TissueDB/Simulators/Intra-abdominal Bleeding Simulator (Fernandes)

The Intra-abdominal Bleeding Simulator (Fernandes) is a low-cost adult trainer built from an adult mannequin torso, silicone organs, fabric-mesh bowel and peritoneum, EVA foam, sponge and latex-tube vessels for practising control of major intra-abdominal haemorrhage during exploratory laparotomy.^[1] The aorta and inferior vena cava carry simulated blood from one-litre reservoirs. Rhythmic compression of the arterial reservoir produces pulsatile flow, while the venous reservoir flows under gravity. The trainee opens the abdomen, identifies the injured vessel, controls bleeding by direct digital compression and performs hemostatic suturing.

1. Obtain commercial anatomical models of the liver, spleen, stomach, kidneys and pancreas.
2. Isolate each organ model and immerse it in plaster to create a negative mould.
3. Allow the plaster mould to dry.
4. Remove the original anatomical model from the plaster.
5. Fill the resulting mould with silicone rubber.
6. Allow the silicone to cure.
7. Remove the silicone organ from the mould.

Editorial QA: inspect each demoulded silicone organ for gross completeness before installation. This is a TissueDB buildability check, not an author-prescribed validation criterion.

1. Use an adult plastic mannequin torso measuring approximately 72 × 54 cm.
2. Cover the entire rear interior of the mannequin with a single layer of EVA material to reduce leakage during simulation.
3. Prepare latex tubing corresponding to Ref. 203, approximately 9 mm external diameter and 6 mm internal diameter.
4. Position tubing to represent the aorta, inferior vena cava, coeliac trunk, superior and inferior mesenteric vessels, renal vessels and iliac vessels.
5. Use the aorta and inferior vena cava as the principal active blood-circuit vessels.
6. Create the required bleeding opening in the selected active vessel. In the validation scenario, the source used an approximately 2 cm partial section of the abdominal aorta at the supramesenteric level.
7. Occlude one end of the aortic tube.
8. Connect its other end through an infusion set to a one-litre saline bag containing simulated blood.
9. Occlude one end of the inferior-vena-cava tube.
10. Connect its other end to a one-litre reservoir that provides flow under gravity.
11. Leave the other abdominal vessel tubes unfilled in the standard configuration.

Editorial QA: before the training scenario, confirm that rhythmic compression of the arterial reservoir produces flow from the selected arterial bleeding point and that the venous reservoir provides gravity-driven flow. This is a setup check, not a content-validation item from the paper.

1. Position the silicone kidneys and pancreas in the retroperitoneal region.
2. Fix them in their anatomical positions using hot glue.

1. Place a fine mesh of semitransparent fabric over the retroperitoneal structures.
2. Use it to represent the peritoneal membrane separating the peritoneal cavity from the retroperitoneum.

Source limitation: the paper separately lists "waterproof fabric" in its materials-cost table but does not state that this item is the semitransparent peritoneal mesh. Do not merge those two material identities without direct evidence.

1. Position the silicone liver, spleen and stomach in their anatomical locations.
2. Fix the organs using hot glue.

1. Use fine synthetic fabric mesh in different colours for the small and large intestines.
2. Add a small amount of polystyrene microspheres to each bowel representation to preserve softness and malleability.
3. Fix each intestinal representation only at its ends.
4. Do not add a mesentery; the authors intentionally omitted it because it would make manipulation more difficult and increase maintenance requirements.
5. Position the bowel representations in the abdominal cavity.

1. Replace the anterior mannequin panel with an EVA plate measuring approximately 72 × 54 cm.
2. Add a thin sponge layer to the EVA plate.
3. Use this composite as the source-described skin-and-subcutaneous-tissue layer through which the laparotomy incision is made.

Editorial QA: confirm that the anterior layer provides access to the abdominal cavity without obstructing the vessel-control task. This is an editorial buildability check rather than an author-defined fabrication checkpoint.

1. Provide appropriate lighting, clothing and standard instruments for exploratory laparotomy.
2. Fill the active reservoir system with simulated blood.
3. In the source validation scenario, create an abdominal-aortic injury with an approximately 2 cm partial section at the supramesenteric level.
4. Begin the scenario with access through the anterior layer and progression to identification of the bleeding point.
5. The learner performs digital compression and prepares the vessel for hemostatic suturing.

• The source configuration is an open exploratory-laparotomy simulator.
• The authors state that it could potentially be adapted to a laparoscopic training box with few modifications, but that adaptation is not the demonstrated build described here.
• The principal evaluated technical tasks were access to the vascular injury, identification of the injured vessel, direct manual compression and hemostatic suturing.
• Transfer of simulator performance to operating-room outcomes was not tested.
• The separately listed waterproof fabric has no source-defined role in the construction narrative.