Abstract
Medical robots provide enhanced dexterity, vision, and safety for a broad range of procedures. In this article, we present a handheld, robotic device capable of performing peripheral catheter insertions with high accuracy and repeatability. The device utilizes a combination of ultrasound imaging, miniaturized robotics, and machine learning to safely and efficiently introduce a catheter sheath into a peripheral blood vessel. Here, we present the mechanical design and experimental validation of the device, known as VeniBot. Additionally, we present results on our ultrasound deep learning algorithm for vessel segmentation, and performance on tissue-mimicking phantom models that simulate difficult peripheral catheter placement. Overall, the device achieved first-attempt success rates of 97 ± 4% for vessel punctures and 89 ± 7% for sheath cannulations on the tissue mimicking models (n = 240). The results from these studies demonstrate the viability of a handheld device for performing semi-automated peripheral catheterization. In the future, the use of this device has the potential to improve clinical workflow and reduce patient discomfort by assuring a safe and efficient procedure.
Issue Section:
Research Papers
Keywords:
venipuncture,
medical robotics,
ultrasound,
machine vision,
deep learning,
automation,
catheterization
Topics:
Needles,
Phantoms,
Robotics,
Ultrasound,
Vessels,
Ultrasonic imaging,
Catheters,
Design,
Image segmentation,
Blood vessels
References
1.
Shademan
,
A.
,
Decker
,
R. S.
,
Opfermann
,
J. D.
,
Leonard
,
S.
,
Krieger
,
A.
, and
Kim
,
P. C. W.
, 2016
, “
Supervised Autonomous Robotic Soft Tissue Surgery
,” Sci. Transl. Med.
,
8
(337
), p. 337ra64
.10.1126/scitranslmed.aad93982.
Moustris
,
G. P.
,
Hiridis
,
S. C.
,
Deliparaschos
,
K. M.
, and
Konstantinidis
,
K. M.
, 2011
, “
Evolution of Autonomous and Semi-Autonomous Robotic Surgical Systems: A Review of the Literature
,” Int. J. Med. Robot. Comput. Assist. Surg.
,
7
(4
), pp. 375
–392
.10.1002/rcs.4083.
Edwards
,
T. L.
,
Xue
,
K.
,
Meenink
,
H. C. M.
,
Beelen
,
M. J.
,
Naus
,
G. J. L.
,
Simunovic
,
M. P.
,
Latasiewicz
,
M.
,
Farmery
,
A. D.
,
de Smet
,
M. D.
, and
MacLaren
,
R. E.
, 2018
, “
First-in-Human Study of the Safety and Viability of Intraocular Robotic Surgery
,” Nat. Biomed. Eng.
,
2
(9
), pp. 649
–656
.10.1038/s41551-018-0248-44.
Fagogenis
,
G.
,
Mencattelli
,
M.
,
Machaidze
,
Z.
,
Rosa
,
B.
,
Price
,
K.
,
Wu
,
F.
,
Weixler
,
V.
,
Saeed
,
M.
,
Mayer
,
J. E.
, and
Dupont
,
P. E.
, 2019
, “
Autonomous Robotic Intracardiac Catheter Navigation Using Haptic Vision
,” Sci. Robot.
,
4
(29
), p. eaaw1977
.10.1126/scirobotics.aaw19775.
Daudelin
,
J.
,
Jing
,
G.
,
Tosun
,
T.
,
Yim
,
M.
,
Kress-Gazit
,
H.
, and
Campbell
,
M.
, 2018
, “
An Integrated System for Perception-Driven Autonomy With Modular Robots
,” Sci. Robot.
,
3
(23
), p. 31
.10.1126/scirobotics.aat49836.
Alexandrou
,
E.
,
Ray-Barruel
,
G.
,
Carr
,
P. J.
,
Frost
,
S.
,
Inwood
,
S.
,
Higgins
,
N.
,
Lin
,
F.
,
Alberto
,
L.
,
Mermel
,
L.
, and
Rickard
,
C. M.
, 2015
, “
International Prevalence of the Use of Peripheral Intravenous Catheters
,” J. Hosp. Med.
,
10
(8
), pp. 530
–533
.10.1002/jhm.23897.
National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey
: 2016
Emergency Department Summary Tables, Report.8.
Sampalis
,
J. S.
,
Lavoie
,
A.
,
Williams
,
J. I.
,
Mulder
,
D. S.
, and
Kalina
,
M.
, 1993
, “
Impact of on-Site Care, Prehospital Time, and Level of in-Hospital Care on Survival in Severely Injured Patients
,” J. Trauma - Inj. Infect. Crit. Care
,
34
(2
), p. 252
.10.1097/00005373-199302000-000149.
Parker
,
S. I. A.
,
Benzies
,
K. M.
, and
Hayden
,
K. A.
, 2017
, “
A Systematic Review: Effectiveness of Pediatric Peripheral Intravenous Catheterization Strategies
,” J. Adv. Nurs
,.,
73
(7
), pp. 1570
–1582
.10.1111/jan.1321110.
Armenteros-Yeguas
,
V.
,
Gárate-Echenique
,
L.
,
Tomás-López
,
M. A.
,
Cristóbal-Domínguez
,
E.
,
Moreno-de Gusmão
,
B.
,
Miranda-Serrano
,
E.
, and
Moraza-Dulanto
,
M. I.
, 2017
, “
Prevalence of Difficult Venous Access and Associated Risk Factors in Highly Complex Hospitalised Patients
,” J. Clin. Nurs.
,
26
(23–24
), pp. 4267
–4275
.10.1111/jocn.1375011.
Rauch
,
D.
,
Dowd
,
D.
,
Eldridge
,
D.
,
MacE
,
S.
,
Schears
,
G.
, and
Yen
,
K.
, 2009
, “
Peripheral Difficult Venous Access in Children
,” Clin. Pediatr. (Phila).
,
48
(9
), pp. 895
–901
.10.1177/000992280933573712.
Walsh
,
G.
, 2008
, “
Difficult Peripheral Venous Access: Recognizing and Managing the Patient at Risk
,” J. Assoc. Vasc. Access
,
13
(4
), pp. 198
–203
.10.2309/java.13-4-713.
Kuensting
,
L. L.
,
DeBoer
,
S.
,
Holleran
,
R.
,
Shultz
,
B. L.
,
Steinmann
,
R. A.
, and
Venella
,
J.
, 2009
, “
Difficult Venous Access in Children: Taking Control
,” J. Emerg. Nurs.
,
35
(5
), pp. 419
–424
.10.1016/j.jen.2009.01.01414.
Carr
,
P. J.
,
Rippey
,
J. C. R.
,
Cooke
,
M. L.
,
Trevenen
,
M. L.
,
Higgins
,
N. S.
,
Foale
,
A. S.
, and
Rickard
,
C. M.
, 2019
, “
Factors Associated With Peripheral Intravenous Cannulation First-Time Insertion Success in the Emergency Department. A Multicentre Prospective Cohort Analysis of Patient, Clinician and Product Characteristics
,” BMJ Open
,
9
(4
), p. e022278
.10.1136/bmjopen-2018-02227815.
Carr
,
P. J.
,
Rippey
,
J. C. R.
,
Budgeon
,
C. A.
,
Cooke
,
M. L.
,
Higgins
,
N.
, and
Rickard
,
C. M.
, 2016
, “
Insertion of Peripheral Intravenous Cannulae in the Emergency Department: Factors Associated With First-Time Insertion Success
,” J. Vasc. Access.
,
17
(2
), pp. 182
–190
.10.5301/jva.500048716.
Lininger
,
R. A.
, 2003
, “
Pediatric Peripheral i.v. Insertion Success Rates
,” Pediatr. Nurs.
,
29
(5
), pp. 351
–354
.https://pubmed.ncbi.nlm.nih.gov/14651305/17.
Witting
,
M. D.
, 2012
, “
IV Access Difficulty: Incidence and Delays in an Urban Emergency Department
,” J. Emerg. Med.
,
42
(4
), pp. 483
–487
.10.1016/j.jemermed.2011.07.03018.
Miliani
,
K.
,
Taravella
,
R.
,
Thillard
,
D.
,
Chauvin
,
V.
,
Martin
,
E.
,
Edouard
,
S.
, and
Astagneau
,
P.
, on behalf of the CATHEVAL Study Group
2017
, “
Peripheral Venous Catheter-Related Adverse Events: Evaluation From a Multicentre Epidemiological Study in France (the CATHEVAL Project)
,” PLoS One
,
12
(1
), p. e0168637
.10.1371/journal.pone.016863719.
Lefrant
,
J.-Y.
,
Muller
,
L.
,
De La Coussaye
,
J.-E.
,
Prudhomme
,
M.
,
Ripart
,
J.
,
Gouzes
,
C.
,
Peray
,
P.
,
Saissi
,
G.
, and
Eledjam
,
J.-J.
, 2002
, “
Risk Factors of Failure and Immediate Complication of Subclavian Vein Catheterization in Critically Ill Patients
,” Intensive Care Med.
,
28
(8
), pp. 1036
–1041
.10.1007/s00134-002-1364-920.
Eddins
,
J.
,
Horattas
,
C.
,
Trupiano
,
J.
,
Hopkins
,
S.
,
Pasini
,
D.
,
Martino
,
C.
, and
Murty
,
A.
, 2002
, “
Changing Concepts in Long-Term Central Venous Access: Catheter Selection and Cost Savings
,” J. Vasc. Access Devices
,
7
(1
), pp. 47
–48
.10.1016/S1083-0081(02)70563-321.
Sou
,
V.
,
McManus
,
C.
,
Mifflin
,
N.
,
Frost
,
S. A.
,
Ale
,
J.
, and
Alexandrou
,
E.
, 2017
, “
A Clinical Pathway for the Management of Difficult Venous Access
,” BMC Nurs.
,
16
(1
), p. 64
.10.1186/s12912-017-0261-z22.
Balter
,
M. L.
,
Leipheimer
,
J. M.
,
Chen
,
A. I.
,
Shrirao
,
A.
,
Maguire
,
T. J.
, and
Yarmush
,
M. L.
, 2018
, “
Automated End-to-End Blood Testing at the Point-of-Care: Integration of Robotic Phlebotomy With Downstream Sample Processing
,” Technology
,
06
(02
), pp. 59
–66
.10.1142/S233954781850004823.
Chen
,
A. I.
,
Balter
,
M. L.
,
Maguire
,
T. J.
, and
Yarmush
,
M. L.
, 2020
, “
Deep Learning Robotic Guidance for Autonomous Vascular Access
,” Nat. Mach. Intell.
,
2
(2
), pp. 104
–115
.10.1038/s42256-020-0148-724.
Balter
,
M. L.
,
Chen
,
A. I.
,
Fromholtz
,
A.
,
Gorshkov
,
A.
,
Maguire
,
T. J.
, and
Yarmush
,
M. L.
, 2016
, “
System Design and Development of a Robotic Device for Automated Venipuncture and Diagnostic Blood Cell Analysis
,” IEEE International Conference on Intelligent Robots and Systems
, Daejeon, Korea, Oct. 9–14,
Institute of Electrical and Electronics Engineers Inc
., pp. 514
–520
.10.1109/IROS.2016.775910225.
Balter
,
M. L.
,
Chen
,
A. I.
,
Maguire
,
T. J.
, and
Yarmush
,
M. L.
, 2017
, “
Adaptive Kinematic Control of a Robotic Venipuncture Device Based on Stereo Vision, Ultrasound, and Force Guidance
,” IEEE Trans. Ind. Electron.
,
64
(2
), pp. 1626
–1635
.10.1109/TIE.2016.255730626.
Leipheimer
,
J. M.
,
Balter
,
M. L.
,
Chen
,
A. I.
,
Pantin
,
E. J.
,
Davidovich
,
A. E.
,
Labazzo
,
K. S.
, and
Yarmush
,
M. L.
, 2020
, “
First-in-Human Evaluation of a Hand-Held Automated Venipuncture Device for Rapid Venous Blood Draws
,” Technology
, pp. 1
–10
.10.1142/S233954781950006727.
Dhingra
,
N.
,
Diepart
,
M.
,
Dziekan
,
G.
,
Khamassi
,
S.
,
Otaiza
,
F.
, and
Wilburn
,
S.
, 2010
, WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy
,
World Health Organization
,
Geneva
, Switzerland, pp. 1
–105
.28.
Mukai
,
K.
,
Nakajima
,
Y.
,
Nakano
,
T.
,
Okuhira
,
M.
,
Kasashima
,
A.
,
Hayashi
,
R.
,
Yamashita
,
M.
,
Urai
,
T.
, and
Nakatani
,
T.
, 2020
, “
Safety of Venipuncture Sites at the Cubital Fossa as Assessed by Ultrasonography
,” J. Patient Saf.
,
16
(1
), pp. 98
–105
.10.1097/PTS.000000000000044129.
Smistad
,
E.
, and
Løvstakken
,
L.
, 2016
, “
Vessel Detection in Ultrasound Images Using Deep Convolutional Neural Networks
,” Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics
,
Springer Verlag
, Berlin, pp. 30
–38
.30.
MICCAI, 2015,
Lecture Notes in Computer Science
, Vol. 9351, Springer, Cham, Berlin.31.
Chen
,
A. I.
,
Balter
,
M. L.
,
Chen
,
M. I.
,
Gross
,
D.
,
Alam
,
S. K.
,
Maguire
,
T. J.
, and
Yarmush
,
M. L.
, 2016
, “
Multilayered Tissue Mimicking Skin and Vessel Phantoms With Tunable Mechanical, Optical, and Acoustic Properties
,” Med. Phys.
,
43
(6; Part 1
), pp. 3117
–3131
.10.1118/1.4951729Copyright © 2022 by ASME
You do not currently have access to this content.
