Combining the rapid prototyping & small-batch production capabilities of makerspaces with the unique challenges faced by hospitals.
December 1, 2016 | ProgressTH We've been busy at work with the local children's hospital, Queen Sirikit National Institute of Child Health (QSNICH). Three additional projects have started, including modifications for an air-warmed blanket used to maintain body temperature for children during surgery. The blanket required more evenly distributed air down the 3 pockets the blanket consists of.
Another project involves creating a cap with handles for children to hold on to when using a bottle designed for exercising the lungs. The bottle must be 1L, but such bottles are difficult for children to hold onto. With 3D printing, custom handles can be designed into a custom threaded cap that makes it easier for children to hold.
Finally, we designed a template for creating 3D printed PLA plastic hand splints. PLA softens in water temperatures of around 95-100 degrees Celsius, then quickly sets when exposed to room-temperature air. This allows us to shape the 2D template into 3 dimensions around a patient's hand and lower forearm.
With 3D printing, the design process is now infinitely more flexible and the savings in costs represent a 20x reduction (from 800-900 THB to only 40 THB, 1 USD = 35 THB).
October 12, 2016 | ProgressTH Microscopy in the lab is very important, especially for dermatology when examining samples from a patient to determine the cause of an ailment.
For technicians at Bangkok's Queen Sirikit National Institute of Child Health (QSNICH) if they want to document anything they see under the microscope, they need to find one of only a handful of mounts and professional cameras in the entire hospital to do so.
So we 3D printed out a smartphone-microscope mount we customized from Thingiverse. We uploaded the modified version including the SketchUp file we used to do the modifying on Thingiverse here.
Unexpectedly, not only did it allow lab technicians to document their findings easier as well as share them instantly with doctors remotely, we found out while they tested it that it helped open up the conversation in the lab when doctors, technicians, and patients were present together. That's because with the large screen on most modern smartphones, you no longer need to take turns peering into the eyepiece of the microscope. Everyone can see everything at the same time on the screen, and healthcare professionals can easily point out and describe details for everyone.
October 12, 2016 | ProgressTH At the heart of the EpiPen is basically an autoinjector. It is a device that is preloaded and can be easily used by untrained people to deliver a dose of medication (in the case of the EpiPen, epinephrine for the treatment of anaphylaxis).
The EpiPen is available for $300 for one, $600 for a 2 pack.
This is obviously overpriced and to prove it, a group of biohackers created a $30 alternative using commercially available autoinjectors, syringes and needles, and a prescription of epinephrine.
The most costly component of the $30 dollar system is the autoinjector itself, though the particular model they used was an Autoject 2 and is reusable.
But can an opensource, 3D printed autoinjector cost even less? Yes it can. We've calculated the plastic used in printing it out on our Ultimaker clone to be about $1 (our conceptual prototype was under $1). So if you add in the springs, syringe and needle, and the epinephrine, you might be somewhere around $3 (especially if you bought some of the items in bulk). Even if you raised it to $5-10 it would still be a bargain and would be reusable.
For now this is a conceptual model but we are actually working on making it functional as well. We have a lot of other ideas in the works too either on our own or through the hospital we are currently partnered with (QSNICH, Bangkok).
July 27, 2016 | ProgressTH We've delivered dozens of prototypes of a dermatology tool consisting of between a 3-5mm wide blade used for a variety of purposes in a local children's hospital (QSNICH in Bangkok).
The prototypes are all printed with PLA plastic, and nearly all of them at a resolution of 0.3 mm.
Nurses took the prototypes and ran them through several processes in order to sterilize them before use. This includes wiping them down with 70% rubbing alcohol, soaking them in a 30% KOH solution, and a round in an ethylene oxide (EO) gas oven designed specifically for sterilizing plastic medical equipment that might not make it through an autoclave. For more information regarding how this process works, read here.
During this process, a 3M EO chemical indicator strip is used to ensure the proper conditions for the correct duration are reached within the chamber to ensure full sterilization.
For instruments printed out using a 0.3 mm resolution, it seems after repeated sterilization cycles, some of the layers near the edges start to come apart. We've tried to fix this by using a 0.15 mm resolution. The layers are much closer, denser, and so might resist coming apart as easily.
We shared our own research with the hospital regarding concerns some designers have had using 3D printing regarding food safety, specifically the microscopic structure of a 3D printed object and the possibility of bacteria hiding in relatively unseen crevices.
3D printing models is one thing, printing out medical devices is another. We're using all the tools and processes at our disposal to ensure these short-run prototypes are sterilized and safe for use in a clinical setting and learning a lot in the process.
For other makers out there interested in a similar project, make sure to work together with experienced medical professionals who have the tools and knowledge to ensure the safe testing of new, custom-made instruments and equipment for their hospital.
July 16, 2016 | ProgressTH We've had some trouble printing our needle disposal system caps because of threading on the inside and the inability to use supports. There was a heavy stringing-effect rendering the threads nearly useless and unsightly.
[image above: Result of faster/hotter print settings are seen on the left, while the slower and cooler settings can be seen on the right. Stringing was already removed post-print at this point on the left cap, but the threading is still poorly formed. No post-print processing was required for the cap on the right.]Cura 15.04.2 settings were set at 0.3mm resolution and high speeds at 200 degrees C. So we lowered the temperature to 180, and reduced the print speed from 65 to 50 mm/s and other speed settings to: bottom layer speed 30, infill speed 65, top/bottom speed 30, outer shell speed 60, and inner shell speed 65 (all speeds are in mm/s).
This produced a major improvement leaving almost no stringing-effect and much less time required to clean up the print after it finished.
Hospitals and even our agriculture projects seem to need a lot of threaded components so figuring out how to make this work might help significantly improve the quality and capabilities of our 3D printing.
July 14, 2016 | ProgressTH We have developed a few prototypes of this system. We delivered 10 for testing at QSNICH children's hospital which featured a twist and lock mechanism. The bottom piece screws onto a plastic container re-purposed from holding large quantities of rubbing alcohol. We worried that the locking process was not intuitive enough and that the tabs might break off as they were pretty small.
After testing though, the nurses found it was easy, even preferable to the screw-on design we proposed as an alternative. So this latest version will be the final (we think) version, with stronger tabs.
[pictured below: the batch of 10 we delivered for hospital-wide testing]
It was designed in SketchUp 2015 (Make) and exported to Cura using the free STL export plug-in you can get from SketchUp's Extension Warehouse (see the Instructable on how to do this here).
[pictured below: the first prototype we developed shows how the whole system looks. The needle goes through the hole and interfaces with the notch allowing hospital staff to pry it off without having to put their hands near it]
Everything we are printing out uses PLA plastic on a heavily modified 300x200x200mm Ultimaker Original+ clone called Extrabot.
We're looking into various datasheets from PLA filament manufacturers to get as much information as we can about toxicity. If anyone knows if PLA filament has BPA added to it (or doesn't), please let us know. So far we have not used it for any application where it would make a difference specifically because we are not sure.
July 14, 2016 | ProgressTH It was one year ago when we first presented the tools and techniques used at our makerspace to QSNICH (Queen Sirikit National Institute of Child Health). Since then, we have been closely working with several nurses to develop ideas they have to solve unique problems they face throughout various departments.
We've helped develop:
We've used SketchUp, Cura, and 3D printing on a heavily modified Ultimaker Original+ clone. Traditional manufacturing was not an option for the nurses because of a constraint in time and resources.
With 3D printing at local makerspaces, they were able to propose an idea, get it designed and printed out, test it, and iterate several times in one month.
For the needle disposal system, we at ProgressTH thought that a screw-on cap over the disposal inlet would have been best. But after testing several prototypes using a locking system, nurses found out the latter was better.
The only limitation so far is when a prototype finally works perfectly and the need for several hundred arises. 3D printing is not really cut out for such quantities, and factories are still not ready to affordably do the tooling unless you are making thousands. Finding a solution for this gap is underway and "microfactories" may be a possible solution.
This month, we returned to give another presentation. This time, we ended up teaching 10-15 nurses and other staff members how to use SketchUp. They designed their own keychains in less than 3 hours.
Follow up workshops are planned. We also are working with several more nurses to expand our collaboration and hope to get other hospitals interested since this event made it into the national news.