In pediatric operating rooms, the immediate access to syringed medications is crucial to any anesthesia team. The first few seconds spend finding a medication can delay necessary administration and grabbing the wrong syringe is an even bigger problem!
In the pediatric ORs at Duke University Hospital, the faculty of pediatric anesthesia came to a consensus on which medications should be pre-prepared and where they should be located: specifically, the two intramuscular medications on the anesthesia machine table and the intravenous medication on top of the machine cart.
After discussing a happening at another institution than stemmed from misplacement of emergency medication, the pediatric anesthesia team decided to examine their compliance on the placement standardization of the medications. A one-day unanticipated audit found variability in both the types of medications pre-prepared and their respective placement in the operating room. Furthermore, an administered survey concluded that although 52% answered that they “never struggle” with maintaining organization of their workspace, 80% answered that they were be receptive in utilizing a device that organizes, standardizes and simplifies access to emergency anesthesia medications in the pediatric operating rooms.
Over the course of 7 months, pediatric anesthesiologist Dr. Rebecca Scholl and Co-Lab engineer Kris Elbert, designed and 3-D printed a series of bracket syringe holders that could be mounted and integrated within the anesthesia carts. Initially, Dr. Scholl come to the Co-Lab with a rudimentary CAD model that her sister had made in SketchUp, but with Kris’ expertise in Fusion 360, they were able to remake the part and change variables easily to add improvements to the design as they came up.
The first prototype was printed on the Ultimakers, cleaned up using general scrapping tools and attached with a magnet to keep the holder from being knocked over when doctors were rushing around to grab things. Four more iterations of the custom syringe holder were designed and printed after Kris visited some of the Duke ORs, including the pediatric unit, to gain insight on how to adapt the holder to function with all the different units at the Duke University Hospital.
The final product, is a laser cut plexi-glass model that that holds IMsuccinylcholine, IM atropine, both 1 mcg/ml and 10 mcg/ml concentrations of epinephrine, a propofol syringe, two vials of unopened medications, and an intubating stylet such as a bougie. The cutouts are custom to the syringes so that the drugs can only be stored in their proper location and position. Moreover, the holder is secured magnetically to the top right corner of the anesthesia machine cart, easily with in reach during an emergency.
Dr. Scholl presented the holders at a conference in Phoenix last May with the holder being trialed in one OR. Now, the holder is deployed in all pediatric ORs at the Duke University Hospital, and after three months of implementation, a survey will be distributed to members of the anesthesia team to assess feasibility, compliance and any opportunities for further improvement.
With the creation of the simple syringe holder to standardize access to emergency medication, Dr. Scholl’s project has gotten her colleagues interested in 3D printing their own tools. The possibilities of 3D printing technology for healthcare prove to be endless with this incredible collaboration between the Co-Lab and Duke University Hospital!