Embedded Files
Figure 1: Schematic of the Current Bronchoscope
Detachable Fiber-Optic Intubation Device
Detachable Fiber-Optic Intubation Device
Project Members: Mark Olesco, Gio De Guzman, Matthew Kohanfars, Eric Hu
Project Members: Mark Olesco, Gio De Guzman, Matthew Kohanfars, Eric Hu
Project Sponsors: Frank Talke and Jaspreet Somal
Figure 2: Endotracheal Tube over Brochoscope's Insertion Tube Figure 3: How the Bronchoscope is Slid Down the Patient's Airway
Project Description
Project Description
Bronchoscopes, as illustrated in Figure 1, are medical devices utilized to access the airways of a patient and is a vital tool in the daily work of an anesthesiologist. The functions of a bronchoscope vary from performing biopsies, imaging, and assisting in the intubation of a patient. When a patient goes under anesthesia, it is vital that they receive assistance breathing properly. To do so, an endotracheal tube must be placed in the airways so that it can be hooked up to a ventilator. There are two existing ways this is accomplished, a laryngoscope and the bronchoscope. To use the bronchoscope, the endotracheal tube must be placed over the insertion tube, as shown in Figure 2. Once in position, the endotracheal tube is slid down the insertion tube into the airway. At times, a patient may possess a narrow airway preventing the endotracheal tube from being properly placed. Current procedures entail taking out the entire bronchoscope, swapping in the right sized endotracheal tube over the insertion tube, and then relocating the correct position of the insertion tube within the patient's airway. This process puts the patient at risk of harmful consequences. To resolve this issue, the team aims to create a detachable bronchoscope that will enable surgeons to keep the bronchoscope in the patient as the endotracheal tube is replaced. This will be time-efficient, less difficult, and a safer alternative when it is implemented.
Bronchoscopes, as illustrated in Figure 1, are medical devices utilized to access the airways of a patient and is a vital tool in the daily work of an anesthesiologist. The functions of a bronchoscope vary from performing biopsies, imaging, and assisting in the intubation of a patient. When a patient goes under anesthesia, it is vital that they receive assistance breathing properly. To do so, an endotracheal tube must be placed in the airways so that it can be hooked up to a ventilator. There are two existing ways this is accomplished, a laryngoscope and the bronchoscope. To use the bronchoscope, the endotracheal tube must be placed over the insertion tube, as shown in Figure 2. Once in position, the endotracheal tube is slid down the insertion tube into the airway. At times, a patient may possess a narrow airway preventing the endotracheal tube from being properly placed. Current procedures entail taking out the entire bronchoscope, swapping in the right sized endotracheal tube over the insertion tube, and then relocating the correct position of the insertion tube within the patient's airway. This process puts the patient at risk of harmful consequences. To resolve this issue, the team aims to create a detachable bronchoscope that will enable surgeons to keep the bronchoscope in the patient as the endotracheal tube is replaced. This will be time-efficient, less difficult, and a safer alternative when it is implemented.
Objectives
Create the ability to easily exchange or insert an endotracheal tube
Maintain the tension of the angulation wires that control the insertion tube's distal tip
Detachment and reattachment design that will maintain the same functionality of a bronchoscope device
Ensuring the seal of working channel (used for suction and injection of medicine) after detachment
Creating a design with an insertion tube outer diameter not exceeding 7 millimeters
Design must only utilize bio-compatible material
Final Design
Figure 4: CAD of Final Design
In the complete design, the control head of the bronchoscope houses the main components that control the detachment mechanism and have the ability to rotate a shaft that is placed in the insertion tube. In Figure 5, a clevis pin (Part #2) is oriented in a horizontal position to hold the insertion tube in place as illustrated. This pin can be quickly taken out and pushed back in through the control body and insertion tube to hold it in place. Having the support alone from the plunger mechanism was not enough to hold the insertion tube and having the ability to rotate the end tip of the bronchoscope device by its 180 degrees and 130 degrees clockwise and counterclockwise rotation had to also be solved. This was then done by adding a 3 millimeter shaft mechanism inside the insertion tube that can be engaged from the outside of this aforementioned tube, shown in figure 5 (Part #5). The engagement of the shaft occurs from the lever arm that also contains a hex fitted mechanism to attach to the shaft. This lever mechanism also shown in Figure 5 (Part #8), can be engaged and disengaged by the user's push and pull.
Performance Results
Endotracheal tube exchange was faster with new device
To detach: 15-20 seconds
To reattach: 20-40 seconds
Distal tip control maintained after detachment process
Final Design Components
Figure 5: Final Design Components
Alignment and Detachment
99% success rate of attachment/detachment between the insertion tube and alignment base
The insertion tube remains attached during operating of the angulation wires
Quick attaching and detaching (the whole exchange process takes no longer than 1 min)
Smooth but secure attachment (larger force needed to detach than to attach)
Good feedback from the surgeons
The team decided to have an alignment base in control body and a modified insertion tube tip. The slot on the insertion tube and a guide pin on the base helped secure the insertion tube and provided only one accepted orientation for insertion. In addition, a clevis pin held the insertion tube in place with the control body once it was connected. The pin can be easily pushed in and pulled out by the doctor for attachment and detachment. Overall, this finalized design allowed consistent and sturdy attachment and quick detachment by meeting all necessary requirements.
Insertion Tube Shaft and Control Lever
1:1 relationship between control lever and distal tip rotation
Able to achieve ~180° upwards and ~130° downwards rotation of the bending section
Have locked and unlocked modes for detachment mechanism
Consistent, reliable connection between insertion tube shaft and control lever
The team decided to place the shaft within the insertion tube while implementing the control lever with the twist-to-lock plunger. Putting the shaft inside the insertion tube solves the problem of reconnecting the angulation wires and it limited the entire controlling system to within the insertion tube thus he distal tip control system was independent of the control body detachment process. The control lever mechanisms that uses a twist-to-lock retractable spring plunger only requires the doctor to pull out and twist the lever in order to control the distal tip or allow for detachment.
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