Custom made in 3D
It’s a delicate procedure that could save this trauma patient’s life - emergency tracheotomy requires skill, quick hands and a steady, confident countenance.
The doctor palpates the throat to find the sweet spot and then its crunch time. In the next few moments the doctor will make a delicate incision to the throat and insert the thin blue tube that everyone around the table hopes will keep this patient alive.
They make a deft incision and the tube slips in with little resistance. Success.
It’s a high-stakes situation, but thankfully on this occasion the patient is no more than a tightly wrapped bundle of latex, foam and faux blood.
This head-and-shoulders mannequin has been constructed for the benefit of a group of nurses and doctors brushing up on their emergency ventilation skills at the HNE Simulation Centre.
About 60 clinicians each year undertake the
Can’t Intubate, Can’t Oxygenate course taught by Dr Rebecca Scott and her John Hunter Hospital anaesthetist colleagues, putting their imagination to work as they intubate mock patients.
While this scenario has always required a stretch of the imagination, a healthy dose of realism was been introduced recently with the assistance of a mini boom of 3D printing at HNE Health.
This new mannequin’s white, lined face has an eerily android look, but his throat is soft and palpable with a 3D print of a trachea at its core. It’s as lifelike as it gets, well, at least as lifelike as modern technology currently allows.
“Previously, we had trialled models that were made from wood, tubing and rubber, but they didn’t provide a very realistic subject,” Dr Scott explains. “So much of what we do is about feeling. To perform a tracheotomy you need to be able to feel the correct incision point and the former models didn’t provide the fidelity to do that.”
With some assistance from HNE Health’s self-taught 3D printing gurus at Clinical Technology - better known around the traps as Biomedical Engineering - the Simulation Centre commissioned prints of real, anatomically-correct tracheas to replace the make-shift tubing that once sat at the core of the mannequins.
The 3D prints have significantly enhanced the training.
“Using the new mannequins with the 3D print provides participants an excellent sense of how to feel for the correct place and make a successful incision,” Dr Scott said.
“Were ask clinicians to treat this simulation as a high-stakes procedure on a living patient, and these new mannequins add to the realism of performing the technique.”
Since word got out that the District’s investing in 3D printing, the requests for a wide range of clinical applications have come thick and fast. While many are feasible, such as the use of 3D printing to plan specific surgeries, they’re currently out of scope - either beyond our printer’s capability or in need of rigorous ethics approval.
Hunter New England Health’s reputation as a leader in using 3D printing for clinical training had very humble beginnings.
It was born out of simple frustration in the ranks of Clinical Technology. The 20-strong team at Clinical Technology is primarily responsible for purchasing, maintaining and repairing a large range of medical equipment across the District.
It is important work that keeps all our frontline staff equipped with everything they need to provide quality patient care. It’s not all fun and lathes.
The team is also responsible for sourcing replacement parts for these same machines. Tracking down specific components is time
consuming. The parts are usually costly and often have to be shipped in from manufacturers overseas. Some are simply obsolete and no longer made. Many of the parts don’t stand up to the test of time - or the day-to-day rigour of the ward - and are soon broken or lost again.
Clinical Technology often finds itself balancing the needs of clinical staff who need their equipment back in action as soon as possible, with the manufacturers and suppliers whose response times could be described in some cases as snail-pace.
It’s not unheard of to wait months for even the smallest components to arrive, says Clinical Technology Director Mal Allen.
Out of this frustration came the 3D printing light bulb moment.
“About three years ago we needed 10 customised mounting brackets,” Mal explains.
“To make them the old way would have taken many hours to produce in-house. We tried to outsource the job and it was going to cost $110 per bracket. It was only $1500 to buy a hobby-grade 3D printer so we just bought it and made them - the printer almost paid for itself in the first day.”
Since word got out that a 3D printer is available, the department’s been flooded with more requests than it can handle. Many
requests can be accommodated, but Mal’s quick to explain the printing has its limits.
“While it’s not the answer to every problem, 3D printing has solved plenty,” Mal said.
“To design and print a 3D part is a short time to wait compared to the weeks some parts take to arrive. To be fair, it’s not just a matter of pressing a button and pulling the item out of the machine though. It’s not Star Trek … yet.”
The team now makes all sorts of components from purpose-designed covers, clips and brackets to hold small but expensive pieces of surgical equipment, to more specialised items that are either expensive or hard to come by in a hurry.
It has been a big shift for the mechanical team staff, who are more at ease working on a lathe than tapping away at the computer on the design software.
This change debunks that old myth - turns out you can teach old blokes new tricks.
Images (from top)
1. Team leader Dr Rebecca Scott with student instructor Max Bennes.
2. Work starts with the design software ...
3. ... then the 3D printer swings into action.
4. The 3D larynx is fitted into simulated throat tissue.
5. A tube is fitted allowing oxygen to be pumped in.