The pediatric ward has been extremely accommodating in helping us set up an apparatus to test the Smartdrip. There doesn’t appear to a extreme need for a IV monitoring device here because as mentioned before, the main IV fluid given is the 5% dextrose which is appropriated(squeezed) to 300 ml before use. However, I was able to gather some useful, on-the-field information such as the available tube size (20 drops/ml), maximum dosage of fluid for protocols (no more than 300 ml for about 5 hrs) and the usual drip rate (16-20 drips/min).
I still wanted to test device in a hospital testing, with the data I have collected, but without a patient. The nurses allowed us to use a separate room in the ward for testing. However, as always for a prototype, we ran into problems. For one, the circuit board has a loose connection that I have not been able to identify. At certain positions, the LCD shorts out. I have checked every connection with a multimeter; with every wire either soldered to the board or printed, all connections are through. Unfortunately, because of this problem, the LCD screen does not work in the upright position when it is clipped to the drip chamber to monitor the drip rate. At this point though, I anticipate that the weight of the device may actually become a problem in this particular setting as the drip chamber that St.Gabriel’s uses is a little smaller than the testing one in the lab. It is quite possible that the device can slowly slip off after a few hours.
To solve the electric short problem, we constructed an apparatus of cloth hangers, bucket-support and measuring cups so that the IV set and the device can be at an incline. Of course, the incline led to another problem: sensing the drops. When at an angle, the drops do not actually fall straight down, but fall off to the side. The device can only sense a droplet if it falls in between the infrared red diode and the detector (thus reducing the level of transmitted light). Otherwise, inaccuracies occur in detection and monitoring of drip rate and volume dispensed. We are still currently trying to figure out how to overcome this hurdle.
On another front, we introduced the ART adherence charts to Grace the coordinator for the program, as advised by the Matron. Grace is the main nurse responsible for maintaining HIV patient check-up. She is the one the patients come to hospital to see, to check their adherence and to restock on medication. A network of adherence community workers does exist, but workers’ main job is to periodically check that the patient is taking the medication every day. As adherence calculations are cumbersome and complicated, only Grace is in charge of precise adherence monitoring. The adherence charts would simplify the calculations and gave the community health workers the power to track adherence; however, Grace feels that the charts would not be useful at this time. Moreover, there is a patient records system set-up for HIV patients that have the capability to calculate and save the adherence immediately during the monthly schedule check-ups with Grace. The community health workers, on the other hand, neither speak nor read English, so using the charts would pose a problem. Thus, at least at this time, determining adherence and the consequent power of responsibility that comes with the knowledge has not expanded to the community health workers.
The adult Venulite transilluminator has found its home in the maternity ward. We introduced it at the department meeting, but we received the real excitement when I actually brought the device to the ward. Unfortunately, Elizabeth was sick that day, but I saw the enthusiasm when the nurse-on-duty Doreen labeled MATERNITY on every side of the Venulite box. She also demonstrated the device to any working staff—be it a cleaner or doctor—who walked through the doors. I helped Doreen use the device to start a few IV lines. It worked well at locating the veins in patients when the blood vessels were not visible; however, because there was no way to gauge the depth of a vein with the device, Doreen still had to try multiple times in some cases to properly start an IV.
The pulse oximeter donated from the company Devon, after much debate between the matron and the doctors, has been placed in the maternity/labor ward. I think it is a great place for the device as the hospital does not have anything that would accurately monitor the vital signs of neonates. The pulse oximeter comes with adaptors for neonates, pediatrics and adult, but I think it is the first option that really addresses an important need of St.Gabriel’s.