The specific objectives of this experiment are: to evaluate the rack mounted equipment and medical supplies necessary for medical procedures; to evaluate the attachments, mounting points, and inner drawer assemblies for the medical supplies; and to evaluate the procedures for performing medical scenarios. The resources available in the HMF miniracks to accomplish medical scenarios and/or procedures include: medical equipment mounted in the racks; a patch panel with places to attach tubing and catheters; self contained drawers full of critical care medical supplies; and an ALS 'backpack' for deploying supplies. The attachment lines, tubing and associated medical supplies will be deployed and used with the equipment and a patient mannequin. Data collection is provided by direct observations by the inflight experimenters, and analysis of still and video photography

Gosbee, John

Krupa, Debra T.

Orsak, Debra

Pepper, L.

English

NASA Technical Reports Server

ATLS:CAT_'rExANDTUBEPLACEMENT
i r"
N91- 2782
PRINCIPLE INVESTIGATORS:
CO-INVESTIGATORS:
John Gosbee, M.D. (KRUG)
Debr/_ru pa (KRUG)
FLIGHT DATE:
L. Pepper, D.O. (NASA SD2)
D. Orsak (MIY3SC) ....
February 28,1990
F
r
TEST OBJECTIVE:
Evaluate the equipment and procedures for performing medical procedures
during microgravity.
TEST DESCRIPTION:
The specific objectives of this experiment are: 1) to evaluate the rack-
mounted equipment and medical supplies necessary for medical procedures;
and 2) to evaluate the attachments, mounting points, and inner drawer
assemblies for the medical supplies; and 3) evaluate the procedures for
performing medical scenarios. The resources available in the HMF mini-
racks include to accomplish medical scenarios/procedures include: 1)
medical equipment mounted in the racks; 2) a patch panel with places to
attach tubing and catheters; 3) self-contained drawers full of critical care
medical supplies; and 4) an ALS "backpack" for deploying supplies. The
attachment lines, tubing and associated medical supplies, will be deployed
and utilized with the equipment and a patient mannequin. Data collection
is provided by direct observations by the inflight experimenters, and
analysis of still and video photography.
EQUIPMENT AND CONFIGURATION:
Two mini-racks (19"x30"x48")
• Central supply drawer located near the top of the rack
• Drawer with the ALS pack and tubing located at the bottom of the rack
MF.D1CaL EV,ILUarIONS Ot¢ rnE KC-135:1990 Fuam" P,ZPORr SUMMARY
https://ntrs.nasa.gov/search.jsp?R=19910023468 2020-03-17T14:59:49+00:00Z
ATLS: CAT_R AND Tue_ PLACEMENT
• Patch panel with connections for suction and oxygen tubing located
near the bottom of the rack
HMF prototype Medical Restraint System
Patient Mannequin with capability to simulate insertion of:
• Foley catheter
• Naso-gastric tube
• Endotracheal tube
(See Figure I for a graphical depiction of the configuration)
DATA ACQUISITION:
• In-flight written questionnaires
• Self report post-test
• Still and video photography
EXPERIMENTER INFORMATION:
John Gosbee (JG) Male 6'1" 165#
Debra Krupa (DK) Female 5"5" 115#
Larry Pepper (LP) Male 5'11" 155#
IN-FLIGHT TEST PROCEDURES AND ASSSOCIATED RESULTS:
Names and locations of CMO's for first 1 3/4 procedures:
DK is Chief CMO, on near side of MRS with Swiss seat waist restraint or
using ad hoc restraints in front of the racks (e.g. using one hand, or a short
tether)
MEDICAL EVALUATIONSON_ KC-135:1990 FLK;HTRZPORT SUMM_Y
_ 72_
ATLS: CA'rt.m'rERAND TUBE PLACEMENT
February 28, 1990
,_o Goso....o. F IGUR E 0 N E
MINI-RACK AND PATIENT RESTRAINT
LAYOUT FOR KC-135
_V
ROPE FOR WAIST
ATTACHMENT
AROUND THE
PERIMETER
Central Supplies
MEDICAL RESTRAINT using Black Foam
SYSTEM (MRS) PROTOTYPE ""
I
EMPTY DRAWER
Patch Panel -- _
oo o oo°
0 0 0 0 0 0 _ Drawerwlths
0 0 0 0 0 0 0 packandtu_Jng
O O O O O O O
MED1C_/. EVALUA_ONS ON _. KC-135:1990 Fuc_n" REPORT SUMMARY
73
ATLS:CA_ZT_RAND TUBE P_CEME_r
JG is Asst. CMO, on far side of MRS with Swiss seat waist restraint
1. DK destows a sharp trash container, hands it toJG to deploy on far side
of MRS
DK "cheated" in deploying this from behind the Patient Monitor.
Otherwise it was easy to handle, and for JG to fix between the rope and
the edge of the MRS.
JG 9
. DK destows the soft trash container and deploys on near side of MRS
with JG's assistance. Since DK's restraint at low altitudes was poor, and
she only could use one hand, JG had to assist from underneath.
JG 5
FOLEY CATHETER
o Both CMO's put on sterile gloves, DK first since she won't stay sterile.
DK had to use one hand to restrain herself in front of the racks to
disengage and open the drawer.
Having one CMO hold the opened packet of gloves was necessary for
the other to aseptically put them on. The CMO has to place one hand
on the finger tip end and one hand holding the folded paper open.
JG 7 (if there is enough time, and both CMO's know the proper
technique)
2. DK destows, opens and presents a FREPP to JG, who uses it to prep the
area, and then hands the FREPP to DK for disposal
DK had to twist and stretch to her limit to disengage the drawer, and
open it. Once open, one FREPP could be fairly easily removed, opened,
and presented to JG in an aseptic fashion.
JG 8
3. DK destows, opens, and presents the Foley catheter to JG; DK disposes
the overwrap.
DK had to twist and stretch to her limit to open the drawer; but stretched
MEDICAL EVALUATIONSON_ KC-135:1990 FuGm" REPORT SUMMARY
_74_
ATLS: CA_TER AND TUBE I'_CE_NT
.
°
less once the drawer is opened up and closer to the MRS. No problem
destowing or presenting the Foley. However, DK had to be real careful
to not let any unsterile part of the overwrap, or her arms touch the sterile
Foley that JG was extracting.
JG 6
DK destows Foley tube and bag, and attachs tube to Foley catheter, and
bag to edge of MRS
DK could easily reach these items in the now extended drawer, but
decided to extract several items at once (like a squirrel), and place them
under bungees near the mannequin legs for easy access. JG had to give
the Foley catheter end to DK, who then attached it the tube and bag,
which was accomplished easily, since both DK and JG were well
restrained and could use both hands. The overwrap for the Foley bag
did not fit in to the soft trash container, and was difficult to bend or crush
in an attempt to do so.
JG 8
DK destows the water-filled Foley syringe, and checks the Foley balloon
on the catheter.
Upon removal of the syringe from itsoverwrap, water was sprayed out.
DK had to grab the Foley catheter end, because JG and DK couldn't line
them up.
JG 8, if DK grabs both the syringe and the catheter end.
o DK destows the KY jelly, JG covers the end of the Foley catheter with
jelly, inserts into urethra of mannequin, and DK blows up balloon.
It was almost impossible for JG to manuver the sterile tip of the Foley
into the small openingofthe KY jelly packet, which DK was holding. In
fact, the tip touched the outer edge of the packet and became"unsterile".
This was due to fine tremors in both hands, and some unsteadiness in
the CMO restraint mechanisms. (Another method for doing this
procedure is required!)
JG 2
MEDICAL EVALUATIONSON _ KC-135:1990 Fxzcnr R£PORT SUMMARY"
75
ATLS:CATHETERANDTUBE PLACEMENT
7o DK destows generic plastic tubing and at-tachs one end to low
intermmittent suction on the patch panel, and the other end of Foley
bag.
The tubing was located in a drawer near the floor, as was the patch
panel. Since DK had to release from the MRS to access these two areas,
she had to restrain herself with only one hand. This method was
unsteady and uncoordinated, so extraction of the tubing was slow, and
dislodged other items in the drawer; and attaching the tubing to the
patch panel was slow and the tubing wasn't attached very well. In
addition, the velcro strips that held down the cover used to hold items
in the lower drawer was almost impossible to put back into place
properly.
JG 3 destowing tubing
JG 8 attaching tubing to Foley
JG 4 attaching tubing to patch panel
OVERALL COMMENTS:
More intensive one-g practice, and/or more parabolas to accomplish certain
tasks, may have made the above tasks easier to accomplish in microgravity.
Some tasks above were abbreviated, or accomplished in the 2-g portion of
flight in the interest of time (e.g., putting on gloves, repositioning some
loose items).
Since adequate restraint mechanisms for a CMO in front of the racks have
not been identified or evaluted,ad hoc methods were attempted by DK with
very limited success.
NASO-GASTRIC (NG) TUBE
1. ALS pack is destowed, opened, and bungeed to the end of the MRS
Since the ALS pack was in the back of the low drawer, DK again had
difficulty opening the drawer, opening the velcroed cover, and extracting
the pack. In fact, DK opened the entire cover, but the other items in the
drawer were wedged into place and did not float out.
M_DIC__L EvaLuano_s o_ _ KC-135:1990 Fuau'r REPORT Su_Y
76--
ATLS:CATI-mrERAND TUBE PLaCEM_N'r
Placing and restraining the ALS pack over the legs of the mannequin
required both DK and JG. Several items that were loosely held down
inside the pack floated loose during the deployment. Since there was
no labels or color code cues, it was difficult to replace loose items, and
good restraint areas of the pack got "filled" up quickly with several
disparate items. Bob Williams made a very astute comment: "its too
busy, you can't find things, or remember where to restow them".
JG 5
2. DK destows tape from drawer, hands toJG, who tears longpiece of tape
o
4m
1
Similar problems to those above. This cloth tape tended to "stick" to the
black foam, and was hard to remove from the drawer.
JG 6
DK destows a generic piece of tubing, attacks one end to the suction port
on the patch panel, and holds the other end near the patient head.
Again, the access to the lower drawer and patch panel was difficult, but
there was some decrease in those difficulties with practice.
JG 4
DK destows the NG tube, unwraps it, and hands it toJG. DK disposes
overwrap material.
No real problem with the upper central supply drawer extended.
Again, DK removed several items, including some listed below, and
placed them under bungees located over the mannequin's legs.
JG 8
DK destows the 60cc syringe, and hands toJG, who attacks it to the NG
tube
No problems noted. JG 8
6. DK destows KY jelly, JG covers end of NG tube with jelly
MEDIC.aL EVAaUAnONS ON TR_ KC-135:1990 Fucn'r RzPoaT Su_,RY
77
ATLS:CA'r_TER AND TUeE Pt_CEM_N'r
Since the NG tube does not have to be sterile, DK could hold both the
KY packet and the NG tube tip at the same time. Thus, there was no
difficulty accomplishing this procedure.
JG 9
7. JG inserts tube into nares of mannequin
Since JG had solid waist restraint, this two-handed procedure was no
more difficult than in one-G. JG 10
8. DK tapes NG into place.
LP takes DK place on the near side of the MRS from the racks.
DK takes JG place on the far side of the MRS from the racks.
9. LP destows a stethoscope from the ALS pack. Difficulty finding this,
since it was in an opaque zippered pocket
JG 7
10. LP at-tachs NG tube to generic suction tubing, and then to the patch
panel. Suction turned on and set at low intermittent on patch panel.
Since LP is taller, and has longer arms, he is able to reach the patch panel
while still attached to the MRS (i.e. restrained at the waist). Thus, this
task was easier than DK was doing it.
OVERALL COMMENTS:
Since this is a clean procedure, not an sterile one, both CMO's could
manipulate all items utilized, and work together. During Foley catheter
insertion, JG could only touch sterile items, but not non-sterile items; and
DK could not touch sterile items, but could handle non-sterile items.
Therefore, this procedure was accomplished easier and faster than Foley
catheter insertion.
Both LP and DK had abit of difficulty in finding items in the upper drawer
and the various areas of the ALS pack. Both had to be careful not to dislodge
items loosely held underneath elastic when vigorously extracting another
item.
MEDICAL EVALUATIONSON FI-ff.KC-135:1990 FUCHT REPORT SUMMARY
78 m
ATLS: Ca_R Am TuBE PL^CEMEnT
NASAL CANNULA
1. DK destows nasal cannula oxygen tube from ALS pack
2. DK gives cannula end to LP to place on mannequin nose and head
With proper waist restraint, LP sould use both hands and easily place
the nasal cannula, with DK's help. JG 8
3. LP attachs other end of nasal cannula tube to oxygen outlet on patch
panel, and sets the flow rate to 4 liters per minute
No problems noted in attaching the cannula. JG 7. However, there were
so many tubes going from the patch panel to the mannequin that LP was
getting his feet tangled when he moved from place to place around the
MRS (recall that the feet pressing against the floor provides the main
stabilization forces, when using the waist restraint on the MRS).
INTUBATION
1. LPdestows tip suction and catheter from lowerdrawer, and attachs one
end to the patch panel suction port.
LP has some difficulty destowing and manipulating this tubing. Once
attached to the panel, LP stuck the tip suction under the mannikin's left
arm/shoulder, since no site for restraining this end of the suction near
the patient's head had been planned or designed for.
JG 7
2. LP moves to head of table
Quite abit of difficulty releasing the carabiner, and then reattaching it
to the rope that is strung around the perimeter of the MRS.
JG4
3. DK destows two pieces of laryngyscope from ALS pack, assembles
them and hands it to LP. DK destows ET tube, 10 cc syringe, and AMBU
bag from the ALS pack, and gives them to LP.
M_DIc_.4L EVALUAnO_S O_ _ KC-135:1990 Fucffr REPORT SUMM/a_Y
79
ATLS:CATHETERAND TUBE PLACEMENT
SaLP first tried to hold the laryngoscope, AMBU bag, and ET tube in his
hands, but found that he needed to locally restrain some of them. In fact,
with LP's first attempt to intubate he forgot that he needed the AMBU
bag and the suction tip ready to use.
For the second trial, LP gathered all the items under a bungee near the
head of the mannequin prior to attempting the intubation.
4. LP intubates mannequin
o
o
7o
The posture necessary for LP to visualize the pharynx of the mannequin
for intubation was difficult to attain and keep. LP needed to bend d own,
move his lower torso away from the MRS, and then extend his neck
backwards. However, hiswaistrestraintimpeded thismanuver. There
is a need to rapidly access the ET tube and laryngoscope right after
removing the face mask and suctioning the patient's oro-pharynx.
JG 6
DK attachs AMBU bag and ventilates mannequin, while LP checks for
breath sounds with a stethoscope.
No real problems noted
JG 9
LP destows ventilator tubing and attachs one end to the "ventilator"
and the other end to the ET tube.
Again, there was some problem accessing the tube and attaching it,
since both the drawer and patch panel were close to the floor. There did
appear to be a training effect regarding restraint during access to the
lower drawers, which LP also mentioned.
JG 6
JG replaces LP near the racks
LP replaces DK on the other of the MRS
JG destows tape and rips off pieces. JG tapes ET tube into place, while
LP holds it up.
MEDICAL EVALUATIONSON_ KC-135:1990 FuG_rr R_'ORT Su_MJa_Y
m SOB
ATLS: CATHFrER A_ TU_E PL^_cr
No problem with destowing, but this cloth tape is hard to rip. Since it
takes two hands to manuver the tape, another set of hands has to hold
the ET tube out of the way
JG 8
OVERALL COMMENTS:
JG was able to adequately restrain his body near the bottom of the racks. To
do this he "wedged" his body the MRS and racks, by placing his upper back
against the edge of the MRS surface, and feet pushing up against the racks.
This manuver required a certain amount of flexibility, and height.
CENTRAL VENOUS CATHETER PLACEMENT
1. JG destows gloves and assists LP in putting them on aseptically
Specific technique required (see above)
JG destows FREPPs, presnts to LP, who preps left shoulder
No problems noted. JG 9
3. JG removes tape and rips six pieces (4 for drapes and 2 for IV bags)
No problems noted. JG 9
4. JG hands two one tape-edged drapes to LP one at a time. JG assists LP
with laying it down on the side near LP, while DO tapes the two edges
Very hard to control all four loose edges of the drape without
contamination, since LP is "sterile" and JG "dirty". It appears that
packaging the drapes appropriately, and defining proper 0-G procedures
could overcome these difficulties.
JG4
5. DO removes a syringe and CV catheter, and presents them to LP
aseptically.
,
MEDICAL EV,ILUaVIONSON vat KC-135:1990 FLICm"ReeORT SUMMARY
81
ATLS:CArd-'rExAND TueE PL_c_rr
.
7.
The catheter and syringe were easy to shake out of there hard plastic
containers so that LP could grab them in a sterile fashion.
JG 9
LP mock inserts the CV catheter
The low fidelity of simulation for this particular task makes evaluation
difficult. A mannequin that allows better simulation is required.
JG no comment
JG removes an IV bag with tubing already attached from the ALS pack,
and gives it to LP.
With all the other lines and tubes next to the mannikin's head, it is
difficult to find an open spot to restrain the IV bag and catheter.
NASA PHOTO REFERENCE
$90-31759 - 60
Peparation of catheter for insertion
$90-31762 - 63
Deployment of package material
$90-31766 - 67
Peparation of catheter for insertion
$90-31776 - 78
Deployment of package material
$90-31782 - 87
Deployment and usage of various tubing
$90-31792 - 93
Deployment and usage of various tubing
M_.DICAL EVALUATIONSON THEKC-135:1990 Fucm" REPORT SUMMARY
82


ATLS: Catheter and tube placement

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