[Updating] Italian hospital saves Covid-19 patients lives by 3D printing valves for reanimation devices

The supply chain was broken, people and 3D printing rose to the occasion

Many have been asking what the implications of the current COVID-19 pandemic are going to be on additive manufacturing as an industry. The relationship between coronavirus and 3D printing is not entirely clear, mostly because we are very far from understanding what the long, medium and even short terms implications of the pandemic are going to be on global supply chains.

Additive manufacturing may be able to play a role in helping to support industrial supply chains that are affected by limitations on traditional production and imports. One thing is for sure though: 3D printing can have an immediate beneficial effect when the supply chain is completely broken. That was, fortunately, the case when a Northern Italian hospital needed a replacement valve for a reanimation device and the supplier had run out with no way to get more in a short time.

The original valve (on the left) and its 3D printed twin.

One of the biggest immediate problems that coronavirus is causing is the massive number of people who require intensive care and oxygenation in order to live through the infection long enough for their antibodies to fight it. This means that the only way to save lives at this point – beyond prevention – is to have as many working reanimation machines as possible. And when they break down, maybe 3D printing can help.

Massimo Temporelli, founder of The FabLab in Milan and a very active and popular promoter of Industry 4.0 and 3D printing in Italy, reported early on Friday 13th that he was contacted by Nunzia Vallini, editor of the Giornale di Brescia, with whom he has been collaborating for several years for the dissemination of Industry 4.0 culture in schools.

She explained that the hospital in Brescia (near one of the hardest-hit regions for coronavirus infections) urgently needed valves (in the photo) for an intensive care device and that the supplier could not provide them in a short time. Running out of the valves would have been dramatic and some people might have lost their lives. So she asked if it would be possible to 3D print them.

After several phone calls to fablabs and companies in Milan and Brescia and then, fortunately, a company in the area, Isinnova, responded to this call for help through its Founder & CEO Cristian Fracassi, who brought a 3D printer directly to the hospital and, in just a few hours, redesigned and then produced the missing piece.

On the evening of Saturday 14th (the next day) Massimo reported that “the system works”. At the time of writing, 10 patients are accompanied in breathing by a machine that uses a 3D printed valve. As the virus inevitably continues to spread worldwide and breaks supply chains, 3D printers – through people’s ingenuity and design abilities – can definitely lend a helping hand. Or valve, or protective gear, or masks, or anything you will need and can’t get from your usual supplier.

[Update 15-3-2020]

After the first valves were 3D printed using a filament extrusion system, on location at the hospital, more valves were later 3D printed by another local firm, Lonati SpA, using a polymer laser powder bed fusion process (photo below) and a custom polyamide-based material.

[Update 16-3-20]

So many – see comments below – have reached out to offer help in producing these parts, both locally and globally. As far as 3dpbm understands, the model for the valve remains covered by copyright and patents. Hospitals do have a right to produce these parts in an emergency (as in this case) but, in order to legally obtain a 3D printable STL file, the hospital that requires the parts needs to present an official request and the patient usually needs to give consent (this procedure varies according to local regulations). We will continue to update this article as new information becomes available.

[Update 16-3-2020]

The device in question is a Venturi valve, used for a Venturi Oxygen mask. These are low-flow masks that use the Bernoulli principle to entrain room air when pure oxygen is delivered through a small orifice, resulting in a large total flow at predictable FIO2.

[Update 17-3-2020]

In light of the overwhelming response to this topic and offers to help that we have received, we have created an online Emergency AM Forum as a way to help hospitals, AM companies and makers share ideas and unite to fight the COVID-19 pandemic. You can register to create a new topic. Healthcare professionals will be able to use the search by radius function on the right-hand side to find local makers, companies and services that can help. More topics will be added daily.

[Update 18-3-2020]

We have received hundreds of requests for the venturi valve STL file. In this video, Cristian Percassi explains (in Italian) why the STL file has not been shared at this time. The first key reason is that – for the time being – only one hospital had a requirement for about 100 venturi valves and the requirement was fully satisfied with the first production batch. Another hospital may now have a similar need and many hospitals around the world may follow. The correct course of action – Percassi explained – is to always check with the official manufacturer first. If the valves are not available, only in case of a confirmed emergency is it possible to contact a 3D printing service provider and produce a replica. However, a high-end powder bed fusion machine is needed to produce parts that have the necessary accuracy and complexity. Percassi also revealed that, contrary to certain reports, they were never threatened with a lawsuit.

[Update 19-3-2020]

Since the need emerged for venturi valves in ventilators for hospitals around the world dealing with the COVID-19 pandemic, several designers and engineers have started working on creating 3D printable models for them. While there are both copyright issues and medical issues that need to be taken into account when 3D printing any medical product, and a critical one such as a venturi valve, in particular, this case has shown that a life and death situation could warrant using a 3D printable replica. GrabCAD user Filip Kober has now created a model and has made it available for free on the 3D model network. Together with our partners at Shapemode, we have 3D printed it using high accuracy stereolithography technology (see photo below) and the device seems to have proper dimensional accuracy. You can find links to this and all other 3D printable files for useful medical devices in this dedicated section of the Forum. If you use it, please post comments and suggestions for other users.

[Update 21-3-2020]

The Isinnova team now developed and successfully tested a 3D printed adapter to turn a snorkeling mask into a non-invasive ventilator for COVID-19 patients. It’s an idea that anyone can 3D print using just about any type of 3D printer—and could help to address the possible shortage of hospital C-PAP masks for sub-intensive oxygen therapy, which is emerging as a concrete problem linked to the spread of COVID-19: an emergency ventilator mask, produced by adjusting a commercially available snorkeling mask. Download the file here.

[Update 22-3-2020]

A physics simulation was released showing oxygen flow in Revision 4 of Filip Kober’s Venturi’s life-saving nozzle for ventilators in COVID-19 treatment.

Please add/discuss anything useful related to this in the dedicated forum.

Davide Sher

Since 2002, I have built up extensive experience as a technology journalist, market analyst and consultant for the additive manufacturing industry. Born in Milan, Italy, I spent 12 years in the United States, where I received my Bachelor of Arts undergraduate degree. As a journalist covering the tech industry - especially the videogame industry - for over 10 years, I began covering the AM industry specifically in 2013, as blogger. In 2016 I co-founded London-based 3D Printing Business Media Ltd. (now 3dpbm) which operates in marketing, editorial, and market analysis & consultancy services for the additive manufacturing industry. 3dpbm publishes 3D Printing Business Directory, the largest global directory of companies related to 3DP, and leading news and insights websites 3D Printing Media Network and Replicatore. I am also a Senior Analyst for leading US-based firm SmarTech Analysis focusing on the additive manufacturing industry and relative vertical markets.

View Comments

  • I suggest finding the person that designed theese, and get the .STL FILE into the public, there are thousands of able and willing people that can print theese.

    • That's a great idea but I'm afraid there may be copyright issues. Please see comment below

          • What kind of company are you if you are going to sue the 3D printing community legally for breaking copyrights when literally people die at this very moment that can be saved right now? There are politicians that even dare to worry about the fall of the stockmarkets than the families that lose members due to the Corona virus. There should be an international law that people could be sued if they put making money before saving lives.

          • i will happily put my name on any business that wants to make this stuff
            why dont we make one big business and everyone works for me .
            try sue me it will be too late because i would continue to supply hospitals with equipment they need while you try take me to court

          • Actually they were already threatened with a lawsuit by the company that originally made them. The company is charging $11,000 US for them.

        • Dudes i need the stl file fuckun now im in sf.. 13 hospitals are running low. Fuck . Plessr help and spread the message

      • Honestly that shouldn't matter right now, all it takes is an anonymous person to put it on thingyverse and boom its available no matter what the file will be out in the internet and it wont be stopped

        • Copyright only applies if you're selling it. You can make as many copies as you want for your own use.

          • Actually, that's not true. Copyright applies whatever the purpose. It's just that if you're not making any money from it, there's no point in suing because the only legal remedy is damages in the form of lost income or loss of reputation etc and if only you were using it, there wouldn't be either...

    • Before sharing, they are testing the valve at the hospital, printed with different materials.
      Then they are going to share the file and specs for printing. Requests are coming from all over italy.

      • Please please please, keep us posted! If you have any info or other sources, please share!
        Thank you!

      • Indeed please keep us posted. I work at 3D Systems and we would like to and are able to help in many countries. It would help to get the CAD and start printing tests on our different machines and technologies.

        • Peter, we have three 3D Systems, NextDent printers and successfully printed the file on Friday March 20, we are prepared to assist if you in printing these if there is a customer to buy them.

    • Totally agree!
      By not releasing the STL file into the public, for me, only means that they are using this pandemic as free publicity for their company. Nasty business...

    • i would brake the law i would not care, if i was in a position of power with factorys at my finger tips .

  • You forgot to mention the most interesting part of the story.
    Before designing the 3d model, they called the company which produces the valves to ask for the 3d file.
    The company refused to give it to them because of patent protection. They decided to move on and modelled the piece measuring the one they had in their hands. Then they started 3d printing.

    • Hi Carla. Thank you for that. I heard about that after, thank you for pointing it out!

    • Pretty shocking. As a mechanical engineer who operates many 3D printers myself, looking at the yellow part, there seems to be nothing overly special about it or really worth a patent. The venturi effect has been employed in carburettors for over 100 years, and in this case all you need are a few critical diameters for the input and output tubing and the desired ratio of gas flows and operating pressures, and you can literally design a generic version that performs the same function but looks nothing like the original (in fact it may be advisable to actually re-design the part to make it easier and more reliable to 3D-print on cheap FDM machines, since the original part geometry is optimised for injection molding).

      But yeah, sounds like the attitude of some American health company. They exist primarily to make a profit - saving lives is a secondary concern.

    • thank you, I think you need to ask the guys who created it. Their Facebook accounts are linked in the article. If you cannot get through let us know and we'll reach out

      • Hello,
        I am the owner of a 3D printing company in Greece. I can print in 3 FDM printers and 2 DLP printers if needed (of course free of charge). Please contact me as soon as possible if needed.

  • Based in the UK Poole, Dorset, happy to print anything related got 2 fdm printer's I print mostly pla.

  • In the US, Trump had publically allowed all medical facilities to break whatever laws may be hampering them in stopping this virus in his 'declaring emergency address' the other day. So, there should be a few medical peeps out there who have modeling skills to make these. AKA design and make them anyway

  • Stumbled across this thread looking for ways to help in finding solutions for this crisis. I don't have a 3D printer but if I wanted to get one that I could use to help supply things like this, which printer should I get and how steep is the learning curve?

    • Hobbyists use printers like the Ender 3, 3 Pro, 5, Tevo Tarantula Pro or the CR 10. Beside these, I also have the Two Trees Sapphire S. They are pretty much cheap, but do require assembly and calibration before proper use. Another option would be the Prusa Mark 3, which is more expensive than the ones enumerated, but they offer support and also assembly for extra money.

      As for the learning curve, if you have patience and you love puzzles and tinkering, it's pretty easy to get the hang of it.

  • Hi this is really good to know about - we are based in Northern Ireland and currently have FDM machines. We are also working with a number of other local companies who have printers. Our company is called NI 3D PRINT and we would be happy to help although it would likely be more useful to hospitals local to us. Feel free to contact us or connect us with others needing this type of assistance.

  • Don't forget the fastest way to get a model of some parts might be to use the hospital CT scanner to scan them. Then use free software such as Inversalius to create a 3D model of them. This can be done in a few hours.

    CT Scanner + 3D Printer = REPLICATOR

    • Hi Jasc did you know bout the #projectopenair? they are creating an ventilator to be created locally...contact them

    • There are many problems with trying to use 1 ventilator on more than 1 patient. The overriding concern is infection control and the elimination of cross-contamination. This is a major concern with prolonged mechanical ventilation of patients even in the absence of pandemic conditions. The second major concern is that splitting the ventilator's tidal volume 4 ways does not guarantee that each patient receives an equal share of the tidal volume. If all 4 patients, for example, had identical lung mechanics (airway resistance, tissue resistance, lung compliance, and chest wall compliance) and the same size artificial airway, then, presumably tidal volumes would be equal. But the likelihood of that is zero. More likely the patients with higher compliance and lower airway resistance would receive greater volumes than the patients with low compliance and high resistance. The reason this is important is that it indicates that there would be little to no control over adjusting the tidal volumes and ventilatory parameters for each patient's particular needs.

      • Thinking out loud about the tidal volume, which make sense.

        But, what if each manifold port had a simple butterfly valve to regulate an equilibrium that is optimal for all 4 patients at once ? HVAC/Bernoulli/flow principles come to mind when trying to get equal outputs from near and far vents/ports.

        Cross contamination is sill a concern.

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