Tag Archives: solution

The difficulty of removing titanium rings

By Kim Smiley

Titanium rings have been growing in popularity because of their durability, strength, light weight and hypoallergenicity.  But unfortunately, the strength of titanium rings can become a problem if one ever needs to be cut off.  When a finger swells with a ring on it, blood flow to the finger is restricted and can cause tissue death in the finger so the issue of how to quickly and safely remove a ring can be quite serious.

Dr. Andrej Salibi, a plastic surgeon at Sheffield Teaching Hospitals in the U.K., recently described a case where a patient came to the ER after his finger swelled following a soak in a hot tub.  Normally, removing a ring from a swollen finger is a quick and relatively easy procedure, but in this case the patient was wearing a titanium ring and all the usual methods used to remove rings failed. Typically, a doctor would grab the ring cutter at this point and simply cut the ring off, but the titanium ring was too strong for a traditional ring cutter.  The fire department was called and attempted to use its own specialized cutting gear, but that also couldn’t cut through the titanium ring.  The patient had to be admitted to the hospital and spent (what I assume was a very uncomfortable) night with his hand elevated.

The next morning, the doctors decided to try something new – bolt cutters.  The bolt cutters finally cut through the metal, but the doctors still had to find a way to pull the metal apart. Using some large, heavy-duty paperclips, two doctors were able to pull the ring far enough apart that the man could slip his finger out.  Thankfully, the man’s finger is going to be fine with no long-term damage.

The bolt cutter solution worked so well, the doctors involved actually published a letter to share the idea with other physicians.  Bolt cutters are commonly available in a many hospitals, but not something that ER doctors may initially think to use.  There is other specialized equipment like dental saws or diamond-tipped saws which may be able to cut through titanium rings, but they aren’t generally readily available in a hospital setting and require more manpower to use.  The potential for accidentally injuring a patient’s finger during the removal process is also higher than with a simple bolt cutter.

Sometimes a simple solution can be the best solution and as this case study demonstrates, it is also important to document and share lessons learned.  Solving a single problem is a good thing, but sharing solutions so that the wheel doesn’t have to be reinvented the next time the problem is encountered is even better.  Maybe some doctor will read the letter published by the doctors involved in this case and a future patient will be spared an extra night of discomfort and unnecessary time in the hospital.

If you are in the market for a ring, you may want to consider carefully whether titanium is the right metal choice.  If you do choose titanium, you may want to stick with pure grade because it is significantly softer and easier to cut than aircraft grade, with has other metals mixed in.  It is also a good idea to remove all rings when working around machinery or if you notice your fingers swelling.

To view a Cause Map of this example, click on “Download PDF” above.

Technique Increases Availability of Donor Kidneys

By ThinkReliability Staff

Transplanted donor kidneys save lives, but availability does not meet demand.  Contributing to the problem is that some people who are willing to be donors have organs that are considered unsuitable for transplant.  A new procedure has been successful in making some of these previously rejected kidneys usable again.

The procedure involves flushing donated kidneys, which would previously have been rejected as unsuitable for transplant, with oxygenated blood (normothermic perfusion).  This can allow use of some damaged kidneys, such as those from the elderly or those with high blood pressure or diabetes.  It decreases the risk of a marginal organ being rejected.  It is believed that this could increase the availability of organs by about 500 a year in the United Kingdom, reducing the number of people on transplant waiting lists by about 10%.   (There are more than 6,400 kidney patients waiting for a transplant in the UK.)

So far, 17 organs that have been through the procedure have been successfully transplanted, between November 2010 and November 2011.  They are all functioning well.  The success of this procedure can be examined in a Cause Map, or visual root cause analysis.   Positive impacts to the goals can be examined in the same way that negative impacts are – by identifying the impacts and asking “why” questions to identify the causes.  Due to this procedure, the patient safety goal has been impacted by reducing the risk of rejected transplanted organs.  The patient services and material goal has been impacted by increasing the availability of donor kidneys.  And, the “labor” goal has been impacted by reducing the amount of time people wait for donor kidneys.

Beginning with these impacts and asking “why” questions, we can identify that the procedure is allowing the use of previously marginal organs by allowing treatment outside the recipient body and  reducing the risk of rejection.  This increases the number of organs that can be used, and since there are still more organs needed than available, this reduces the amount of time on the waiting list.

Although this procedure should increase the number of organs available and reduce time on the waiting list, it still will not provide enough organs for everyone who needs one.  Donor outreach to increase donors and family understanding of the life-saving organ donation process is still needed.

To view the Outline and Cause Map, please click “Download PDF” above.  Or click here to read more.