FASTx Trainers Manual

Trainers Manual
April 2010 www.pyng.com

2010 Pyng Medical Corp.
Pyng Medical Corp. www.pyng.com
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This Trainers Manual is an essental component of the
FASTx
TM
Sternal Intraosseous Device educaton program. It
contains the guidelines and informaton needed to
eectvely and e ciently teach emergency personnel how to
perform sternal intraosseous (IO) infusion using the FASTx.
Although the FASTx can be quickly and easily mastered, this
is a SPECIALIZED MEDICAL PROCEDURE WHICH SHOULD NOT
BE ATTEMPTED BY UNTRAINED PERSONNEL.
Quality educaton is paramount to ensure users achieve
the highest levels of competence and condence with this
lifesaving device.
Upon completon of training students will be able to:
Discuss the principles of intraosseous infusion
List indicatons and precautons for use of the FASTx
Demonstrate safe and eectve use of the FASTx on a
manikin and on training devices
Explain and demonstrate the removal procedure for
the FASTx
Pyng Medical Corp. is commited to saving lives in seconds.
Comments and suggestons for improvement of training and
use of the FASTx are greatly appreciated.
Pyng Medical Corp.
7-13511 Crestwood Place
Richmond BC V6V 2E9 Canada
Phone:
604-303-7964
1-800-349-7964
TRAINERS MANUAL
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TABLE OF CONTENTS
INTRODUCTION ................................................................................. 1
INTRAOSSEOUS INFUSION AND FASTx...............................................2
INDICATIONS AND PRECAUTIONS.......................................................5
DEMONSTRATION .............................................................................. 6
STEP-BY-STEP INSTRUCTIONS ............................................................ 7
SKILL PRACTICE TO MASTERY ............................................................ 9
REMOVAL ........................................................................................ 10
FASTx TRAINING DEVICE INSTRUCTIONS..........................................11
TROUBLESHOOTING ........................................................................ 16
FASTx SKILLS EVALUATION .............................................................. 18
FASTx WRITTEN EVALUATION ......................................................... 19
REFERENCES.....................................................................................23
FASTx LESSON PLAN
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INTRODUCTION
(5 minutes)
1. Introduce yourself and welcome students
2. Display course objectves:
By the end of this session you will be able to:
Discuss the principles of intraosseous infusion
List indicatons and precautons for use of the FASTx
Demonstrate safe and eectve use of the FASTx
on a manikin and training device
Explain and demonstrate the procedure for removal
of the FASTx
3. Provide overview of training:
Brief discussion of intraosseous infusion and
FASTx device
Demonstraton of FASTx (done in real-tme)
Step-by-step instructon
Skill practce to mastery
Troubleshootng
Evaluaton

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1. Have students recall their most recent cardiac arrest
patents (codes) or most recent atempt to secure
vascular access on a trauma casualty, and then ask
these questons:
Were you able to establish a patent IV?
How many atempts were required?
How long did this process take?
Were chest compressions interrupted to start
the IV?
Would your patents benet from a faster, more
reliable procedure?
Studies show it takes an average of 3-12 minutes to
establish an IV with failure rates of 10-40% in the
pre-hospital set ng. Transport is ofen delayed due
to the di culty of insertng an IV in a moving
vehicle.
2. Ask:
Who is familiar with IO?
Who has done IO before?
How does IO work?
Fluids and medicatons infused into the bone
marrow are drained into the vascular/circulatory
system
Who has performed this Sternal IO procedure on
a patent?
Ask the student to share briey about the
experience.

INTRAOSSEOUS INFUSION AND FASTx
(10-15 minutes)
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3. FASTx:
Provides vascular access comparable to a central
line
The manubrium is the most eectve IO site
(research shows uids and medicatons reach the
heart in 20-30 seconds) due to its close proximity
to the heart and immediate absorpton via internal
mammary and azygos veins which empty directly
into vena cava.
Takes about 10 seconds to insert, less than
60 seconds for entre procedure
Does not interfere with other procedures and
can be used concurrently (compressions,
cricothyroidotomy, etc.)
The locaton of the manubrium inserton site
high on the torso is ofen protected in trauma
and military situatons, and allows for
emergency care from a single area near the
patents head
Can be inserted while transportng the patent in
moving vehicles
Fluids and medicatons can be administered as
you would for IV such as slow drip, boluses or
pressure infuser
Fluids and medicatons have been infused
into sternums at 30ml/min by 1m gravity drip,
120ml/min by pressurized source and 250 ml/
min by syringe (infusion rates)
Safe for patent (penetrates 6mm into the
manubrium) and sta
Is quick to learn and easy to retain
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4. Pass around sample Infusion Tubes
Note its exibility this allows it to move with
patents skin which prevents it from dislodging
Look at steel bone portal it will be inserted just
inside marrow space
Approximately 14 gauge inner diameter tubing
Approximately 17 gauge inner diameter portal
See page 3 for system infusion rates
5. Hold up Introducer
Releases at a depth of 6 mm from the surface of
manubrium to place in the marrow space
Muscle-powered
(not batery-dependent, spring-loaded or
pneumatc)
- Typically approximately 30 pounds into
Simstern block
- Compare to typical CPR at approximately
90 pounds
- Actual force will vary depending on patent
anatomy
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Establish a sternal Intraosseous access route for
uids or drugs
For patents 12 years of age and older (adolescent
to adult)
Use whenever vascular access is required to
facilitate emergency resuscitaton
Can be lef in place up to 24 hours

PRECAUTIONS/WARNINGS
Trauma, infecton or burns at inserton site may
preclude use
Safety with very severe osteoporosis has not been
proven
Use in patents with recent sternotomy may prove
less eectve
The functon of the device may be aected by
fracture of the sternum or vascular injury which may
compromise the integrity of the manubrium or its
vascularizaton
Inserton in sites other than the manubrium may
result in ineectve infusion and/or serious injury to
the patent and are not approved
Reuse of FASTx is not recommended due to the
potental of cross-contaminaton, which may lead to
serious injury or death. The FASTx is unlikely to
functon afer use.
INDICATIONS
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1. Be sure the trainer, manikin and other equipment are
ready for a speedy, awless procedure. Practce,
practce, practce!
2. Invite someone to tme it. Ask students to hold their
questons untl aferward.
3. Describe a real-life scenario with the manikin as
your patent
(ex1: Heres a 68 year-old male in cardiac arrest we
need to give drugs Im going to use the FASTx.)
(ex2: A 19 year-old male with bilateral lower extremity
amputaton is in severe pain following tourniquet appli-
caton, hemorrhage and breathing have been controlled
and the airway is secure. There are no visible or pal-
pable peripheral veins because of signicant blood loss.
Im going to use the FASTx to secure vascular access.)
4. Perform procedure.
5. Ask if this appears to be superior to numerous IV
atempts, interruptng CPR and/or delaying transport.
DEMONSTRATION
(Should be less than 1 minute)
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1. Expose sternum and locate sternal notch.
Tell students to place nger in the
sternal notch.
Have them pair up and do the same with their
partner.
This is the landmark its easy to nd on any
patent. Thats where you place the Target Foot.
2. Clean inserton site.
3. Remove the Adhesive Liner with the Locking Pin.
By pulling the Locking Pin o, the Adhesive Liner
comes o too.
4. Stand at patents head or side, hold Introducer in
dominant hand (or as comfortable).
Align the Target Foot notch with the patents
sternal notch.
Point out that this is over the midline and
perpendicular to the manubrium.
Hold Introducer perpendicular to manubrium and
PAUSE. Consider the angle of the manubrium.
This positon ensures the Infusion Tube tp will be
inserted correctly.
Give everyone an opportunity to see what
perpendicular to the manubrium looks like and
also model NOT perpendicular.
STEP-BY-STEP INSTRUCTIONS
(5-10 minutes)
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5. Press down completely with increasing force
untl you hear and feel Infusion Tube separate
from Introducer.
Hold this positon while you ask a couple of
students to describe the pressure you just used.
Note: The force used will be less with the FASTx
than with the FAST1 (for those with experience with
the FAST1). Please see step 5 on page 4.
Reinforce that it was smooth and steady.
Dont stab, jab or twist just push untl it
releases.
6. Withdraw the FASTx Sternal straight back while
holding down the Target Foot.
Support comes out with the Infusion Tube.
Discard the FASTx Sternal following local
contaminated sharps protocols.

7. Connect the IV line, or source of uid or
medicaton, directly to the luer.
Clip the Strain Relief Hook on the Infusion Tube luer,
to the Target Foot clip.
Opton: (refer to your protocol)
Flush with uid to clear
Conrm placement by aspiraton
8. Remove the liner from the Protectve Dome and
apply the Dome over the Target Foot Infusion Site.
Use of the FASTx Dome is optonal as the Target
Foot also provides protecton.
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Most medical providers will only need one or two trials to
be totally competent and condent however, since everyone
achieves mastery of psychomotor skills at a dierent rate, be
sure to plan for and allow plenty of tme with this secton.
Remember, once a medical provider feels comfortable with
the FASTx, he/she is more likely to utlize it.
HANDY TEACHING HINT:
Put the students who nish rst to work: they can quickly
be taught to reset the trainer, turn the manikins disk, etc.,
which frees you up to work more closely with anyone who
requires more instructon. Reassure those who are struggling
that, I needed to practce that a few tmes too.
SKILL PRACTICE TO MASTERY
(Time variable)
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Students are taught how to remove the FASTx because
theres a strong possibility the hospital sta may
request assistance (or just reassurance) with the
procedure.
1. Remove Protectve Dome from Target Foot.
2. Turn o the source of uid and medicaton and
disconnect IV tubing.
3. Grasp Infusion Tube with ngers or clamp and pull
perpendicular to the manubrium untl entre
Infusion Tube (including metal tp) emerges from
the patents chest.
Note: pull in one contnuous moton (do not start/
stop) untl removed. Use the tube to pull, not
the luer connecton. It is normal for the tubing to
stretch.
4. Peel o the Target Foot and dress the site as per
standard protocol.
5. Discard Infusion Tube and Target Foot following
local contaminated sharps protocol.

REMOVAL of FASTx
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DEPLOYMENT
1. Remove the red Locking Pin from the Handle of
the FASTx Training Device.
Note: The FASTx Training Device does not have the
Adhesive Liner on the Target Foot.
2. Place the FASTx Training Device on a Simstern
block (yellow foam with plastc over white foam).
3. Ensure to push down completely to deploy the
FASTx Training Device into the Simstern block.
FASTx TRAINING DEVICE INSTRUCTIONS
11
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4. Pull the FASTx Training Device straight back while
holding down the Target Foot to separate the
Handle from the Infusion tube, which is now
inserted into the Simstern bone.
5. Connect the luer to the IV line or source of uid
or medicaton. Connect the Infusion Tube Strain
Relief Hook to the Target Foot.
6. Place the Dome over the Target Foot.
Note: Use of the FASTx Dome is optonal as the
Target Foot also provides protecton.
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7. To remove, grip as close to the lower end of the
Infusion Tube as possible.
Pull the Infusion Tube out from the Simstern
bone.
Note: Pull in one contnuous moton (do not start/
stop) untl removed. Use the tube to pull, not
the luer connecton. It is normal for the tubing to
stretch.
RESETTING THE FASTx TRAINING DEVICE
1. Reset the FASTx Training Device using the Reset
Tool.
Push the Reset Tool into the hole in the back of the
FASTx Handle. Push gently untl you hear and feel
a click.
Note: You do not need to push hard to reset the
FASTx Training Device.
2. Carefully push down on the Needle Cover, and
hold it down with your thumb and/or ngers to
prepare for the next step.
REMOVAL
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3. While holding down the Needle Cover, load the
Infusion Tube over the Stylet.
Note: Load the Infusion Tube with the Strain Relief
Hook towards the side of the Handle (90 degrees
from the FASTx logo).
4. Load the blue Ant-Buckle into the slot next to the
Stylet with Infusion Tube.
Ensure to snap the Ant-Buckle into place.
5. Snap the Target Foot back on the Needle Cover.
Ensure that the Target Foot notch is aligned with
the Handle notch.
6. Check alignment of the Target Foot on the Needle
Cover. Ensure each needle is in its respectve
separate hole. (If not, repeat step 5.) Pull Needle
Cover back out in place.
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7. Snap the red Locking Pin back in the Handle.
8. The FASTx Training Device is now ready for re-use.
Note: The FASTx Training Device needles will get
worn with re-use and the device may need to be
replaced.
The Infusion Tube will stretch afer multple uses
and may need to be replaced.
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1. Fluid or medicaton does not ow through IV line to site.
Flush to clear. If uid or medicaton does not ow even
afer ushing, infusion should be discontnued and an
alternatve method of vascular access should be used.
2. Leakage at Inserton Site (Extravasaton).
If excessive, use alternatve method of vascular access.
3. First atempt to place FASTx fails.
Double check inserton site, patent positon, medic
positon, and try again with a new device. Be sure to re-
mind students to save a device if the procedure/atempt
with the FASTx was not successful (afer protectng the
sharps) for shipment back to Pyng for examinaton.
4. Removing entre Infusion Tube
Pull perpendicular to the manubrium untl the entre
Infusion Tube (including metal tp) emerges from the
patents chest.
Ensure to pull in one smooth contnuous moton (do not
start/stop) untl removed. Use the tube to pull, not the
leur connecton. It is normal for the tubing to stretch.

5. Introducer does not release.
Pull Introducer back, if Infusion Tube remains in patent,
verify placement by aspiratng marrow, proceed with
use.
If marrow cannot be withdrawn, remove tube and insert
second FASTx.
TROUBLESHOOTING
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6. Introducer releases but Infusion Tube is not secured in
patent.
Use new FASTx.
7. Force is applied but Introducer does not release.
Without pulling back, ensure Introducer is perpendicular
to manubrium and force is being applied directly along
this line.
TROUBLESHOOTING
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1. Expose Sternum and locate Sternal Notch
2. Clean inserton site
3. Remove Adhesive Liner and Locking Pin
4. Stand at patents head or side, hold Introducer in
dominant hand (or as comfortable)
5. Align Target Foot with patents Sternal Notch
6. Press down completely with increasing force untl Infu-
sion Tube separates from Introducer

7. Withdraw FASTx straight back while holding down the
Target Foot
9. Discard the FASTx following local contaminated sharps
protocols
10. Connect the source of infusion to the luer
11. Clip the Strain Relief Hook on the Infusion Tube luer to
the Target Foot clip
12. Remove liner from Protectve Dome and apply Dome
over the Target Foot Infusion Site (use of the FASTx
Dome is optonal)
FASTx SKILLS EVALUATION
18
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1. Precautons/Warnings for the FASTx include:
a) previous sternotomy
b) compromised skin over site
c) severe osteoporosis
d) all of the above
2. The landmark for the Target Foot is the:
a) xiphoid process
b) sternal notch
c) subclavian ridge
d) Angle of Louis
3. Preparaton of the site should include:
a) sterile draping
b) wash with soap and water
c) maintain aseptc technique throughout the procedure
d) no preparaton is recommended
4. Approved sites for the FASTx include:
a) manubrium of sternum
b) medial tbia
c) proximal humerus
d) none of the above
FASTx WRITTEN EVALUATION
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5. Proper placement of the Infusion Tube can be ensured
by holding the Introducer:
a) at a 45-degree angle to the oor
b) perpendicular to the manubrium
c) vertcal to the body of the sternum
d) aimed toward the heart
6. The Introducer is powered by:
a) pneumatc force
b) bateries
c) springs
d) muscles
7. How should force be applied to the Introducer?
a) with a quick thrust
b) smooth, increasing untl release
c) steady, decreasing for 5 seconds
d) any of the above is acceptable
8. The FASTx can be lef in place for:
a) 24 hours
b) 1 hour
c) only untl the patent is stabilized
d) 48 hours
9. Which of these can be delivered through the FASTx?
a) epinephrine
b) blood and blood products
c) normal saline or Ringers Lactate
d) all of the above
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1. Precautons for the FASTx include:
a) previous sternotomy
b) Compromised skin over site
c) severe osteoporosis
d) all of the above
2. The landmark for the Target Foot is the:
a) xiphoid process
b) sternal notch
c) subclavian ridge
d) Angle of Louis
3. Preparaton of the site should include:
a) sterile draping
b) wash with soap and water
c) maintain aseptc technique throughout the procedure
d) no preparaton is recommended
4. Approved sites for the FASTx include:
a) manubrium of sternum
b) medial tbia
c) proximal humerus
d) none of the above
ANSWER KEY

21
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5. Proper placement of the Infusion Tube can be ensured
by holding the Introducer:
a) at a 45-degree angle to the oor
b) perpendicular to the manubrium
c) vertcal to the body of the sternum
d) aimed toward the heart
6. The Introducer is powered by:
a) pneumatc force
b) bateries
c) springs
d) muscles
7. How should force be applied to the Introducer?
a) with a quick thrust
b) smooth, increasing untl release
c) steady, decreasing for 5 seconds
d) any of the above is acceptable
8. The FASTx can be lef in place for:
a) 24 hours
b) 1 hour
c) only untl the patent is stabilized
d) 48 hours
9. Which of these can be delivered through the FASTx?
a) epinephrine
b) blood and blood products
c) normal saline or Ringers Lactate
d) all of the above
22
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Macnab, Andrew, Christenson, Jim, Findlay, Judy, Horwood,
Bruce, Johnson, David, Jones, Lanny, Phillips, Kelly, Pol-
lack, Charles, Robinson, David J., Rumball, Chris, Stair,
Tom, Tiany, Brian and Whelan, Max : A new system for
sternal intraosseous infusion in adults. Prehospital
Emergency Care, 4:2, 173-177.
Findlay J, Johnson DL, Macnab AJ, MacDonald D, Shellborn
R, Susak L: Paramedic evaluaton of an adult
intraosseous infusion system. Prehospital and Disaster
Medicine 2006; 21(5), 329335.
David L Johnson; Judy Findlay; Andrew J Macnab; Lark Susak:
Cadaver testng to validate design criteria of an adult
intraosseous infusion system. Military Medicine, March
2005; 170, 3; ProQuest Medical Library, 251-257.
Tsitlik JE et al: Elastc Propertes of the Human Chest During
Cardiopulmonary Resuscitaton. Critcal Care Medicine
1983; 11(9):685-692.
REFERENCES
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