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UW-Madison BME 300 - Tracheostomy Tube Security Device

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Tracheostomy Tube Security Device Client: Dr. Timothy McCulloch Advisor : Professor Paul Thompson Leader: Katie Pollock Communicator: Rebecca Clayman BWIG: Kim Safarik BSAC: Paul FossumBackground: Problem Statement: In patients who have had a tracheotomy performed, a major post surgery problem is discomfort from the tracheotomy collar. The collar must be secured tightly to keep the tracheotomy tube in place so the patient can breathe. However, if the collar is kept at the proper tension, it can cause ulcers on the patient’s skin. Our goal is to design a tracheotomy strap that is comfortable, easy to clean and equipped with monitoring devices to ensure that proper pressure is exerted on the neck. Background: A tracheotomy is a surgical procedure in which a cannula (a very thin tube) is placed into the tracheal lumen. A tracheotomy tube is then placed inside the cannula creating a semi-permanent or permanent hole. This creates a tracheostomy hole, which allows the patient to breathe through the tracheotomy tube. The terms tracheostomy and tracheotomy are used interchangeably in a hospital setting although technically a tracheotomy is a procedure and a tracheostomy is a hole through which the tube is placed. http://www.kevinmd.com/blog/hello/51/959Figure 1 Diagram of the anatomy surrounding a tracheotomy tube. Tracheotomies are a common and necessary procedure. They are performed when a patient’s airway is obstructed, most commonly by a foreign object or tumor. Tracheotomies can also be performed in cases of lung disease or severe airway inflammation. The tracheotomy procedure bypasses the obstruction and creates an airway for the patient to breathe.After a tracheotomy is performed, the surgeon secures the tube with sutures onto the front of the neck and then secures them further with a tracheotomy strap or collar. The strap ties into one side of the tracheotomy tube and around the back of the neck into the other side of the tube. Currently, our client Dr. McCulloch uses a long simple piece of cloth to secure the tracheotomy tube. He prefers this method not only because he can control the tension of the strap, but he doesn’t have to worry about the size of the patient during the operation. http://www.medicdirect.co.uk/images/tracheostomy_large.jpg Figure 2 Tracheotomy strap currently used by Dr. McCulloch. The most common post surgery problem is discomfort from the tracheostomy strap. The strap must be secured tightly enough to secure the tube in place; however, if it is secured too tightly, skin ulcers may develop underneath the strap due to capillary relapse. If the strap exerts more than 30mmHg of pressure on the neck, it causes the capillaries in the neck to close. This limits circulation and begins the ulceration process. However, accidental decannulation can result if the strap is not tied tightly enough, causing the tracheotomy tube to slowly work its way out of the tracheostomy hole which leads to suffocation and potentially death. Client Requirements: Our goal is to design a tracheostomy strap that is comfortable, easy to clean and equipped with monitoring devices to ensure that proper pressure is exerted on the neck. This will involve the fabrication of a wider, more comfortable strap around the back of the neck. The material should be able to expand and contract with neck fluctuation. Neck fluctuation is a direct result of excess fluid inthe body. We will also be fabricating a pressure monitoring system using balloons filled with a comfortable substance that will increase the comfort and adjustability of the pressure on the back of the neck. The strap must also be easy to maintain and be used for 5-7 days without being taken off of the patient. Design: Our design will have three main components: the front connections that attach the strap to the tracheotomy tube, the back pressure system that is somewhat self adjusting, and the material out of which the strap will be made. Strap Connections The strap connections are an important design element because they provide the first level of protection against decannulation. If the straps remain stationary, then so must the tube. Currently, Dr. McCulloch uses a simple white cotton strap to secure the tracheotomy tube. He ties the strap in a knot on either side of the tracheotomy tube, so that the strap cannot be loosened and cause an accidental decannulation. The problem with this strap design is that although it is very secure, it cuts off circulation in the patient’s neck and creates ulcers.Most of Dr. McCulloch’s colleagues use the collar shown in Figure 3. This collar is convenient because it can be adjusted to any neck size due to its two pieces connected by velcro. This allows nurses to undo the strap and evaluate the patient’s neck to determine if they are developing ulcers. However, this adjustability sacrifices the integrity of the tube’s position. If the strap is not adjusted to precisely the same location when it is reattached, the tracheotomy tube will not be secured as tightly as it should, and it can slowly work its way out of the hole resulting in accidental decannulation. Our goal was to design a strap which safely holds and locks the tube in a given position, with adjustability for patient neck size and nurse access so that a patient’s neck may be monitored for ulcers. http://www.marpacinc.com/Images/bariatricart.jpg Velcro Currently, many straps are produced which employ velcro as their means of attachment to the tracheotomy tube. Velcro is easily adjustable, but is difficult to reposition accurately. For this reason, we did not select velcro as our strap attachment method. Figure 3 Top collar is model currently used by Dr. McCulloch's colleagues.Redesigned hat snaps In this design, the stationary part of the strap on the back of the neck will have two male knobs on the furthest edge of each side of the strap. These will be connected to a long series of female holes which can wrap through the slits in the tracheotomy tube and double back to connect to the male knobs. This method will be convenient because it will allow for a wide range of neck sizes. This method is also locking. The hole position can be marked down and duplicated if the nurse needs to monitor the patients neck or detach the strap for any reason. Figure 4 Redesigned hat snaps connection Belt Design This


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UW-Madison BME 300 - Tracheostomy Tube Security Device

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