When Your Lifeline Keeps You Up At Night
Innovator: Karen Jenkins, RN
Innovation: Arm Immobilization Device
In human ingenuity lies limitless potential; it is not restricted to engineers tinkering in their basements or scientists toiling in their laboratories. Sometimes the greatest innovations come from the simplest necessity—and unlikely inventors are born. For longtime trauma nurse Karen Jenkins, the need was obvious, and her inspired solution was simply a matter of course. “It doesn’t take a rocket scientist to come up with this,” says Jenkins about the arm immobilizing device she developed. But it does take one determined, compassionate and very resourceful CHW nurse.
Three decades of trauma experience
Jenkins has been an RN on the medical surgical floor at St. Joseph’s Hospital in Phoenix, Arizona for 29 years, where she has spent the majority of her career specializing in trauma and working the night shift (as a gift to her husband for their 25th anniversary, she has just recently agreed to move to the day shift). On the surgical and trauma floors, most patients have either come straight from surgery or from the emergency room, typically with IV’s already placed in their arms for the administration of intravenous fluids such as blood or medicine.
Because of the size of the vein and its easy accessibility, the pit of the arm—on the inside of the elbow— is the most common place for any paramedic, anesthesiologist or doctor to insert an IV into a patient. For a medical professional in a hurry to treat and save a patient, there are few good veins on the human body to choose from, and, in some cases, the arm is the only location with a vein large enough to handle the insertion of an IV. Because it is readily accessible, an IV placed in the arm is also easier for nurses to monitor and manage once the patient is being cared for in the hospital. Seems logical enough, right?
The problem with IVs and sleep
But now imagine yourself laid up in a hospital bed with that IV inserted into the middle of your arm. In order to insure that you are receiving the fluids you need, the IV in your arm is also attached to a pump, which is run by a machine that will begin to beep as soon as there is an obstruction in the line or an interruption in the delivery of the IV fluid. If you bend your arm in any way and block the flow, the machine will begin to beep. In order to make the machine stop beeping, a nurse must come to your room, straighten your arm and push a button on the machine. Only a registered nurse is authorized to push that button, so neither you nor any family member in your room can reset it. So, as nighttime comes around and you drift off to sleep, what is the likelihood that you will be able to keep your arm straight all night long?
As Jenkins knows firsthand, it is next to impossible for patients to keep their arm straight throughout the night while they sleep. The result is that both nurse and patient are constantly disrupted: The nurses on duty must stop the work they are doing in order to wake people and tell them to straighten their arms, and patients are awakened by both the beeping machine and the nurses on duty. To make matters worse, each time the alarm goes off, it means patients are not getting the medicine they need. Apart from knowing her own aggravation with the situation and that of her colleagues working the floor, Jenkins would witness the persistent frustration of her patients: “Just throw the machine out the window. Let me sleep!” they would plead. And she knew she needed to do something about it.
From improvisation to innovation
Figuring there had to be a simple fix to be found within the medical community, Jenkins did a search to see what might already be available to help her deal with the problem. At first she thought perhaps it was just St. Joseph’s that was lacking the necessary device, but she was shocked to discover that, in fact, there was absolutely nothing in existence that would help patients keep their arms straight when inserted with an IV.
Jenkins had never considered herself an inventor. But it turns out she’d been inventing clever workarounds for this persistent problem for years. Out of sheer desperation, she and other nurses would create makeshift apparatuses from whatever they could find on-hand—rolls of gauze, ace bandages, pillows, foam, 2x4’s, duct tape—anything to keep those arms straight overnight. But Jenkins wanted more than a temporary (and unsanctioned) workaround and came up with the idea of reconfiguring a brace that is normally used for keeping legs straight. She jerry-rigged the brace to fit the arm and made it flexible rather than fixed, for better patient comfort. Made of egg-crate mattress foam, with two Velcro straps to hold it on and a metal bar that runs down the arm to keep it straight, the device runs from mid-forearm to mid-bicep and includes a small “window” to give nurses a visual of the IV site, in order to monitor for any leaking or swelling. It’s straightforward, functional and requires no special instructions. There is even an economic benefit, making the device more cost effective than the alternative: Compared to the cost of taking the IV out and relocating it—assuming you have another place to put it—Jenkins’ solution is significantly cheaper, saving on the expenses of IV bags, tubing, dressing kits and nurses’ time.
From collaboration to clinical trials
With support from CHW and St. Joseph’s Hospital and Medical Center 230 original models were manufactured for a clinical trial, which was supposed to last for three to four weeks. Demand was so high, they were gone within ten days. With Jenkins identified as the inventor, CHW has since secured a patent for the device and is currently looking for a licensing partner to make it commercially available to hospitals nationwide.
As she prepares for an upcoming reunion with fifty CHW nurses who have worked together over the last 30 years—13 of whom are still working at St. Joseph’s—Jenkins reflects on the quality of her experience with CHW as both a nurse and an innovator. “I started at St. Joseph’s when our COO, Patty White, was a nurse just like me. It is inspiring and motivating to see people just like me who were promoted to the top. And we couldn’t ask for better people in leadership. They listen to the nurses, hear what we’re saying and try to fix any problems.” It is a working model that Jenkins clearly takes to heart.
