One of the biggest risks that patients face when they undergo dialysis is coming into focus with the start of a five-year project aimed at building and testing a simulator that could revolutionize how nurses and technicians are trained.

The $717,000 project is led by Joseph Singapogu, a Clemson University research assistant professor of bioengineering who learned of the need for a simulator while shadowing David Cull of Greenville Health System. Funding is provided by the National Institutes of Health.

Joseph Singapogu (center) demonstrates the simulator with Naren Vyavahare (left) and David Cull.

Joseph Singapogu (center) demonstrates the simulator with Naren Vyavahare (left) and David Cull.

The simulator will be designed to teach students to find the fistulas that serve as lifelines for patients whose kidneys have failed and need dialysis to survive. It’s a critical skill because missing the mark with the needle can cause serious complications.

Just as important as developing the simulator, researchers will be studying how effective it is in teaching nurses and technicians the skills they need to serve patients, Singapogu said.

“If our validation studies show that performance on the simulator improves outcomes on patients, then this could be adopted widely,” he said. “That means that hundreds of thousands of patients’ lives will potentially be impacted.”

Patients typically need dialysis three times per week. Most patients are connected to the dialysis machine through a fistula, which is a vein and artery that have been surgically connected.

Finding a fistula can be a challenge when it’s buried deep in the flesh. The needle that goes into the fistula is large, which enhances the risk for complications. Going all the way through the vein or off to the side can cause a lot of bleeding.

The arm might swell. If the fistula clots, the patient might have to be connected to the dialysis machine through a catheter that is inserted into the jugular, raising the risk of blood infection.

The idea behind the study is to help find new ways of avoiding complications by better training nurses and technicians. When they use the simulator, nurses and technicians will learn to feel for vibrations in the fistula and then map out its direction, all with their sense of touch.

The prototype simulator that the team has developed is round and about the width of a car tire.

A sheet of cured silicone that simulates the flesh is laid over several tubes that are spaced out on a platform and simulate fistulas. The same kind of motor that makes cell phones buzz creates the vibration.

Later versions of the simulator will measure the needle’s motion, force, angle and location. The simulator will be connected to a virtual mentoring system that will give trainees feedback on how they are doing.

Singapogu said that he has seen other simulators in the shape of an arm, but theirs is round to help nurses and technicians hone their abilities.

“We want to isolate the skill,” he said. “The skill is tactile. Being round, there’s no way they can orient themselves as to where these fistulas are. They have to put their fingers on the vibration and map out the direction of where the fistula is going. Once they get a tactile sense of where it is, they can put in the needle at the right orientation.”

The grant that Singapogu received is a K01 Mentored Research Scientist Career Development Award. Collaborators involved are at Tufts University, the University of Alabama and the University of Arizona in addition to those at Clemson and GHS.

Martine LaBerge, chair of Clemson’s Department of Bioengineering, said,  “I congratulate Dr. Singapogu and his team on the grant. It is a testament to the quality and creativity of the research they are doing in a cutting-edge field.”