Date of this Version
R. Reynolds, “Development of an Intraperitoneal Catheter Placement Device for Use on the Battlefield.” M.S. thesis, University of Nebraska-Lincoln. Apr. 16, 2021.
The objective of this project was to simplify peritoneal cavity access so an Airforce field medic can safely infuse oxygen microbubbles (OMBs) into the intraperitoneal space for the emergency treatment of hypoxia due to lung damage. To solve this problem, we created an intraperitoneal catheter placement device for use on the battlefield. The three common methods and some of the most common devices for peritoneal cavity access were reviewed. Injury frequencies for each of the three methods were analyzed. The results showed that each of the access techniques gives a similar rate of iatrogenic injury.
The battlefield conditions where the device will be used were also researched. The intraperitoneal infusion of OMBs is most likely to occur at or following the tactical field care stage. A field medic’s bag can be large and heavy. Thus, the catheter placement device needed to be small and lightweight (< 1 kg). Also, since field medics do not receive as much training as surgeons do, the device insertion technique needed to be simple, have no requirement for advanced surgical training, and have a minimal chance for error.
A major part of device development was a study to determine the optimal pressure range for initial insufflation of the peritoneal cavity. The study was performed on twelve fresh porcine carcasses to compare the minimum preperitoneal insufflation pressure and the minimum initial peritoneal cavity insufflation pressure. Pressures greater than 10 mmHg resulted in initial cavity insufflation and pressures greater than 20 mmHg resulted in preperitoneal insufflation in porcine models.
Description of the first functioning prototype was set forth. A threaded trocar was used to control peritoneal cavity entrance. The threaded trocar was rotated by a hand crank that increased the ergonomics and speed of entry. A spring-loaded flexible pressure cylinder at 20 mmHg was used to inform the user when the peritoneal cavity was accessed. The applied pressure was low enough to not insufflate the abdominal wall during insertion. As soon as the cavity was reached, the pressure was sufficient to insufflate the cavity and the user was informed when to stop advancing the trocar. Thus, the simple device successfully reaches the peritoneal cavity with little surgical knowledge required.
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