Laerdal Virtual Phlebotomy User Manual
Virtual I.V.
Directions for Use
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Self-directed Phlebotomy learning
SIM-003-W00 rev B
Virtual Phlebotomy
Directions for Use
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Virtual Phlebotomy
Directions for Use
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Virtual Phlebotomy
Directions for Use
Tabl e of C ont e nts
CONTENTS
1 Introduction 5
2 Benefi ts, Learning Objectives and Features 11
3 Setting up the system 17
4 Quick start user guide 27
5 Using the haptic device 35
6 System overview 39
7 Training Sequence 55
8 Administration 67
9 Packing up the system 85
10 Frequently asked questions (FAQ) 91
11 Support 99
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Virtual Phlebotomy
Directions for Use
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Virtual Phlebotomy
Directions for Use
Introduction
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Virtual Phlebotomy
Directions for Use
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Virtual Phlebotomy
Directions for Use
Introduction Introduction
1 INTRODUCTION
Virtual Phlebotomy is a Self-Directed Learning System for training the cognitive and psychomotor skills
of venous blood specimen acquisition for accurate laboratory analysis.
Virtual Phlebotomy conforms to all relevant standards and guidelines developed by the Clinical
and Laboratory Standards Institute (CLSI) and the Occupational Safety and Health Administration
(OSHA). To ensure that Virtual Phlebotomy is appropriate for your training needs, a host of instructor configurable options allow the system to be configured to local guidelines, local protocols, and the
needs of your specific learner community.
Virtual Phlebotomy serves as an alternative to the human arm while retaining all of the elements
necessary to a realistic learning experience, except the risk. The training system provides phlebotomy
education and hands-on skills practice, allowing learners to practice the procedural, cognitive and
motor skills of phlebotomy.
Advanced 3-D graphic animation and state-of-the-art force feedback technology provide the learner
with a true-to-life feel for all aspects of the phlebotomy procedure including vein palpation, needle
manipulation, skin and vein puncture, tube attachment, exchange and inversion, venipuncture site
pressure application and dressing, and needle removal. The simulator includes an extensive spectrum
of patient models, case scenarios tailored to specific learning objectives, pathophysiologic reactions,
and complications.
At the heart of the learning process is the comprehensive assessment of performance, competency
review mechanisms, and a complete competency training curriculum.
Novices will find that with every simulation, they will learn from their mistakes, complications, and
the automated assessment, remembering critical steps and improving their performance; while more
expert practitioners will be surprised by the scope and realism of the simulation, and its ability to
accurately reproduce important training elements of the procedure.
This Directions for Use is to be used only as a reference for the system, as the simulator provides a
‘System Tutorial’ video, a ‘Procedural Training’ video, ‘Help’ screens, and guiding messages that can
stand on their own for tutoring the student in how best to use the simulator.
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Virtual Phlebotomy
Directions for Use
Introduction
1.1 This Manual includes:
• The Learning Objectives for this product, to serve as a guide both for instructors and
students to make best use of the training benefi ts offered by the Virtual Phlebotomy SelfDirected Learning System.
• Instructor benefi ts, student benefi ts and a comprehensive feature list.
• Directions for setting up the system, including the equipment included with product and the
‘care’ of the haptic device. This section includes the Quick Start Set-Up guide, also included
as a fold-out with the product packaging.
• The Quick Start Reference guide, which provides the trainee with rapid directions for use of
the Virtual Phlebotomy simulator and haptic device.
• An instructional manual for using the Virtual Phlebotomy simulator for both the student and
instructor.
• A simple overview of the debriefi ng, competency training, and competency review functions
of the Virtual I.V. product.
• A frequently asked questions guide for addressing any problems encountered with the product
• Customer support contact information.
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Virtual Phlebotomy
Directions for Use
Benefits, Learning Objectives and Features
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Virtual Phlebotomy
Directions for Use
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Virtual Phlebotomy
Directions for Use
Benefits, Learning Objectives
& Features
Benefits, Learning Objectives
& Features
2 BENEFITS, LEARNING OBJECTIVES AND FEATURES
Virtual Phlebotomy allows students to practice and instructors to train in a risk-free environment,
while maintaining the stress of a real world procedure through complete visual and tactile realism.
simulator trains a broad range of cognitive and psychomotor skills in phlebotomy based on a diversity
of patient case scenarios and 3D anatomical models, from pediatric to geriatric, that encompass the
variability of human anatomy and physiology.
Virtual patients respond with physiological reactions based on your interaction with virtual anatomy,
virtual equipment, the force feedback device, and the specific case scenario. Bleeding, bruising, vein
engorgement, vein collapse, vein compromise and vein rolling, are just some of the pathologies
and obstacles encountered throughout learning. A host of other complications force the learner to
respond appropriately and add depth and realism to the learning experience.
This
2.1 Learning Objectives
• Overcome initial discomfort and fear associated with performing phlebotomy.
• Includes all of the relevant learning and training objectives of the CLSI (Clinical Laboratory
and Standards Institute) venous specimen acquisition guidelines.
• Students must select proper tubes for the tests requested, apply them in the proper order of
draw, cleanse the site properly with the proper antiseptic, identify the patient, and perform
all of the steps critical to every venipuncture.
• Simulates and trains all critical steps and skills of Phlebotomy; from patient identifi cation, to
specimen acquisition, to proper specimen handling and labeling.
• Standard Precautions and infection control
• Patient identifi cation and interaction
• Site and vein selection
• Necessary equipment selection, and proper equipment usage
• Site preparation for specifi c tests
• Venous access with a multi-sample needles
• Specimen tube selection and usage
o Correct Tube/Additive Selection
o Correct order of draw
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Virtual Phlebotomy
Directions for Use
Benefits, Learning Objectives
& Features
• Pressure application and puncture site dressing
o Correct order of Draw
o Proper site cleansing technique
o Specimen compromise
o Proper specimen mixing
• Common and rare complications and how to deal with them.
o Learn the feel of the procedure including palpating veins, needle insertion and feeling
the “pop”, attaching the specimen tubes, applying pressure, dressing the puncture site,
stretching the skin to stabilize the vein, and removing the needle.
o Exposure to a variety of patient anatomies, patient cases and complications, force the
learner to learn the procedural variations necessary to successfully complete the specimen acquisition procedure.
o Exposure to less common, more advanced, specimen acquisitions such as blood cultures
and specimens requiring special cleansing techniques.
• Perform differential diagnosis of patient cases, related to acquisition of venous blood specimens in different areas of the arm and hand.
• Learn proper hand position for performing the procedure for venous access, specimen acquisition and venipuncture site dressing.
• Perform appropriate bevel orientation and angle of insertion during multi-sample needle stick.
• Progress through a tiered hierarchy of ever more diffi cult patient cases, ranging from beginning student through advanced practitioner.
• Recover from complications such as vein collapse in the elderly and accidental arterial sticks.
• Learn the importance of complications such as nerve involvement by actually penetrating
nerves; producing an audible response from the patient.
• Learn realistic equipment behavior, such as vacuum loss in a specimen tube if attaching a tube
to the tube holder when needle is outside the skin.
2.2 Benefits for the instructor
• Allows instructor to train, and learner to practice, the actual procedure with complete realism in an environment that is risk-free to the patient, learner and instructor.
• Because Virtual Phlebotomy is fully self-directed, the instructor can leverage his classroom
lectures and direct interactions with the students by allowing students to practice the procedure on their own time with comprehensive assessment.
• Extensive assessment evaluates each step of the procedure while competency review structures allow the instructor to obtain a comprehensive understanding of student’s progress,
specifi c strengths and specifi c weaknesses.
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Virtual Phlebotomy
Directions for Use
Benefits, Learning Objectives
& Features
• Metrics-based debriefi ng of student performance facilitates effective feedback and guidance to
students.
• Simplifi es training and skills sustainment with an engaging training environment.
• Confi gurable options align training to local guidelines and protocols and adjust the training
curriculum to correspond to the needs, requirements and capabilities of the learners.
• Exposes students to real-world cases and situations.
• Presents the student with a customized training experience adjusted to their needs and performance level.
• A comprehensive phlebotomy procedure training video and a system tutorial video introduces
the learner to the system allows the learner to start using the system and learning phlebotomy almost immediately with minimal instructor oversight.
• Printable debriefi ngs allow students to document their progress.
• Full integration with the Laerdal Competence Management System allows remote instructor
oversight and education management.
2.3 Benefits for the student
• Unlimited practice of common and rare patient cases.
• Progression through a tiered hierarchy of cases of increasing diffi culty.
• Learn and practice needle procedures through interaction with life-like patient anatomy in
real-world scenarios.
• Select “Practice Cases” for quick play that is not recorded or “Competency Training” for
more structured procedural simulations and performance tracking.
• Track your progress as you progress through competency training.
• Learn and review proper I.V. insertion procedures, anatomy and physiology with dynamic
simulations and tutorials.
• Extensive assessment evaluates each step of the procedure from Patient Identifi cation, to
Tube Labelling and provides video tutorials for each incorrect step, allowing students to
understand their errors, learn from their mistakes, and improve skills with every case
scenario
• Automated debriefi ng identifi es critical and non-critical errors, and provides videos and
animations depicting ideal performance and possible complications.
• Comprehensive phlebotomy procedure training video covers the complete process of phlebotomy by venous access, including complications, (how to avoid and deal with them), causes
of pre-analytical errors, etc.
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Virtual Phlebotomy
Directions for Use
Benefits, Learning Objectives
Benefits and Learning Objectives
• Printable debriefi ngs allow students to document their progress.
• Full integration with the Laerdal Competence Management System allows students to remotely review progress and understand problem areas.
2.4 Overall Features
• Conforms to and trains all of the protocols, guidelines and procedure steps developed by
CLSI (Clinical Laboratory and Standards Institute) and OSHA (Occupational Safety and
Health Administration) for a complete understanding of phlebotomy for safe venous specimen
acquisition and accurate laboratory results.
& Features
• 57 Unique Case Scenarios focus on specifi c learning objectives
• Over 20 case scenario and site specifi c simulation variables add realism and variability to the
simulation
• Case scenario specifi c debriefi ngs provide accurate and relevant post-procedure feedback.
• 27 practice cases with previews of the patient arm can be accessed directly.
• 3 Level Competency Training with cognitive tests and remediation
• More advanced levels include additional complications such as vein collapse and provide less
guidance on proper tube selection and draw order.
• Cognitive questions follow training guidelines for novice and expert users.
• 29 unique patient models range in age from pediatric to geriatric and encompass the variability of human ethnicity, anatomy and physiology.
• Each model presents different challenges and characteristics in the context of phlebotomy.
• 4 available vein access sites per patient including the left and right antecubital, and the left and
right Dorsal Hand (including Medial Wrist).
• A 3D interactive Anatomical Viewer presents pronated and supinated arm models that can be
selectively dissected to reveal underlying anatomical structures to provide comprehensive and
intuitive learning of relevant anatomy.
• A comprehensive phlebotomy procedure training video covers the complete process of phlebotomy by venous access; including patient and site preparation, proper procedure, complications, causes of pre-analytical errors, etc.
• A system tutorial video trains the learner to use the Virtual Phlebotomy system.
• The Competency Review structure records student progress during competency training and
provides insight into learner training progress.
o View individual case scenarios and cognitive test debriefi ngs.
o Print individual case scenarios and cognitive test debriefi ngs.
o View a learning curve for learner competency training.
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Virtual Phlebotomy
Virtual Phlebotomy
Directions for Use
Directions for Use
Benefits, Learning Objectives
Benefits and Learning Objectives
& Features
o Focus on the last 10, 25, or 50 cases to understand current problems areas.
o Identify specifi c skill weaknesses across a number of completed cases.
2.5 Simulation Features
• Force feedback (Haptic) simulation allows users to feel the “pop” of venipuncture, as well as
the sponginess of veins when palpating.
• Skin and vein puncture forces depends on the model and the case scenario, as well as the
location and size of the vein.
• Vein palpation strength depends on the size and depth of the vein, as well as the model and
specifi c case scenario.
• Veins that are not visible may still be palpable.
• Over two dozen pieces of equipment and a number of procedure steps specifi c to phlebotomy add depth, understanding, and a sense of immersion to the simulation experience:
• Hand washing and gloves are included for proper aseptic technique.
• Different gauges of multi-sample needles must be chosen based on the site and the specifi c
case scenario requirements.
• Tubes with different additives must be attached in the proper draw order.
• A tube tray is provided to store your empty tubes and acquired specimens.
• Sharps, Bio-Hazard and Trash Containers can be selected for proper equipment disposal.
• Three different site cleansers must be used appropriately for the case scenario and specimen
being acquired; Chlorhexidine Wipe, Alcohol Wipe, Povidine Iodine swab.
• Site must be properly dressed with either an adhesive dressing or tape and gauze.
• 12 different tubes (6 different additives, 2 draw sizes) with confi gurable colors for specifi c
additives.
• A Pop-Up tube reference chart identifi es the tests, and appropriate tubes, tube order, and
tube additives.
• Correct equipment behavior and equipment failure simulation
o Tourniquet application engorges the distal veins.
o Apply pressure to the site with gauze while removing the needle.
o Vacuum loss if specimen tube is attached to needle when needle is outside the skin.
o Tube fi ll rate depends on the case scenario.
o Applying a warm compress to the site will engorge the veins if applied for long enough.
• Proper Tube mixing; learner must invert the specimen tubes for proper mixing.
• Tube labeling includes specifi c handling and labeling instructions for each specimen.
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Virtual Phlebotomy
Directions for Use
Benefits, Learning Objectives
Benefits and Learning Objectives
• Asking the patient to make a fi st realistically engorges the veins.
• Variable vein blueness and visibility, depending on the case scenario.
• Check patient identifi cation and if they followed physicians orders.
• Pre-existing conditions including in-place equipment force learners to use alternate, less optimal sites for venous access.
• Complications
o Bruises appear as a result of mistakes made during venous access and continue to grow
until pressure is applied.
o Accurate simulation of vein collapse in elderly patients. The simulation allows you to
recover from vein collapse by attaching a short draw tube or reapplying the tourniquet.
o Accurate simulation and assessment of nerve penetration. Patients respond with an audi-
ble exclamation when nerve involvement occurs.
o Prolonged bleeding for patients on anti-coagulant therapy requires the learner to apply
pressure to the haptic device until bleeding stops.
o Accidental sticks of the artery produce redder blood, faster fi ll, prolonged bleeding and
can be submitted as samples. Pulsing arteries can actually be felt during palpation.
o Inserting a large needle into a small vein will cause vein compromise, bruising and
swelling.
o Needle probing (excessive movement during insertion) causes bruising.
o Veins roll when the skin is not stretched to anchor the vein.
& Features
2.6 Usability Features
• The user can navigate to different sites, gather equipment and view the case scenario while
performing the procedure.
• A Haptic Device Interact icon tells you when and how to interact with the haptic device dur-
ing the procedure.
• An automatic tube attachment option will automatically attach tubes form the tube tray to
minimize mouse clicks.
2.7 Debriefing/Assessment Features
• Debriefi ng ensures the learner performs the procedure correctly, or is negatively assessed.
• Printable debriefi ngs allow students to document their progress.
• Assessment of equipment usage, complications and procedure tasks.
• Subcutaneous animations for venous access attempts and training videos for all errors.
• Fully integrated with the Laerdal Competence Management System.
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Virtual Phlebotomy
Directions for Use
Setting up the system
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Virtual Phlebotomy
Directions for Use
Benefits and Learning Objectives
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Virtual Phlebotomy
Directions for Use
Setting up the System
3 SETTING UP THE SYSTEM
WARNING
Precautions when using the haptic device
• The haptic device is a precise and sensitive instrument. To ensure proper working order, please
handle with care.
• Dropping the haptic device, bending the needle, or other abuse may render the device
inoperable.
• To ensure proper functionality, calibrate the haptic device as required.
• Although the needle is blunt, it can still cause injury if used in an improper manner. Be careful
and always replace them in the needle holder after use.
• Before starting the procedure, make sure that the needle is completely removed from the device
and that the specimen tube is completely removed from the needle. Here is a schematic of the
needle / specimen tube confi guration:
• After completing procedure, remove the needle from the device CAREFULLY and SLOWLY
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Virtual Phlebotomy
Directions for Use
Setting up the System
WARNING
Precautions when using the haptic device
• The Virtual Phlebotomy™ Self-Directed Learning System has been designed to work on the
computer supplied with the product. The computer is an integral part of the system. It will
not work on other computer platforms, because of its requirements for very specifi c, high
speed graphics capabilities. Do not attempt to install and run this software on any other
computer other than that which has been provided by the manufacturer.
• No software should be installed on the computer supplied with the Virtual Phlebotomy™
Self-Directed Learning System, except for those products supplied by the manufacturer of
the software.
• Running any program, such as anti-virus software, on the computer supplied with the simulator, may cause the Virtual Phlebotomy™ Self-Directed Learning System to crash or slow
the simulation to an unstable condition. This is a dedicated computer and should not be
used for other purposes, except those explicitly stated by the software manufacturer.
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Virtual Phlebotomy
Directions for Use
Setting up the System
This diagram, also available as a fold-out set of instructions that is included in the
Virtual Phlebotomy™ packaging, explains the order of unpacking and installation of
the simulator. Special attention should be paid to unpacking the haptic device and
plugging in the cables in the correct order and placement.
(1) Set-up and turn on the computer as indicated by the manufacturer:
(2) Plug in the power cord of the haptic device into the wall socket, but do not connect to haptic device:
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Virtual Phlebotomy
Directions for Use
Setting up the System
(3) Plug in the USB cord of the haptic device into the computer, but do not connect to haptic device:
WARNING
Do not discard your packing materials or shipping restraint.
You will need these to move/transport your device.
(4) Remove the haptic device and needle holder from the packaging:
(5) Completely remove the restraining strap carefully from the haptic device:
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Virtual Phlebotomy
Directions for Use
Setting up the System
(6) If the needle is not already attached to the haptic device, remove the haptic device needle from the
software packaging and plug it into the connector at the back of the haptic device.
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Virtual Phlebotomy
Directions for Use
Setting up the System
Plug the (7) USB cord and (8) Power Cord into the back of the haptic device. (9) Plug the power
cord from the wall socket into the power brick. The haptic device, which has been pre-calibrated by
the manufacturer, is now ready to use with the simulator:
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(10) The completed, set-up Virtual Phlebotomy™ Self-Directed Learning System. Note the location
of the haptic device directly in front of the monitor.
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Virtual Phlebotomy
Directions for Use
Setting up the System
(11) Before using the software, you will first need to obtain license keys for the
modules you have purchased.
(11.1) Exit the Boot Screen.
Contact your laerdal representative or customer service agent to obtain
(11.2)
the license module key.
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Virtual Phlebotomy
Directions for Use
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Virtual Phlebotomy
Directions for Use
Quick start user guide
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Virtual Phlebotomy
Directions for Use
Setting up the System
QuickStart User Guide
4. QUICK START USER GUIDE
This guide provides the trainee with a quick path through the application, based on the use of
the Practice Case mode. It is expected that the beginning student will either have had a class in
Phlebotomy and/or have watched the System Tutorial and Procedure Training videos to understand
the Virtual Phlebotomy Self-Directed Learning System and the procedure.
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Virtual Phlebotomy
Directions for Use
QuickStart User Guide
QUICK START GUIDE
Turn on the computer. To start the application, click on the Virtual Phlebotomy section of the Boot Screen Menu.
1. Logging In
Once started, log onto the application with one of two default users :
Username: demouser1
Password: password
Username: demouser2
Password: password
Login as Administrator to access Instructor features and create accounts:
Username: Administrator
Password: <Provided on the information sheet inside your desktop computer, or by
Laerdal Technical Service at 1 (800) 431-1055 EXT. 5596. This password will always
work, even if you change the Administrator password.>
Read further instructions to learn how to create new user accounts.
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QuickStart User Guide
QuickStart User Guide
2. Main Menu
This screen presents a menu of options, including:
Virtual Phlebotomy
Directions for Use
Virtual I.V.
Directions for Use
• Competency Training Mode: A progressive, tiered hierarchy of case studies and required skills that
ranges from novice (Level 1) to expert (Level 3).
• Practice Cases: Individual cases can be tried from all of the levels.
• Anatomical Viewer: This module presents a three-dimensional (3D) model of the arm that can be
used to identify structures and learn anatomy.
• Procedure Training: This video introduces the beginning student to the techniques and skills
required for venous specimen acquisition.
• System Tutorial: This video shows the trainee how to use the Virtual Phlebotomy simulator
system.
• Competency Review: This module shows the trainee record of performance.
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