Comment by Balgair | Hacker News Reader

Comment by Balgair | Hacker News Reader

Aside: I work in med-tech. One of the largest complaints of doctors and nurses, especially in the ICU, is the cables and tubes. There are just SO MANY cables and tubes in a working ICU. Nurses and docs are constantly stepping on them, pulling them out, choking off blood/saline/urine/air in some tube, knocking power off of another, etc. Most of the machines can't do wireless, as some of the machines will 'jam' that particular bandwidth to operate (MRI, etc).

As this article seems to be collecting a lot of great people that know their cabling, is there anything we can do to reduce or eliminate the headaches that are cables and tubes in a panicked ICU? Anything may help, and I'd love to know some more ideas.

EDIT: One thing I've found for cable bundle twisting issues is that 'N-in-hand' braiding the cables helps relieve some of the stresses when they inevitably get twisted up. Think 30 wires/tubes all twisting about as the patient/machine is whirled about. Braiding the cables helps the wires on the outside of the bundle not twist and pull out as much as they are on the outside radius of the bundle. The braiding helps, in that over enough distance, all the wires spend equal 'time' in the inside and the outside of the cable's width.

Does anyone know of a good resource on cable/tube twisting and how to help with it?

One option, I think, is to accept that cables and tubes will be stepped on, and then attempt to mitigate pull-outs and pinches. (Which, admittedly, is close to the approach you already have.)

Longer cables and tubes would help diminish pull-outs, and could make a lot of the other suggested solutions possible too. Unfortunately the only way to achieve this is probably to call the manufacturer and pray... maybe they have longer options, or female-female adapters that can be used to connect multiple cables together?

Preventing pinches us also something the manufacturer could solve by just making the middle section of tubes—the bit on the ground—a lot heftier. But you could also DIY it by slotting on some corrugated cable conduit? It comes slit down the side, so you could maybe slot it on after cables and tubes are all set up. It would be impossible to clean, but maybe in the grand scheme of a hospital budget it could just be declared disposable?

Image if the conduit I have in mind: https://2ecffd01e1ab3e9383f0-07db7b9624bbdf022e3b5395236d5cf...

This actually seems like a really interesting problem to me.

I don't think there's one pretty solution here. You'd have to break it down a bit.

- Do the patients go to the machine, or machine to the patient? Wireless makes sense for the latter, not the former.

- What's the failure mode? An alarm/alert to the nurse station, or death? Wireless makes sense for the former, I think.

- Are there any machines at every bedside? Do all of them need to be used at once? Detachable/modular cabling might make sense here.

- Are the cables different? Or can you come up with a "standard" cable/connector for most of the gear?

The audio world solved the "cables being knocked out" problem a long time ago with locking connectors (not screw-ins, so they're still quick connect) like Speak-On and XLR. The former is much more formidable.

> The audio world solved the "cables being knocked out" problem a long time ago with locking connectors (not screw-ins, so they're still quick connect) like Speak-On and XLR. The former is much more formidable.

Audio has the advantage of both ends being heavy and solid. Attaching a line that goes into a person with stitches or a balloon (urinary catheter) is done, but what happens when those get yanked forcefully is bad.

Thanks a ton for the questions and the thoughts! It is a terribly hard problem to solve, hence the plea to others on HN.

> - Do the patients go to the machine, or machine to the patient?

In an ICU, where these problems are most acute, the machines come to the patient. You can fill a good sized room with these machines if the patient is in an especially dire state. Like, maybe 30 carts if it is really bad.

> What's the failure mode? An alarm/alert to the nurse station, or death?

It's death. Death is the failure mode. There are others, like severe organ damage, but death is one worth talking about.

> Are there any machines at every bedside? Do all of them need to be used at once?

It depends. If the patient is fairly alright, you'll have maybe a few machines for vitals and not much more. If they are not alright, then you can have a LOT of machines in the room. Though you can have machines on stand-by, if they are in there, they are being used generally.

> Are the cables different? Or can you come up with a "standard" cable/connector for most of the gear?

Again, it depends. Some companies will standardize their cables and tubes, but they tend to not do so across companies. Also, cable and tube diameter is pretty much set by the need. Airways need laminar flow, so they tend to be larger, blood is more viscous, so it needs less than an airway, but it's still got to have some girth. Electrical can be very small, but if you need to deliver a lot of amps, then the cables grow. I'm sure you could come up with the optimal size across a lot of different applications and get a list of all the possible sizes, but that matrix would be very large all the same and might as well be continious.

> The audio world solved the "cables being knocked out" problem a long time ago with locking connectors (not screw-ins, so they're still quick connect)...

Yeah, there are a lot of quick connects out there, but the issue is that you have a patient that is in ICU psychosis trying to break out, or a panicked parent thrashing about, or a doc trying to lurch for the right tools or get to the patient. In these types of situations, you have to plan for the totally crazy events, not the calmer ones. Like, imagine trying to do audio mixing in the middle of the mosh pit. You're trying to plan for that event.

This might be a "problem where every instance is bespoke". Another would be nuclear a weapon detonation or a major hurricane. You can plan for it and run simulations all you want, but your resource constraints aren't known until after the event.

ICU rooms contain patients teetering at the edge of death, who might take months to heal or die. They might be "almost out" and suddenly crash into a totally different crisis than the one they were wired up for an hour ago (cardiac patient has a stroke, stroke patient has an MI, bariatric surgery patient throws a pulmonary embolus, etc). Ventilation, gastric tube, rectal tube, urinary catheter, 10 central venous drips, an arterial line, and a 5-lead EKG and pulse ox, all on in a patient who's on a pneumatic mattress that is constantly rocking the patient to prevent bedsores, is not uncommon.

And there are three vendors attached to every device. For example, Masimo has the pulse ox device, but the leads are from Cardinal Health under license (no doubt produced under subcontract in China, with soy-based insulation) and the sensor sticker is held on with a second layer of generic silk tape because that's what the nurse had at the time.

If you really wanted to do this, you'd have to have the entire suite designed by a single engineering firm with an obsessive focus on supply chain management. You'd need the Boeing or Airbus of ICUs. But doctors are generally convinced they don't need engineers, so good luck with that.

ICU is not trivial as everything is done quickly.

At first thought, overhead cable gantries would be the best as you could quickly toss the cable/tube into it, but then the area around the patent would have tubes getting in the way, so some thought would have to be put into how the cables come out of the gantries.

Other techniques such as pre-laid cable guards could work (a smaller version of the things cables go through to temporarily cross a road), but those people would still be tripping on, laying a cable or tube would be disruptive and they would be annoying to keep clean.

Thanks for the input!

Yeah, overhead cables aren't the best, as a lot of the time, the length of the tubes and cables aren't long enought to do that. Also, yes, you'll end up with a 'beaded curtain' of tubes and stuff going into the patient.

The idea of having everything routed under and then up to the bedside is not bad, though cable length is still an issue.

It is a hard problem for sure.

In an ideal world, the sizes of medical equipment be standardized, and have bays in the bed that they plug into, with the bed providing power. This would keep the tube and cable lengths short, and you could have a guard around the bed to keep people from accidentally leaning on the tubes or pulling them out. The control consoles would have to be external to the module though, as you don't want visiting kids (or knees) pushing shinny buttons under grandmas bed. Having the control panels be remote would help reduce the number of people needed to be next to the person, giving the people who are directly operating on the patient more room. This would also make patent transport easier, as you would no longer need a army of people to help move all the equipment keeping the patient alive or the possible errors that can be introduced by disconnecting and reconnecting the equipment.

It kind of sounds like they need a raised floor. Cabling bundles can be fed into ports in the floor tiles and run the length of rooms without being exposed in a way that people would trip on them.

Raised floors would be hard to keep clean in a hospital.

Thanks for the input! That's a pretty good idea!

The main issue is that you don't have the time to pull up the flooring and then run the lines. You get the machines into the room and then into the patient ASAP, as they tend to be some of the only things keeping them alive. Think a machine that replaces heart-beat function and that you will have a hard time disconnecting.

Maybe a foam pool noodle split longitudinal. You can feed in tubes/cables in the split after being hooked up, when you have time. Should protect the tubes/cables and be light weight and cheap. Cut to desired length. Put some Velcro straps at the ends of noodle to secure them in a position along the tubes.

This is what I put around the lines of my sailboat.

Or, for a pre-split alternative, foam water pipe insulation: https://www.homedepot.com/p/M-D-Building-Products-1-in-x-72-...

Bad idea in search of good idea, start with power, some sort of bumper car style power distribution system. You could do something similar to the newer floor pick up system, where the ceiling has a fine grid of + and - terminal rails, and the carts have hookups designed to always be touching at least 1 of each polarity, and then normalize the power.

MR tech here. Newer MR safe power injectors and patient monitoring systems are wireless, which is very handy. They can be controlled from outside the room. I don’t know how they work, but I’ve assumed that they are avoiding particular frequencies. The downside is the batteries, which seem particularly short lived.

I gotta ask, why are you on HN? I know I'm a bit of a rare bird here, so it's always interesting to see what brought others like me to HN.

Interesting stories and news coverage mainly. The commentary on tech news is hard to beat. I also work in a minor role in a radiology IT department and some of the coverage here is very relatable.

Thanks! That's mostly me as well. The commentary here is very good generally. You've seen the bestComments section of the site before I assume? It's a good clearinghouse of HN's community: https://news.ycombinator.com/bestcomments

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