1 00:00:01,520 --> 00:00:07,099 We have created this training video using a format that contributes to enhanced and accelerated learning. 2 00:00:07,519 --> 00:00:14,460 However, we recognize some trainers will want to move freely throughout the video in order to better support their training schedules and processes. 3 00:00:15,320 --> 00:00:23,640 Therefore, the following time code markers are provided for the trainer who wishes to move forward or backward in the video to a specific training section. 4 00:00:27,579 --> 00:00:32,960 Every day, thousands of EMS personnel respond to emergencies involving traumatic pelvic injury. 5 00:00:33,619 --> 00:00:39,439 These pelvic fractures have a mortality rate of between 5% and 50% due in part to the significant 6 00:00:39,439 --> 00:00:43,000 hemorrhage that may occur in the pelvis with minimal external signs. 7 00:00:43,840 --> 00:00:48,960 Achieving pelvic stabilization and reducing the pain caused by a pelvic injury is difficult 8 00:00:48,960 --> 00:00:51,320 to achieve outside of the hospital environment. 9 00:00:51,960 --> 00:00:55,600 Left untreated, pelvic injury is painful and can be lethal. 10 00:00:56,740 --> 00:01:02,259 In trauma patients that have suspected pelvic fracture and possible internal bleeding, EMS 11 00:01:02,259 --> 00:01:08,180 providers need rapid access to a non-invasive, life-saving pelvic stabilization device that 12 00:01:08,180 --> 00:01:13,620 can be applied quickly and easily in any environment. That device is Ping Medical's 13 00:01:13,620 --> 00:01:19,099 T-Pod Responder. The T-Pod Responder pelvic stabilization device, with its patented 14 00:01:19,099 --> 00:01:24,459 circumferential tightening mechanism, provides the most effective means of stabilizing injuries 15 00:01:24,459 --> 00:01:29,000 to the pelvis while mitigating pain and reducing blood loss from pelvic injuries, 16 00:01:29,000 --> 00:01:31,060 which may include pelvic fractures. 17 00:01:32,599 --> 00:01:35,400 The T-Pod Responder is lightweight and compact. 18 00:01:36,140 --> 00:01:40,079 The T-Pod Responder comes packaged in a sealed, durable Mylar bag 19 00:01:40,079 --> 00:01:42,079 complete with step-by-step instructions. 20 00:01:42,959 --> 00:01:47,819 The package is quick-opening, lightweight, and easily fits in any aid bag. 21 00:01:49,420 --> 00:01:49,859 Efficient. 22 00:01:50,480 --> 00:01:54,599 The mechanical advantage pulley system can be easily closed with one hand. 23 00:01:54,599 --> 00:01:58,019 This makes the application of the T-Pod Responder possible 24 00:01:58,019 --> 00:02:00,700 when only one provider is available on the scene. 25 00:02:01,620 --> 00:02:02,400 Easy to use. 26 00:02:02,900 --> 00:02:05,599 The T-Pod Responder can be applied under any conditions, 27 00:02:05,819 --> 00:02:08,139 in any environment, working in moving vehicles, 28 00:02:08,319 --> 00:02:11,620 in confined spaces, and under conditions of limited visibility. 29 00:02:12,740 --> 00:02:13,560 Rapid deployment. 30 00:02:14,180 --> 00:02:16,639 The adjustment mechanism, or patented pulley system, 31 00:02:16,819 --> 00:02:19,500 allows for pelvic stabilization in seconds. 32 00:02:20,800 --> 00:02:21,400 Compatible. 33 00:02:21,400 --> 00:02:23,800 The T-Pod Responder is latex-free, 34 00:02:24,120 --> 00:02:27,280 and it is 100% radiolucent and non-metallic, 35 00:02:27,280 --> 00:02:31,460 making it completely x-ray, MRI, and CT scan compatible. 36 00:02:33,060 --> 00:02:33,699 Adjustable. 37 00:02:34,479 --> 00:02:37,819 The T-Pod Responder's belt can be folded or cut to fit the patient. 38 00:02:38,419 --> 00:02:42,439 For larger patients, two belts can be linked together using the hook-and-loop surfaces. 39 00:02:43,080 --> 00:02:47,400 This highly adjustable system allows the responder to provide circumferential compression 40 00:02:47,400 --> 00:02:49,340 to virtually any size patient. 41 00:02:49,939 --> 00:02:51,860 Before we learn the application steps, 42 00:02:52,039 --> 00:02:55,840 let's familiarize ourselves with the important nomenclature of the T-Pod Responder 43 00:02:55,840 --> 00:02:58,740 so that we can know how to navigate our way around the device. 44 00:02:59,900 --> 00:03:03,860 The X-ray Detection tab, or XRD tab, shown here. 45 00:03:04,419 --> 00:03:10,060 This is the only feature of the T-Pod Responder that will be visible during X-ray, MRI, or CT scans. 46 00:03:11,060 --> 00:03:16,919 Removing a pelvic stabilization device to facilitate medical treatment or imagery can be painful and dangerous. 47 00:03:17,379 --> 00:03:20,840 With the T-Pod Responder, removing the device is not necessary. 48 00:03:20,840 --> 00:03:28,840 The tab is hook-and-loop backed, so it can easily be moved to the optimal position at any time the teapot is in use. 49 00:03:29,599 --> 00:03:38,719 The teapot belt is light, flexible, and malleable, easily forming to the patient's shape as it compresses around the pelvis, providing symmetric pressure. 50 00:03:40,139 --> 00:03:45,099 The application history label is printed with typical categories of necessary data. 51 00:03:45,099 --> 00:03:52,060 The provider can use permanent markers to annotate the application time and any reapplication times following adjustments. 52 00:03:53,039 --> 00:03:58,280 When used, this feature ensures an accurate record of the TPOD responder's application timeline. 53 00:03:59,240 --> 00:04:06,379 The pull tab is an ergonomically designed handle, complete with finger loop, that allows the provider to securely pull the adjustment cord. 54 00:04:07,479 --> 00:04:13,500 This engages the adjustment pulley mechanism to evenly close the belt opening and circumferentially compress the pelvis. 55 00:04:14,439 --> 00:04:15,800 The locking hooks. 56 00:04:16,180 --> 00:04:20,639 Seen here are four small composite hooks molded into the surface of the adjustment mechanism. 57 00:04:21,759 --> 00:04:28,019 These hooks are used to store and secure the 36-inch or 91-centimeter long cord of the adjustment mechanism. 58 00:04:28,920 --> 00:04:32,439 Properly used, they prevent accidental loss of circumferential pressure 59 00:04:32,439 --> 00:04:35,740 due to rapid and uncontrolled loosening of the adjustment mechanism. 60 00:04:36,560 --> 00:04:39,220 They are necessary to shorten the adjustment cord 61 00:04:39,220 --> 00:04:43,279 so that the pull tab can be safely secured to the front of the adjustment mechanism. 62 00:04:43,500 --> 00:04:47,040 The adjustment cord guides, seen here, 63 00:04:47,040 --> 00:04:51,259 bring the two adjustment cords together and guide them as the provider tightens 64 00:04:51,259 --> 00:04:52,100 the mechanism. 65 00:04:52,100 --> 00:04:56,399 These guides are an application reference point that you will learn in 66 00:04:56,399 --> 00:04:58,100 the training portion of this video. 67 00:04:58,100 --> 00:05:01,680 Make a mental note on their location relative to the device 68 00:05:01,680 --> 00:05:05,100 as you will be asked to reference them during the application protocol. 69 00:05:05,100 --> 00:05:08,500 The mechanical advantage pulley system 70 00:05:08,500 --> 00:05:12,100 ensures a simultaneous circumferential compression of the pelvis 71 00:05:12,100 --> 00:05:16,759 requiring a minimal application of force on the part of the provider. 72 00:05:16,759 --> 00:05:21,800 The patented pulley system does the difficult work for the provider, and unlike some devices, 73 00:05:21,800 --> 00:05:26,639 this system allows the provider to apply a wide spectrum of pressure, gauging the exact 74 00:05:26,639 --> 00:05:31,939 amount necessary to effectively compress the patient's pelvis. 75 00:05:31,939 --> 00:05:35,660 Application Talk-Through The application of the TPOD responder is a 76 00:05:35,660 --> 00:05:37,540 simple six-step procedure. 77 00:05:37,540 --> 00:05:42,220 However, before we learn the steps in sequence, let's talk through the entire procedure to 78 00:05:42,220 --> 00:05:47,079 familiarize you with some of the finer points of the application. 79 00:05:47,079 --> 00:05:53,899 Think about number one, the position, number two, placement, three, compression, four, 80 00:05:53,899 --> 00:05:59,019 lock and secure, and five, record and transport. 81 00:05:59,019 --> 00:06:03,060 These concepts will be explained in detail, and later we'll directly relate them to 82 00:06:03,060 --> 00:06:06,100 the application steps. 83 00:06:06,100 --> 00:06:10,759 If the decision is made for pelvic stabilization, your first consideration in the application 84 00:06:10,759 --> 00:06:16,360 protocol is position, meaning how to position yourself relative to the patient and how the 85 00:06:16,360 --> 00:06:21,000 patient will be positioned before the application begins. 86 00:06:21,000 --> 00:06:25,240 As always, you must follow the guidance and established protocols of your direct medical 87 00:06:25,240 --> 00:06:26,379 oversight. 88 00:06:26,379 --> 00:06:29,540 That supersedes any instruction given here. 89 00:06:29,540 --> 00:06:34,100 Whenever possible, and if your protocols permit, you should assess digital pulse and nerve 90 00:06:34,100 --> 00:06:39,939 sensation in the patient before and after applying the teapot responder. If so directed, it is 91 00:06:39,939 --> 00:06:45,839 important to assess critical findings before and after each intervention. Optimally, the patient 92 00:06:45,839 --> 00:06:52,079 should be positioned supined or flat on their back. You should begin work perpendicular to the patient 93 00:06:52,079 --> 00:06:57,079 at the patient's pelvis, and optimally, if you can, it is best to position yourself with your 94 00:06:57,079 --> 00:07:02,899 dominant hand superior or toward the patient's head. Clear away any loose clothing or gear that 95 00:07:02,899 --> 00:07:09,060 could impede your access to the patient's pelvic region. Understand you're going to wrap the T-pod 96 00:07:09,060 --> 00:07:15,439 belt completely around the patient's pelvis and then circumferentially compress. Therefore, do 97 00:07:15,439 --> 00:07:20,180 what is necessary to give yourself a clear application pathway by removing gear, excess 98 00:07:20,180 --> 00:07:27,740 clothing, or debris. Next, think placement. Open the Mylar package, remove the T-pod device, and 99 00:07:27,740 --> 00:07:33,680 immediately separate the adjustment mechanism and the belt. Place the adjustment mechanism on the 100 00:07:33,680 --> 00:07:39,399 patient's chest with the adjustment cord guides closest to you. This ensures that pull tab will 101 00:07:39,399 --> 00:07:44,319 be close to you and that the action necessary to complete the compression will be pulling toward 102 00:07:44,319 --> 00:07:51,899 you. Pick up the belt and orient it. The textured side faces the patient. The hook and loop side 103 00:07:51,899 --> 00:07:59,439 faces out. With the belt oriented hold one end in your dominant hand. Use the relief typically 104 00:07:59,439 --> 00:08:04,420 formed by the curvature of the lumbar spine on the patient and using your dominant hand guide 105 00:08:04,420 --> 00:08:09,100 the pelt under the patient and reach across the patient with your non-dominant hand to capture 106 00:08:09,100 --> 00:08:15,240 and position the belt. You want to pull the amount you visually estimate will allow you to wrap the 107 00:08:15,240 --> 00:08:20,100 belt around the patient leaving the end three to four inches short of the patient's midline. 108 00:08:20,100 --> 00:08:25,800 This initial measurement allows you to bring the standing end, or the end closest to you, 109 00:08:25,800 --> 00:08:31,740 up and around the patient. You trim this end of the belt again three to four inches from the 110 00:08:31,740 --> 00:08:38,940 midline. When complete, you should have a six to eight inch gap relative to the midline. This gap 111 00:08:38,940 --> 00:08:43,379 will be closed by the adjustment mechanism, and it is the closing of this gap that will provide 112 00:08:43,379 --> 00:08:49,019 the circumferential compression of the pelvis. The iliac crest of the patient should be aligned 113 00:08:49,019 --> 00:08:51,159 with the upper superior edge of the belt. 114 00:08:51,759 --> 00:08:54,100 If you cannot identify this anatomical landmark, 115 00:08:54,360 --> 00:08:56,440 try using the patient's greater trochanters. 116 00:08:57,940 --> 00:09:01,059 The trochanters are typically more difficult to acquire. 117 00:09:01,299 --> 00:09:03,379 However, if you must use this reference point, 118 00:09:03,580 --> 00:09:06,259 the belt should be positioned so that the greater trochanters 119 00:09:06,259 --> 00:09:08,059 are aligned with the center of the belt, 120 00:09:08,279 --> 00:09:11,980 between the superior upper and inferior lower edges of the belt. 121 00:09:12,480 --> 00:09:16,360 In some cases, it may be necessary to gently roll the patient 122 00:09:16,360 --> 00:09:18,340 in order to correctly position the belt. 123 00:09:19,019 --> 00:09:24,279 When the belt is properly positioned, check for the iliac crest and the upper edge alignment, 124 00:09:24,279 --> 00:09:30,299 or look for the greater trochanter alignment, and then bring the standing end of the belt up and over the patient. 125 00:09:32,179 --> 00:09:36,639 Optimally, you should cut the belt with trauma shears or, if necessary, a blade, 126 00:09:37,100 --> 00:09:43,100 leaving the standing end 3 to 4 inches short of the patient's midline, just as you did on the opposite end of the belt. 127 00:09:43,100 --> 00:09:52,600 If for some reason you cannot trim the belt, you can still complete the application by folding the standing end of the belt back under itself as shown here. 128 00:09:55,419 --> 00:10:03,179 Holding the belt with your non-dominant hand, pick up the adjustment mechanism and position it so that the adjustment cord guides are closest to you. 129 00:10:03,759 --> 00:10:09,220 You will have the most control if you position the adjustment mechanism with the distal portion anchored first. 130 00:10:09,220 --> 00:10:15,220 Now align the front edge of the adjustment pulleys with the leading edge of the belt, as shown in this example. 131 00:10:15,220 --> 00:10:24,220 Holding the distal end of the adjustment mechanism with your non-dominant hand, pull the mechanism toward you and lay the mechanism onto the belt. 132 00:10:24,220 --> 00:10:33,220 Again, the device is properly aligned when you have the front edges of the pulleys aligned with the leading or trimmed or folded edges of the belt. 133 00:10:33,220 --> 00:10:37,240 Simply lifted off the belt and repeat 134 00:10:37,240 --> 00:10:40,840 the placement steps until you have the device aligned as instructed. 135 00:10:40,840 --> 00:10:44,299 Double check the hook and loop of the adjustment mechanism 136 00:10:44,299 --> 00:10:47,299 applying even pressure to be certain to securely anchored 137 00:10:47,299 --> 00:10:51,820 and ready for compression. Grasp the pull tab in your dominant hand 138 00:10:51,820 --> 00:10:55,179 and do not release it until the compression movement is completed 139 00:10:55,179 --> 00:10:59,539 and the adjustment cord is locked and secure. This allows you to maintain 140 00:10:59,539 --> 00:11:02,279 positive control of the pull tab and cord 141 00:11:02,279 --> 00:11:06,000 preventing unnecessary tangles or twisting. 142 00:11:06,000 --> 00:11:09,179 Your next consideration is compression. 143 00:11:09,179 --> 00:11:12,919 Using even pressure, pull toward you with the pull tab 144 00:11:12,919 --> 00:11:15,639 and observe as the adjustment pulleys close the gap 145 00:11:15,639 --> 00:11:19,860 and apply circumferential compression. 146 00:11:19,860 --> 00:11:23,600 Apply circumferential pressure until the belt is tight. 147 00:11:23,600 --> 00:11:26,240 The amount of pressure required to stabilize the pelvis 148 00:11:26,240 --> 00:11:27,580 will vary. 149 00:11:27,580 --> 00:11:29,539 The adjustment pulleys allow the provider 150 00:11:29,539 --> 00:11:34,519 to apply exactly the amount of force they deem necessary. 151 00:11:34,519 --> 00:11:39,179 Once the pelvis is stabilized, you can lock and secure the teapot. 152 00:11:39,179 --> 00:11:43,340 Do this while keeping the pull tab in your dominant hand and while maintaining constant 153 00:11:43,340 --> 00:11:44,340 pressure. 154 00:11:44,340 --> 00:11:50,000 Use your non-dominant hand to guide the adjustment cord into the locking hooks, as shown here. 155 00:11:50,000 --> 00:11:55,259 Regardless of direction, clockwise or counterclockwise, maintain pressure on the pull tab and guide 156 00:11:55,259 --> 00:12:00,200 the cord into the locking hooks until the pull tab is brought to within 6 inches of 157 00:12:00,200 --> 00:12:05,600 the adjustment mechanism. Now secure the pull tab to the adjustment mechanism using the 158 00:12:05,600 --> 00:12:11,559 hook and loop backing. Your final step is to record the application time on the application 159 00:12:11,559 --> 00:12:20,769 history label. Application Steps. This portion of the training video demonstrates all of 160 00:12:20,769 --> 00:12:29,370 application steps in sequence. Step one, position. Position the patient. Position yourself relative 161 00:12:29,370 --> 00:12:36,330 to the patient. Step two, placement. Prepare the application pathway by clearing away excess 162 00:12:36,330 --> 00:12:42,789 clothing, gear, or debris. Unpack the teapot responder, separate, and set the components 163 00:12:42,789 --> 00:12:53,509 within easy reach. Position the teapot belt by sliding the belt under the lumbar spine of the 164 00:12:53,509 --> 00:13:01,019 patient. Now check the length. You want to leave three to four inches between the end of the belt 165 00:13:01,019 --> 00:13:07,960 and the patient's midline. Pull the belt toward the patient's feet. It may be necessary to gently 166 00:13:07,960 --> 00:13:15,240 roll the patient to help position the belt. Adjust the position of the belt relative to one of two 167 00:13:15,240 --> 00:13:22,120 anatomical landmarks. First, use the upper iliac crest of the patient, and if for some reason this 168 00:13:22,120 --> 00:13:28,059 is not possible, try using the greater trochanters. The top edge of the belt must be aligned with 169 00:13:28,059 --> 00:13:32,639 the upper iliac crest or the trochanters must be positioned relative to the middle of the 170 00:13:32,639 --> 00:13:39,279 belt. Once positioned, trim the belt to fit using trauma shears or, if necessary, a blade. 171 00:13:40,120 --> 00:13:43,840 Cut the near end of the belt, leaving three to four inches from the midline, just as you 172 00:13:43,840 --> 00:13:49,720 did for the opposite side. Once the belt is trimmed, hold the belt with your non-dominant 173 00:13:49,720 --> 00:13:55,980 hand and pick up the adjustment mechanism in your dominant hand to position it. 174 00:13:55,980 --> 00:13:58,940 Attach the far end of the belt first. 175 00:13:58,940 --> 00:14:02,940 Do this by laying the adjustment mechanism so that the leading edge of the mechanical 176 00:14:02,940 --> 00:14:08,620 advantage pulley system matches the leading edge of the far side of the belt. 177 00:14:08,620 --> 00:14:13,860 Holding the belt and mechanism with your non-dominant hand, pull the mechanism toward you and lay 178 00:14:13,860 --> 00:14:16,299 it down on the near side belt. 179 00:14:16,299 --> 00:14:19,059 Now check the placement of the mechanism and the belt. 180 00:14:19,059 --> 00:14:23,179 If not satisfied, remove and replace the mechanism. 181 00:14:23,179 --> 00:14:28,059 If satisfied, move to step three, compression. 182 00:14:28,059 --> 00:14:30,379 Pull the pull tab toward you. 183 00:14:30,379 --> 00:14:32,480 Use even pulling force. 184 00:14:32,480 --> 00:14:37,840 Use your non-dominant hand to guide and monitor the application of the circumferential pressure. 185 00:14:37,840 --> 00:14:42,159 When the pulley system has closed the six to eight inch gap, or if you feel the pelvis 186 00:14:42,159 --> 00:14:48,700 is stabilized, then begin the next step. Step four is to lock and secure the teapot 187 00:14:48,700 --> 00:14:54,200 adjustment mechanism. Maintain constant pressure on the pulley system by keeping the pull tab 188 00:14:54,200 --> 00:14:59,940 in your dominant hand. Do not release the pull tab under any circumstances. Guide the 189 00:14:59,940 --> 00:15:05,700 adjustment cord into the locking hooks while you move the cord in a clockwise or counterclockwise 190 00:15:05,700 --> 00:15:11,059 direction. Stop wrapping the cord when the pull tab is six to eight inches from the surface 191 00:15:11,059 --> 00:15:16,480 of the adjustment mechanism. Using the hook and loop backing on the pull tab, secure it to the 192 00:15:16,480 --> 00:15:22,600 surface of the mechanism. And step five, record the time of the application on the application 193 00:15:22,600 --> 00:15:32,169 history label. Reapplication considerations. Occasionally, medical providers may want to 194 00:15:32,169 --> 00:15:37,990 inspect the patient's skin integrity or perform other assessments. This will require the release 195 00:15:37,990 --> 00:15:42,669 of the circumferential pressure to permit inspection and the reapplication of the teapot 196 00:15:42,669 --> 00:15:48,850 responder and the reapplication of circumferential pressure. Simply reverse the process using your 197 00:15:48,850 --> 00:15:54,549 dominant hand, grasp and lift the pull tab, and maintain pressure and positive control of the tab 198 00:15:54,549 --> 00:16:00,710 and cord. Using your non-dominant hand, guide the cord as you detach from the locking hooks. 199 00:16:03,299 --> 00:16:07,940 Lift the attachment mechanism on the far side, lifting and pulling the adjustment mechanism 200 00:16:07,940 --> 00:16:14,700 toward you. Keep positive control of the entire mechanism, cord, and tab. Set the mechanism 201 00:16:14,700 --> 00:16:21,559 out of the way and conduct your inspection. When complete, set the adjustment mechanism 202 00:16:21,559 --> 00:16:27,120 down on the top of the belt and secure the hook and loop surfaces. Now grasp the pull 203 00:16:27,120 --> 00:16:33,240 tab in your dominant hand and pull toward you, applying even pressure. Using your non-dominant 204 00:16:33,240 --> 00:16:38,440 hand, guide the adjustment cord into the locking hooks in a clockwise or counter-clockwise 205 00:16:38,440 --> 00:16:44,080 direction. Stop wrapping when you are six to eight inches from the surface of the adjustment 206 00:16:44,080 --> 00:16:50,919 mechanism. Secure the pull tab to the belt. Record the reapplication time on the application history 207 00:16:50,919 --> 00:16:56,500 label. At a minimum, circumferential compression should be released every 12 hours to check for 208 00:16:56,500 --> 00:17:03,200 skin integrity and provide wound care as necessary. Ping Medical's T-Pod Responder provides safe, 209 00:17:03,200 --> 00:17:06,859 secure, and effective stabilization treatment for pelvic injuries 210 00:17:06,859 --> 00:17:11,079 and possible pelvic fractures. Independent studies have confirmed 211 00:17:11,079 --> 00:17:15,119 the teapot responder's effectiveness in binding the pelvis, reducing blood 212 00:17:15,119 --> 00:17:18,559 loss, and lowering complications associated with the injury. 213 00:17:20,200 --> 00:17:23,220 Clinical use warning. Reuse of the 214 00:17:23,220 --> 00:17:27,000 teapot responder is not recommended once it has been used on an injured person 215 00:17:27,000 --> 00:17:30,980 due to the potential for cross-contamination. Serious injury 216 00:17:30,980 --> 00:17:39,660 or death may result. Why T-pod responder? Pelvic fractures have a mortality rate of 5 to 50 percent 217 00:17:39,660 --> 00:17:44,480 due mainly in part to the significant hemorrhage that may occur in the pelvis with minimal external 218 00:17:44,480 --> 00:17:50,980 signs. Achieving pelvic stabilization and reducing pain from a pelvic injury is difficult to achieve 219 00:17:50,980 --> 00:17:57,079 outside of the hospital environment. The T-pod responder is a non-invasive, life-saving pelvic 220 00:17:57,079 --> 00:18:06,119 stabilization device that can be applied in any environment. Considerations. If an obese patient 221 00:18:06,119 --> 00:18:13,579 requires pelvic stabilization utilizing the T-pod responder, two belts can be combined using one 222 00:18:13,579 --> 00:18:19,779 power unit as an extender and the other as the pulley and tightening mechanism. Monitor pulse 223 00:18:19,779 --> 00:18:25,339 and blood pressure in accordance with your organizational protocols. The T-pod responder 224 00:18:25,339 --> 00:18:29,880 should be replaced when soiled or after every 24 hours of continuous use. 225 00:18:30,940 --> 00:18:34,079 Place Foley catheters prior to the application as needed. 226 00:18:35,339 --> 00:18:42,119 Children under 50 pounds or 23 kilograms may be too small to obtain the 6-inch gap needed for closure.