Piston syringes are not ideal for delicate and complex procedures, such as central line placement and peritonsillar abscess drainage. Our ED at Thomas Jefferson University does not stock control syringes, available in oral surgery offices and operating rooms, so we decided to convert the ubiquitous piston syringe into a more advanced control syringe.
The awkward grip required to maintain negative pressure on a piston syringe makes it obvious that the geometry of a control syringe would make maintaining negative pressure easier. Drawing back on the piston is also made more difficult by bloody gloves or a bloody syringe, as can be the case during central line placement. Reviewing peritonsillar abscesses and their proximity to the internal carotid artery makes it obvious that fine syringe control is required when draining these collections.
We thought 3D printing would be the ideal tool to generate a solution. It is exciting to see the technology work its way into health care. It has already been used to create anatomic models, generate tissue, and formulate pharmaceuticals. (Biomed Eng Online. 2016;15:115; http://bit.ly/2uK9sgE; P T. 2014;39:704; http://bit.ly/2Uvk7KJ.) It has tremendous potential in medicine to generate novel parts and devices quickly, which the engineering field has termed “rapid prototyping.”
This process starts with an idea that takes shape in sketches to form the basis of computer-based 3D models. The models are converted to physical prototypes within a matter of hours using 3D printing. Each prototype can then be quickly tested and refined.
Fortunately, Thomas Jefferson University Hospital has a dedicated Health Design Lab that provides students, researchers, and clinicians with resources, including a complement of Ultimaker 3D printers. The printers have already been used on several clinical and research projects.
We began our design process by making sketches of potential solutions. Open-source 3D modeling software (AutoCAD) was used to generate 3D models of attachment prototypes, which were printed using a polylactic acid plastic. Nine iterations of the syringe attachments were made, which we evaluated and refined.
The final device consists of a plunger, which has a single ring for the thumb, and a syringe attachment, which has one ring for the index finger and one for the middle finger. Both attachments have two components that snap together and securely attach around the piston syringe. The components are permanently attached to the syringe to minimize the possibility of accidental detachment during use. Anthropomorphic data were used to create different sizes of the attachments to accommodate a range of hand sizes. Devices were created to attach to 10 mL BD syringes. The dimensions can be edited to accommodate syringes of different sizes and produced by various manufacturers.
The syringe attachments are well suited for procedures where clinicians must aspirate and inject but not damage nearby vital structures. The device will enhance the safety of procedures where millimeters can mean the difference between successful patient care and permanent injury or death.
An invention disclosure on the device was submitted to Thomas Jefferson University, and a trial is being considered to evaluate if the device improves teaching central line placement. Free tutorials are available for all software and prototyping techniques used in this project. The attachments can be viewed and downloaded for printing at https://www.thingiverse.com/matt_grzywinski/designs.
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Mr. Grzywinskiis a fourth-year medical student andDr. Kleinmannis a clinical assistant professor of emergency medicine, both at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia. Follow Mr. Grzywinski on Twitter @matt_grzywinski.