UltraSniper: An Ultrasound Needle Guide to Aid Nerve Block Procedures

UltraSniper:An Ultrasound Needle Guide to Aid Nerve Block Procedures

Kate Fox, Binhan Pham, Minghui Shi, Jonathan YuUW Bioengineering Capstone SymposiumMay 23, 2016

Subheading

Kate Alexandra Fox () - Should we take this slide out or combine it with other solutions?Minghui Shi () - I think we should take this slide out and add a bullet point to prior art.

Kate Fox, Binhan Pham, Minghui Shi, Jonathan YuDr. Christopher Neils, Dr. Alyssa Taylor

Dr. Daniel Low AnesthesiologistDr. Timothy CasiasAnesthesiologist

Keith Williams Director of Hardware EngineeringPaul DunhamPrincipal Transducer EngineerSaeed AliakbariMechanical Engineer Angel BrownSystem EngineerOur Team

OverviewBackground and PurposeCurrent SolutionsDesign OverviewEvolution of DesignPrototype Testing and ResultsConclusionsFuture Directions

G.E. Healthcare

Background and PurposeUltrasound (US) guided nerve block Anesthetic injection toward nerve(s)Difficult to keep needle in US planeG.E. Healthcare

Source: Dartmouth-Hitchcock Medical CenterConsequences of losing needle viewInadvertent needle puncturePneumothoraxNerve damageIntravascular injectionLocal anesthetic systemic toxicity

Second major bullet animated in

Current Solutions

Brattain et. al. IEEE EMBS Conference 2011Fixed AngleClear Guide OneCIVCO InfinityHarvard DesignLimited needle pathExpensive,No physical guidanceDoes not support distal injection sitesShort arms, sterility not addressed, limited clinical relevance

First 3 commercially available. Fixed angle: Several companies, including CIVCO, Protek, and GE, have several lines of these types of needle guides for various applications.Clear guide one optical tracking with real-time feedback of needle trajectory by tracking the needles current position. Custom and proprietary components are required while no physical guidance is given. Regular calibration and servicing is required. Still highly dependent on anesthesiologist's technique as no physical guidance is provided. CIVCO Infinity: Disposable guide slit. Allow more freedom than fixed angle but is still attached to the probe not allowing for distal injections and providing no depth prediction or guidance on target angle within slit area. Harvard design: 10 cm arms can be locked into place. Needle must be inserted through hole, but no discussion of sterility. Short arms do not allow to reach distant depths and based on our review, we found this device to not be clinically relevant

Background and Purpose

Limitations of existing ultrasound needle guides:in-plane insertions onlydiscrete insertion anglesno needle trajectory prediction

Purpose: To design an ultrasound needle guide that ensures 100% in-plane needle view with high first-pass success rate over clinically relevant depths.

Design Process

Lower flow chart and include all 4 and pick up where we left off

Phase 1: Background Research and Planning

Phase 1: Background Research & Planning | Phase 2 | Phase 3

Clinical observationsPatent search and evaluationDesign criteria & constraintsNeedle visibilitySonoSite L38 probe compatibleTarget depth: 0.5-6 cmAdjustability, Sterility, Durability...

Brainstorming

Bold top criteria ? Take out descrip. And make bigger over white background. Sp(?)

Design Overview

Phase 1: Background Research & Planning | Phase 2 | Phase 3

3 main components: probe attachment, hinged arms, needle guideAims:Adjustable needle angle and depthMaintain needle in US planeImproved accuracy and safety

Phase 2: Prototyping and Iteration of Design

Standard 5oz Tabasco bottle for scale

Phase 1 | Phase 2: Prototyping & Iteration of Design | Phase 3

Prototype 1.02-piece 3D printed probe attachmentHinged Lego armsAreas for improvement

Prototyping by Components

Phase 1 | Phase 2: Prototyping & Iteration of Design | Phase 3

Probe AttachmentHinged ArmsNeedle GuideShapeThicknessJointMaterialLengthShapeHinge hole sizeGuide slit HoleInsertion hole sizeShapeThickness

Selected Intermediate Prototypes

Phase 1 | Phase 2: Prototyping & Iteration of Design | Phase 3

Current Prototype

Phase 1 | Phase 2: Prototyping & Iteration of Design | Phase 3

Current Prototype - Continued

Phase 1 | Phase 2: Prototyping & Iteration of Design | Phase 3

LIVE DEMO. Figure larger, text on the figure

Phase 3: Prototype Testing and Evaluation Simple Paper Tracing Test for Determining Range of DepthCurrent Freehand Technique vs UltraSniperTesting CriteriaMeasured Time Required to HitNumber of AttemptsNeedle VisibilityExperimental Set UpTargets at Clinically Relevant Depths Cameras for Video CaptureTimersFeedback

Phase 3: Evaluation and Redesign of Prototype

Statistical Analysis Potential Improvement in all Criteria Feedback from Experienced Physicians Overwhelmingly Positive Incorporated Suggestions on Needle Guide PartTesting at WISH with Novice Students Positive ReviewsImprovements in Experimental Design

ConclusionDevice meets original design criteria/constraints?Easier to keep needle in planeCompatible with L38 probeAble to reach desired range of target depthsSterility: possibly use extra probe coverFurther testing and iterations neededWorked well as a team

Future WorkNeedle trajectory prediction3 potentiometers to measure anglesSeparate potentiometer holder

Future Work - continuedNeedle trajectory predictionCalculate needle trajectory from arm angles using LabViewOverlay trajectory on ultrasound screen or display projected needle depth

Future Work - continuedSterilityDifferent materialsAttachment for out-of-plane insertionsPublication in equipment section of Anaesthesia

Thank you!