New technology and updated features can make maintaining medical devices difficult and that is true when it comes to anesthesia devices. TechNation contacted industry experts to find out how biomeds can extend the life of anesthesia devices, what to look for when purchasing equipment and more. Members of the roundtable panel include Mindray Strategic Marketing Manager for Perioperative Care Scot Carriker, Paragon Service President Thomas Green, Dräger Technical Product Manager Ken Horsfield and CE-Tech Anesthesia Specialist Matt Strickley.
Q: How can a biomed extend the life of anesthesia devices?
Carriker: Authorized biomeds play a vital role in extending the life of anesthesia devices, and they can accomplish this through various means. First, biomeds should ensure they are properly trained and should consider periodic re-training with the device manufacturer. Staying current with supplier recommended preventative maintenance schedules should ensure optimal uptime, while utilizing additional products like specialty filters may help prolong the life of the machine by managing typical equipment exposure to moisture and material degradation.
Green: The life of an anesthesia machine is limited to either the desired new features of newer equipment or the availability of parts and service. If an anesthesia machine is no longer supported by the manufacturer, then the service provider must have all of the parts available to immediately return the life support device back into use by the anesthesia provider. If the service technician cannot do so, then I would say that the device has reached the end of its life.
Horsfield: Perform the periodic maintenance in accordance with the manufacturer’s recommend testing interval. Also be sure to replace all recommended maintenance parts at the correct replacement interval as these items are usually wear and tear items that have a known limited service life. When implementing device repairs always use only genuine OEM parts that are obtained either from the manufacturer or a qualified distributor source.
Strickley: Proper maintenance will extend the life of any machine. A machine that looks good and works well is very likely to have a long service life. Biomed can definitely ensure that the equipment is thoroughly cleaned and cosmetically well-maintained. Biomed can prevent failures by following maintenance plans and regularly replacing parts that are known to fail over time. When problems do occur, a biomed that communicates well with the customer can help to alleviate maintenance-related concerns or perceptions that might otherwise shorten the service life of a perfectly good machine.
Q: What are some important features to look for when purchasing anesthesia devices?
Carriker: It is important that anesthesia devices not only meet all the clinical challenges that one would expect over the life of the device, but it is also extremely important to evaluate the total cost of ownership of the device, device connectivity and overall safety concept. Total cost of ownership includes acquisition price, regular consumables costs, and regular maintenance costs over the life of the device. Service, maintenance kits and consumable costs can vary greatly between suppliers. It is important to understand length of standard warranties and what consumables are proprietary as these items can not only impact the total cost ownership of the device but may also require more of the biomeds’ time. As facilities and systems drive toward improved interoperability, interfacing with devices of various suppliers can be challenging and expensive. Utilizing non-proprietary, open standards like HL7 can simplify implementation and reduce costs. Finally, safety is paramount. The machine should be able to ventilate and deliver agent in case of complete power failure, have an extended battery life, and the ability to protect against surgical fires with the advantage of blending O2 and air to reduce the combustible percentage of oxygen.
Green: Service support. The hospital or surgery center must have dependable and responsive service.
Horsfield: Because each customer is different, this really depends on the goals of each institution. However, clinicians today are being asked to ventilate sicker and more obese patients. In addition, tomorrow’s health care payment models are designed to reduce a patient’s length of stay. In order to accomplish this, hospitals will look to deliver therapies to patients in order to discharge patients faster and reduce the opportunity for hospital-acquired infections. Health care institutions should be looking for anesthesia technology that offers advanced ventilation capabilities, supports streamlined infection control, and provides connectivity to your EMR in order to monitor and improve best practices.
Strickley: Many new devices have software that includes an automated machine checkout. I believe that this is preferred as it guarantees that a level of safety has been established by the user prior to patient use. Software in newer models has also been developed to assist the end user in determining efficient levels of anesthetic agent and fresh gas flow rates. Another consideration would be the ventilator modes that are needed versus the ventilator modes that are available from the machine. Some newer machines are capable of being integrated with the electronic medical record to capture key parameters such as anesthetic agent consumption and fresh gas usage. This is an important consideration as it may also affect patient billing. I would also recommend to a facility looking to maximize on its investment to look for a machine that has been a big seller. The more machines that are out there in hospitals, the longer that particular model is generally supported by the manufacturer and third-party organizations. Once the manufacturer’s end of support date hits, the more machines that were sold will determine how much longer the device can be supported by third-party vendors and the used/refurbished parts market.
Q: How will new technology and other advances impact the anesthesia devices market?
Carriker: Many new advancements are focused around IT integration and software enhancements but, generally, technology is moving anesthesia machines from mechanical to electronic systems where possible. Electronic controls and advanced algorithms can help clinicians improve clinical care and help administration manage costs, but it is important that any incorporation of electronics does not negatively impact the safety concepts behind the machine such as maintaining the ability to deliver fresh gas and agent to the patient even without power.
Horsfield: Dräger’s focus with its new technology development surrounds improving patient safety, maximizing uptime, and enhancing the service experience. With the Perseus A500, Dräger introduced its “turbovent” ventilator, which enables the Perseus A500 to become the first anesthesia machine in the U.S. capable of delivering Airway Pressure Release Ventilation (APRV) in the operating room. This enables patients from the ICU to continue their ICU ventilation therapy even during surgery. In addition, Dräger is focused on improving the service experience by offering “remote” service offerings in order to better maintain uptime, implement updates more quickly, and improve service processes.
Strickley: As a biomed tech, I am not necessarily an expert on the sales market, but as a technology insider I expect to see more and more organizations upgrade their anesthesia systems with newer technology. I think that the manufacturers have done an excellent job in developing new safety technologies such as the automated machine self-tests. I also think that improvements in mechanical design and software have helped to improve the efficiency of gas usage.
Q: What type of credentials should third-party organizations possess or maintain? What should be considered when evaluating third-party organizations?
Carriker: There would be no difference in credentialing in-house biomeds, direct service representatives or third-party organizations when it comes to maintaining medical equipment. It is important that all service providers receive authorized training from the manufacturer. If a facility is considering a third-party service provider, it would be incumbent on the facility to ensure the third-party organization was up-to-date with all equipment in question.
Green: Are the technicians factory trained? What is the response time? Experience of the service technicians? How long has the company existed? What is amount of liability insurance? Parts inventory? References.
Horsfield: For each specific model device they propose to perform repairs and or maintenance on, verify the individual has received a certificate of proper training from an accredited trainer such as an IACET authorized provider. Obtain references from several other satisfied customers. Verify the organization is in good standing with the Better Business Bureau. Verify the organization is bonded and has sufficient and extensive liability coverage to work on life support equipment.
Strickley: In my opinion, third-party vendors ultimately are selling their engineers and technicians. They should be able to provide the qualifications (e.g. certifications, degrees, experience, manufacturer service schools, etc.) of the employees that will be working on the equipment. When considering third-party organizations, obviously the first question that comes to mind is, “how much does it cost?” Next, the customer should evaluate what services are being provided for the indicated cost. For instance, when it comes to anesthesia, will trace gas testing also be performed to ensure that the working environment is safe for OR personnel? Can and will the third-party organization service anesthesia gas monitors and modules? What PM procedures does the third-party organization follow for anesthesia machines? Do they follow manufacturer recommendations? Is there a regular parts-replacement schedule for each machine? How many makes and models of anesthesia machines can the third-party organization support? Is the third-party organization current on the newer makes and models?
Q: How can biomed help ensure patient safety in regards to anesthesia devices?
Carriker: Biomeds can play a large role to ensure patient safety by following manufacturers’ procedures listed in operators and service manuals. By following manufacturers’ recommendations and using original manufacturers’ replacement parts, biomeds can help improve equipment up-time and be certain that only validated components are used.
Horsfield: The device should include the means for providing robust real-time data logging of the important “flight data” parameters such as alarms, measured data, user settings, device errors and operational data. The biomed’s access to the full spectrum of imperial tactile information will enhance investigations about root cause determination of use errors and equipment malfunctions. The lessons learned will often lead to additional training aimed at improving clinical outcomes and also reduce the likelihood of similar equipment malfunctions.
Strickley: Biomed plays an important role in ensuring patient safety. Anesthesia systems are comprised of many safety mechanisms that run in the background; end users do not necessarily see or test them during normal operation. Biomeds test these safety mechanisms during regularly scheduled maintenance. We not only ensure that anesthesia devices are functioning properly and meeting manufacturer specifications at the time of inspection, we prevent failures from occurring during clinical use. Another safety role of biomed techs is to assist as trainers and educators to clinical staff.
Q: What else do you think is important for TechNation readers to know about anesthesia devices?
Carriker: Anesthesia machines are critical life support devices, and as such require the appropriate level of attention from biomeds, anesthesia techs, CRNA, doctors and anyone else who may interact with it. It is highly recommended that all manufacturers’ procedures are followed to ensure optimal run time. OEM suppliers will track, where possible, failure rates and analyze life cycles in order to continually make improvements to component designs. Biomeds can be an integral part of this process by reporting unexpected component failures back to OEM suppliers. In addition, anesthesia platforms should be scalable to allow for new functionality (ventilation modes, low flow tools, etc.) when available or required by users in order to lengthen the useful life of the product and provide more value to the institution.
Green: Choose a manufacturer that treats ISOs fairly in regards to service training, parts availability and parts pricing.
Horsfield: Modern anesthesia devices are very complex life support systems. You should never attempt repairs on such devices unless you have received an appropriate level of specialized training on that specific product. When uncertain how best to approach a device repair, you are encouraged to seek advice from a very experienced peer or expert in this field. Most reputable device manufactures provide free 24/7 technical support and more often than not you are not the first customer to report a particular behavior. It is quite likely that these folks have already responded to reports of this nature and have provided accurate information to get the problem resolved in a timely manner.
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