Moulage Minute: Newborn, with Umbilical Cord

Time: 13–15 minutes

Skill Level: Advanced

Supplies: (Find supplies and more at www.moulageconcepts.com.)

1 cup water

Two infant feeding tubes

Three packets unflavored gelatin

Clear moulage gel

Clear latex

Dark blue spray paint

Heavy fishing line

IV tubing

Penrose drain

Red spray paint

Equipment:

24-gauge needle

Bowl

Candy thermometer

Double-boiler

Funnel

Hot pot

Laminated board

Palette knife

Scissors

Thermometer

Toothpick

Technique:

Using scissors, remove the ends from the feeding tubes. In a well-ventilated area, apply blue spray paint to both tubes, rotating several times to ensure complete coverage. See Figure 1.

Using scissors, remove the ends from the IV tubing. In a well-ventilated area, apply red spray paint to IV tubing, rotating several times to ensure complete coverage. See Figure 2.

Heat the moulage gel to 120°F. On the laminated board, apply a thick bead of moulage gel to the bottom half inch of blue tubes; let the tubes sit at least three minutes or until the moulage gel has set and the tubes are secured firmly together. See Figure 3.

On the laminated board, apply a thick bead of moulage gel to red tubing. Secure red tubing to the top of blue tubes, applying additional moulage gel material as needed to the bases of all three tubes; let the tubes sit approximately five minutes, or until firmly set. See Figure 4.

Holding firmly at the secured end, begin coiling the blue tubes around the red tubing. See Figure 5.

Using clear moulage gel, apply a thick bead along and between the tubes, holding firmly for approximately three minutes or until set. Place a filter needle on the syringe containing the clear moulage gel, and place the needle inside one blue tube. Press lightly on the plunger to disperse heated moulage gel, filling the top half inch of the tube. Repeat this technique on the second blue tube. Hold the tubes upright approximately 30 seconds, or until the moulage gel has fully set. See Figure 6.

Carefully tie off the end of the Penrose drain. Using six to eight inches of heavy fishing line, tightly wind the line around the end of the drain approximately five to six times and tie off in a triple knot. Gently begin threading coiled tubing, sealed end down, inside the Penrose drain, working the tubing down the sheath until the tubing is flush with the end of drain. See Figure 7.

Using a toothpick, create a barrier on the end of the coiled tubing. Gently push the toothpick through the end of the coiled tubing and the moulage gel, approximately half inch from the end, ensuring tubing does not slide down the drain. See Figure 8.

Place water in the top pan of a double boiler, and sprinkle the contents of the box of gelatin over the water. Allow the gelatin to set for three minutes to bloom. Place the pan and candy thermometer over medium heat, and stir lightly until the granules have melted and the candy thermometer reaches 120°F. Remove the pan from heat, and allow the gelatin mixture to cool to 80 degrees. Carefully place a funnel inside the open end of the drain next to the toothpick, and fill the cavity with the gelatin mixture. See Figure 9.

Remove the funnel and toothpick, and tightly seal the end of the drain. Using six to eight inches of heavy fishing line, tightly wind the line around the end of the drain, approximately five to six times, and tie off in a triple knot. See Figure 10.

Place the umbilical cord flat inside the refrigerator for at least four hours, or until the gelatin mixture is fully set. Using a scalpel or sharp scissors, cut off the end of umbilical cord directly below the fishing line. See Figure 11.

Assessment Note:

The umbilical cord should always be examined to verify length, uniform diameter, vessel verifications, knots, adequate amount of Wharton’s jelly, or any abnormalities of the membrane.

Dispatch:

Medic 32 Respond Code 3 woman giving birth in car. Flying J Truck Stop, Hwy 5, nearest cross street, Pomeroy Ave. Chino Fire responding. 0620 hours. Dispatch clear.

On Scene:

Place a newborn doll or simulator in the back seat of a car, swaddled in a pretreated amniotic fluid-stained light-colored shirt. (To create an amniotic fluid-stained shirt: In a spray bottle, combine a half drop of red food coloring with 1 cup of water. Lightly spray a mist of fluid, three inches in diameter, on the surface of the garment. Working quickly, spread the mixture with a spatula, moving the liquid from one side to the other and staining the top layers of fibers. Place the freshly stained sweater flat on a protected work space to dry completely—approximately one hour, depending on humidity—before placing on newborn.) Using a large blush brush, apply white eye shadow to the cheeks, chin and forehead of the newborn, blending well into the jaw and hairline. Using a medium-size paint brush, liberally apply lubricating jelly to the creases of arms, elbows, neck folds and groin area; blot lightly with a tissue. Using clear latex as glue, apply three to four drops of the latex to the umbilical cord and secure to the navel of the newborn; apply slight pressure around the edges of the cord to adhere. Place a few drops of blood on the cut end of the umbilical cord.

Place “birthing mother” in back seat of car. Using a make-up sponge or your fingers, liberally apply pink make-up to the cheeks, chin and forehead of the patient’s face, blending well into the jaw and hairline. Apply a small amount of light blue eye shadow to the area under the eyes to create dark circles. Apply a light mist of sweat mixture to the chin, upper lip and forehead. Using water, saturate the front strands and bangs of the mother’s hair. Scatter several pieces of women’s clothing and an empty duffle bag around the backseat of the car. Using a cotton ball, apply blood to the cutting blades of a small pair of make-up scissors. Carefully place the scissors near the mother.

Use in Conjunction With:

Vernix

Clear, ruptured membranes

Fresh blood

Helpful Hint:

Umbilical cords can be made in advance, stored covered in the refrigerator and reused indefinitely. Allow the cord to come to room temperature at least five minutes before proceeding to “On Scene.

Cleanup and Storage:

Gently remove the umbilical cord from the abdomen of the doll, taking care to lift gently on the edges while removing the cord from the skin. Store the umbilical cord flat on a wound tray loosely covered with plastic wrap. Multiple umbilical cords can be stored side-by-side, but they should not touch to avoid cross-color transference. Using a soft cloth lightly sprayed with make-up remover, wipe makeup and lubricating jelly from the face, torso, extremities and folds of skin. The treated receiving blanket can be stored, dried, in your moulage box for future simulations.

Bobbie Merica is the author of Medical Moulage: How to Make Your Simulations Come Alive, Moulage! Bridging the Gap in Simulation and Moulage Magic! Theatrical Tricks to Bring Simulation to Life. All works are based on her popular Moulage Mastery! Bridging the Gap^TM in Simulation workshops. She received her certification in Moulage-The Art of Injury Simulation; Biological/Chemical/Terrorism and WMD terrorism training through TEEX. Upon discovering the absence of moulage specific to a clinical/hospital setting, she designed and implemented the first of a series of 3D clinical wounds, moulage kits and courses that she teaches all over the country. She began her career as a simulation technologist with California State University, Chico, where her collaborative work in the development of the Rural Northern California Simulation Center earned runner-up honors in Advance magazine 2009 Best Nursing Team contest. She is a contributing author for EMS World and HealthySimulations.com, and medical moulage & trauma expert for the Bureau of Public Health Emergency Preparedness, AZ. She will be offering the Medical & Trauma Moulage Workshop for Simulated Clinical Experiences, August 29–31, at the Little America Hotel & Resort in Cheyenne, WY. For more information, visit www.moulageconcepts.com.