Presented by: Kai-Ho Fok M.A.Sc, MD, FRCSC
St. Michael's Hospital

Introduction

Continuous bladder irrigation (CBI) is used in a variety of clinical settings including post-transurethral surgery and the emergency department. Currently, CBI administration relies on nurses to diligently monitor and switch irrigation bags, as well as titrate the inflow rate based on effluent color. Inappropriate administration can result in discomfort to patients, clot urinary retention, repeat injury to the pathological or surgical site, extended hospital stays, and even operative management. Our objective was to create an autonomous CBI system that decreases the incidence of disrupted irrigation flow and monitors the outflow to alert clinicians of critical events. 

Materials

3D printing and off-the-shelf microcontrollers were used to design a device to fit the needs identified by stakeholders at our institution. An in vitro model of the bladder was created to test our design. The mechanical, electrical, and software subsystems were adjusted accordingly to meet our design requirements. 

Results

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Our in vitro CBI model was able to simulate routine CBI administration with sudden bleeding. Bovine blood was used to simulate the bleeding events. A device was created that met identified stakeholder needs. Accurate detection of critical bleeding events, catheter blockage, and empty irrigation bags were achieved. The device responds to bleeding appropriately by increasing the irrigation rate. When the catheter is blocked, it stops the irrigation and alerts the nurse. Our system accurately titrated the irrigation rate to match a set outflow blood level parameter; conserving irrigation and minimizing nursing workload.  Continuous monitoring of CBI effluent was recorded.

Conclusion

We anticipate our device will decrease the cognitive load on nurses in busy clinical settings and improve workflow.  Moreover, the detection of critical events will likely decrease patient morbidity. Continuous monitoring of the CBI outflow may prove to be a new clinical decision-making tool for ongoing hematuria. Clinical trial is pending.

Funding

This work was supported by the St. Michael’s Foundation, Toronto, Ontario, Canada through the Angels’ Den competition and the Keenan Foundation, as well as Alayne and Ron Metrick.

Co-Authors

Sufyan Shaikh, BSc
University of Toronto

Ray Jayatunga,
University of Toronto, Institute of Biomedical Engineering

Shamir Malik,
University of Toronto, Temerty Faculty of Medicine

Jonguk Lee,
University of Toronto, Temerty Faculty of Medicine

Brian Carrillo, PhD
WellSpring Research

Monica Farcas, MEng, MD, FRCSC
University of Toronto, Temerty Faculty of Medicine, Institute of Medical Science, St. Michael's Hopsital