Moulage: Nuts & BoltsKrista Kipper BSN, RN

HealthPartners Clinical Program Manager

Clinical education that measurably improves care.

Moulage– The artistic technique of incorporating realistic

cues, such as wounds, perspiration, blood, or therapeutic devices, to increase the “psychological fidelity” of a simulation.

Moulage

Clinical education that measurably improves care.

Alignment with objectives Participant considerations– Level of experience– Environment– Inter-professional education

Subject– Human– Mannequin

Knowledge– Physiology of the situation– Mechanism of injury

Considerations

Clinical education that measurably improves care.

What do you need?

Clinical education that measurably improves care.

Wigs – Halloween purchase

Wounds & Incisions – Halloween purchase

Eye Shadows & Blushes– Many colors

Make-up brushes Water Color markers Finger paints Distilled water

Dish detergents– Blue– White– Pink/red

White shaving cream Red bubble wrap Red plastic food wrap– Winter holiday purchase

Food coloring

Moulage Supplies

Clinical education that measurably improves care.

Artificial blood Spray bottle – Distilled water to spray

diaphoresis– Scented concentrate

Liquor/alcohol Fruity for DKA breath

Adhesives– Tapes– Tegaderm

Moulage Supplies cont…

“White” eraser Powder

Clinical education that measurably improves care.

Body Fluids Magic

Clinical education that measurably improves care.

Moulage Supplies cont…

Mixing Basics– Secure locking containers – Spoons– Leur-lock syringe– Cath tip syringe– Drainage bags for IV fluids– Funnels– Measuring cups

Clinical education that measurably improves care.

Avoid– Mold Growth

Food Products?

Clinical education that measurably improves care.

Possible Exceptions:– No direct contact with mannequin

Edema: Cream of wheat/oatmeal in secured bags covered with nylons

Coffee grounds added to a fluid presented in a basin– Cornstarch for thickness– Rice crispies/broken chips in a baggie for crepitus– Plain gelatin with red food coloring for clots

Food products?

Clinical education that measurably improves care.

Benefits– Blending make-up for bruises is easier– Adhesives stick better – Individual can assist with device or moulage– Individual can assist with clean up– Realistic facial expressions and movement

Human Subjects

Clinical education that measurably improves care.

Limitations:– Need breaks – May have allergies to moulage/device materials– Inability to perform all “critical actions” when

simulating a medical emergencies (ie. Intubate)– Limitations to the application of devices (ie. Foley)– Limitations related to exposure

Human Subjects

Clinical education that measurably improves care.

Benefits– More realistic device application (ie. Intubation)– Easy exposure– Ability to alter physiological findings – No allergic concerns– No timing issues related to breaks

Mannequin Subjects

Clinical education that measurably improves care.

Limitations:– Lack of movement & facial expressions– Devices do not fit realistically– Surface staining– Realistic blending of make-up is challenging– Variances' to the adhesive qualities of materials

Mannequin Subject

Clinical education that measurably improves care.

Human Mannequin

Example of Bruises

Clinical education that measurably improves care.

Example of Bruises

Clinical education that measurably improves care.

Example of Wounds

Clinical education that measurably improves care.

Example of Wounds

Clinical education that measurably improves care.

Example of Burns

Clinical education that measurably improves care.

Example of Burns

Clinical education that measurably improves care.

Basic device needs– Dressings– Basins– Drainage collection devices

IV infusion over flow Foley Stool collection device

– Medications– Intravenous supplies– Chux– Armbands– Oxygen flowmeter– Oxygen Adjuncts

Moulage Supplies cont….

Clinical education that measurably improves care.

Additional medical device considerations:

– Bag valve mask– Splints– C-collar– Backboard– Traction– Chest tubes– JP bulbs– IV pumps– Feeding pumps– Feeding tubes– Suction Canister– Yankeur

THE LIST IS ENDLESS!!!

Medical Supplies cont…

Clinical education that measurably improves care.

Use expired materials (ie. Medications, defib pads) Repackage materials (ie. Cath kits, central line kits) Predetermined disposal site Make friends with ancillary departments (ie.

Pharmacy, Biomed, Materials) Refill & Reuse… Reuse… Reuse

Show me the money!!!

Clinical education that measurably improves care.

Meconium– Green finger paint– Yellow finger paint– Blue dish detergent

Mix finger paints, adding until desired color. Add dish detergent for color and consistency.

Sample Recipe

Clinical education that measurably improves care.

Liquid C-diff Stool– ½ cup Corn starch– 2 tsp Shaving cream– Black finger paint– Green finger paint– Red finger paint– 2 drops green food

coloring– 1 drop red food coloring– Blue dish detergent

Pour distilled water into a bowl for the approximate amount of stool, add green and red finger paints to make a brown color, add a tiny amount of black finger paint and food coloring. Mix corn starch, shaving cream, and blue dish detergent for realistic consistency.

Sample Recipe

Clinical education that measurably improves care.

Blood Clots– 1 box Gelatin– Food coloring– Water

Mix according to box directions but use half as the amount of water. Add food color until desired color obtained. Pour into a cake pan (9x13). Place in refrigerator overnight to settle.

Sample Recipe

Clinical education that measurably improves care.

Bruise– New – Older

Oozing blood

Make the moulage needed for your simulation

Assignment