Haptic Robotic Training to Decrease Catheter Complications

Led by Scarlett Miller, associate professor of engineering design and industrial engineering, and Jason Moore, associate professor of mechanical engineering, a multi-disciplinary and multi-institutional research team aims to develop an innovative robotic training system to reduce the number of complications associated with central venous catheter placement. 
IMAGE: Tyler Henderson. Source: Pennsylvania State University

Each year, more than five million central venous catheters(CVC) are placed in a large vein in the neck, chest or groin to providepatients with fluids, blood or medications. The thin, flexible tubes emptytheir contents into or close to the heart, providing almost immediatetreatment. Of these five million patients, close to 1.7 million experience somesort of complication related to the catheter insertion — that is one in everythree patients.

A Penn State-led, multi-disciplinary and multi-institutionalresearch team aims to develop an innovative robotic training system to reducethe number of complications associated with CVC placement.

Through a five-year, $2,233,411 grant recently awarded bythe National Institute of Health’s National Heart, Lung and Blood Institute,principal investigators Jason Moore, associate professor of mechanicalengineering, and Scarlett Miller, associate professor of engineering design andindustrial engineering, will lead a team of engineers, medical professionalsand graduate students to build upon their previous dynamic haptic CVC worksupported by the NIH. Co-investigators include the project’s lead medicaldoctor David Han, professor of surgery and radiology at Penn State College ofMedicine; Lisa Sinz, associate dean for clinical simulation at Penn StateCollege of Medicine and professor of anesthesiology, critical care medicine andneurosurgery; and Philip Ng, medical director of the Procedure Center and VascularAccess Services at Cedars-Sinai in Los Angeles.

The new project will use the team’s innovative concept ofdynamic haptic robotic training (DHRT), where a programmable robot is used toapply force to a surgical resident’s hand to replicate the feeling of insertinga needle into a patient’s body, to develop and implement an entire CVCprocedural training system. The new DHRT+ system will integrate a mixed-realitysmart tray, advanced testing surface, high-functional fidelity virtualultrasound imaging and real-time, adaptive feedback assessment.

“The DHRT+ system is focused on not just decreasing and eveneliminating the mechanical complications and the training of that, but alsolooking at the entire procedure, so from the moment that they start consentingthe patient to the moment that they insert the final devices,” Miller said.

She explained that by focusing on the process from beginningto end, the team will decrease not only mechanical complications but alsoinfectious complications. Infections can happen from not using appropriatesterile techniques, both before and after the central line placement.

Moore highlighted that by widening the scope to includesterilization practices and patient records review, the steps that peoplegenerally need to memorize will be included in the training process and theseskills learned will transfer into clinical use.

“We can make it (training) be much more effective for theuser and help eliminate some of the patient complications that we see,” hesaid. “If somebody is trained with the DHRT+, we hypothesize this will have astrong impact on patient well-being at the end of the day."

To prepare residents for the patient diversity they will seein the clinic, the DHRT+ will simulate varying realistic insertion scenarios.The device will provide direct feedback and assessment to users, providingimmediate results on what they did right and what skills need improvement. Itwill also connect to the DHRT+ Global Learning System, a centralized systemthat automatically stores and analyzes performance information and updates theDHRT+ simulation to continually improve learning performance.

Han, also an investigator on the original NIH grant, saidwhile training residents with simulators is not new, the idea of incorporatingstructural design and the interface between the simulator and the learner toprovide personalized, real-time, real-data feedback is. He feels thecollaborative nature between engineers and medical professionals brings adifferent perspective to the project—leading to innovative solutions that mightnot otherwise come to be.

“Collaborating with researchers who bring a differentperspective is incredibly valuable to identifying, developing and creating newmethods and techniques,” Han said.

Currently, there is no standardized training procedure forcatheter insertion training throughout the health care industry. Through aconnection due to their previous DHRT work, the Penn State team invited Ng andCedars-Sinai to become part of the project, creating the multi-institutionalcomponent needed to take the research to the next level. Through thepartnership with two medical facilities, Penn State Health Milton S. HersheyMedical Center and Cedars-Sinai, the team expands their research population,ultimately leading to more accurate system adoptability and implementationdata.

Ng, who was fascinated by the system’s ability to changescenarios and track time and needle entry angle, said the project has all thenecessary facets to address the issues with current simulation training.

“It’s one thing to be really proficient on a simulator, tobe fast and accurate, but it’s a different thing to say that the learning inthe sim center gets translated to the bedside and results in fewercomplications, improved safety and less stress on everybody,” he said. “Everycase that they do in the sim center should be viewed as learning a differenttool they will put in their toolbox so that when they are faced with an actualclinical scenario out there, they can reach into their toolbox, apply whatthey’ve learned and get the right tool for the right job.”

Ultimately, the team hopes to translate what is learned withthe DHRT+ to the bedside, leading to improved patient safety and comfort.

“As engineers and engineering designers, we are constantlytrying to create innovations,” Miller said. “We always say, ‘It could be you inthe hospital setting having this procedure done.’ The training of that personleading up to that moment is really important. It’s not just you—it could beyour family member or close friend having this done. The reason that drives meto improve our health care system for this procedure that is done so commonly,but has such a high complication rate, is that opportunity to have that impacton people’s lives.”