Anesthesia devices continue to play an important role in health care but they can be difficult to maintain. TechNation reached out to a variety of individuals in the HTM industry to get insights regarding anesthesia device features, maintenance and more.
Participating in this roundtable article on anesthesia devices are Ashish Dhammam, director of corporate sales, Soma Technology; Pete Feldman, senior biomedical electronic tech at Waukesha Memorial Hospital; Diane Geddes, CEO, RepairMED; Thomas G. Green, president of Paragon Service; and James Jumper, BMET I, Baylor Scott & White Health.
Q: What are the latest advances or significant changes in anesthesia equipment? What technologies are worthy of the initial investment?
Ashish Dhammad, Soma Technology
Dhammam: Recent models have added new ventilation modes and most manufacturers are trying to increase the similarities between their ventilator and anesthesia monitor interfaces.
The advancement of low flow technology and savings on anesthetic agent spend have also been a focus.
Geddes: Manufacturers continuously introduce technological advances in their equipment which focus both on patient safety and efficiency. The integration to the hospital information system is worthy of the initial investment.
Green: The main improvements in anesthesia equipment over the past 10 years have been ventilation modes that were previously only used in ICUs. These include pressure support ventilation (PSV), synchronized intermittent mandatory ventilation (SMMV) and synchronized mandatory minute ventilation (SMMV) and various derivatives of each mode. These modes are a very nice feature for orthopedic cases where the patient initiates the breath and the ventilator completes the breath.
Feldman: The anesthesia equipment of today is trending toward a compact ergonomic design for ease of use and surfaces that are easier to keep clean to reduce nosocomial infections. This equipment has integrated cutting edge monitoring that is versatile and customizable to increase diagnostic confidence. The ventilator has ICU quality ventilation across all patient categories and has low flow and minimal flow anesthesia modes to improve anesthetic delivery and reduce financial impact. Anesthesia equipment using the latest vent technology such as turbo vent ventilation with airway pressure release ventilation (APRV) and volume auto flow which provides protective ventilation therapy in the OR for all patient categories is worthy of the initial investment.
Jumper: Target controlled, low-flow anesthesia systems have been around for a few years now, but these machines can automatically adjust flow and vaporizer settings based on end values preset by the anesthesiologist. Also, new technology for the CO2 absorbers such as the spiralith which is a lithium-based absorber that does not generate the dust that traditional soda lime canisters do. Soda lime dust is a huge issue in maintenance.
Q: How will those changes impact the anesthesia equipment market in the future?
Dhammam: Newer ventilation modes, even though not used as extensively in anesthesia settings, can lead to better patient recovery outcomes. There will also be a push for efficacy in integration platforms by purchasing patient monitors, anesthesia monitors and anesthesia machines from the same manufacturer.
Diane Geddes, RepairMED
Geddes: There’s a huge market in the future especially with aging equipment. Hospitals will be looking to replace the old systems with more reliable and efficient equipment.
Green: If an anesthesia provider deems these ventilation modes necessary for patient care, then it could result in the sale of replacement equipment.
Feldman: I think that as the technology advances in ventilation and anesthetic delivery we are going to see the market demand more anesthesia equipment that benefits patients across all categories. This equipment will be easier for the provider to use and will have a low consumption of costly anesthetic agents. Setup, self-checks and routine maintenance will be fast and simple. Accessibility to patient data and complete clinical information will be at your fingertips in one compact ergonomic system that ensures a good return on investment.
Jumper: As these technologies grow older and more commonplace it will likely become more affordable and more broadly used leading to increased patient safety and faster patient recovery times.
Q: How can a facility with a limited budget meet the anesthesia equipment needs of today?
Dhammam: Refurbished and demo options are the best way to save money without compromising quality or features.
Geddes: Third-party vendors will be able to support facilities with limited budgets at significantly lower costs of repair and maintenance.
Thomas G. Green, Paragon Service
Green: Purchasing refurbished modern anesthesia equipment from a reputable refurbisher is a great alternative.
Feldman: Start by identifying the types of surgery cases that are performed at your facility. If all you are doing are ortho cases as opposed to everything up to heart cases the need for anesthesia equipment is vastly different. Choose anesthesia equipment that meets the needs of your surgery patient mix but also gives you the best access to the latest technology from an OEM with a solid history of manufacturing anesthesia equipment. Buy only what you need to have safe patient outcomes with a good return on investment with respect to your surgery patient mix.
Jumper: Even with budget restrictions a facility can ensure that the patient has a safe and effective anesthetic procedure by ensuring proper maintenance and calibration of the anesthesia equipment and vital signs monitoring equipment.
Q: What are the most important things to look for in an anesthesia equipment provider?
Dhammam: Service and response times, long-term costs, maintenance costs and local support are key.
Geddes: Training and knowledgeability of the equipment. Availability of OEM replacement parts is crucial in order to ensure the integrity of each device.
Green: Check the refurbisher/service provider’s resume. Are they factory service trained on the device to be purchased/serviced? Do they perform field service to hospitals and surgery centers? Where do they obtain parts? Do they have adequate liability insurance? Will they provide local references?
Feldman: A worldwide manufacturer with a long-standing reputation of designing, manufacturing and product support of high-quality anesthesia equipment. What I mean by that is the equipment manufacturer should have a proven history of making equipment that is well designed with a high level of safety and function and does not have numerous safety recalls or lawsuits against it. This equipment should be dependable, long lasting, and have parts, product support, product updates and field service for at least 10 years of service life. There should also be manufacturer training available as well as complete service manuals.
Jumper: For me, important attributes for an equipment provider are offering continuous support, equipment that is technician friendly when it comes to repairs and maintenance, and offering training schools to biomedical equipment technicians.
Q: Is it possible to keep up with the latest anesthesia equipment advances and improvements without buying brand new?
Dhammam: Absolutely! Demo/refurbished vendors oftentimes carry the latest models. New manufacturers also often have options for floor models when budgets are limited.
Geddes: It is only possible if manufacturers will provide upgrade options to equipment at a minimal cost.
Feldman: If you purchased a product from reputable manufacturer then you should already have equipment that has the ability of being updated as far as software and vent advances as they become proven and available. Most manufactures will support their product for at least seven years but your top-notch manufacturers will not only support their product for seven years but they will incorporate new advances in the industry in some form into their existing platforms. This should carry your current anesthesia equipment well past the seven year mark making it easier to stay close to the latest technology.
Green: Yes. Most anesthesia equipment refurbishers have modern anesthesia equipment models in stock for a great alternative to purchasing new at a savings of 25-35 percent.
Jumper: Some add-ons or replacement parts with technological advancements can be purchased to upgrade existing anesthesia equipment such as the spiralith absorbent mentioned earlier or upgraded patient monitoring equipment. These additions can increase effectiveness or patient safety for older equipment.
Q: How can a biomed extend the life of anesthesia devices?
Pete Feldman, Waukesha Memorial Hospital
Dhammam: Proper maintenance is a major factor in extending the life of any medical equipment. Good clinical training, with a focus on the proper usage of anesthesia machines, can help reduce staff abuse, wear and tear.
Geddes: Biomed technicians should be trained and certified on maintaining these devices. The clinical engineering department should ensure that, at a minimum, the recommended preventive maintenance is strictly implemented.
Feldman: A good rule of thumb is to follow the manufacturer’s recommendations for preventive maintenance. Most manufacturers have a list of tests, verifications or calibrations that are to be completed at least every six months. Some manufactures have preventive maintenance kits that are to be installed at least once a year. There are also some manufacturers that have no preventive maintenance kits and it is up to the technician to identify and replace valves, gaskets and such as they determine necessary. In any event, following the manufacturer’s recommendations is crucial in keeping your anesthesia equipment running for as long as possible.
Jumper: The easiest way to extend the life of the devices is to follow the manufacturer’s recommendations for maintenance and ensure that the clinical staff is also maintaining and using the equipment properly. Offer training to the clinical staff if needed.
Q: What else would you like to add or do you think is important for biomeds to know about anesthesia equipment?
Dhammam: No matter how daunting a new anesthesia machine model may appear, the principles of repair remain the same. While automation has advanced in an effort to reduce human error, basic troubleshooting is enough to detect and fix common problems, including leaks. By keeping in mind the fundamental aspects across all anesthesia machines, biomeds can apply their current knowledge while also expanding to include the latest technological advancements.
Geddes: Training is crucial for the biomed departments that are responsible for working on anesthesia devices.
Green: Always check the reputation and background of each company, especially in these days of Internet buying. How long in the medical business? Does the company specialize in anesthesia equipment or just sell everything? What are the owner’s qualifications?
Jason Jumper, Baylor Scott & White Health
Feldman: My rule is to treat anesthesia equipment as if one of your family members was going to be the next person it’s going to be used on. This equipment is life support and as such it needs to be treated with the upmost care. If there is something that is not quite right do not ignore it. Take the equipment out of service and get it repaired correctly! The OR staff may get upset with you but it is your responsibility to keep that equipment working as it was intended to without harming anyone. In the big picture the OR staff will understand it is better to postpone a case rather than have a unintended outcome.
Jumper: Anytime you perform maintenance try to treat it as if you could be the next patient on that machine.
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