Matthew Murdock – Independent Project

Matthew Murdock – Independent Project

Class of 2017

Introduction to Topic

Vascular surgery, is the premiere service in the treatment, prevention or repair, from aneurysms, to strokes, to the common sore. Each year more and more people are succumbing to the complications of various vascular diseases and disorders. Vascular care stems great interest for me after I have learned that both sides of my family, have had a history of various vascular problems, from stroke to heart disease. The purpose for conducting this project will be to improve the care of patients that have been diagnosed with vascular diseases and the improvement of some of the operative complications associated with treatment..  Ultimately vascular surgery is associated with “high rates of perioperative morbidity and mortality” (Bird & Nesbitt, 2013) thus, proving the need for advances in patient care. Specifically complications such as gossypiboma has proven to be a longstanding problem in the entire surgical community.

Project Description

In order to study and to gain a unique perspective in the care of a vascular patient I shadowed at the Maryland Vascular Center at the University of Maryland-Baltimore-Washington Medical Center under Dr. Marshall Benjamin, Chief of Surgery. I shadowed to develop a solution that has great effects in the improvement of the vascular patient whether it be in a surgical setting or in a post-operative standpoint in care. With my shadowing experience, I spent time between the operating room watching various procedures and understanding their implications and outcomes. As well as spending time in the clinic and the vascular pharmacy to gain a better understanding of the overall care of a vascular patient and the needs associated with these types of diseases and repairs. Operative time is a factor in these cases as prolonged times can lead to negative outcomes. Due to the number of instruments time can be saved by having faster methods of accounting for these instruments to finish operations as quick as possible to prevent the risks associated with prolonged operative times such as: infection, bleeding and other life threatening complications.

Experience Description

My time at the Maryland Vascular Center started off with primarily shadowing Dr. Benjamin and his staff in the clinic. The staff was included but not limited to nurses, ultrasound technicians, administrative staff and various other medical professionals. Each patient that was seen had an ultrasound study done prior to being seen by the physician. Of those conducted the most common test was the Ankle Brachial Index (ABI). This test would record the waveforms and the pressures in the arteries in the arms and legs. Once they obtained this number a ratio would be formed to determine the amount of blood reaching the legs in comparison to that of the arms. This would give Dr. Benjamin an accurate description of the patient’s arterial system and would determine if the patient is at risk for other vascular disorders. Next the doctors would review these studies and monitor the patient for other vascular diseases. Once these studies were reviewed Dr. Benjamin or one of his team members would meet with the patient to discuss the results of the test. After discussing their findings with the patient, the doctors and the patients would discuss treatment options. This was one of the toughest parts of the whole process. Breaking bad news to somebody was one of the hardest parts of my entire time in this experience. The treatment options suggested would range from an arteriogram, a special type of imaging to monitor blood flow to the body, to surgery to fix a threatening condition. Some of the most daunting procedures were the repair of abdominal aortic aneurysms (AAA) a long intensive eight-hour surgery. I had the opportunity to watch multiple open AAA repairs. The operating room itself was probably one of my most favorite times of my shadowing experience; to be able to see everything we have learned in the past few years come to life and to see its real-world applications was fascinating. The open repair of an abdominal aortic aneurysm is a daunting procedure it involves taking out the diseased section of the aorta and replacing it with an artificial portion of graft to establish better blood flow. This procedure involves cutting open the patient’s abdomen and removing part of the aorta and sewing in a graft. One of the main problems associated with this procedure amongst many is colon ischemia, and blood loss. In fact the first procedure I watched a patient became severely bradycardic due to unknown reasons, that was a very scary moment. Besides from abdominal aortic aneurysm repair I also was afforded the opportunity to see a carotid endarterectomy a procedure in which a surgeon removes plaque from a patient’s carotid artery, the main artery to supply blood flow to the brain. This procedure can be somewhat risky as they require constant watching of a patient brain function once the artery is clamped. But after the surgery the results are dramatic, there is an increase in blood flow to the brain and the patient feels better.

Overall, my experience was great. I thoroughly enjoyed my time at the University of Maryland Baltimore-Washington Medical Center my mentor was fantastic and afforded me wonderful opportunities that will never be forgotten. It made me further consider medicine as a career choice specifically vascular surgery is a field that I am specifically interested in.

Innovation Description

During my time shadowing, especially in the operating room, I realized that counting surgical instruments and keeping track of them became a daunting task. A procedure to repair an Abdominal Aortic Aneurysm can account for hundreds of tools. Valuable time was spent counting these instruments during a surgical procedure. Therefore, I spent time researching into surgical counting methods previously mentioned above. Most RFID surgical instrument tracking models involve the use of mass counting of surgical instruments. Placing them into trays and relying on that method of counting. The created innovation relies on zone monitoring in comparison to that of a mass counting system. Based on the different zones the surgeon can monitor the position of surgical instruments to determine whether they are left in the body cavity or whether they are within the deemed “safe zone.” RFID tracking is not a new technology; it has been “commercially available since the 1970’s and is a part of our daily lives. Vicinity RFID-enable documents can be securely and accurately read from up to 20 to 30 feet away” (United States Department of Homeland Security , 2017). RFID is primarily composed of two main factors, tags and readers; “tags are generally responsible for communicating radio waves to the readers who interpret the radio signals to identify the specific identity” (U.S. Food and Drug Administration, 2014). Ultimately, there are two different types of RFID tags: passive and active. Passive RFID tags generally require stronger signals, and the signal strength is usually constrained to very low levels. Due to the constrained vicinity of the surgical environment, a passive RFID tag is the predominant choice as it sets a specific choke point for the instruments to pass through. With this specific choke point the RFID scanner can easily pick up the signals transmitted by the tags on the surgical instruments. For the purposes of this innovation passive RFID tags were chosen to eliminate the use of batteries or other fail safe systems that could prove detrimental. Furthermore, since there is a small area of operation for surgical instruments before they enter the body cavity, they are easily scanned as they enter the different zones in the operating room, which in turn shows a smaller margin of error.

In a surgical setting each instrument can be tagged with a unique RFID tag with its own unique identifier. Once each instrument is passed over the RFID scanner the scanner can record and store its information so that it can be easily tracked and looked upon after each surgery to prevent any adverse outcomes resulting in catastrophic patient results. This poses a less daunting challenge than prior methods of counting hundreds of surgical instruments, as it provides a simple, yet accurate, way for counting surgical instruments and can instantly alert medical staff if errors in the count are detected. Besides just counting surgical instruments an automated or computerized display can also be used to visually show the surgeon’s what instruments are missing, and the last zone in which they were found in.

Project Topic

Introduction to Topic

Vascular surgery, is the premiere service in the treatment, prevention or repair, from aneurysms, to strokes, to the common sore. Each year more and more people are succumbing to the complications of various vascular diseases and disorders. Vascular care stems great interest for me after I have learned that both sides of my family, have had a history of various vascular problems, from stroke to heart disease. The purpose for conducting this project will be to improve the care of patients that have been diagnosed with vascular diseases and the improvement of some of the operative complications associated with treatment..  Ultimately vascular surgery is associated with “high rates of perioperative morbidity and mortality” (Bird & Nesbitt, 2013) thus, proving the need for advances in patient care. Specifically complications such as gossypiboma has proven to be a longstanding problem in the entire surgical community.

Project Overview

Project Description

In order to study and to gain a unique perspective in the care of a vascular patient I shadowed at the Maryland Vascular Center at the University of Maryland-Baltimore-Washington Medical Center under Dr. Marshall Benjamin, Chief of Surgery. I shadowed to develop a solution that has great effects in the improvement of the vascular patient whether it be in a surgical setting or in a post-operative standpoint in care. With my shadowing experience, I spent time between the operating room watching various procedures and understanding their implications and outcomes. As well as spending time in the clinic and the vascular pharmacy to gain a better understanding of the overall care of a vascular patient and the needs associated with these types of diseases and repairs. Operative time is a factor in these cases as prolonged times can lead to negative outcomes. Due to the number of instruments time can be saved by having faster methods of accounting for these instruments to finish operations as quick as possible to prevent the risks associated with prolonged operative times such as: infection, bleeding and other life threatening complications.

Experience

Experience Description

My time at the Maryland Vascular Center started off with primarily shadowing Dr. Benjamin and his staff in the clinic. The staff was included but not limited to nurses, ultrasound technicians, administrative staff and various other medical professionals. Each patient that was seen had an ultrasound study done prior to being seen by the physician. Of those conducted the most common test was the Ankle Brachial Index (ABI). This test would record the waveforms and the pressures in the arteries in the arms and legs. Once they obtained this number a ratio would be formed to determine the amount of blood reaching the legs in comparison to that of the arms. This would give Dr. Benjamin an accurate description of the patient’s arterial system and would determine if the patient is at risk for other vascular disorders. Next the doctors would review these studies and monitor the patient for other vascular diseases. Once these studies were reviewed Dr. Benjamin or one of his team members would meet with the patient to discuss the results of the test. After discussing their findings with the patient, the doctors and the patients would discuss treatment options. This was one of the toughest parts of the whole process. Breaking bad news to somebody was one of the hardest parts of my entire time in this experience. The treatment options suggested would range from an arteriogram, a special type of imaging to monitor blood flow to the body, to surgery to fix a threatening condition. Some of the most daunting procedures were the repair of abdominal aortic aneurysms (AAA) a long intensive eight-hour surgery. I had the opportunity to watch multiple open AAA repairs. The operating room itself was probably one of my most favorite times of my shadowing experience; to be able to see everything we have learned in the past few years come to life and to see its real-world applications was fascinating. The open repair of an abdominal aortic aneurysm is a daunting procedure it involves taking out the diseased section of the aorta and replacing it with an artificial portion of graft to establish better blood flow. This procedure involves cutting open the patient’s abdomen and removing part of the aorta and sewing in a graft. One of the main problems associated with this procedure amongst many is colon ischemia, and blood loss. In fact the first procedure I watched a patient became severely bradycardic due to unknown reasons, that was a very scary moment. Besides from abdominal aortic aneurysm repair I also was afforded the opportunity to see a carotid endarterectomy a procedure in which a surgeon removes plaque from a patient’s carotid artery, the main artery to supply blood flow to the brain. This procedure can be somewhat risky as they require constant watching of a patient brain function once the artery is clamped. But after the surgery the results are dramatic, there is an increase in blood flow to the brain and the patient feels better.

Overall, my experience was great. I thoroughly enjoyed my time at the University of Maryland Baltimore-Washington Medical Center my mentor was fantastic and afforded me wonderful opportunities that will never be forgotten. It made me further consider medicine as a career choice specifically vascular surgery is a field that I am specifically interested in.

Innovation

Innovation Description

During my time shadowing, especially in the operating room, I realized that counting surgical instruments and keeping track of them became a daunting task. A procedure to repair an Abdominal Aortic Aneurysm can account for hundreds of tools. Valuable time was spent counting these instruments during a surgical procedure. Therefore, I spent time researching into surgical counting methods previously mentioned above. Most RFID surgical instrument tracking models involve the use of mass counting of surgical instruments. Placing them into trays and relying on that method of counting. The created innovation relies on zone monitoring in comparison to that of a mass counting system. Based on the different zones the surgeon can monitor the position of surgical instruments to determine whether they are left in the body cavity or whether they are within the deemed “safe zone.” RFID tracking is not a new technology; it has been “commercially available since the 1970’s and is a part of our daily lives. Vicinity RFID-enable documents can be securely and accurately read from up to 20 to 30 feet away” (United States Department of Homeland Security , 2017). RFID is primarily composed of two main factors, tags and readers; “tags are generally responsible for communicating radio waves to the readers who interpret the radio signals to identify the specific identity” (U.S. Food and Drug Administration, 2014). Ultimately, there are two different types of RFID tags: passive and active. Passive RFID tags generally require stronger signals, and the signal strength is usually constrained to very low levels. Due to the constrained vicinity of the surgical environment, a passive RFID tag is the predominant choice as it sets a specific choke point for the instruments to pass through. With this specific choke point the RFID scanner can easily pick up the signals transmitted by the tags on the surgical instruments. For the purposes of this innovation passive RFID tags were chosen to eliminate the use of batteries or other fail safe systems that could prove detrimental. Furthermore, since there is a small area of operation for surgical instruments before they enter the body cavity, they are easily scanned as they enter the different zones in the operating room, which in turn shows a smaller margin of error.

In a surgical setting each instrument can be tagged with a unique RFID tag with its own unique identifier. Once each instrument is passed over the RFID scanner the scanner can record and store its information so that it can be easily tracked and looked upon after each surgery to prevent any adverse outcomes resulting in catastrophic patient results. This poses a less daunting challenge than prior methods of counting hundreds of surgical instruments, as it provides a simple, yet accurate, way for counting surgical instruments and can instantly alert medical staff if errors in the count are detected. Besides just counting surgical instruments an automated or computerized display can also be used to visually show the surgeon’s what instruments are missing, and the last zone in which they were found in.

By | 2017-05-15T15:06:05+00:00 May 15th, 2017|Biomed Capstone Project 2017|0 Comments

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