Development and evaluation of hand-held robotic technology for safe and successful peripheral intravenous catheterization on pediatric patients

Peripheral IntraVenous Catheterization (PIVC) is often required in hospitals to fulfil urgent needs of blood sampling or fluid/medication administration. Despite of the importance of a high success rate, the conventional PIVC operation suffers from low insertion accuracy especially on young pediatric patients. On average, each pediatric patient is submitted to 2.1 attempts before venous access is obtained, with around 50% failure for the first attempt. The risks of such multiple attempts can be severe and life-threatening as they can cause serious extravasation injuries. Given the levels of precision and controllability needed for PIVC, robotic systems show a good potential to effectively assist the operation and improve its success rate. Therefore, this study aims to provide such robotic assistance by focusing on the most challenging and error-prone parts of the operation. In order to understand the difficulties of a pediatric PIVC, a survey investigation is conducted with specialists at the beginning of this research. The feedbacks from this survey indicates an urgent need of a hand-held robot to assist in the catheter insertion control to precisely access the target vein. To achieve the above goal, a novel venipuncture detection system based on sensing the electrical impedance of the contacting tissue at the needle tip has been proposed and developed. Then several ex-vivo and in-vivo experiments were conducted to assess this detection system. Experimental results show that this system can be highly effective to detect venipuncture. Subsequently, based on this venipuncture detection system, four different handheld robots have been developed to provide different levels of autonomy and assistance while executing a PIVC insertion: 1. SVEI, short for \u2018Smart Venous Enter Indicator\u2019, is the simplest device without actuation. The user needs to do the whole PIVC operation, and this device only provides an indication of venipuncture by lighting up an LED. 5 2. SAID, short for \u2018Semi-Autonomous Intravenous access Device\u2019, integrates a motor to control the catheter insertion. The user is required to hold the device still and target it to a vein site. He/She then activates the device. The device inserts the catheter automatically and stops it when venipuncture is detected. 3. SDOP, short for \u2018Smart hand-held Device for Over-puncture Prevention\u2019, integrates a latch-based disengage mechanism to prevent over-puncture during PIVC. The user can keep the conventional way of operation and do the insertion manually. At the moment of venipuncture, the device automatically activates the disengage mechanism to stop further advancement of the catheter. 4. CathBot represents \u2018hand-held roBot for peripheral intravenous Catheterization\u2019. The device uses a crank-slider mechanism and a solenoid actuator to convert the complicated intravenous catheterization motion to a simple linear forward motion. The user just needs to push the device\u2019s handle forwards and the device completes the whole PIVC insertion procedure automatically. All the devices were characterized to ensure they can satisfy the design specifications. Then a series of comparative experiments were conducted to assess each of them. In the first experiment, 25 na\uefve subjects were invited to perform 10 trials of PIVC on a realistic baby arm phantom. The subjects were divided into 5 groups, and each group was asked to do the PIVC with one device only (SVEI, SAID, SDOP, CathBot and regular iv catheter). The experimental results show that all devices can provide the needed assistance to significantly facilitate and improve the success rates compared to the conventional method. People who have no experience of PIVC operation before can achieve considerably high success rates in robot-assisted PIVC (86% with SVEI, 80% with SAID, 78% with SDOP and 84% with CathBot) compared to the control group (12%) who used a regular iv catheter. Also, all 5 subjects using SVEI, 3 out of 5 subjects using SAID, 2 out of 5 subjects using SDOP and 4 out of 5 subjects using CathBot were able to successfully catheterize the baby arm phantom on their first attempt, while no subjects in the control group succeeded in their first attempts. Since SVEI showed the best results, it was selected for the second round of evaluation. In the second experiment, clinicians including both PIVC experts and general clinicians were invited to perform PIVC on a realistic baby arm phantom with 3 trials using SVEI and 3 trials in the conventional way. The results demonstrate that SVEI can bring great benefits to both specialists and general clinicians. The average success rates were found to be significantly improved from 48.3% to 71.7% when SVEI was used. The experimental results reveal that all experts achieved better or equal results with SVEI compared to the conventional method, and 9 out of 12 non-experts also had better or equal performance when SVEI was used. Finally, subjective feedback acquired through post-trial questionnaires showed that all devices were highly rated in terms of usability. Overall, the results of this doctoral research support continued investment in the technology to bring the handheld robotic devices closer to clinical us

Design and Integration of Electrical Bio-Impedance Sensing in a Bipolar Forceps for Soft Tissue Identification: A Feasibility Study

This paper presents the integration of electrical bio-impedance sensing technology into a bipolar surgical forceps for soft tissue identification during a robotic assisted procedure. The EBI sensing is done by pressing the forceps on the target tissue with a controlled pressing depth and a controlled jaw opening distance. The impact of these 2 parameters are characterized by finite element simulation. Subsequently, an experiment is conducted with 4 types of ex-vivo tissues including liver, kidney, lung and muscle. The experimental results demonstrate that the proposed EBI sensing method can identify these 4 tissue types with an accuracy higher than 92.82%

Phlebot: The Robotic Phlebotomist

Phlebotomy is a routine task, performed over a billion times annually in the United States alone, that is essential for proper diagnosis and treatment. We designed and constructed Phlebot, a robotic assistive device that uses near- infrared imaging and force-feedback to guide a needle into a forearm vein for blood sample collection or intravenous catheterization. Through initial validation on phantoms, we show that it is feasible to automate phlebotomy reliably. We envision the device to be a first major step towards more affordable point-of-care testing and diagnostic healthcare systems. In the long term, we expect that Phlebot will expedite healthcare delivery and drastically reduce needle stick injuries, instances of hemolysis, and infections caused by blood-borne pathogens

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 357)

This bibliography lists 186 reports, articles and other documents introduced into the NASA Scientific and Technical Information System during Dec. 1991. Subject coverage includes: aerospace medicine and physiology, life support systems and man/system technology, protective clothing, exobiology and extraterrestrial life, planetary biology, and flight crew behavior and performance

Virtual reality distraction for acute pain in children

Background Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The eDectiveness of VR distraction on acute pain intensity in children is uncertain. Objectives To assess the eDectiveness and adverse eDects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, hand searched relevant journals and contacted study authors. Selection criteria Randomised controlled trials (RCTs), including cross-over and cluster-RCTs, comparing VR distraction to no distraction, non-VR distraction or other VR distraction. Data collection and analysis We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post-procedure). Secondary outcomes were adverse eDects, child satisfaction with VR, pain-related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables. Main results We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their diDerent perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results. We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision

Force-Sensing-Based Multi-Platform Robotic Assistance for Vitreoretinal Surgery

Vitreoretinal surgery aims to treat disorders of the retina, vitreous body, and macula, such as retinal detachment, diabetic retinopathy, macular hole, epiretinal membrane and retinal vein occlusion. Challenged by several technical and human limitations, vitreoretinal practice currently ranks amongst the most demanding fields in ophthalmic surgery. Of vitreoretinal procedures, membrane peeling is the most common to be performed, over 0.5 million times annually, and among the most prone to complications. It requires an extremely delicate tissue manipulation by various micron scale maneuvers near the retina despite the physiological hand tremor of the operator. In addition, to avoid injuries, the applied forces on the retina need to be kept at a very fine level, which is often well below the tactile sensory threshold of the surgeon. Retinal vein cannulation is another demanding procedure where therapeutic agents are injected into occluded retinal veins. The feasibility of this treatment is limited due to challenges in identifying the moment of venous puncture, achieving cannulation and maintaining it throughout the drug delivery period. Recent advancements in medical robotics have significant potential to address most of the challenges in vitreoretinal practice, and therefore to prevent traumas, lessen complications, minimize intra-operative surgeon effort, maximize surgeon comfort, and promote patient safety. This dissertation presents the development of novel force-sensing tools that can easily be used on various robotic platforms, and robot control methods to produce integrated assistive surgical systems that work in partnership with surgeons against the current limitations in vitreoretinal surgery, specifically focusing on membrane peeling and vein cannulation procedures. Integrating high sensitivity force sensing into the ophthalmic instruments enables precise quantitative monitoring of applied forces. Auditory feedback based upon the measured forces can inform (and warn) the surgeon quickly during the surgery and help prevent injury due to excessive forces. Using these tools on a robotic platform can attenuate hand tremor of the surgeon, which effectively promotes tool manipulation accuracy. In addition, based upon certain force signatures, the robotic system can precisely identify critical instants, such as the venous puncture in retinal vein cannulation, and actively guide the tool towards clinical targets, compensate any involuntary motion of the surgeon, or generate additional motion that will make the surgical task easier. The experimental results using two distinct robotic platforms, the Steady-Hand Eye Robot and Micron, in combination with the force-sensing ophthalmic instruments, show significant performance improvement in artificial dry phantoms and ex vivo biological tissues

Aerospace medicine and biology: A cumulative index to a continuing bibliography (supplement 358)

This publication is a cumulative index to the abstracts contained in Supplements 346 through 357 of Aerospace Medicine and Biology: A Continuing Bibliography. It includes seven indexes: subject, personal author, corporate source, foreign technology, contract number, report number and accession number