Staging Technique for Simulation: “Have you had any swelling in your legs?”

Recreating abnormal physical findings can be a fun and frustrating step in adding fidelity to a simulation.  Mixing up blood and urine—no problem.  Frustration arose when a heart failure scenario required pitting edema of the lower extremities.  Manikins just don’t have a feature for the soft and spongy swelling associated with heart failure. 

My “Ah-hah” moment happened when I purchased a memory foam pillow and noticed that if you pressed in with your hand the impression lingered and then recovered—exactly what happens when a patient is assessed for edema.  I then set out to find a way to use memory foam on a manikin to look and feel like edema.

An internet search resulted in a foam cutting business who also worked with memory foam.  To my surprise, there sold scraps of 1” blue memory foam for $1.00 and would cut it in half to make ½” foam pieces for no charge. Memory foam can also be purchased by the yard.  An additional purchase, was a package of plastic “foot/ankle” models from a dollar store on which to practice.

Women’s knee-hi hose had been used in the past for safely covering the lower extremity of a manikin, so this was an obvious solution to the problem of how to hold the foam in place on the slippery foot and ankle.  Not that easy.  The foam slipped around on the plastic and the hose could not be slipped over the foam easily or at all.  Gluing down the foam was out of the question.  Also, the blue color looked creepy under the flesh-colored hose. EdemaBlog_1

The challenges then were:  1)  conceal the blue color without sacrificing the ability to leave an impression in the foam,  2)  secure the foam so a cover such as the knee-hi hose could be applied and  3) solutions to 1 & 2 that do no harm to the manikin’s skin and appears as close to real skin as possible.

To conceal the blue color, tape or fabric would interfere with leaving the impression of “pitting edema”.  In my search for tape, the answer came in a roll of 3M  2” tan Cobanã wrap.  It had two features that were perfect—self-adherent and elastic.  Now the blue memory foam could be covered, the wrap adhered to the foam to hold it in place and it was compressible.

A knee-hi hose in a color near the manikin’s “skin” color was chosen.  Cutting off the  toe and top band and sealing the edges with clear nail polish is optional.  The hose was slipped over the foam- Cobanã  covered foot and ankle.  This could also be applied safely to a standardized patient.

Thicker memory foam can also be used in the female abdomen to mimic a fundus.   Secure the foam over something more rigid, for example, a folded washcloth and insert under the abdominal wall.  The thicker the foam, the more pregnant or boggy the fundus.EdemaBlog_2