Enhancement of the Intravenous Cannulation Catheter; Cyclical Marginalization of Social Groups in Triage Systems

Carlesi, Lindsay, School of Engineering and Applied Science, University of Virginia
Elliott, Travis, Science Technology and Society Department, University of Virginia
Mehta, Nishaki, Cardiovascular Medicine, University of Virginia

Intravenous (IV) cannulation is a procedure common to admitted patients, with about 90% receiving intravenous therapy in some form. Of those, 40% of adults require a second attempt at a successfully getting an IV line, these patients being labelled as “hard sticks”. Denying hard sticks non-equivalent health care options, as compared to “easy sticks” based on their condition, decides these patient’s fates prematurely. People have recognized this inconsistency and have subsequently developed superior technology to increase the likelihood of sticking a patient correctly, such as ultrasound and infrared imaging devices, topical anesthetics, and distraction techniques for children (NIR, 2018). Additionally, in response to the need for multiple sticks in certain patients, many hospitals have put in place protocols in the case of “hard sticks”. In UVA’s hospital for example, a medical practitioner is allowed two attempts to achieve a successful line access until they have to call the IV team with an ultrasound machine.
However, the creation and implementation of these devices and protocols have led to new bioethical issues. How do you decide when to use an expensive, highly technical device, such as ultrasound or infrared technology on a patient? Such expensive machinery, with only a few newly trained medical professionals competent on the device, cannot match the volume of needle insertion patients. Thus, some patients are still denied adequate quality of care, or the devices are used as unintended.
The aim of the technical portion of this paper is to develop a to create cost-effective devices that could be seamlessly added to the current IV cannulation process and increase first pass rate.
Through the constraint discovery process of the technical project, it became apparent that despite the aim of the project, a solution will never be suitable for all patient types. In attempt to create new devices focused to alleviate the health disparity created by the original technology, further groups are excluded. Thus, patient treatment becomes specialized by patient type to best treat the situation. Select social groups are included in the design and others are not. As advancement continues, that patients who are not designed for in the system has to jump through larger hoops.
This pattern discovered during the design process, led to relation between medical device design and the social construction of technology (SCOT) theory. SCOT is focused around the dynamic needs of social groups and how technology is developed to reach a point of stabilization among the groups. Interpretive flexibility among the social groups often times leads to multiple solutions to many versions of one problem. The purpose of this analysis is to understand how the selection process of one solution hinders the progress of another social group due to a not all-encompassing solution. Thus, the aim of the STS research paper is to analyze how the cyclical nature of SCOT impacts the patients within the medical field.
IV insertions are such a common place invasive procedure in treatment protocol, an important aspect to this project is the variation and quantity of patient types. The triage system was chosen for this analysis as it is representative of a healthcare process where all patient types are subjected to the system. A triage system is used by healthcare practitioners to determine which patients should receive treatment and care first, based on their clinical status, the prognosis of disease, and available resources. (Baciu, 2017) Triage systems are most commonly used in healthcare settings that has a large volume of patients with various conditions, such as emergency departments or urgent care centers. Algorithms have been designed to optimize patient health and reduce cost. However, one should question if this system is biased or if the system of knowledge is designed to exclude certain patient groups?
The inability to address all patient type variations creates care inequity in a healthcare. The reason for this inequity may be the resultant of a conscious or implicit bias, or similarly a lack of constraint discovery in the design process. No matter the reason for marginalization, the cyclic production of problems still seems to exists. This portfolio is designed to address the unmet clinical needs within IV insertions, but also to understand on a large scale the constant need for innovation.

BS (Bachelor of Science)
Intravenous Catheter , Triage System, Health Disparities, Bubble Level

School of Engineering and Applied Science

Bachelor of Science in Biomedical Engineering

Technical Advisor: Nishaki Mehta

STS Advisor: S. Travis Elliott

Technical Team Members: Nia Blibo, Taylor Sealy

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