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A stretchy bandage with the words “NO IV” written in bright pen doesn’t work when it comes to protecting legs and arms needed for more than just a blood test.

Peri-operative nurses at Auckland District Health Board (ADHB) identified a problem: how to alert colleagues and patients themselves that the patient has restricted extremities.

“This is where the veins in an arm or a leg shouldn’t be used for procedures such as drawing blood or inserting an IV line because they’re needed for other uses,” says Dr Gillian McCarthy from Victoria University’s (VUW) School of Design Innovation.

McCarthy has degrees in design and psychology, and focuses on improving the interactions people have with medical and assistive technologies.

She joined forces with industrial designer Dr Edgar Rodríguez Ramírez who leads the school’s Smart Interactions Design group and Justin Kennedy-Good and Dr Sarv Taherian at ADHB’s Ara Manawa team to find a solution. Ramírez designs smart physical medical devices, game design, apps for medical conditions that include stroke rehabilitation, cerebral palsy, and pelvic floor disorders. Kennedy-Good is director of Ara Manawa – ADHB’s inhouse multidisciplinary design team. Taherian is Principal Design Strategist at Ara Manawa.

“ADHB nurses had been prototyping various solutions to reduce risk of the Lymphedema (fluid retention) in their patients. They reached out to Ara Manawa, and we approached Gillian for help,” says Kennedy-Good.

Together, they brought on PhD students Lina Goldstein and Mallika Sathe who are getting underway with this research and developing practical research experience.

This collaborative team has now gained funding to find new ways of managing restricted extremities. “For example, patients with chronic kidney issues need good arm veins for dialysis, and both the patient and healthcare staff need to know quickly and easily that these veins shouldn’t be used for other procedures,” says McCarthy. The team is focusing on patients with chronic kidney disease as there are approximately 400,000 cases in New Zealand.

While there is little formal reporting of the misuse of restricted extremities, eight surgeries for patients with chronic kidney disease were cancelled at Auckland City Hospital in 2021 for this reason. Hospital-acquired complications are also more common for patients with

chronic kidney disease. Just 1,794 people pay the MedicAlert service to warn of a restricted extremity.

“We’re using our funding to expand the team and research approach behind this new collaboration, and then apply for further funding to develop an in-hospital alert to notify clinical staff of patients’ restricted extremities and create an education programme for patients.

“While we’ll start with input from ADHB, the results will have national relevance. We hope the results from co-designing with clinicians and patients will help identify different sustainable technologies,” says McCarthy.

Outcomes for Māori are a key element of this new collaboration. Health disparities are well documented for patients with chronic kidney disease. Māori have a higher incidence of the disease, are diagnosed later, require dialysis at three times the rate of non-Māori, and have poorer health outcomes.

This is the first research collaboration between Ara Manawa and the School of Design Innovation. Part of the funding will be used to identify individuals and communities who can help to ensure the research processes and outputs will be well-suited to Māori communities. This will include discussions with key Māori communities in Auckland, and Kevin Roos and Misty Edmonds of IUE whom we featured in our March 2021 MedTech Bites

Pasifika in the renal ward at ADHB are also overrepresented with restricted extremities and the team is working with a recently appointed Pasifika nurse from the renal ward to recruit patients for later stages of the research. They will also seek to involve patients from the Kēreru dialysis clinic in East Tamaki.


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