Extending the life of anesthesia devices and the most important features to look for when purchasing these important medical devices are among the topics addressed by TechNation’s panel in this month’s roundtable article. Industry experts on the panel are Julie Anderson, General Manager, Sharn Anesthesia; Joe Bowen, Senior Technician, Anesthesia Department Lead, USOC Medical; Scott Garrett, BMET III, Piedmont Atlanta Hospital; Thomas G. Green, President, Paragon Service; Garth O. Meikle, CBET, Supervisor, Clinical Engineering Technology, CE-Tech; Thomas G. Green, President, Paragon Service; and Nancy Werfel, Perioperative Marketing Manager, Mindray North America.
Q: How can a biomed extend the life of anesthesia devices?
Anderson: Preventative maintenance is the key.
Bowen: The best way to extend the life of your anesthesia equipment is to do regular PMs. PMs on anesthesia equipment typically entail changing out filters and hoses. The reason these get changed out is that these filters and hoses will get clogged up over time and if not taken care of that material will eventually work its way into other more sensitive pieces of hardware inside your anesthesia equipment. Then, instead of spending $600 on a PM kit, you’ll be spending several times that on a repair.
Garrett: I’d say by getting the proper training and doing the required PM. Replacing parts when required and sometimes when it is not indicated by the manufacturer. For example, I replaced all the rubber seals, bellows, etc. even though the manufacturer has no recommendation for this.
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.
Meikle: First and foremost, the biomed can ensure that they have an excellent working relationship with their anesthesia (tech) staff; a relationship that fosters care and pride for the devices that impact their ability to provide patient care. This type of relationship has many ancillary benefits including device up-time and service life.
Werfel: Perform the preventive maintenance per the schedule in the service manual. Be vigilant in monitoring moisture produced by the breathing system. Some combinations of machines, CO2 absorbers, and HME filters create more moisture than others. A heated breathing system reduces moisture which can have a corrosive effect on the internal components of the machine over time. It is also beneficial to use bacterial filters on the inspiratory and expiratory ports.
Q: What are the most important features to look for when purchasing anesthesia devices?
Anderson: Post-purchase costs are a key feature that is often overlooked. In the heat of pursuit of new technologies, the cost of related consumables and associated maintenance costs are often overlooked. They can be budget-busters. All too often the incremental improvements provided by newer technologies do not justify added expense. For example, a rural eye surgery center may not need as robust of an anesthesia machine as a busy hospital with a transplant program, two robots and a trauma program.
Bowen: Most anesthesia equipment I have worked on use the same types of hardware inside, so there really isn’t much difference between one brand and another. This is especially true of newer equipment, as most companies, nowadays, are using Draeger parts internally. I would recommend that whatever equipment you’re purchasing, you make sure it meets all your needs today and any needs you might anticipate for the future.
Garrett: Ease of use for the anesthesia staff. Does the unit have the ventilation modes you need to handle all your different types of cases? Repair history of the machine. Did another hospital have any issues keeping these units performing?
Green: Service support. The hospital or surgery center must have dependable and responsive service.
Meikle: Considerations would depend on the answers to questions such as: What are the clinical needs of my patients and the capabilities of my facility (medical center, teaching hospital, surgery center, etc.), service (heart, general, orthopedics, etc.) or staff? What ventilation modes do my patients need (VCV, SIMV, PCV, PCV-VG, …)? Is my patient information currently shared electronically? Does the device allow for future upgrades (electronic health records, vent modes, etc.)?
Werfel: 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. Device Connectivity – as hospitals become more connected and work toward interoperability objectives, interfacing with devices of various suppliers can be challenging and expensive. Utilizing Open Standards like HL7 can simplify implementation and reduce costs. Reliable and easy to service – key components for diagnosis, repair or exchange should be easily accessed. The anesthesia system design should be sturdy and compact, preventing accidental damage under normal handling and transport conditions.
Q: What are the latest advances or significant changes in anesthesia equipment? What technologies are worthy of the initial investment?
Anderson: We see a lot of innovative airway devices. All seem to help, but none is perfect for every patient in every scenario. A wise department would have many options available at all times. When a rescue device is needed, it is needed. Budgets should not be the concern at that moment.
Green: Older anesthesia systems had only volume or pressure control ventilators. Modern anesthesia systems incorporate ICU ventilator technology such as pressure support, SIMV, SMMV, etc. Another new technology is the incorporation of a semiautomatic self-test of the anesthesia machine before use on a patient.
Meikle: A more stringent CMS (Center for Medicaid and Medicare) reimbursement criterion and increased access to health care is driving industries to adapt, to include anesthesia. The need to have anesthesia systems interfaced with EHR is becoming more widespread, all while controlling cost/improving patient outcomes.
Werfel: Electronic fresh gas flow improves accuracy and supports low flow anesthesia which reduces cost to the facility and pollution to the environment. It is important to note that too much reliance on electronics and technology is a departure from the traditional anesthesia delivery many anesthesiologists are experienced with. For example, electronic vaporizers may be more precise, however they require power and cannot be used in the case of total power failure. That is also true of alternative re-breathing systems, which may be beneficial for use with certain patient acuities, but do not provide a visual indication of potential system leaks as do traditional bellows.
Q: How will new technology and other advances impact the anesthesia devices market?
Anderson: In the long-term, new technologies will improve patient safety. That has been the goal, it remains the goal and there has been significant, measurable success.
Meikle: Real-time data (patient and systems) acquisition is a much sought after feature that promises to increasingly improve patient safety outcomes, as well as the bottom line in an ever competitive and changing health care environment.
Werfel: New technologies will continue to advance anesthesia practices. This will happen by:
• Offering new ventilation modes to the clinician that specifically target varying patient population requirements.
• Next generation devices will begin to offer decision support tools. (Some of these options are already available in Europe.)
• Simplifying the user experience with user interface and setting customization.
• Taking advantage of other technologies already available in the general consumer market (IT, hardware and consumer user interface advances).
Q: What type of credentials should third-party organizations posses or maintain? What should be considered when evaluating third-party organizations?
Garrett: I think third-party techs should definitely be factory trained. I’m not comfortable at all letting someone work on a life support piece of equipment that was shown by someone who was shown by someone else how to repair/PM my anesthesia machines.
Green: Are the technicians factory trained? What is the response time? Experience of the service technicians? How long has the company existed? What is the amount of liability insurance? Parts inventory? References?
Meikle: Any organization (in-house, third-party, or OEM) must have leadership in place which values continued personal and professional development. This can be exemplified by among other things – certified manufacturer/vendor training, CBET/CLES/CRES, and formal schooling. Cost of service, verifiable references and proven organization standing in the industry cannot be overlooked.
Werfel: Third-party service providers can be effective as long as they remain current with OEM training requirements. Biomed technical courses are offered by manufacturers and participants should receive a certificate with an expiration date, requiring periodic re-certification.
Q: What else do you think is important for TechNation readers to know about anesthesia devices?
Anderson: They are not all created equal.
Garrett: Anesthesia machines have some of the same features as respiratory ventilators. They also have some software driven calibrations that make it a little less intimidating to work on.
Meikle: An anesthesia machine is a collection of systems that work together and understanding the various systems (i.e. ventilator, high/low pressure circuits, gas delivery, scavenging, electronic vaporizer, etc.) will make servicing easier, taking away much of the intimidation factor that occasionally comes from working on such high-profile life-support devices, particularly in a high-paced/high-stress environment like the operating room.
Werfel: Increasingly important, in addition to the cost of acquisition, is the cost of ownership. This includes cost for maintenance, consumable accessories, and realization of drug costs savings through utilization of low-flow anesthesia and agent usage calculations. The platform should be upgradeable as new features, both software and hardware, become available so your fleet will not obsolete prematurely.
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