provide a step-by-step visualisation of the blood collection process, however these do not replace the need for actual hands-on experience.
  • a teaching aid for practising the taking of a blood sample comprising a flexible member capable of simulating a body limb or member, the flexible member being adapted to receive fluid capable of simulating blood, wherein the teaching aid also comprises pressure measuring means for measuring the application of pressure to the flexible member.
  • the teaching aid may be configured to simulate any body limb or member, such as an arm, finger or foot. In a particular envisaged embodiment, the teaching aid is configured to simulating an infant ' s foot .
  • the flexible member may also comprise a portion capable of simulating an infant's leg.
  • the foot is detachable from the leg portion.
  • the flexible member is preferably adapted to receive at least one fluid filled receptacle.
  • the foot is adapted to receive at least one fluid filled receptacle in the area which corresponds to an infant ' s heel .
  • the fluid filled receptacle is replaceable and is preferably filled with an artificial blood substance.
  • the fluid filled receptacle comprises a reticulated foam core which acts as a reservoir for the artificial blood substance.
  • the fluid filled receptacle has a pierceable latex coating to permit puncture by a needle or incision device.
  • the flexible member contains at least one substantially rigid component which simulates bone.
  • the flexible member may optionally have at least three substantially rigid components.
  • the leg portion of the flexible member preferably comprises two substantially rigid components simulating the tibia and femur bones of the infant's leg.
  • the foot portion preferably comprises one substantially rigid component which represents a simplified simulation of the bones of the foot and ankle .
  • the substantially rigid components are manufactured from a silicone material.
  • the substantially rigid components are connected via a plurality of joints which are adapted to simulate real movement of the joints of an infant's leg.
  • the fluid filled receptacle has means for releasably securing said receptacle to the substantially rigid component in the foot portion.
  • said means for releasably securing the fluid filled receptacle to the substantially rigid component in the foot portion comprises a male member which corresponds to a female body member in the substantially rigid compbnent.
  • the female body member is located in the substantially rigid component of the foot portion in the area which corresponds to an in ant's heel.
  • the female body member typically has a spring which is depressed when the male member on the fluid filled receptacle is inserted into the female body member and rotated.
  • said means for releasable securing the fluid filled receptacle to the substantially rigid component in the foot portion takes the form of a bayonet fastening.
  • the pressure measuring means may be mechanical or electrical.
  • the pressure measuring means comprises a fluid filled pouch, located inside the flexible member and a transducer which is suspended within the fluid filled pouch.
  • the fluid is an inert substance such as silicone oil.
  • the teaching aid also comprises a user interface unit which includes a pressure measurement display.
  • the transducer converts the pressure measurement into an electrical output which is transmitted to and shown on the display.
  • the pressure measurement display comprises a needle meter.
  • the pressure measurement display may alternatively comprise a LCD display.
  • the teaching aid may also comprise indicating means.
  • the indicating means provides means for alerting the user when they apply an incorrect amount of pressure to the foot portion of the teaching aid.
  • the flexible member is manufactured from a soft elastomeric material such as polyurethane .
  • the polyurethane is in a foam form.
  • the soft elastomeric material may be coated in an elastomer or latex skin material such as polydimethylsiloxane.
  • the pierceable latex coating of the receptacle is substantially flush with the elastomer or latex skin material of the foot portion.
  • the foot portion can be provided in a variety of size and shapes to simulate a variety of conditions.
  • a second aspect of the present invention there is provided a method of practising blood sampling using the apparatus of the first aspect of the present invention, the method comprising the steps of:
  • the method may be used to practice heel puncture infant blood sampling.
  • FIGS 1 and 21 are illustrations of the teaching aid of the present invention.
  • FIG. 1 illustrates the production process for the leg component
  • Figures 3 and 4 are illustrations of the leg and foot portion
  • FIG. 5 is an illustration of alternative types of foot portion which can be used
  • Figures 6 and 12a are illustrations of the inner components of the foot and leg portions
  • FIGS 7, 8 and 11 illustrate the inner components of the foot portion
  • Figure 9 illustrates one embodiment of the pressure measurement display
  • Figure 10 is an illustration of the simulated ankle joint
  • Figure 12b is an illustration of the simulated hip joint
  • Figures 13 to 15 and 18 to 20 are illustrations of the receptacle which is received in the foot portion
  • Figures 16 to 17 show the manner in which the receptacles can be supplied and stored
  • Figure 21 show an exploded view of two receptacles in position on the foot portion, and;
  • Figure 22 shows the receptacle and the manner in which the receptacle can be fitted to the female part on the foot portion in more detaiL.
  • a teaching aid is generally depicted at 1, and comprises a flexible simulation of an infant's leg 2 which is mechanically jointed to simulate all ranges of naturally human movement.
  • the teaching aid allows a medical trainee to practice neonatal heel puncture blood sampling without any direct risk to actual infants.
  • the trainee performs each step of the procedure as they would on a real infant, by using the actual equipment necessary for blood collection. This allows them to fully familiarise themselves with the task and perfect their technique before doing it for real.
  • the apparatus includes a user interface unit 3 which has a pressure measurement display 4.
  • the display 4 may take the form of an LCD display. However, as shown in the depicted embodiment, the display may be in the form of a panel needle meter which allows real time feedback.
  • the display can be seen in greater detail in Figure 9 and in the depicted embodiment provides an easy to read pictorial indication of whether the pressure being applied to the foot of the teaching aid is satisfactory.
  • a suitable squeeze pressure is indicated by a smiling baby symbol 28, whilst excessive pressure is indicated by a crying baby symbol 29, and insufficient pressure is presented by a sleeping baby symbol 30.
  • This visual feedback lets the user relate their performance directly to the reality of the procedure.
  • the teaching aid may have an integral warning or indicator which provides an audible signal such as a buzzer if the user applies an incorrect amount of pressure (either too much or too little) to the foot portion. This is particularly useful if the user is practising the technique using the apparatus on his or her own, as he or she will be able to fully concentrate on the technique and will not have to stop to observe the visual feedback.
  • the leg 2 is manufactured from soft pliable materials which replicate the actual feel of an infant's leg. This is advantageous as the leg can be manoeuvred by the user realistically into an accessible position in order to collect a heel blood sample.
  • the "flesh" of the baby leg is made of a suitable polymer, for example polyurethane (PU) foam.
  • PU foam is particularly suitable as it is durable and can be manipulated using flexible moulding techniques. In addition, this material can be custom mixed into a suitable firmness.
  • the PU foam is provided in a two- part system which is compatible with reaction injection moulding (RIM) techniques at high or low pressures.
  • RIM reaction injection moulding
  • the leg is manufactured by pouring the polyurethane foam into a fibreglass mould 7, where it then expands in order to fill the cavity which surrounds the inner components of the legs (not visible when in use) .
  • the foam leg is then moulded in liquid polydimethylsiloxane (PDMS) to create a layer of "skin".
  • PDMS is an elastomer which has a elastic modulus of 2.12 x 10 3 (N/cm 2 ) which lies in the range quoted for normal human skin. This combination of PU foam flesh and PDMS elastomer skin provides a realistic feel for the user to squeeze.
  • the inner components include pressure measurement apparatus, which measures the amount of pressure or squeeze that the trainee uses on the teaching aid, and substantially rigid components which simulate the bones of the leg. These are described in more detail below.
  • the inner components of the leg are positioned between the walls of the fibreglass mould 7 as shown in Figure 2 and pressure is applied to the oil pouch through the tube connected to a pump.
  • the walls are closed around the inner components and the injection machine injects the PU foam mix.
  • the two-part lid is fixed around the neck of the simulated femur bone instantly, and the foam expands in the closed mould.
  • the teaching aid utilises solid silicone components to simulate the major bones of an infant's leg.
  • the simulated femur 8 tibia 9 and fibula 10 can be seen best in Figures 12a.
  • the scaled model of each bone is developed using CAD.
  • the human foot has a great number of bones, however the majority of these are insignificant to the technique herein described.
  • Those that are important are the calcaneous (heel) bone and the talus.
  • the calcaneous is very close to the skin of the heel and is the bone which must be avoided when puncturing the skin. It is therefore important that the trainee is able to feel the size and shape of this bone.
  • the talus is the bone which sits on top of the calcaneous and forms the hinge joint of the ankle. It is also important that the trainee can feel this joint working as the foot is bent back during the technique.
  • a simplified version of these bones is provided as a unitary component 12, shown in Figures 6 to 8.
  • a customised pin hinge joint is incorporated into the main body of the apparatus and is shown at 27 in Figure 10.
  • the compressible region of movement in a baby's ankle is represented in the apparatus with a 30°degree foam wedge.
  • the wedge is attached to the inside wall of the hollow shaft of the pin joint which is part of the foot bone.
  • the foam wedge When the foot has moved through 20°, the foam wedge hits the angled pin (attached either end to the lower leg bones) and is compressed for the next 30° of dorsiflexion. At its compressed limit of 50°, the solid surface attached to the other side of the foam wedge is pushed against the surface of the angled pin, and prevents any more movement
  • the baby leg comes in a two-part form, as shown in Figures 3 and 4, namely an actual leg portion 14 and foot portion 15.
  • the foot portion 15 is easily detachable from the leg portion 14 using a twist and pull action to allow for blood refill, capillary bed sponge replacement or change over of the baby heel module.
  • a number of different foot portions 15 are available for use with the leg portion 14, as shown in Figure 5.
  • the variety of foot portions allow different types of profusion, size and blood viscosities to be represented and practised upon.
  • a foot portion which represents a normal term infant can be used to practice the technique.
  • a foot portion which represents a premature infant or an infant with a "club" foot can be used.
  • Further foot portions which represent a cold under profused baby's foot or bruised over-pricked baby's foot may also be used.
  • the foot portion is adapted to receive at least one fluid filled receptacle 16, as best seen in Figure 1. Typically two fluid filled receptacles 16 are used.
  • the receptacles 16 can be releasably secured to the foot portion of the leg. The manner in which the receptacles 16 are secured is shown in greater detail in Figures 13 to 15.
  • the receptacle 16 as shown in Figures 13, 14 and 15, and in Figures 18 to 20, includes the pinned bulb male parts 17 of a bayonet fastening system which correspond to a female part 18 cemented inside unitary component 12 of the foot portion. This corresponds to the area of an infant's heel where a blood sample would typically be taken.
  • the receptacle has a replaceable, reticulated sponge or foam core 19 which accurately represents the capillary bed in a real baby's foot.
  • the reticulated foam core reservoirs and delivers a fluid, generally an artificial blood substances, or blood substitute, when the trainee punctures the receptacle and applies pressure to the foot portion 15.
  • the foam represents and replicates the capillary bed of tiny blood vessels beneath the skin which is punctured during the heel puncture of the real baby.
  • the skeleton structure of the fully opened pore flexible ester-type polyurethane foam is comparable to the human capillary bed network of blood vessels.
  • the entire receptacle can be removed from the foot portion 15 and replaced.
  • the receptacles are inserted into the heel at an angle of 45° from each plane as shown in Figures 11 and 21. This angle ensures that the dome lids of the receptacles, as described below, lie in the contour of the skin surface at the heel .
  • the receptacle 16 comprises a lower cup 20 which lies beneath the surface of the skin and an upper domed lid 21 which follows the contour of the heel surrounding it.
  • the cup 20 is connected to the male part 17 via a latex flange adhered to its base.
  • the disposable receptacles are replaced by the user after each use.
  • the structure of the receptacles and the manner in which they can be inserted and removed from the foot portion is shown in more detail in Figure 22.
  • Each receptacle is removed by pushing it into the open end of the female part 18 cemented inside unitary component 12 of the foot portion, thereby depressing the spring 22 inside the female part 18, shown in Figure 14 and then rotating it by a quarter turn while the pin bulbs 17 of the male part are guided by a track cut into the inside wall of the female part.
  • the spring which is now released pushes the ' receptacle out of the foot portion for simple removal.
  • To insert a new receptacle the process is repeated in reverse order.
  • the receptacles can be supplied to the user on a perforated latex sheet 22 ready to pop out as required, as shown in Figures 16 and 17.
  • the receptacle can be removed using the bayonet fastening which secures it to the simulated bone in the foot portion and disposed of.
  • a new receptacle is inserted into the fastening system.
  • a fluid filled receptacle is used to provide the "blood" in the flexible member, it is recognised other embodiments are possible.
  • the entire foot/leg/limb/member may be hollow or have a cavity which is filled with fluid.
  • the type of receptacle may differ from that described above, and take the form of a bag, sack or pouch which may simply sit in the flexible member, or be inserted, attached or mounted in the flexible member by any appropriate means, such as screws, adhesives, rubber bands or VelcroTM.
  • FIG. 23 An exploded view of the teaching aid is shown in Figure 23.
  • the user punctures the heel of the apparatus at a position determined by the blood letting receptacles, visible on the surface of the "heel".
  • the receptacles cover the surface area which has been confirmed to be safe to puncture with the depth control spring loaded lancet used in the real procedure. This teaches the user to recognise the safe area of the puncture site.
  • the blood letting receptacles have a fake blood saturated reticulated foam core which replicates the blood flow mechanism of the capillary bed.
  • references to a fluid capable of simulating blood are not intended to limit or in any way restrict the colour, consistency or chemical constituents of the fluid. Rather, references to the fluid being capable of simulating blood are simply intended to clarify that the fluid should be of sufficient fluidity and/or of a low enough viscosity for it to be extracted from the flexible member in a similar fashion to the manner in which blood would be extracted from a limb or member when taking a blood sample.
  • the teaching aid also comprises pressure measurement means, shown in Figure 6.
  • the leg 2 houses a miniature pressure transducer 23 which is suspended in a silicon oil pouch 24 (represented by the shaded area) , which covers an area of the leg and heel when pressure is applied.
  • a silicon oil pouch 24 represented by the shaded area
  • the silicon oil pouch covers these areas.
  • the pressure output from the transducer can be seen by the user on the calibrated needle meter 4 on the front face of the user interface unit 3, as shown in Figures 1 and 9.
  • the measure of success of the squeeze pressure being applied is indicated by an illustrated panel which the needle moves over.
  • the transducer is positioned distant to the heel as can be seen in Figure 6 so that the user does not feel it below the "skin".
  • the silicon oil is encapsulated in a silicon oil pouch which is sufficiently thin and flexible that it cannot be felt.
  • the miniature pressure transducer 23 effectively measures the squeeze pressure applied to the heel by measuring the pressure in the encapsulated silicone oil pouch 24.
  • the device is freely suspended in the oil pouch, which is positioned to fill the space between the simulated skin and the bone in the foot portion. As a result, the device is suspended further up the body of the apparatus at a necessary distance from where the user squeezes the heel.
  • the pouch has a watertight seal 25 to enclose the oil in the pouch and the wiring of the pressure transducer runs through a hole bored in the simulated femur bone 26 to the amplifier in the circuit box of the user interface unit.
  • the silicone oil is of particular use as it is an inert substance which will not degrade the electrical wiring of the pressure transducer.
  • the pouch has two holes at the heel to allow insertion and removal of the disposable puncture pouches.
  • any suitable type of miniature pressure transducer may be used, for example the entran EPL series.
  • the chosen transducers is sufficiently small and low profile so that it is not felt by the user under the skin of the leg.
  • the transducer typically has a thin elastic diaphragm which hangs freely in the pouch, with its surface in contact with the silicone oil. As the pressure in the oil changes, the diaphragm deflects.
  • the diaphragm has strain gauges on its surface, which accurately senses the small strains induced in it, and produces an output voltage proportional to the pressure.
  • the strain gauges are arranged on the diaphragm surface in a bridge circuit which increases the output signal and reduces the effect of noise.
  • the transducer converts the pressure measurement into an electrical output.
  • the output signal range is generally in the region of 50mV and the needle meter of the user interface unit generally has a range in the region of 0 to 10V, so a gain of 200 is required to use the full range of the meter.
  • the amplified voltage moves the needle of the meter shown in Figure 9.
  • the meter display is calibrated to show the successful range of pressure for the trainee to apply the heel of the teaching aid.
  • the invention mimics the texture, flexibility and appearance of a baby's leg in order for users and, in particular, trainee doctors, nurses and midwives to practice the heel prick procedure and gain feedback on their performance.
  • the invention allows practice of the procedure without any risk to patients.
  • Use of the apparatus will build the confidence of a user before they are required to take a blood sample from a real baby.
  • the apparatus will reduce actual risk of damage to the heels of newborn babies by allowing trainee doctors and nurses to prefect the technique using the apparatus before they must perform the procedure for real. This will minimise the risk of excessive or insufficient pressure being applied to a baby's heel during neonatal heel puncture blood sampling.
  • the teaching aid may be adapted such that it simulates a different body part or member, such as an arm, finger or toe, and can be configured to resemble either an adult, child or infant body member.
  • References in the present application to infants are intended to encompass newborns, neonates and small children.
  • the apparatus is intended for practising the taking of a blood sample in adults or older children, perhaps on the arm or finger
  • the medical training aid it would be sufficient for the medical training aid to be provided as a fluid filled flexible member, for example, with the fluid filled receptacle or receptacles.
  • the pressure measuring means may be omitted from the teaching aid if the taking of the sample would not, in reality, require the application of pressure or squeezing of the body member.

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Abstract

A teaching aid comprises a flexible simulation of a body limb or member and can be used to practise taking blood samples. In a described embodiment, the teaching aid simulating an infant’s leg which is mechanically jointed to simulate all ranges of naturally human movement, and allows a trainee to practice neonatal heel puncture blood sampling.

Description

Medical Teaching Aid
The present invention relates to a medical teaching aid for practising the taking of blood samples.
There are many instances where blood samples are taken from a patient. Phlebotomists regularly take blood samples for a variety of analytical purposes, whilst medical practitioners, nursing staff and also patients may be required to extract a blood sample in allergy, blood metabolite, and diabetic testing.
The extraction of a blood sample is, with practice, a generally quick and simple procedure. However, when faced with the requirement to take a sample for the first time, for example in a newly diagnosed diabetic patient, or during medical training, the procedure may seem awkward, tricky, or in some cases distressing or frightening.
Particular difficulties arise if the sample is to be taken from a baby, infant or child. Blood tests are carried out on newborn babies, typically of four to five days old, to screen for congenital and genetic diseases, such as phenylketonuria (PKU) , hyperthyroidism, cystic fibrosis and other thyroid problems. Currently the test involves pricking the baby's heel with an automatic incision device, and then squeezing the heel to obtain enough blood for the sample .
Different tests require different amounts of blood and are collected in different vessels. However, most lab tests can be carried out using small quantities of blood. The Guthrie Test, which is a routine blood test carried out on all newborns, involves the collection of a capillary blood sample obtained by a heel prick. Up to 1 ml of blood can be sampled from this method. Blood is collected on a blotting paper card with a number of circles which, for a sufficient sample, must be permeated on both sides with the blood. The test is usually carried out with automatic incision devices which ensure a prick depth of around 2.0mm to 2.4mm. This optimum depth produces the most blood (for a sufficient sample) whilst maintaining the safety of the baby.
It is vital that when the baby's heel is pricked, the incision device does not touch the calcaneous (heel) bone, arteries or nerves. Medical staff are currently instructed to puncture the plantar surface (sole) of the foot on the most medial or lateral portion (edges of the sole) . Staff should also avoid the posterior curvature of the heel (as this is where the bone is close to the skin) and previous puncture sites, as this can lead to infection and damage to the heel.
When carrying out the technique, staff will typically clean the baby's heel with an alcohol wipe, and wait for this to air dry before selecting a suitable puncture site as described above. The baby's heel is held firmly whilst the automatic incision device is positioned over the puncture site and activated. The incision device is then removed and the first drop of blood is wiped away from the baby's heel, which is then held downwards to allow blood flow. Pressure is then applied to the entire heel to produce a drop of blood to which a capillary tube can be held to collect. The pressure applied to the heel is eased intermittently to allow the capillary bed to refill with blood, so that a continuous blood flow is maintained. This procedure is sometimes known as an "ooze and ease" technique. When a capillary tube is filled with sufficient blood, the application of pressure is stopped, and a sterile gauze is held over the site with gentle pressure to stop the bleeding.
There are many factors which affect blood flow, including the profusion of the baby's heel (how warm it is), gravity (i.e., the position of the heel), the amount of pressure and technique used during squeezing of the baby's heel (i.e., whether it is constant or intermittent) and the amount of time which has elapsed since the original incision, as blood clots after approximately two minutes. The best "ooze and ease" technique described above effectively "milks" the heel as the application of intermittent pressure and easing allows the capillary bed to refill with blood. The procedure should be completed quickly before blood starts to clot, otherwise the heel must be re-pricked, at the risk of more pain or damage to the baby. Blood sampling of this type is performed by a variety of medical staff . For routine blood screening of newborn babies, a sample will be taken by a doctor or nurse in the hospital, or more commonly by a visiting community midwife when the baby is home. However, there is no formal training in the procedure or technique . In fact the current method of learning the procedure simply involves watching a tutor or third party perform the procedure. Effectively, the first few times the medical practitioner or nurse performs this procedure, they practice on actual infants. This is clearly undesirable, as the first few times are often unsuccessful. For example, lack of experience in carrying out the technique may result in an insufficient sample being taken, perhaps because the procedure takes too long and the blood clots before a sufficient amount is collected. Without experience, it is also often difficult to know how hard to squeeze the baby's heel to obtain a sufficient sample whilst causing minimum distress to the baby. This can result in a loss of confidence in carrying out the technique .
In addition, premature and sick babies have to have blood samples taken regularly, and sometimes every few hours. Samples are collected in a capillary tube and are tested for gas levels, such as oxygen or carbon dioxide. Because blood samples are required frequently, the baby's heel can become over-pricked, inflamed and bruised. In fact, some babies may have so many of these tests that further tests cannot be carried out until their heels have a chance to heal. Many medical procedures requiring practice and technique have teaching aids available which allow practitioners to practice before having to carry out the procedure on an actual patient. A particularly wide segment of this market relates to teaching aids for procedures involving needles and work beneath the skin. These procedures have a high risk of damage to the patient, which dictates the need for knowledge, skill and confidence from the medic. Newborn heel puncture blood sampling is recognised as a difficult procedure, which requires a number of attempts before the technique is perfected. However, there are no formal induction or training programmes, and very few teaching aids on the market specifically for this purpose. One of the few teaching aids on the market is a foam baby foot which is used as a teaching aid for the heel stick technique. However, this only acts as a demonstration tool and does not provide any kind of feedback or realistic experience. Brochures and videos are also available which provide a step-by-step visualisation of the blood collection process, however these do not replace the need for actual hands-on experience.
It is therefore an aim of an aspect of the present invention to provide a teaching aid which can be used to practice the taking of blood samples before carrying out the technique on actual persons or infants.
According to a first aspect of the present invention there is provided a teaching aid for practising the taking of a blood sample, comprising a flexible member capable of simulating a body limb or member, the flexible member being adapted to receive fluid capable of simulating blood, wherein the teaching aid also comprises pressure measuring means for measuring the application of pressure to the flexible member.
The teaching aid may be configured to simulate any body limb or member, such as an arm, finger or foot. In a particular envisaged embodiment, the teaching aid is configured to simulating an infant ' s foot .
The flexible member may also comprise a portion capable of simulating an infant's leg. Preferably the foot is detachable from the leg portion.
The flexible member is preferably adapted to receive at least one fluid filled receptacle.
Preferably the foot is adapted to receive at least one fluid filled receptacle in the area which corresponds to an infant ' s heel .
Preferably the fluid filled receptacle is replaceable and is preferably filled with an artificial blood substance.
Preferably the fluid filled receptacle comprises a reticulated foam core which acts as a reservoir for the artificial blood substance.
Most preferably the fluid filled receptacle has a pierceable latex coating to permit puncture by a needle or incision device.
Optionally the flexible member contains at least one substantially rigid component which simulates bone. The flexible member may optionally have at least three substantially rigid components. In this embodiment, the leg portion of the flexible member preferably comprises two substantially rigid components simulating the tibia and femur bones of the infant's leg. The foot portion preferably comprises one substantially rigid component which represents a simplified simulation of the bones of the foot and ankle .
Preferably the substantially rigid components are manufactured from a silicone material.
Preferably the substantially rigid components are connected via a plurality of joints which are adapted to simulate real movement of the joints of an infant's leg.
Preferably the fluid filled receptacle has means for releasably securing said receptacle to the substantially rigid component in the foot portion.
Preferably said means for releasably securing the fluid filled receptacle to the substantially rigid component in the foot portion comprises a male member which corresponds to a female body member in the substantially rigid compbnent.
Preferably the female body member is located in the substantially rigid component of the foot portion in the area which corresponds to an in ant's heel.
The female body member typically has a spring which is depressed when the male member on the fluid filled receptacle is inserted into the female body member and rotated.
Most preferably said means for releasable securing the fluid filled receptacle to the substantially rigid component in the foot portion takes the form of a bayonet fastening.
The pressure measuring means may be mechanical or electrical.
Preferably the pressure measuring means comprises a fluid filled pouch, located inside the flexible member and a transducer which is suspended within the fluid filled pouch. Typically the fluid is an inert substance such as silicone oil.
Preferably the teaching aid also comprises a user interface unit which includes a pressure measurement display. The transducer converts the pressure measurement into an electrical output which is transmitted to and shown on the display.
Preferably the pressure measurement display comprises a needle meter. The pressure measurement display may alternatively comprise a LCD display.
The teaching aid may also comprise indicating means. The indicating means provides means for alerting the user when they apply an incorrect amount of pressure to the foot portion of the teaching aid. Preferably the flexible member is manufactured from a soft elastomeric material such as polyurethane .
Preferably the polyurethane is in a foam form.
The soft elastomeric material may be coated in an elastomer or latex skin material such as polydimethylsiloxane.
Preferably when the fluid filled receptacle is secured in the foot portion the pierceable latex coating of the receptacle is substantially flush with the elastomer or latex skin material of the foot portion.
Preferably the foot portion can be provided in a variety of size and shapes to simulate a variety of conditions.
According to a second aspect of the present invention there is provided a method of practising blood sampling using the apparatus of the first aspect of the present invention, the method comprising the steps of:
- piercing the latex coating of the fluid filled receptacle on the foot portion of the flexible member; - applying pressure to the foot portion in order to draw a sample of the artificial blood substance; - receiving, from the pressure measurement display on the user interface unit, a visual signal corresponding to the amount of pressure which is applied to the foot portion; and
adjusting the amount of pressure which is applied to the foot portion in response to the visual signal. The method may be used to practice heel puncture infant blood sampling.
There will now be described by way of example only various embodiments of the invention, with reference to the following drawings, in which:
Figures 1 and 21 are illustrations of the teaching aid of the present invention;
Figure 2 illustrates the production process for the leg component;
Figures 3 and 4 are illustrations of the leg and foot portion;
Figure 5 is an illustration of alternative types of foot portion which can be used;
Figures 6 and 12a are illustrations of the inner components of the foot and leg portions;
Figures 7, 8 and 11 illustrate the inner components of the foot portion;
Figure 9 illustrates one embodiment of the pressure measurement display;
Figure 10 is an illustration of the simulated ankle joint;
Figure 12b is an illustration of the simulated hip joint; Figures 13 to 15 and 18 to 20 are illustrations of the receptacle which is received in the foot portion;
Figures 16 to 17 show the manner in which the receptacles can be supplied and stored;
Figure 21 show an exploded view of two receptacles in position on the foot portion, and;
Figure 22 shows the receptacle and the manner in which the receptacle can be fitted to the female part on the foot portion in more detaiL.
Referring firstly to Figure 1, a teaching aid is generally depicted at 1, and comprises a flexible simulation of an infant's leg 2 which is mechanically jointed to simulate all ranges of naturally human movement. The teaching aid allows a medical trainee to practice neonatal heel puncture blood sampling without any direct risk to actual infants. The trainee performs each step of the procedure as they would on a real infant, by using the actual equipment necessary for blood collection. This allows them to fully familiarise themselves with the task and perfect their technique before doing it for real. To assist in the learning process the apparatus includes a user interface unit 3 which has a pressure measurement display 4. The display 4 may take the form of an LCD display. However, as shown in the depicted embodiment, the display may be in the form of a panel needle meter which allows real time feedback. The display can be seen in greater detail in Figure 9 and in the depicted embodiment provides an easy to read pictorial indication of whether the pressure being applied to the foot of the teaching aid is satisfactory. For example, in the depicted embodiment, a suitable squeeze pressure is indicated by a smiling baby symbol 28, whilst excessive pressure is indicated by a crying baby symbol 29, and insufficient pressure is presented by a sleeping baby symbol 30. This visual feedback lets the user relate their performance directly to the reality of the procedure. In addition the teaching aid may have an integral warning or indicator which provides an audible signal such as a buzzer if the user applies an incorrect amount of pressure (either too much or too little) to the foot portion. This is particularly useful if the user is practising the technique using the apparatus on his or her own, as he or she will be able to fully concentrate on the technique and will not have to stop to observe the visual feedback.
The leg 2 is manufactured from soft pliable materials which replicate the actual feel of an infant's leg. This is advantageous as the leg can be manoeuvred by the user realistically into an accessible position in order to collect a heel blood sample. The "flesh" of the baby leg is made of a suitable polymer, for example polyurethane (PU) foam. PU foam is particularly suitable as it is durable and can be manipulated using flexible moulding techniques. In addition, this material can be custom mixed into a suitable firmness. Typically in manufacturing the leg, the PU foam is provided in a two- part system which is compatible with reaction injection moulding (RIM) techniques at high or low pressures. The production process for the leg component is illustrated in Figure 2. The leg is manufactured by pouring the polyurethane foam into a fibreglass mould 7, where it then expands in order to fill the cavity which surrounds the inner components of the legs (not visible when in use) . When set fibreglass mould is removed the foam leg is then moulded in liquid polydimethylsiloxane (PDMS) to create a layer of "skin". PDMS is an elastomer which has a elastic modulus of 2.12 x 103 (N/cm2) which lies in the range quoted for normal human skin. This combination of PU foam flesh and PDMS elastomer skin provides a realistic feel for the user to squeeze.
The inner components include pressure measurement apparatus, which measures the amount of pressure or squeeze that the trainee uses on the teaching aid, and substantially rigid components which simulate the bones of the leg. These are described in more detail below.
The inner components of the leg are positioned between the walls of the fibreglass mould 7 as shown in Figure 2 and pressure is applied to the oil pouch through the tube connected to a pump. The walls are closed around the inner components and the injection machine injects the PU foam mix. The two-part lid is fixed around the neck of the simulated femur bone instantly, and the foam expands in the closed mould.
The teaching aid utilises solid silicone components to simulate the major bones of an infant's leg. The simulated femur 8 tibia 9 and fibula 10 can be seen best in Figures 12a. The scaled model of each bone is developed using CAD. The human foot has a great number of bones, however the majority of these are insignificant to the technique herein described. Those that are important are the calcaneous (heel) bone and the talus. The calcaneous is very close to the skin of the heel and is the bone which must be avoided when puncturing the skin. It is therefore important that the trainee is able to feel the size and shape of this bone. The talus is the bone which sits on top of the calcaneous and forms the hinge joint of the ankle. It is also important that the trainee can feel this joint working as the foot is bent back during the technique. A simplified version of these bones is provided as a unitary component 12, shown in Figures 6 to 8.
Adult bones are solid, and as a result the ankle joint generally moves through a definite angle in plantar flexion (moving the foot towards the floor) and dorsiflexion (raising the foot towards the shin) . When one solid bone hits another, the flexion is limited, however newborn baby's bones are still developing and their composition is of compressible cartilage. As a result, the ankle joint of a baby is much more flexible than an adult joint, and this is used in the heel squeeze procedure by bending the baby's foot against the shin in order to get more blood. In the present invention it is important for the user to be able to have an accurate portrayal of the real-life technique, in other words to feel the flexibility of the newborn baby's ankle in order to practice the heel squeeze procedure realistically, and grow accustomed to bending the baby's foot right back against the shin of the lower leg. To incorporate this flexible limit, a customised pin hinge joint is incorporated into the main body of the apparatus and is shown at 27 in Figure 10. The compressible region of movement in a baby's ankle is represented in the apparatus with a 30°degree foam wedge. The wedge is attached to the inside wall of the hollow shaft of the pin joint which is part of the foot bone. When the foot has moved through 20°, the foam wedge hits the angled pin (attached either end to the lower leg bones) and is compressed for the next 30° of dorsiflexion. At its compressed limit of 50°, the solid surface attached to the other side of the foam wedge is pushed against the surface of the angled pin, and prevents any more movement
The bendy joints which are found in a newborn baby are replicated by the above described flexible limit ankle joint 27 (shown in Figure 10) ball and socket hip joint 13 (shown in Figure 12b) and a hinged knee joint 7 (shown in Figure 4) .
The baby leg comes in a two-part form, as shown in Figures 3 and 4, namely an actual leg portion 14 and foot portion 15. The foot portion 15 is easily detachable from the leg portion 14 using a twist and pull action to allow for blood refill, capillary bed sponge replacement or change over of the baby heel module. To assist in the training process, a number of different foot portions 15 are available for use with the leg portion 14, as shown in Figure 5. The variety of foot portions allow different types of profusion, size and blood viscosities to be represented and practised upon. As can be seen in Figure 5, a foot portion which represents a normal term infant can be used to practice the technique. Alternatively, a foot portion which represents a premature infant or an infant with a "club" foot can be used. Further foot portions which represent a cold under profused baby's foot or bruised over-pricked baby's foot may also be used.
The foot portion is adapted to receive at least one fluid filled receptacle 16, as best seen in Figure 1. Typically two fluid filled receptacles 16 are used. The receptacles 16 can be releasably secured to the foot portion of the leg. The manner in which the receptacles 16 are secured is shown in greater detail in Figures 13 to 15.
The receptacle 16 as shown in Figures 13, 14 and 15, and in Figures 18 to 20, includes the pinned bulb male parts 17 of a bayonet fastening system which correspond to a female part 18 cemented inside unitary component 12 of the foot portion. This corresponds to the area of an infant's heel where a blood sample would typically be taken. In one embodiment the receptacle has a replaceable, reticulated sponge or foam core 19 which accurately represents the capillary bed in a real baby's foot. The reticulated foam core reservoirs and delivers a fluid, generally an artificial blood substances, or blood substitute, when the trainee punctures the receptacle and applies pressure to the foot portion 15. The foam represents and replicates the capillary bed of tiny blood vessels beneath the skin which is punctured during the heel puncture of the real baby. The skeleton structure of the fully opened pore flexible ester-type polyurethane foam is comparable to the human capillary bed network of blood vessels. In an alternative embodiment the entire receptacle can be removed from the foot portion 15 and replaced. The receptacles are inserted into the heel at an angle of 45° from each plane as shown in Figures 11 and 21. This angle ensures that the dome lids of the receptacles, as described below, lie in the contour of the skin surface at the heel .
The receptacle 16 comprises a lower cup 20 which lies beneath the surface of the skin and an upper domed lid 21 which follows the contour of the heel surrounding it. The cup 20 is connected to the male part 17 via a latex flange adhered to its base. The disposable receptacles are replaced by the user after each use. The structure of the receptacles and the manner in which they can be inserted and removed from the foot portion is shown in more detail in Figure 22. Each receptacle is removed by pushing it into the open end of the female part 18 cemented inside unitary component 12 of the foot portion, thereby depressing the spring 22 inside the female part 18, shown in Figure 14 and then rotating it by a quarter turn while the pin bulbs 17 of the male part are guided by a track cut into the inside wall of the female part. The spring which is now released pushes the' receptacle out of the foot portion for simple removal. To insert a new receptacle, the process is repeated in reverse order. The receptacles can be supplied to the user on a perforated latex sheet 22 ready to pop out as required, as shown in Figures 16 and 17.
Once used, the receptacle can be removed using the bayonet fastening which secures it to the simulated bone in the foot portion and disposed of. For the next use of the teaching aid, a new receptacle is inserted into the fastening system. Although in the preferred embodiment a fluid filled receptacle is used to provide the "blood" in the flexible member, it is recognised other embodiments are possible. For example, the entire foot/leg/limb/member may be hollow or have a cavity which is filled with fluid. In addition, the type of receptacle may differ from that described above, and take the form of a bag, sack or pouch which may simply sit in the flexible member, or be inserted, attached or mounted in the flexible member by any appropriate means, such as screws, adhesives, rubber bands or Velcro™.
An exploded view of the teaching aid is shown in Figure 23.
In use, the user punctures the heel of the apparatus at a position determined by the blood letting receptacles, visible on the surface of the "heel". The receptacles cover the surface area which has been confirmed to be safe to puncture with the depth control spring loaded lancet used in the real procedure. This teaches the user to recognise the safe area of the puncture site. As the outer surface of the receptacle has a latex "skin" an incision can easily be made. Once an incision has been made, the user applies pressure to the heel in order to obtain a blood sample. The blood letting receptacles have a fake blood saturated reticulated foam core which replicates the blood flow mechanism of the capillary bed. The user must adopt the technique of squeezing and releasing intermittently in order to collect a sufficient sample. References to a fluid capable of simulating blood are not intended to limit or in any way restrict the colour, consistency or chemical constituents of the fluid. Rather, references to the fluid being capable of simulating blood are simply intended to clarify that the fluid should be of sufficient fluidity and/or of a low enough viscosity for it to be extracted from the flexible member in a similar fashion to the manner in which blood would be extracted from a limb or member when taking a blood sample.
In order to provide feedback on the user ' s technique the teaching aid also comprises pressure measurement means, shown in Figure 6. The leg 2 houses a miniature pressure transducer 23 which is suspended in a silicon oil pouch 24 (represented by the shaded area) , which covers an area of the leg and heel when pressure is applied. When pressure is applied during the technique, it is usually over the surface of sole of the foot and over the back surface of the ankle, up to about halfway up the leg. It is therefore important that the silicon oil pouch covers these areas. When the heel is being squeezed to obtain a blood sample, the pressure output from the transducer can be seen by the user on the calibrated needle meter 4 on the front face of the user interface unit 3, as shown in Figures 1 and 9. The measure of success of the squeeze pressure being applied is indicated by an illustrated panel which the needle moves over. The transducer is positioned distant to the heel as can be seen in Figure 6 so that the user does not feel it below the "skin". Similarily the silicon oil is encapsulated in a silicon oil pouch which is sufficiently thin and flexible that it cannot be felt. The miniature pressure transducer 23 effectively measures the squeeze pressure applied to the heel by measuring the pressure in the encapsulated silicone oil pouch 24. The device is freely suspended in the oil pouch, which is positioned to fill the space between the simulated skin and the bone in the foot portion. As a result, the device is suspended further up the body of the apparatus at a necessary distance from where the user squeezes the heel. The pouch has a watertight seal 25 to enclose the oil in the pouch and the wiring of the pressure transducer runs through a hole bored in the simulated femur bone 26 to the amplifier in the circuit box of the user interface unit. The silicone oil is of particular use as it is an inert substance which will not degrade the electrical wiring of the pressure transducer. The pouch has two holes at the heel to allow insertion and removal of the disposable puncture pouches.
Any suitable type of miniature pressure transducer may be used, for example the entran EPL series. The chosen transducers is sufficiently small and low profile so that it is not felt by the user under the skin of the leg. The transducer typically has a thin elastic diaphragm which hangs freely in the pouch, with its surface in contact with the silicone oil. As the pressure in the oil changes, the diaphragm deflects. The diaphragm has strain gauges on its surface, which accurately senses the small strains induced in it, and produces an output voltage proportional to the pressure. The strain gauges are arranged on the diaphragm surface in a bridge circuit which increases the output signal and reduces the effect of noise. The transducer converts the pressure measurement into an electrical output. The output signal range is generally in the region of 50mV and the needle meter of the user interface unit generally has a range in the region of 0 to 10V, so a gain of 200 is required to use the full range of the meter. The amplified voltage moves the needle of the meter shown in Figure 9. The meter display is calibrated to show the successful range of pressure for the trainee to apply the heel of the teaching aid.
The invention mimics the texture, flexibility and appearance of a baby's leg in order for users and, in particular, trainee doctors, nurses and midwives to practice the heel prick procedure and gain feedback on their performance. The invention allows practice of the procedure without any risk to patients. Use of the apparatus will build the confidence of a user before they are required to take a blood sample from a real baby. In addition, the apparatus will reduce actual risk of damage to the heels of newborn babies by allowing trainee doctors and nurses to prefect the technique using the apparatus before they must perform the procedure for real. This will minimise the risk of excessive or insufficient pressure being applied to a baby's heel during neonatal heel puncture blood sampling.
Although the embodiment herein described is specifically intended for use in practising heel puncture infant blood sampling, the teaching aid may be adapted such that it simulates a different body part or member, such as an arm, finger or toe, and can be configured to resemble either an adult, child or infant body member. References in the present application to infants are intended to encompass newborns, neonates and small children.
Where the apparatus, is intended for practising the taking of a blood sample in adults or older children, perhaps on the arm or finger, it will be appreciated that it would be sufficient for the medical training aid to be provided as a fluid filled flexible member, for example, with the fluid filled receptacle or receptacles. In other words, the pressure measuring means may be omitted from the teaching aid if the taking of the sample would not, in reality, require the application of pressure or squeezing of the body member.
Various modifications and improvements can be made within the scope of the invention herein intended.

Claims

1. A teaching aid for practising the taking of a blood sample, comprising a flexible member capable of simulating a body limb or member, the flexible member being adapted to receive fluid capable of simulating blood, wherein the teaching aid also comprises pressure measuring means for measuring the application of pressure to the flexible member.
2. A teaching aid as claimed in Claim 1 where the flexible member simulates an arm.
3. A teaching aid as claimed in Claim 1 where the flexible member simulates a finger.
4. A teaching aid as claimed in Claim 1 where the flexible member simulates a foot.
5. A teaching aid as claimed in Claim 4 where the flexible member simulates an infant's foot.
6. A teaching aid as claimed in Claims 5, where the flexible member also comprises a portion capable of simulating an infant's leg.
7. A teaching aid as claimed in Claim 6, where the foot is detachable from the leg.
8. A teaching aid as claimed in the preceding Claims, where the flexible member is adapted to receive at least one fluid filled receptacle.
9. A teaching aid as claimed in Claims 4 to 8, where the foot is adapted to receive the at least one fluid filled receptacle.
10. A teaching aid as claimed in Claim 9, where the foot is adapted to receive the at least one fluid filled receptacle in the area which corresponds to the heel of the foot .
11. A teaching aid as claimed in the preceding Claims where the fluid filled receptacle is replaceable.
12. A teaching aid as claimed in the preceding Claims where the fluid filled receptacle is filled with an artificial blood substance.
13. A teaching aid as claimed in Claim 12 where the fluid filled receptacle comprises a reticulated foam core which acts as a reservoir for the artificial blood substance.
14. A teaching aid as claimed in the preceding Claims where the fluid filled receptacle has a pierceable latex coating to permit puncture by a needle or incision device.
15. A teaching aid as claimed in the preceding Claims where the flexible member contains one or more substantially rigid components which simulate bone.
16. A teaching aid as claimed in Claim 15, where the one or more substantially rigid components are manufactured from a silicone material.
17. A teaching aid as claimed in Claims 15 to 16 having at least two substantially rigid components connected via a plurality of joints which are adapted to simulate real movement of the body limb or member .
18. A teaching aid as claimed in Claims 15 to 17 where the fluid filled receptacle has means for releasably securing said receptacle to a substantially rigid component in the foot.
19. A teaching aid as claimed in Claim 18, where the means for releasably securing the fluid filled receptacle to a substantially rigid component in the foot comprises a male member which corresponds to a female body member in the substantially rigid component.
20. A teaching aid as claimed in Claim 19, where the female body member is located in the substantially rigid component of the foot in the area which corresponds to the heel of the foot.
21. A teaching aid as claimed in Claims 19 to 20, where the female body member typically has a spring which is depressed when the male member on the fluid filled receptacle is inserted into the female body member and rotated.
22. A teaching aid as claimed in Claims 18 to 21, where said means for releasably securing the fluid filled receptacle to a substantially rigid component in the foot takes the form of a bayonet fastening.
23. A teaching aid as claimed in the preceding Claim where the pressure measuring means is mechanical.
24. A teaching aid as claimed in the preceding Claim where the pressure measuring means is electrical.
25. A teaching aid as claimed in the preceding Claim where the pressure measuring means comprises a fluid filled pouch, located inside the flexible member and a transducer suspended within the fluid filled pouch.
26. A teaching aid as claimed in Claim 25 where the fluid contained in the fluid shaped pouch is an inert substance such as silicone oil.
27. A teaching aid as claimed in the preceding Claim comprising a user interface unit which includes a pressure measurement display.
28. A teaching aid as claimed in Claims 25 to 27 where the transducer converts the pressure measurement into an electrical output which is transmitted to and shown on the pressure measurement display.
29. A teaching aid as claimed in Claims 27 to 28 where the pressure measurement display is a needle meter.
30. A teaching aid as claimed in Claims 27 to 28 where the pressure measurement display is an LCD display.
31. A teaching aid as claimed in the preceding Claim comprising indicating means for alerting the user when they apply an incorrect amount of pressure to the flexible member of the teaching aid.
32. A teaching aid as claimed in the preceding Claim where the flexible member is manufactured from a soft elastomeric material such as polyurethane.
33. A teaching aid as claimed in Claim 32, where the polyurethane is a foam.
34. A teaching aid as claimed in Claims 32 to 33, where the soft elastomeric material is coated in an elastomer.
35. A teaching aid as claimed in Claims 32 to 33, where the soft elastomeric material is coated in a latex skin material such as polydimethylsiloxane.
36. A teaching aid as claimed in Claims 8 to 35, where the pierceable latex coating of the receptacle is configured such that it is substantially flush with the elastomer or latex skin material of the foot when the fluid filled receptacle is secured in the foot.
37. A method of practising blood sampling using the apparatus of Claims 1 to 36, the method comprising the steps of: - piercing the latex coating of the fluid filled receptacle on the foot portion of the flexible member; - applying pressure to the foot portion in order to draw a sample of the artificial blood substance; - receiving, from the pressure measurement display on the user interface unit, a visual signal corresponding to the amount of pressure which is applied to the foot portion; and - adjusting the amount of pressure which is applied to the foot portion in response to the visual signal .
PCT/GB2005/002157 2004-06-11 2005-05-31 Medical teaching aid WO2005122105A2 (en)

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US9916773B2 (en) 2007-05-21 2018-03-13 Jc3 Innovations, Llc Medical device and procedure simulation and training
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US9886874B2 (en) 2007-05-21 2018-02-06 Johnson County Community College Foundation, Inc. Medical device and procedure simulation and training
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GB0413022D0 (en) 2004-07-14

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