What does your staff want in a patient monitor? One word: simplicity. And manufacturers are working hard to give you that, even as you host more complicated cases.
Now more than ever, monitors are more user-intuitive, with multi-colored waveforms and parameters for at-a-glace reading. They're easier to navigate and toggle by switches, more all-encompassing so that you don't have multiple boxes on the anesthesia machine, and easier to clean and disinfect.
"It can never get too simple. Just like the environment of an airline pilot, an anesthesiologist or CRNA deals with such complex sets of data and circumstances, that he needs a monitoring set-up that is maximally simplistic, easy to use and consistent throughout the work environment - from pre-op to OR to the PACU," says Adam Dorin, MD, MBA, an anesthesiologist and the medical director of the Grossmont Plaza Surgery Center in La Mesa, Calif. "Multiple studies over the past few decades support the fact that the logistics and environment of a medical care setting can have profound effects on morbidities, mistakes and mortalities by healthcare providers."
Here's a rundown of what manufacturers are doing to make your staff's jobs less complicated. We also run down the newest monitors on page 42.
A new way to read CO2
The SenTec Digital Monitor System (DMS) with ear clip, approved by the FDA in August for sale in the United States, is a single sensor for the combined measurement of both carbon dioxide and pulse oximetry. A 3-gram probe goes on the back of the patient's earlobe, as would an earring, and it takes both readings digitally. The idea is to eliminate the problems associated with traditional end-tidal readings, says Terry Jacobs of SenTec.
The system is designed for use on patients who either are mechanically ventilated, non-invasively ventilated or consciously sedated where knowing their respiratory status and oxygenation status are important diagnostic combinations, he says.
"Because it can read CO2 levels through the skin, this would be a pretty cool device to assist with MAC/sedation cases where you want to assess the adequacy of ventilation in a non-intubated patient," says Dr. Dorin.
The DMS is liquid chemical germicide compatible and can be centrally linked to data management systems through such interfaces as LAN networks and nurse call systems.
New to the market is a more diverse monitor from Philips - the VS1. It monitors blood pressure, pulse rate, oxygen saturation and temperature and includes four blood pressure modes: single-measurement, STAT mode, specified-interval mode and user-programmable protocols. The programmable protocols are meant to be especially useful for monitoring patients in the PACU.
For example, you can program the monitor to take a patient's blood pressure every 15 minutes for the first hour after surgery and then every 30 minutes for the second hour. "The staff doesn't need to change the measurement interval between the first and second hours," says Eve Lee, a product manager for Philips.
Able to save up to five such interval protocols, the VS1 reduces staff time for setting and re-setting monitors and helps ensure that the proper measurements are taken at the proper times.
"All of our monitors are pre-programmed by the company, and they were set up as per the anesthesiologists' preferences - they were set up to their liking with regard to the alarms and what appears on the screen," says Greg DeConcillis, the administrator at Boston Out-Patient Surgical Suites. "To be honest, I wasn't that involved because I didn't have to be; we just let them go. We've maybe tweaked one or two preferences for the rest of the staff, but having the pre-sets saves them lots of time."
For all ages
The American Academy of Pediatrics recently reported to the FDA that there is a dearth of medical and surgical devices made with pediatric patients in mind. Several manufacturers are ahead of that curve.
"A monitor that will handle different ages is nice," says Mr. DeConcillis. "You have to have different criteria, different alarms and such if you're treating a wide variety of patients each day."
Welch Allyn has added neonatal and pediatric modes to its Vital Signs Monitor 300 Series. With the push of a button, the end user can switch between modes and intermittently or continuously monitor blood pressure, pulse oximetery, temperature and pulse rate, says product manager Jana Esler.
The monitor simplifies the steps clinicians take to obtain patient vital signs data, says Ms. Esler, because of its flexibility and patented SureTemp Plus electronic thermometry capabilities for quick temperature readings.
"If it's accurate, easy to use and fast," says Dr. Dorin, "it could be very helpful."
Mindray's PM-8000 also includes modes for adult, pediatric and neonatal patients, recording ECG, respiration, non-invasive blood pressure, temperature, Masimo SpO2 and pulse rate. You can add invasive blood pressure or temperature and termal recorder options.
And Aspect Medical will launch a new BIS Pediatric Sensor in early 2005. The sensor, which runs on the XP platform, has a fourth electrode that helps capture and discard artifact and is aided by the XP platform, which is resistant to electrocautery and provides enhanced EMG filtering, according to Aspect's Emily Anderson.
Another way to measure
GE Healthcare has added a new parameter - the Entropy - to its monitors. The parameter measures cortical activity via an open algorithm (which won the 2000 award for top clinical application of technology from the Society for Technology in Anesthesia). Cortical activity occurs mostly in the gray matter of the cortex and is linked to wakefulness and ability to respond to stimuli; the Entropy provides a quick and easy measurement of the effect of certain anesthetics on the central nervous system by reading cortical activity. Therefore, GE's Dan Prueher says, you might be able to wake up and extubate patients faster and more reliably, as well as improve your drug management, avoid unnecessarily deep anesthesia and prevent unexpected recovery.
This summer, Health and Human Services Secretary Tommy Thompson called for healthcare to adopt more technologies that can be interfaced to create digital patient records and to facilitate better information technology. Adding such technologies to your facility can also help you meet JCAHO patient safety goals including improving effectiveness of communication among healthcare workers and improving clinical alarm systems. Monitors manufacturers are answering this call.
Nonin's Avant 4000, a wearable digital pulse oximeter, connects wirelessly to a tabletop display utilizing Bluetooth technology.
Not only does this bring your equipment in line with the evolution toward more technology, says Nonin's Lynne Bedell, it will also
- eliminate some cable clutter in the OR;
- let you quickly and easily reposition the patient if needed; and
- let the patient be mobile in PACU.
Integration is a key feature of Nellcor's Oxinet III Central Station and Paging System, which works with the company's OxiMax pulse oximeters. The system lets you link up to 24 bedside monitors via a wireless or hardwire network to a central station monitor display, where you can be alerted to any alarm events. You can also buy optional pagers and wireless PDAs to supplement bedside and central station alarms.
In addition, Colin Medical's Press-Mate Prodigy II includes barcode patient-ID capabilities, so you can digitally track and record patients' vital signs.
New chips integrating all wireless frequencies for medical purposes, solutions to interference of electrocautery with wireless systems and wireless integration of anesthesia machines, ventilators and monitoring systems are all on the cutting edge of anesthesia practice, says Ray Hasel, the medical coordinator of the OR at Lakeshore General Hospital and Ambulatory Care Centre in Pointe Claire, Quebec.
Sensitive to tightening budgets, manufacturers are offering more monitors for spot checks in the PACU. Small and light, these quickie monitors let you get the necessary vital signs without ornate features.
"We're currently evaluating some for my new center," says Christine Therrien, RN, the administrator at Brookside Surgery Center in Battle Creek, Mich. "They could come in handy," and the price is nice when looking at a large capital outlay - you can keep your more expensive and extensive monitors in the OR.
Welch Allyn offers the Spot Vital Signs, which measures blood pressure and SpO2, and includes the previously mentioned SureTemp for about one-tenth the cost of a full monitor. Nellcor has two handheld devices for such purposes: the OxiMax-compatible N-45 Handheld Pulse Oximeter and the NPB-75 Handheld Capnograph/Pulse Oximeter.
Lightweight and portable
"A good monitor for the PACU is a good monitor for the OR," says Dr. Dorin. "In fact, I prefer monitoring systems where the OR and the PACU monitors are the same, so you can transfer patients using monitors on the rare occasion this is necessary and have all parts interchangeable, and so you can use other center-based monitors or parts just in case one unit breaks down."
Datascope's Trio - compact and portable, with customizable settings according to patient size and built-in power supply; Colin Medical's Press-Mate Pal - with the minimum number of controls on the front panel and a digital display meant to be read at several angles; and Critcare's Poet Plus 8100 - featuring simple, one-level menus and dedicated function keys for easy set-up across departments - offer such advantages.
And Aspect Medical has made its BIS monitoring more portable - and connected - with the BISx system, which the company will launch at this month's American Society of Anesthesiologists convention. The BISx lets you obtain BIS information from one device about the size of a hockey puck, says Ms. Anderson. End users simply plug and play because the device can integrate with a wide range of patient-monitoring platforms sold by other manufacturers.
Everything old is new again
Ultimately, says Dr. Dorin, the most important aspect of a monitor is the one of the oldest considerations in the book.
"Despite the fact that technology has significantly advanced the fields of anesthesiology and surgery over the past two to three decades, I believe that the basic pulse oximetry, blood pressure, EKG monitors and the basic gas analyzers are just as good as any computer-driven model on the market," he says. "I really like the fact that the older models just keep on working, have few parts that can go bad and don't crash because of some software malfunction."