Setting Up a Permanent WETLAB
Many hospitals and organisations are looking to establish permanent Wetlab facilities. Wetlab Ltd have years of experience setting up wetlab facilities and we would be delighted to assist in any way we can. If you are thinking of this establishing this type of facility here are a few pointers.
First find your room! Ideally this should be away from the patient related activity and public areas of the hospital. The size of the available room will obviously determine the number of participants who can use the facility at any one time. Leeds established a permanent wetlab in a former perfusion equipment storeroom in the basement of the hospital. Even this required considerable negotiation and was only finally agreed at chief executive level. However, don’t let this put you off!
Having successfully located and commandeered a suitable room in which to establish your skills laboratory, it is likely you will need to ask the Estates Department to make some modifications.
This should be wipe clean, non- slip material e.g. tiled or sheet linoleum. The sides of the room should be tanked so there are no corners or edged into which waste fluid can escape.
Ensure you have enough workspace. (fig 1) Allow 120 cm of bench space for each station, and if possible arrange for participants to work opposite each other, in which case the bench or table should be no more than 100 cm wide. In addition, bear in mind the height of the work surface. Some participants may prefer to sit down (so don’t forget the stools), whilst others will prefer to stand. The usual height of a regular desk or table is approximately 72 cm, which is probably too low to be comfortable for long periods. A kitchen worktop is approximately 92 cm high and this seems to be the best height to work for minimising backache, whether the participants sit or stand. At Wetlab Ltd they use a simple ironing board to produce a table that can be adjusted for ten different height settings, (fig 2) and has the benefit of being able to fold flat for easy storage.
An alternative technique is to start with standard desks and add additional height by using polystyrene foam blocks of the type used to insulate wall cavities. Ensure you also have enough work surfaces for consumable items such as gloves, aprons, sutures etc, to be set out ready for use.
(Fig1) The O’Regan Table Inspired by David O’Regan (Leeds) and produced by Wetlab Ltd
You will need to power the lamps on the tables so try and have sufficient sockets close to the work stations and use either rubber cable covers or Gaffer tape to prevent accidents. You will also need to use electronic equipment such as a laptop computer or a projector so allow space for it and the necessary power sockets. In addition an RCD should be used.
FRIDGE / FREEZER
An ordinary domestic appliance is required for storing fresh and frozen tissue. We would always recommend the largest you can get as it soon fills up and its always cheaper to order stock in bulk.
A good industrial dishwasher will make life easier when cleaning large numbers of instruments and stainless steel workstations. Also potentially useful is a sterilising unit but if your budget doesn’t stretch to these then it’s a large sink full of hot water, Mr Muscle, and vigorous polishing.
It can get a little uncomfortable in a small room with hard working trainees and animal tissue. Check that the ventilation is adequate, either through air conditioning or open windows.
SECURITY AND SAFETY
Check the security and make sure it will keep out unwanted visitors and ensure that emergency exits are identified and operate properly. Make security, safety and cleanliness the individual responsibility of each user.
THE OCCASIONAL WETLAB
For the occasional wetlab it is perfectly feasible to use an existing seminar room but it is worth bearing in mind that most seminar rooms have a carpet tile floor covering. It is important to ensure that you protect the floor any soft furnishings with heavy gauge plastic sheeting. This may be a slip or trip hazard, so tape it down well with Gaffer tape. If you decide not to use a sheet make sure that the participants are careful not to drip, drop or spill anything that could be hazardous or unpleasant to the next user of the room. Despite placing sharps bins next to each participant, it is not unusual to find a pile of suture needles on the tables and in the carpet at the end of a wetlab session. If you are using a multi- use facility it is imperative to impress upon participants the importance of sharps disposal; a single needle on the carpet could lead to you being banned from the facility for good. If you are running the session you are also responsible for the clean up! If a room does have a wipe clean surface we recommend the use of a magnetic broom to ensure needle removal.
As you are aware by now Wetlab Ltd specialise in taking wetlab sessions into hospitals, Hotels and Conference venues. If you prefer to follow this route we will be delighted to assist you .
Workstations and seating
Fridge / Freezer
Security and Safety
By far the most commonly used tissue for cardiac surgical training is pig heart, which is readily available and similar in many respects to human heart. Pig hearts however are generally smaller than human hearts and have prominent muscle bar at the base of the right coronary sinus, which can create problems when practising an aortic valve replacement. Bovine hearts are sometimes available but tend to be rather large.
Pig ureter provides a convenient and realistic substitute for vein when practising coronary anastomoses. Artificial substitutes, such as urinary catheters, are not satisfactory. Lengths of descending aorta are useful for a range of activities. If you wish to pressurise them with fluid however, remember to ligate all the intercostals vessels. This is time consuming work, but could be delegated to junior trainees as basic surgical training!
For a list of tissue available from Wetlab click here.
It is strictly forbidden to have animal and human tissue in the same room. This means you cannot use discarded lengths of human saphenous vein or mammary artery in your wetlab.
GETTING THE TISSUE
It is important to establish a reliable source for animal tissue, which should be of human consumption standard in order to guarantee quality. DEFRA / EEC regulations require pig hearts to be cut at the abattoir for meat inspection purposes. Unless harvested specifically for medical training purposes in which case you will need lots of paper work to prove who you are, where the tissue is going, why and what you will do when you have finished with it. If they agree to supply you it is likely that hearts will have the aortas trimmed very closely, and the atria removed.
Sometimes the whole top of the heart will be cut away, making it useless for training purposes. It may be possible to secure a regular supply of useable hearts and other tissue by making a trip to your local abattoir, Due to animal rights demonstrations these are very secure and guarded now but if you do get entry try to talk to the slaughter men and show them what you want.
If you have problems with tissue supply Wetlab Ltd will always be happy to help and ship you your requirements.
Storage and preparation
Unless you have a high turnover and regular supply, store the tissue in a freezer until needed. Defrost pig hearts overnight in salted water which helps to keep bacterial growth to a minimum which is responsible for the unpleasant odours. Do not be tempted to add bleach or similar antibacterial agents as these will eat away at the tissue leaving it slimy to the touch. First thing in the morning rinse the hearts several times until clear of blood. Keep them in water until needed and preferably ice water.
When the tissue is on the workstation keep it fresh by spraying with a house plant mister this will also stop them drying out. Tissue like Aorta and ureter thaw almost immediately so they can be kept frozen until required.
Check your hospitals waste disposal policy- It will have one but it may charge you to get rid of tissue . Never be tempted to take it home to feed the dog.
There are a number of purpose designed tissue holders available. For cardiac skills they sometimes come complete with suture retainers.
Wetlab have developed a number of holders and workstations especially for cardiac workshops. In addition to the Disposable wetlab station also known as a DWLS click here. These are available from wetlab ltd. The heart is held in place by two knitting needles and they make life very easy as no washing or drying is required. The heart can be mounted within the base box for advanced training as this mimics the minimum access in real life .
For very basic use you could use a medium plant pot with a loose cloth packed out with paper or cloth with the heart nestled on the top.
The Following lists are for guide use only when budgeting for the set up of an in- house Wetlab room.
It is also possible to obtain good quality cheap instruments from overseas, together with second hand for use purely for your wetlab sessions. Wetlab ltd will be happy to assist if you have any particular requirements.
As part of wetlabs continuous striving to provide high quality training at affordable prices we are able to offer an inexpensive alternative to the above Wetlab are pleased to make available Wetlabs New WL001 set of instruments Click on the instrument page for more information.
This is a comprehensive pack to
cover most requirements - click here to buy!
All of these are designed to be single use for patient care, but may be reused many times in a wetlab
( Not after being used on a patient)
Sutures are a major source of ongoing expenditure for your wetlab. Out of date or discarded packs from the operating department can often be obtained and it is also worth chatting with your friendly suture rep who may be supportive.
Using the skills Laboratory
Depending on size, configuration and equipment, the skills laboratory can be used for either formal instruction or self directed learning. The primary focus however is on self directed learning the DVD series produced by wet lab Ltd and available form the Royal College of Surgeons of England demonstrates a number of commonly performed cardiac operations, and the intention is by following the demonstrations trainees will use the DVD’s to guide their activities in the wet lab environment. Repeated and regular practice will allow the trainee to develop the familiarity with each procedure that can be translated into the clinical setting.
It is important to state that familiarity in the wet lab does not confer competence in the operating room! Trainees should be expected to keep a record of their wet lab activity and as a further aid to learning the RSCE has produced a trainer’s record of activity for use in conjunction with the DVD series. The document can also be used by trainers to track progress and if wished can be used as a tool for assessment and appraisal.
The use of the wet lab need not necessarily be confined to specialist trainees. Imaginative trainers and trainees will be able to utilise the facility for basic surgical training and multi/professional learning.
You have to establish some suitable `rules of engagement’ concerning the use of the room you may find it advantageous to appoint a responsible trainee with authority to oversee the smooth running of the facility. The major issues of cleanliness and re-ordering of materials is highly recommended and we can not emphasise enough the need for the delegates or people using the facility to clear up and in particular the disposal of all sharps.
Finally some trainees may have cultural or religious objections to using pig tissue in the wet lab, they should be advised accordingly and where ever possible wet lab ltd will be happy to find alternatives.
Disposal of tissue
As a medical centre you more than likely have excellent provision for the disposal of the tissue used in the wetlab however it is worth checking.
Obviously the amount of tissue for disposal would rise with the use of a permanent wetlab facility and a procedure should be thought of for its disposal.
Cleaning and monitoring
The emphasis will be on the person who uses the facility to clean away afterwards. Some times this falls down and problems occur leaving the project in jeopardy.
One way round this is to not only log all users but to install a digital hard drive video surveillance camera system in the room which aids security The system records non stop and does not have tapes or anything changed after about a ten days it would start to record over its own memory and provides proof of use of use etc. Generally people don’t forget to clean away if they know they will be seen.
Participants should be made aware that whilst every precaution has been taken to ensure that the skills wetlab is run in accordance with the relevant health and safety regulations , Participants are themselves responsible for taking appropriate precautions to prevent untoward events
Contact Kevin Austin
Wetlab Ltd is more than happy to assist if you need any more information or help.