I.

Topic: Doppler Blood Flow Monitor In-Service Training

Objective:
The students will articulate and demonstrate the features, functions, benefits and
applications for the Cook Medical DP-M350 Blood Flow Monitor for a simulated
audience of medical professionals in compliance with the products Instructions for
Use (IFU).

Purpose:
The purpose of this lesson is to demonstrate for the students what an in-service
instructional session should consist of when conducted for hospital staff. This will
serve as a model for the students to work from and integrate into their own words,
practice for proficiency, and demonstrate competency to two assessors.

Materials:
Instructor: A Cook Medical DP-M350 Doppler blood flow monitor, one extension
cable, one standard cuff, one Cook Doppler marketing brochure, iPad with pre-
recorded sounds of both venous, and arterial blood flow sounds cued up and ready
to play, Doppler troubleshooting guide.

Students: Note taking materials, a copy of the Cook Doppler marketing brochure,
field resource guide for reference, Doppler troubleshooting guide.

II. Procedure

A. Training relevance:
The Doppler Blood Flow monitor is one of the key products that each of the
students will be selling as a primary function of their job as District Managers (DM)
for Cook Medical. The Doppler is considered the “gold standard” for monitoring of
tissue transfer flaps, with many peer reviewed articles to support this claim. When
any hospital is considering purchasing this equipment, the first step toward a
successful trial is that the hospital staff is comfortable with it. This requires a DM
educate as many of the hospital staff as possible, and empower them to understand
the function of the Doppler, troubleshooting steps, and when to call the physician.

B. Body of the Lesson:

1. Outline and steps- Features and Functions

Step 1: Introduce yourself, the purpose of the in-service training, and which
physicians, and type of surgeries the Doppler will be supporting.
Step 2: Explain that the Cook Doppler blood flow monitor functions the same way as
a pencil Doppler, but is actually at the sight of an anastomosis.
Step 3: Display the Doppler marketing material to show the enlarged view of the
silicone cuff around the vessel.

Step 4: Play the arterial and venous Doppler recordings from the iPad to
demonstrate the differences in the sounds, tone, and intensity.

Step 5: Demonstrate the functions on the front of the Doppler, Power button,
Volume, Channel changer, Test button (note that the buttons are pressure sensitive),
the light display and its function.

Step 6: Show the two different colored cables, green and blue, and their functions.

 Plug in the green cable to a channel port on the Doppler (emphasis that
both sets of cables are disposable, are intended for one time use)
 Show the red/black tab connection for connecting the blue and green cable
 Use this point to first reinforce the fact that the crystal and wire will break
away from the silicone cuff with 1/10th of a pound of tension (this is
deliberate)

Step 7: Explain to the hospital staff that they patient will have the Doppler attached
to them at all times, and will arrive out of post-op with it connected.

 The monitoring of blood flow usually lasts 4-7 days, but must be discontinued
after 29 days.
2. Outline and steps- Troubleshooting

Step 1: During nursing checks, as dictated by the physician, you do not hear the
Doppler blood flow sounds at all, or the sound quality has changed.

 Verify that the blue indicator light is illuminated (this also indicates that the
power is on for the unit)
 Attempt to increase the volume
 Press the “Test” button, an audible chime tells you that the circuitry is
functional
 Verify that the correct channel is being monitored- the indicator light should
be illuminated over the channel port that has the cable being monitored
plugged into it.
 Use the cable-channel verifier to test both ports by plugging it into each of the
two ports. Rubbing on the cable channel verifier will produce an audible
sound, indicating that the port is functional.
 Test the green cable by first plugging it into one of the Doppler’s ports, then
connecting the cable-channel verifier to the other end. Rubbing on the cable-
channel verifier will produce an audible sound, indicating that the green cable
is functional.
 If there is still no audible sound heard, or the sound is of poor quality, gently
palpate around the surgical site to see if the Doppler probe signal returns.
 Have the patient change positions to verify that the vessel has not been
compressed by the patient’s position.
 If none of these steps provide a return of sound, or sound quality, contact the
physician immediately.

3. Questions and Practice

A. These are questions to be asked of the students as a teach-back, and hands-on
practice component of the lesson.

 Question 1: What are all the items that are needed for a Doppler
surgery?
 Question 2: What are the items needed for an in-service?
  Question 3: What are the steps for troubleshooting, if you don’t hear
sound from the Doppler, where there previously was sound? (Work
from the box to the patient).
 Question 4: What are the steps for troubleshooting in the operating
room? (Work from the patient to the box).

B. Hands-on practice

Step 1: Have the students practice manipulating the buttons, cables, and cable test
verifier.

Step 2: Create simple troubleshooting problems for the students, wrong channel,
probe dislodged, volume that is too low, dead battery. Assist them through the
steps.

Step 3: Ask the students to walk through the steps of using the Doppler as if they
were explaining to a single nurse who would be responsible for monitoring the
patient (role-play).

Step 4: Have each of the students practice the in-service in front of each other, with
emphasis on features, functions, benefits, and application of the Doppler blood flow
monitor.

C. Closure:
Review the major components and functions via a teach-back with the entire class.
Ask questions about the need, and application of the components of the Doppler,
and accessories, how they are used during the in-service.

D. Follow-up activity- Reinforcement:

Each of the students will perform a Doppler in-service within a one month period of
time for one of their current customers. The in-service can be for as many, or as few,
personnel as manageable, and coordinated with the nursing educator of the
department.
E. Evaluation of the lesson and the teaching process:
I will evaluate this lesson by reflecting on how well the students were able to
demonstrate, and articulate the primary functions, and application of the Doppler
blood flow monitor. I will also be reflecting on their use of the iPad for sound bites,
the marketing images to create context, and their emphasis on the key limitations of
the Doppler, such as maximum duration of monitoring, charging time, battery life,
and the cables being disposable.