Isabella Gallegos discovered she wasn’t squeamish during her first day in the operating room.
A 14-year-old’s leg needed a repair, bringing in an experienced surgical team for Gallegos to observe. The nurses prepped the patient and soon enough, the surgeon chose from his array of orthopedic tools: mallets, steel saws and other equipment for hammering.
“It was insane,” Gallegos said. “For my first surgery to walk in on, they were hammering stuff into his entire leg. There was blood flying.”
Gallegos was shocked at the intensity and swiftness of the orthopedic procedure. The biomedical engineering junior gained an appreciation for the inner-workings of the medical field and how biomedical engineering is used beyond the classroom.
Gallegos was one of 10 biomedical engineering juniors part of the Biomedical Clinical Engineering Partnership (BiCEP), an opportunity for biomedical engineering students to understand real-world medicine practices. Last summer, participants shadowed professionals at Adventist Health Sierra Vista and developed products to try and solve problems they discovered.
“Throughout the entire hospital, there’s biomedical devices that are used for almost anything you can think of,” Gallegos said. “Getting the perspective from the doctor and seeing patients walk out of the hospital with new, life-changing technology inside them really helps you understand why you do what you do as a biomedical engineer.”
The 10-week program consisted of a Summer Immersion in Design Experience course focused on device design and biomedical entrepreneurship, as well as an eight-week Clinical Immersion Experience (CLINEX) Program, where students shadow hospital staff. Participants received a $1000 scholarship to support summer living expenses.
For the first five weeks, pairs of students rotated through the emergency room, intensive care unit, neonatal intensive care unit, OB-GYN department and surgery department. In the second half of the program, students researched and designed prototypes in a specific department.
Thinking outside the box
During BiCEP participant Sydney Gallo’s ER rotation, she saw a man with internal throat bleeding go into shock who needed immediate medical attention to save his life.
“They didn’t notice that he was slipping into shock until his blood pressure fully dropped and he was in the danger zone,” Gallo said.
Gallo works as an emergency medical technician, where she performs capillary refill tests to check if patients have adequate blood flow. In practice, the tests mean she presses an individual’s fingertip to make sure the initial color returns within two seconds.
In the hospital, she noticed this practice was not common, resulting in situations like the one Gallo saw in the ER. This inspired her to create a color sensor device to automatically screen patients for signs of blood loss that could lead to shock.
The sensor is designed to detect the difference in fingerpad color before and after being pressed and track the time it takes for the color to return. The process is designed to work for all skin tones, according to Gallo.
“My favorite part was being able to choose a problem you’re passionate about and that interests you fully,” Gallo said. “We were given 100% freedom to come up with our own ideas, which is scary and daunting on its own, but it also is very freeing.”
When brainstorming how to make detecting the pre-stages of shock easier, Gallo found inspiration for her project in the NICU. The premature infants are very small and require especially tiny blood pressure cuffs. Gallo changed these small and lightweight devices to test blood flow in adult patients.
NICU Medical Director Dr. Steven Van Scoy, who is also a clinical mentor for BiCEP, supported her efforts to adapt the product for a different medical use. A positive quality of participants like Gallo is their open minds, Van Scoy said.
“Most of us in medicine have been in it for a while, and we evolve our equipment along the same line,” Van Scoy said. “The students, without any preconceived notions of what that piece of equipment or invention should look like, can come at it from a completely different angle.”
Improving women’s health
Gallegos’s interest peaked in the OB department. After talking with doctors and nurses, she discovered an issue with the placenta remaining attached after the mother gives birth.
When the placenta, a temporary organ that keeps the fetus alive during pregnancy, doesn’t detach, immediate intervention is required to avoid complications, often resulting in invasive methods to remove it. Doctors often have to reach their hand into the uterus to remove the placenta.
Gallegos felt strongly that there was a better option, leading to the creation of a silicone-based “wand” prototype that gently twists to remove the placenta from the uterine wall.
She and her project partner Makenna Ladyga had to conduct their own experiments, testing a 3D model through a program called Solidworks. According to Gallegos, there is minimal research in women’s health. Physicians helped them know how much force the device could use while still protecting the uterus.
“Taking that clinical feedback and turning it into engineering requirements is a really important skill to have,” Gallegos said.
BiCEP projects are later integrated into the curriculum through lower division case studies or senior projects, according to biomedical engineering professor Christopher Heylman, one of the program supervisors. Gallegos’s project continued through a biomedical engineering senior project that presented their final design at a showcase in March.
Moving away from the ‘gold standard’
Zoey Jen discovered a problem with spinal fusion, a surgery sometimes performed when the squishy discs supporting someone’s spine start to break down. Some patients returned for surgery multiple times. Repeated spinal fusions decrease their mobility in the future, according to Jen.
Spinal fusion is the “gold standard,” or standard practice, for treating instability around the spine, but it causes greater stress around the fused vertebrae. This surgery reduces how much the spine can handle in the future, leading to complications such as adjacent segment disease.
Jen and her partner Olivia Armas worked towards a product that biologically mirrors a spinal disc, discovering it was difficult to replicate a part of the human body that was so unique. The disc would need to both compress and withstand pressure at the same time, according to Jen.
By the end of the program, she had a prototype for the device, but there was still a long way to go. Five biomedical engineering seniors Allison Cline, Morgan Gentzen, Madison Henry, Catherine Semaan and Myl Lauc continued Jen’s efforts through a senior project.
“Time is constrained during the school year,” Jen said. “To get the most out of a project like this, you need to have almost double the amount of time.”
Over the last two quarters, the five students have built off of the foundation established from the BiCEP project. Many competing prototypes use a ball-and-socket design, whereas their 3D-printed model draws on natural anatomy dimensions, according to Henry.
“You can really see how each person’s contributions have come to life and made this project what it is,” Semaan said. “One of the best parts about being in a larger group is that we all have so much to offer, and because of that, we’ve really been able to go far.”
Despite the 30 cumulative weeks spent developing the biomimetic intervertebral disc replacement, more development will be needed before it can be patented, tested, approved by the FDA and used in medical settings, according to Semaan.
“This is going to be inside someone for a long period, so we need to make sure the materials we use and how it’s implanted are safe for people,” Semaan said.
The seniors were unable to afford titanium endplates and more sophisticated design qualities due to their project budget, according to Henry. In the hospital, BiCEP participants also had to consider cost when making their prototypes.
Ventilators, which help patients with struggling lungs breathe properly, save patients from invasive practices that cause sore throats and infections. However, the expense makes ventilators hard to access for smaller hospitals like Adventist Health, according to Jen.
“Physicians will use what they have and kind of throw things together,” Jen said. “A lot of devices that do solve those problems are super expensive.”
Improving patient care and workflow
In the ICU, flipping patients on their stomachs may be normal, but it often isn’t easy. Joshua Olsen observed up to nine nurses working in tandem to flip ill patients onto their stomach to increase their oxygen levels.
Not only does the flipping process pose injury risk to the patients, but it interrupts the hospital work flow and means an hour of lost time, according to Olsen.
Olsen and his project partner Vincent Pecoraro began constructing a large, mechanical contraption that could attach to an ICU hospital bed and flip the patient without needing excessive human force.
“The technological side of healthcare is very underdeveloped, and that was just kind of shocking to see how much there is needed to be done,” Olsen said.
Olsen prototyped his design in Solidworks and worked with wood and cables to begin simulating. Biomedical engineering students worked on the design, presenting the PronusLift at the biomedical engineering senior project showcase.
“Having the clinical experience that most people don’t get to see in their lifetime was pretty amazing,” Olsen said.
The future of BiCEP
When Gallo observed a hip replacement surgery, she discovered an odd correlation; between her BiCEP partner, the anesthesiologist, the doctor and one of the medical assistants, they all had majored in biomedical engineering at Cal Poly.
BiCEP is funded through this upcoming summer, marking the fifth year of the program and an end to their five-year grant from the National Institute of Health.
After fundraising, they hope to expand the program to multiple hospitals, which would provide more students with an opportunity to participate. They are currently recruiting for the upcoming summer, said Heylman.
One of the most rewarding parts of BiCEP was being behind-the-scenes and seeing how engineered devices made an impact in the medical field, according to Jen.
“Sometimes, we get lost in the classes we’re taking and don’t actually know what we’re doing it for,” Olsen said. “To see an actual impact is eye-opening and important.”
This story originally appeared in the April printed edition of Mustang News. Check out more stories from the issue here.