Intravenous Infusion Set Research Articles

Utilizing MBSE for disposable intravenous infusion set: A case study on systems thinking in medical device industry.

AbstractSystems Engineering has demonstrated significant value and has become increasingly necessary. However, this has increased challenges in the quest to build next gen systems tailored to changing customer needs and evolving industry requirements. Many systems engineering practices have evolved catering to these challenges, leading to development of model‐based systems engineering approaches. This paper describes leveraging MBSE and systems thinking application in medical device industry to adapt with changing customer needs, comply with regulatory constraints and advance towards sustainability.

A technique for fabricating a hollowed nasal stent using a connector of an intravenous infusion set to manage iatrogenic nasal vestibular stenosis in an infant

The presented technique describes the steps for fabricating a hollow and rigid intranasal stent to maintain the patency of the nasal passage after iatrogenic nasal vestibular stenosis in an infant. The technique uses a connector between the injection bulb or site and the hypodermic needle of an intravenous infusion set to ease the impressionmakingand avoid the additional step of hollowing the stent.

Separation of Amino Acids, Dyes, and Pigments Using Novel Pressurized Circular TLC Assembly for Secure Medical Imaging Applications.

A novel pressurized flow system for circular thin-layer chromatography (PC-TLC) has been successfully established and employed for the separation of amino acids, dyes, and pigments for safe medical imaging applications. In this system, the mobile phase is applied to a regular TLC plate through the tube and needle of an intravenous infusion set. The needle was fused in a hole underneath the center of the plate, while the second side end of the tube was connected to a microburette containing the solvent. This new assembly proved itself better in terms of separation time (within 5 minutes) and controlled flow of the solvent and horizontal movement of analyte components over chromatograms with better separation and R f values (glutamine: 0.26, valine: 0.44, phenylalanine: 0.60, chlorophyll a: 0.52, chlorophyll b: 0.43, xanthophyll: 0.18, carotenoid: 0.97, and pheophytin: 0.60) when a number of samples of amino acids, dyes, and pigments were separated by the developed apparatus and the conventional TLC procedure. The developed method was found distinctly rapid, precise, and eco-friendly (less solvent consuming) as compared to traditional ascending TLC.

Inappropriate intravenous infusion set occluded by cryoprecipitate.

Inappropriate intravenous infusion set occluded by cryoprecipitate.

A Simple CO2 Generating System Incorporated with CDC Light Trap for Sampling Mosquito Vectors

Simple SummaryThis study successfully developed a CO2 generating system that can be incorporated with a CDC light trap for the overnight collection of mosquitoes. We produced CO2 continuously by dripping an aqueous solution of 12% w/w hydrochloric acid (HCl) (30 drops or 1.6 mL/min) controlled by an intravenous drip infusion set onto limestone powder (800 g) that produced an average of 55 mL CO2/min (equivalent to the CO2 exhalation from two chickens). The efficiency of this trap set for capturing mosquitoes was evaluated in the field compared with the light trap alone and the light trap baited with 1 kg dry ice. The results revealed that the trap with the acid and limestone significantly increased the number and species composition of mosquitoes collected compared with the light trap alone. It could collect all important vector species of Aedes, Armigeres, Coquilletidia, Culex and Mansonia as collected by the trap with dry ice, although the numbers were fewer. Our CO2 producing system is reliable, simple and inexpensive, and could be an alternative method when dry ice is unavailable.Traps for capturing mosquitoes and other blood-feeding arthropods are often baited with carbon dioxide (CO2) as an attractant. Dry ice is popularly used as a CO2 source due to its high efficiency and ease of use. However, dry ice can be difficult to obtain in many rural and remote areas. The objective of this study was to develop a simple and inexpensive method that could continuously generate CO2 overnight (about 10 h) while being used with CDC light traps for sampling adult mosquitoes. In principle, CO2 was produced from the reaction between hydrochloric acid (HCl) (12% w/w) and limestone powder (mainly composed of calcium carbonate, CaCO3). In laboratory experiments, an average of 256 mL of CO2 was produced from 1 g of limestone. For continuous production of CO2, an intravenous drip infusion set, as commonly used in hospitals, was modified for dripping the acid solution (1 L in a normal saline bag) onto limestone powder (800 g in a 1.5 L bottle) at a flow rate of 30 drops/min (about 1.6 mL/min). With this procedure, an average of 55 mL of CO2 per min was obtained (approximately equivalent to the CO2 exhaled by two chickens). The performance of this CO2 generating system incorporated with CDC light traps for sampling mosquitoes was evaluated in three rural villages of Sanpatong District, Chiang Mai Province, Thailand. Three trap sets were used, i.e., Set I, light trap alone; Set II, light trap with dry ice (1 kg); and Set III, light trap with limestone and acid. In each village, mosquitoes were collected at three fixed sites, each with one of the three trap sets. They were rotated daily for three rounds (9 nights per village and 27 nights in total). A total of 1620 mosquitoes (97.7% being females) consisting of Aedes, Anopheles, Armigeres, Coquilletidia, Culex and Mansonia were captured across three different sampling sets from all villages. The predominant species collected were Culex vishnui (n = 760, 46.91%), Cx. bitaeniorhynchus (n = 504, 31.11%) and Cx. tritaeniorhynchus (n = 157, 9.69%). Light traps alone (Set I) collected very low numbers of mosquitoes (n = 12) and species (6 spp.), whereas light traps with dry ice (Set II) collected the highest numbers of mosquitoes (n = 1341) and species (14 spp.). Although the light trap with limestone and acid (Set III) collected fewer mosquitoes (n = 267) and species (9 spp.) than the trap set with dry ice (Set II), it collected all common vector species in the study areas as collected by Set II. The presence of an acid solution had no bias in the collection of mosquitoes with different physiological ages as determined by the parous rate. The present study demonstrated that this CO2 generating system is reliable, simple and inexpensive, and could be an alternative to dry ice. The system can be modified to increase the amount of CO2 generated for higher efficacy of mosquito collection. This CO2 production method can be applied to collect other blood-sucking arthropods as well.

A novel, cost-effective lens irrigation system for rigid endoscopes in transnasal endoscopic surgery.

In transnasal endoscopic surgical procedures, the lens of the endoscope often becomes fogged or smeared with mucus or blood. The surgeon has to clean the lens and reintroduce the endoscope multiple times during the surgery, making it a tiring process. This paper describes an innovative lens irrigation system comprising a modified 16 Fr Foley catheter, a 20 cc or 50 cc syringe filled with warm normal saline (0.9 per cent), and a commercially available intravenous infusion set. The rigid endoscope is introduced into the catheter through the urine draining port. When the lens gets smudged with blood or mucus, the irrigating saline in the syringe is forced through the inflating port. A clear vision was restored immediately on flushing the syringe. The system did not compromise the operative space or hinder manoeuvrability. This cost-effective, innovative lens irrigation system saves the time spent in cleaning the lens and enhances operational efficiency, especially in a low-income setting.

ASSESSMENT AND COMPARISON OF INJECTION TECHNIQUES USING MANNEQUIN AS A LEARNING TOOL AND OSPE AS AN EVALUATION METHOD

Objective: The aim of the current study was to compare the effectiveness of only demonstration and demonstration coupled with the powerpoint method (intervention) in acquiring the knowledge of injection technique using objective structured practical examination (OSPE) as an evaluation tool. Methods: The present study was conducted among IInd professional medical undergraduates (N=80). Identification of medical devices, parts of a syringe and intravenous (IV) infusion set, intramuscular (IM) injection and intravenous infusion techniques were taught using demonstration and intervention method. Participants were then evaluated for their knowledge by OSPE method using validated checklists. Participants were also asked to give feedback for the teaching and evaluation method. Data were analyzed using SPSS 20.0.0, IBM Corporation. Results: After the intervention method 100% participant could identify needle, cannula, and IV infusion set. Noticeable difference was found in identifying parts of a syringe and IV infusion set after intervention method. OSPE evaluation post-intervention showed that more number of participants could perform the steps of injection correctly and in sequence. OSPE scores post-intervention differed significantly (<0.001) with demonstration method. Conclusion: Demonstration coupled with the powerpoint teaching method was found better than the demonstration method alone. This method should be used to impart practical knowledge of injection technique.

Central Line Care and Management: Adopting Evidence-Based Nursing Interventions

Central line–associated bloodstream infections occur not only in the intensive care unit but also the non–intensive care units of the hospital. The purpose of this article is to review current evidence to guide perianesthesia nurses in the care of a patient with a central vascular access device (CVAD). The CVAD bundle focuses on five key elements: hand hygiene, maximal sterile barrier, chlorhexidine antiseptic, catheter site selection, and daily evaluation of the need for the device. Once the CVAD is placed, evidence-based care and maintenance are the responsibility of the nurse. Ensuring proper maintenance and care of a CVAD falls within nursing practice and interventions can significantly reduce the patient's risk of central line–associated bloodstream infection. The single most crucial step a nurse can take to help prevent central line–associated bloodstream infections is performing proper hand hygiene. Other interventions focus on dressing management, bathing practices, access of intravenous infusion sets, blood draws, and management of port line occlusions. Familiarity and adoption of best practice interventions in the maintenance and care of patients with CVADs will help the perianesthesia nurse protect patients and prevent harm.

There is no I in Escape: Using an Escape Room Simulation to Enhance Teamwork and Medication Safety Behaviors in Nursing Students

Background. Nurse educators are challenged to develop simulation activities that will engage interest and help baccalaureate nursing students administer medications safely. Students must be able to recognize and report medication errors and effectively collaborate with their patient care team to provide safe and competent care to patients across the healthcare spectrum. Escape rooms are an innovative learning platform where students can work as a team to build these skills. Aim. We report on the strategies and resources used to create and implement an escape room simulation for a problem-based learning activity to practice medication safety behaviors, using critical thinking, communication and team building skills. Methods. Using Kolb’s Learning Cycle and the International Association for Clinical Simulation in Learning (INACSL) Standards of Best PracticeSM, we developed a team-based, four-hour escape room simulation activity around detecting and reporting medication errors in the hospital setting. The escape room simulation included a high-fidelity patient manikin, two embedded participants in the roles of family member and health care provider (HCP), puzzles, riddles, clues and lifelines. The learning objectives were paired with essential Quality and Safety Education for Nurses (QSEN) competencies. Promoting Excellence and Reflective Learning in Simulation (PEARLS) was used for debriefing. Results. The result was a hybrid escape room simulation that mimics a situation nursing students might face in the hospital setting where they have to work as a team to assess a new patient, reconcile medications, perform medication calculations, problem solve intravenous infusion set ups, and communicate medication errors. Data collected for quality purposes indicated a positive student response. Discussion / Conclusion / Implication. The escape room platform served as a foundation for incorporating other simulation modalities and provided a stimulating learning activity. The next step is to conduct a multi-site study with pre-test and post-test data collected from students to gauge learning and behavior change.

Abdominal puncture as a new method to determine sex in tuviras ( Gymnotus sp.)

Tuviras (Gymnotus sp.) are a small fish widely used as live bait in sport fishing. Interest in its culture has increased, but there are still several bottlenecks that need to be solved. For example, the process of sexing in tuviras is difficult since they do not present sexual dimorphism. Thus, the aim of this study was to verify if an abdominal puncture could be used as an inexpensive, fast and reliable technique to identify the sex of adult Gymnotus sp. Before performing the abdominal puncture, five individuals were dissected to determine the exact location of the gonads. Based on this information, the abdominal puncture was performed 6 cm away from the tip of the animal's head and 1 cm below the lateral line with an intravenous infusion set connected to a 5 ml syringe. An abdominal puncture was performed on 24 adult animals that were larger than 20 cm in length. Twenty-two individuals were sexed correctly, and the accuracy degree was 91.66%. The survival rate of the animals 96 hr after the abdominal puncture was 100%. These results indicate that the abdominal puncture is an easy, simple, fast and inexpensive technique that can be performed in a reliable way.

Modelling insulin adsorption in intravenous infusion sets in the intensive care unit

While contentious, some studies suggest regulating blood glucose (BG) improves clinical outcomes. Model-based approaches have been successful at modulating BG in intensive care unit (ICU) setting using insulin. However, insulin adsorption by infusion set materials may reduce the quality of control. Previous studies highlight the occurrence of significant adsorption, but are highly variable in methodology and results. No study considers or accounts for all potential variables affecting insulin adsorption by infusion tubing. This study identifies and provides a first model for insulin adsorption.A two-compartment insulin adsorption model is developed based on conservation of mass. It describes ‘free’ (F) insulin in solution and ‘bound’ (B) insulin adsorbed to material surfaces. Experimental data from the literature is used to validate the model based on fitting error and consistency in identified model parameters for the same material. Parameters k1 and Beq describe the adsorption rates of insulin and the equilibrium for insulin bound to material surface, and are identified for two different infusion set materials (PE and PVC).The model dynamics fit the experimental data well. A steady state analysis shows it converges to the expected final result. Values Beq mostly fell within the expected range, but overall parameter values varied significantly between studies, materials, and flow rates. These results show the need to refine the model, or discretise the infusion set tube into several identical compartments to account for spatial changes in adsorption across the infusion set tube length, to better capture the observed dynamics independent of other variables. The results also show the need for better experimental setup and reporting to provide enough data to assess more complex model structures.

Sphygmomanometer for Invasive Blood Pressure Monitoring in a Medical Mission.

In patients undergoing high-risk surgery or presenting with major comorbidities, invasive arterial pressure monitoring is often used as the standard of care;1 however, its availability one of the challenges an anesthesiologist may face in remote areas.2 After ultraviolet disinfection, a sphygmomanometer and an intravenous infusion set can be assembled to deliver effective continuous arterial pressure monitoring without a functioning monitor (panel A).This setup described does not allow for a zeroing process. Instead, the heparin solution is injected through the stopcock to make the air column pressure in the tube (shown by the sphygmomanometer) reach the level of the patient’s mean arterial pressure (panel B). When the system is opened to the patient, it can be seen that the sphygmomanometer pointer fluctuates with the cardiac cycle. Its advantages include beat-to-beat blood pressure monitoring and accurate blood pressure reading at low pressures.3 It has the same complications as conventional arterial monitoring, like thrombosis and air embolus. Constant attention is needed to keep the catheter patent, and the tube should be flushed frequently. It also should be noted that this setup can only reflect the trend of mean arterial pressure rather than systolic and diastolic pressures. Simultaneous non-invasive blood pressure monitoring is recommended to overcome this shortcoming. None of these limitations should take away from the usefulness of this device in the field, because only simple pieces of equipment are needed, and the overall trend of pressure will be accurate.The authors acknowledge the support and coordination assistance from the Department of Anesthesiology of Preah Ket Mealea Hospital, Phnom Penh, Cambodia.The authors declare no competing interests.

Model based insulin absorption into intravenous infusion sets in adult and neonatal intensive care unit’s

Abstract Introduction: While still a contentious topic, some studies suggest regulating blood glucose (BG) between 4.4 and 8.0 mmol/L improves clinical outcomes. Model based approaches have been successful at modulating BG in intensive care unit (ICU) setting using insulin. However, insulin absorption by infusion set materials may reduce the quality of control. Previous studies highlight the occurrence of significant absorption, but are highly variable in methodology and results. No study considers or accounts for all potential variables affecting insulin absorption by infusion tubing. This study will identify and model these variables to better understand and account for potential insulin losses. Modelling Methodology: The insulin absorption model developed is a compartment model based on conservation of mass. Literature data was collected and the model was validated based on fitting error. K1 and K2 are the absorption rates of insulin into the tubing and the rate of insulin release into free flow, respectively. K1 and K2 and were identified iteratively using Matlab to fit the model to literature data. Results and Discussion: The model fit the experimental data for PE and PVC tubes well, with a max percentage difference of 8.54% between the fitted and experimental data. The model was more inaccurate for PVC tubes than PE tubes. K1 values identified were similar magnitude for both materials, K2 was a similar magnitude for PVC, but not PE. Limited data from other studies meant they could not be used to test the model more completely. The assumption that the concentration of insulin in the syringe is what is specified could also be a source of variability. More experiments need to be carried out to make conclusions on K1 and K2, relative to specific materials, but this first model of this phenomenon is fundamentally sounds, justifying explicit validation testing.

English

Intravenous infusion is one of the most common treatments administered to patients. However, there are patients who undergo surgery, patients who are in a state of coma, and patients with dengue cases to name a few. This patient requires continuous medication and this treatment is called piggyback infusion. In such cases, continuous monitoring is an indispensable factor in patient care. Efficient monitoring and controlling can be made possible by using wireless control for the device. This paper is about a microcontroller-based intravenous piggyback infusion system that will monitor and control using Wireless Sensor Network (WSN). This paper also discusses remote wireless Ethernet-based communication which can monitor and control the infusion rate by using PC and Android mobile phone. This also discusses the implementation of an infrared sensor installed in the drip chamber of the intravenous infusion (IV) set which is capable of counting the drop rate in real time monitoring.

수액 소진 알람시스템을 위한 동일평면형 광센서의 연구 및 제작

Intravenous (IV) infusion set is one of the most common treatment methods applied to hospitalized patients. However, it is necessary to check the injection of IV solution in order to prevent patients from any possible medical injuries. In this paper, using the optical sensors to detect exhaustion of IV solution was proposed. The optical sensor is coplanar structure composed of LED and photodiode which is installed according to focal distance of the lens. These two elements detect exhaustion of IV solution at the desired point conveniently. Through the results of experiments using various wavelength of LED (R.G.B), the blue LED was selected to the optimum light source. The suggested optical sensor can detect exhaustion of IV solution by the differences in the amount of light which is caused by properties such as total reflection, refractive index and scattering. From the implementation, the detector is applicable to both containers of IV solution, glass bottle and plastic pack. And also the result shows apparent differences according to existence of IV solution even if the IV solution color and illumination were changed.

Needlestick injury in a pregnant inpatient in an overcrowded hospital

Needlestick injury (NSI) is commonly reported among healthcare workers, but is not well documented in patients. We report a case of an NSI in an HIV-negative, gestational hypertensive patient admitted to a hospital for induction of labour at term. Owing to an insufficient number of hospital beds, patients were seated in an overcrowded corridor of the antenatal ward where a patient stepped on the needle of an inadvertently disconnected intravenous infusion set of another pregnant patient, who was HIV-infected. The injury occurred prior to labour induction. Antiretroviral post-exposure prophylaxis to prevent HIV infection was administered to the injured patient and her newborn. This report illustrates how hospital bed shortage may compromise patient safety and discusses measures to prevent NSI among patients and hospital overcrowding.

Needlestick injury in a pregnant inpatient in an overcrowded hospital

Needlestick injury (NSI) is commonly reported among healthcare workers, but is not well documented in patients. We report a case of an NSI in an HIV-negative, gestational hypertensive patient admitted to a hospital for induction of labour at term. Owing to an insufficient number of hospital beds, patients were seated in an overcrowded corridor of the antenatal ward where a patient stepped on the needle of an inadvertently disconnected intravenous infusion set of another pregnant patient, who was HIV-infected. The injury occurred prior to labour induction. Antiretroviral post-exposure prophylaxis to prevent HIV infection was administered to the injured patient and her newborn. This report illustrates how hospital bed shortage may compromise patient safety and discusses measures to prevent NSI among patients and hospital overcrowding.

Pumpless steady-flow microfluidic chip for cell culture

The current research engineered a pumpless energy-efficient microfluidic perfusion cell culture chip that works by modifying the basic gravity-driven siphon flow using an intravenous (IV) infusion set as a conventional, inexpensive, and sterile tool. The IV set was modified to control the constant hydrostatic head difference, thereby maintaining the steady flow rate medium perfusion. The micro-bioreactor chip demonstrated flexibility in controlling a wide range of flow rates from 0.1 to 10ml/min, among which 1- and 5-ml/min flow rates were examined as suitable shear flows for long-term dermal fibroblast cell culture, paving the way for artificial skin development.

The Effect of Tubing Dwell Time on Insulin Adsorption During Intravenous Insulin Infusions

Insulin adsorbs to plastic tubing, which decreases the concentration of an insulin solution delivered from an intravenous infusion set. Dwelling insulin within tubing before starting the infusion decreases adsorption but delays treatment initiation and wastes time in infusion preparation. The lack of data on dwell time effects results in wide variability in practice. We aim to determine the effect of dwell time on insulin concentration from intravenous infusion tubing. In this in vitro study, we used insulin solutions with concentrations of 0.1 unit/mL, 1 unit/mL, and 10 units/mL. Each solution dwelled in intravenous infusion sets for 0, 15, 30, or 60 min. After the dwell, we measured insulin concentrations from the solution bags and tubing. We repeated each insulin concentration-dwell time combination five times. Comparisons were performed using analyses of variance. For each of the three insulin concentrations, the mean insulin concentrations from the tubing were not significantly different between dwell times. Duration of dwell time did not affect insulin adsorption in polypropylene intravenous infusion sets. We recommend that following a 20-mL flush, insulin infusions can be started without any dwell time. Removal of dwell times may improve clinical practice by minimizing preparation time and will allow faster initiation of insulin infusion therapy.

Central Line–Associated Bloodstream Infections in Neonatal Intensive Care: Changing the Mental Model from Inevitability to Preventability

Previously considered unavoidable complications of hospital care (reflecting an "entitlement" mental model), health care-associated infections are now considered as medical errors and cause significant preventable morbidity and mortality in neonates. Prevention of such infections, particularly central line-associated bloodstream infections (CLABSI), should be an important patient safety priority for all neonatal intensive care units (NICUs). An important first step is to promote a mental model of CLABSIs as preventable complications of care. Other general strategies are (1) promoting an organizational culture of safety and empowerment of staff; (2) hand hygiene; (3) avoiding overcrowding and understaffing; (4) using breast milk for enteral feedings; and (5) involving families in infection prevention efforts. Specific strategies to prevent CLABSI are (1) insertion practices: insertion of all central vascular catheters under strict sterile conditions with the aid of a checklist; (2) maintenance practices: ensuring that entries into the lumen of the vascular catheter always occur under aseptic conditions, minimizing catheter disconnections, and replacement of intravenous infusion sets at recommended intervals; (3) removal of all central lines as soon as possible. Participation in national or statewide quality improvement collaboratives is an emerging trend in neonatology that can enhance CLABSI prevention efforts by NICUs.