By Dan Carrigan

Emma Necessary isn’t shy about her invention. After five years as a registered nurse in VCU Health intensive care units, she’s used to dealing with what most people would rather not talk about.

“We’re unfazed. It’s just part of our day in, day out,” she said. “We’ll have a bite of pizza in the break room, and then you’ve got to run back out and run into every bodily fluid under the sun.”

One night shift, frustrated by the recurring issues she saw with FMS – fecal management systems – Necessary had an idea.

“If only there was a way to help the strain … and also keep this patient in a safe position while on a ventilator,” she said. “And then it just kind of came to me.”

The result is the Flow Positioning Wedge, a simple-looking device that enhances patient comfort and the efficiency of their care.

Designed for use with other FMS devices, the wedge does more than position patients, which can keep their lungs open and reduce pressure injuries. It also incorporates a nonstick channel that supports the role of gravity in waste elimination: The channel can eliminate backflow as well as leaks while protecting a patient’s skin from caustic fluids.

“There’s always a problem to solve,” Necessary said of her work, “and part of our job as ICU nurses is staying ahead of that problem – not only the best outcome medically, but the best emotional experience.”

The Flow Positioning Wedge addresses a widespread but rarely discussed issue in ICUs around the world: Diarrhea is common among patients, whether from medical conditions such as liver failure or treatments such as antibiotics and chemotherapy. Studies show that 17% of U.S. adults will require intensive care at some point, and many will experience complications related to waste management.

A cross-campus solution for patients

Necessary said nurses offer a valuable perspective from being able to observe a problem and then develop a patient-centered solution.

“I think it’s dignity and comfort,” she said of the mindset. “Nobody wants to be in a room full of nurses getting cleaned up all of the time … no matter how sick we are.

“If you can have that hour of sitting resting comfortably with your family, with the TV on in between medical procedures, rather than undergoing a painful cleanup, it’s everything we can hope to give back to somebody.”

Turning her night-shift idea into a tangible product took teamwork, and VCU’s innovation ecosystem made it possible.

An ICU physician connected Necessary with VCU TechTransfer and Ventures, which helps license and commercialize campus inventions to bring them to market. It brought in Casey Grey, Ph.D., an adjunct professor and postdoctoral researcher in the Department of Mechanical and Nuclear Engineering at the VCU College of Engineering.

“It’s a product of that environment at VCU,” Grey said. “You can walk over to the hospital, tell them who you are, what you’re trying to work on, and they’ll connect you with the right people.”

He and his team of undergraduate researchers worked closely with Necessary to develop a functional prototype of the Flow Positioning Wedge, drawing on her real-world ICU insight to guide the engineering process. What began as an interim solution at the bedside evolved through multiple design phases – including 3D printing, foam molding and iterative adjustments – to ensure the most recent prototype would not only function clinically but also feel familiar and usable for front-line care teams.

“Right now it looks like what we’re going to be doing is just a glorified version of what Emma did in the ICU,” Grey said. “We know the properties of the wedge are suited for the patient to reduce pressure injury and then just give that channel.”

The team focused on making the wedge durable, comfortable and easy to clean, while preserving the simplicity that made Necessary’s original concept so effective.

“It’s just nice to see something going to a patient right now,” Grey said. “The stuff we’re working on is incredibly important. It’s got a pathway to get there.”

Pursuing a path to market

Bringing the Flow Positioning Wedge from concept to hospital has required more than engineering design tweaks. Necessary and the team have received guidance on patents, licensing and next steps for real-world deployment. TechTransfer and Ventures stepped in early to support and protect her idea and connect her with resources to move it forward.

“Just knowing that you have somebody who you know to call and just bounce questions off of,” Necessary said of the partnership’s value. “I’m a nurse. I’m not in the business side of everything, and I’m not in the engineering side. I’m just learning.”

Her team is now wrapping up final prototypes and preparing for small batch testing in ICUs at VCU Medical Center. The goal, she said, is to “work with some companies and kind of get this thing on the market.”

Thomasine Isler, innovation and industry engagement manager at TechTransfer and Ventures, said the wedge is a model for how front-line perspectives can drive meaningful innovation.

“Emma’s idea is a reminder that innovation doesn’t have to start in a lab – sometimes it starts at the bedside,” Isler said. “She saw a problem, stepped up and brought people together across VCU to solve it. That’s what we enjoy supporting at TechTransfer – solutions that are smart, scalable and grounded in patient care.”

For Grey, who earned master’s and doctoral degrees in engineering from VCU, that collaborative commitment to solve real-world problems prompted his return to campus after almost a decade working with large corporations.

“It’s incredible. That’s why I came back to VCU,” he said. “It drew me to grad school, and then drew me back as a postdoc, and I hope to stay here forever because of that relationship.”

And for Necessary, the Flow Positioning Wedge reflects how the relationship between patient and caregiver is grounded in both compassion and innovation.

“We’re here to help care for people in every step of their journey,” she said. “And we know that somebody would be doing that for us as well and our loved ones. We don’t see any difference between our patients, ourselves and our loved ones. They’re part of our family, so we’re giving them the care they need.”