The exhibit hall at the 52nd Association of periOperative Registered Nurses Congress in New Orleans was big. How big? A friend recently gave me a pedometer to help me reach my goal of walking 10,000 steps per day, or about five miles (recent studies show people who do so lose more weight than those who simply exercise 30 minutes a day), and I had no problem meeting that goal the two days I spent in the hall seeking out the newest products for operating room nurses. Here's what I saw on each day's journey, organized into 11 sections:
- Capital equipment
- Fluid control
- Patient transfer, surfaces and positioning
- Gloves and hand care
- Patient monitoring
- Sterilization, disinfection, reprocessing
- Instruments and supplies
- Drapes and gowns
- I saw two high-tech supply management products from Omnicell. The first was a fully automated supply cabinet called OptiFlex SS that combines supply management software with secure cabinet technology; the second was an automated tabletop medication dispenser called Anesthesia TT, designed to improve anesthesia med management.
The OptiFlex SS is a cabinet-based automated dispensing system that holds supplies needed in the surgical suite, from consumables and trays to implants and consignment items, says the company. OptiFlex SS combines the Omnicell Color Touch monitor, PC, scanner and keyboard all built into the cabinet, along with the OptiFlex SS software. During a demo, I saw firsthand how these dispensing cabinets could improve nursing efficiency. The system can manage both cabinet and external items, automate replenishment and provide accurate, real-time inventory reports. As transactions occur in a unit, the inventory on hand is updated in the unit station scanning software. The system incorporates reorder points and par levels, and it prints pick tickets in stocking location sequence, streamlining the picking process. A preference list system creates a unique bar code for each surgical case based on the physician, procedure and patient.
Anesthesia TT automatically dispenses meds in areas where space is limited and fewer meds are typically needed, the company told me. The system fits easily on any counter or table and can be bolted to the surface for additional security. When your anesthesia provider calls up a patient name on the screen, a drawer opens and dispenses the medication (a single system can hold up to 288 items), which you then scan under a bar coder. The system provides a continuous running list of all medications used during the case. A post-case reconciliation feature lets your anesthesia provider electronically document waste and total amount issued for controlled substances.
- If you're in the market for a new electrosurgical generator, Megadyne's new Mega Power might be a good option. It features large displays that are easy to read, the ability to recall previous power settings and modes on set-up, and quick scroll for fast and accurate power-setting adjustments. The Mega Power has six clearly labeled mode settings: pure cut, blend, coag, spray, bi-polar and advanced cutting effect (for scalpel-like cutting with minimal thermal necrosis and reduced scarring) and an optional foot pedal for fast switching between cut and coag modes. A highly visible return electrode warning light enhances patient safety. A new accessory is the company's 12-use E-Z Pen Reusable Electrosurgical Pencil. It's the same weight as a disposable. Every time you sterilize one, the display will count down from 12 to zero to let you know how many more times you can use it; it then locks you out after use 12, so you can't plug it into the generator. The pencils will work with any generator. Because the tips must be replaced each time, the cost of one pencil works out to about $4 per use.
- Smoke evacuators are important for OR staff safety, but I've found that many surgeons and nurses don't like to use them because of the noise and inconvenience. That's why I was impressed by the Plume Safe Autosense from Buffalo Filter. It's turbo mode is virtually silent - even when you increase the suction, it's very quiet. It's also quite convenient in two ways. First, it's small; second, it features an LCD screen that counts down the minutes left on the filter.
- A recent Outpatient Surgery survey found that nearly 42 percent of OR managers are dissatisfied with their boom purchases for reasons including insufficient arm reach, difficult maneuverability, lack of adjustability and not enough space to meet current or future needs. CompView Medical's Nu-Boom might be good if you're worried about becoming one of those dissatisfied OR managers - it's a boom that doesn't hang from the ceiling. NuBoom incorporates a patent-pending pedestal-and-boom design, so it's freestanding. That means you can quickly (less than a week) and less expensively retrofit your OR to include or add a boom. According to a company representative, the Nu-Boom provides a precise, ergonomic, 360-degree operating field positioning capability for displays and equipment, and incorporates an integrated OR control system designed to improve OR efficiency by providing centralized control.
- For prevention of deep vein thrombosis in your diabetic and obese patients (or in any patient with poor circulation), Kendall has introduced the SCD Express, which can deliver compression to the leg, foot or both, and automatically detects the type of patient garment and adjusts appropriately. The battery-powered SCD Express is comprised of both the foot pump and SCD.
- Richard Wolf's new E-Line Ultrathin Semi-rigid Uteroscope has a tip and matte finish that allow for easy insertion into the ureter. The oval operating channel provides better flow and allows for larger instruments; instruments emerge at the six o'clock position for easy orientation; and the high-density fused quartz fiber optical bundle provides a rod lens-like clarity.
- Ultratech's SmartBins feature motion-activated lids that keep hands safe from biohazardous wastes. Infrared sensors detect motion and automatically open the lid, which closes three seconds after the hand or object is moved from the area. SmartBins come in three sizes and range in price from $55 to $120. This is an ingenious product, but I wish the opening of the lid were larger.
- On the liquid waste disposal side, DeRoyal's Aqua-Box is a canister and liner evacuation system that will quickly empty, treat and dispose of fluid surgical waste directly into your sanitary sewer system. The Aqua-Box will work with any fluid waste containment system and is designed to wall mount on any utility room or OR wall, preventing the need to transport fluid waste from room to room. In addition, Bemis has updated its Quick-Drain System with an adaptor that lets you drain large canisters safely and effectively. See "What's At Your Disposal?" on page 75.
- I liked DeRoyal's Puddle Guppy - it reminded me of a Swiffer for the OR. It's an easily maneuverable floor aspirator with a detachable handle, which minimizes staff's exposure to fluid waste while eliminating the use of blankets and sheets.
- To prevent fluid from ever reaching the floor, Microtek has a new Knee Arthroscopy Drape with an inflatable ring at the top of the fluid-collection pouch. The tube is given its shape by air instead of a steel wire. If you bump a wire, it will stay compressed. This springs back to continue capturing fluid. And if it fills up, fluid won't lip over the edge because of the tube's roundness. There is a drain in the middle of the drape.
Patient transfer, surfaces and positioning
From pre-op to post-op, many options for making the patient more comfortable were on display.
A new recliner from Champion Healthcare Seating, the 85 Series, features a swing-open arm that makes it easier to transfer patients to and from a stretcher or wheelchair. A latch secures or releases the arm. I really liked the ease of use for this chair. A bonus: It's easy to clean. The underside of the chair is exposed for cleaning. And the seat comes off - there are just four screws to deal with - for easy cleaning. It has a retractable step for shorter patients. Reupholstering is a snap, because you can just clip on a new covering. The 85 Series is rated for up to 300 pounds.
For the OR, Skytron has a new Hercules Bariatric Table. It features 1,200-pound capacity and a 1,000-pound articulation weight.The company claims it has greater articulation than any other bariatric table. The Hercules can be lowered to 23 inches for general purpose use.
I saw a lot of new patient positioning devices I'd consider using in my facility (see "If You're Thinking of Buying ' Patient Positioning Devices" on page 82). From Sundance, there was a complete line of Z-Flo Fluidized Positioners, which contain tiny microspheres that mold to the patient. Z-Flo positioners are less than half the weight of gel or fluid positioners, are easy to clean and reuse because of urethrane coverings, and are impervious to fluids. I thought these would be especially good for bariatric support, because they return to their original shape after use. Davol's Action Positioning Pads contain a polymer instead of a gel and are also easy to clean and reuse. There were larger pads that will fit any regular table and specialty pads, such as polymer stirrups and candy cane covers, that I thought were neat. These pads felt light and durable. Something else I liked: There's only one seam on each pad, reducing the chance of their breaking. If you do get a hole, repair kits are available. Bariatric positioners were also on display. Devon/Tyco had BerryFoam, a full line of wider and thicker disposable pads made of latex-free foam. And Olympic Medical had a new extra-large Vac-Pac that's 8 inches wider than the previous largest size. The Vac-Pac, made of rubberized vinyl fabric, is filled with air from any OR vacuum source; it's reusable and radiolucent and has a protective valve that closes automatically when the suction line is disconnected. This size of the Vac-Pac lists for about $390.
For patient lifting and transfer, there was the Hoverchair from Hovertech for patient lifting and transfer. It works much like Hovertech's other products - mattresses inflate from the floor to the height of a stretcher, bed or chair in less than a minute. When fully inflated, you can move the patient much more easily. I thought this would be handy for obese patients. The TotalLifter from Surge Medical also seemed to be a good choice for moving bariatric patients. The transfer pad now comes sized for this patient population at 60 inches by 72 inches. Made from a strong, proprietary fiber that's flexible and soft to touch, the TotalLifter weighs two pounds, but can support up to 650 pounds without tearing. It is available in two styles: fluid-repellent on both sides, or fluid-repellent on one side and absorbent on the other. The absorbent top surface on the latter model will hold up to 5.5 ounces of fluid per square foot. The disposable pads are individually packaged for convenient storage and portability.
Gloves and hand care
- I got to try out three new surgical gloves at this year's show. First was Sempermed's Syntegra CR, a synthetic glove that I thought had a nice feel and was easy to don, even with my hands a little sticky (it was after lunch). The Syntegra has a textured surface for better gripping, but that didn't hinder the ability to don the double-glove, because the inside is a smooth styrene-isoprene-styrene that helps it slide on. Ansell's Gammex Surefit is a standard-weight and -thickness powder-free latex surgical glove that is smooth except for a sticky band on the cuff. This means the glove is easy to don, but also helps ensure the cuff will stay in the gown, preventing roll-down. I was impressed by the fit, sensitivity and strength of the Biogel Eclipse by Regent. It's made of powder-free latex that is essentially protein-free due to the manufacturing process, in which the raw material and not the surface is treated to remove latex proteins. This doesn't hamper the tension strength, according to the company, and helps prevent reactions to both latex and the chemicals gloves are often treated with. The Biogel Eclipse retails from about 80 cents to about $1.25 per glove.
Ecolab Healthcare's Endure 450 is the newest waterless, brush-free, alcohol-based surgical hand antiseptic. The company says Endure 450 provides persistent antimicrobial protection for up to six hours. The scrub also contains moisturizers and conditioners to maintain skin health.
Getting accurate readings on patients' temperatures and blood pressures are important components of monitoring. Here are two new products to help you in this area.
Welch Allyn's newly redesigned SureTemp Plus 692 Thermometer still lets you take predictive temperatures in as little as four seconds (or full temperature in three minutes), but has been enhanced in its user-friendliness. There are now picture indicators on the large LCD display that show where the temperature is being taken: orally (the head on the icon will flash), axillary (torso) or rectally (lower body). A separate pediatric icon will flash if you've changed the setting to take a child's temperature. The rectal indicator will flash only if the rectal probe is connected, and there are different colored wells for different probes (rectal is red, oral and axillary are green), and the probes will not fit in incorrect wells. In addition, you can now remove the wells to clean them.
For blood pressure readings, Smartpump has the Tourniquet 1C, which can take upper- and lower-extremity pressure readings at the same time. The Tourniquet 1C has a five-hour battery back-up and will go into sleep mode for up to 750 hours to keep the battery fresh. It self-calibrates and self-checks, and displays and monitors each channel's unique cuff pressure and time settings independently. The Tourniquet 1C is accurate to 2 percent - others are accurate to 10 percent, says the company. Translation: At 300mm Hg, that's /-6. When you're done, the machine prints the readings onto a sticker. You just peel off the backing, write in the patient ID and stick it on the patient chart. The sticker information includes the product ID, serial number and total elapsed time in addition to the pressure readings. I was able to figure this out without ever having seen it before - it was a very user-friendly device.
New in overhead surgical lights was Burton's AIM 100 Minor Surgery Light, which can be ceiling- or pedestal- mounted. At 95,000 lux, it's very bright; It had a great swing radius (60 inches on the ceiling) and was easy to maneuver. The AIM 100 also features adjustable focus and a sterilizable handle.
Teleflex Medical was offering the Xenalight Illuminator, a light source for endoscopic procedures that is compatible with most scope brands. The patented Xenalight outperforms xenon, metal halide, and halogen in terms of lamp output, the company says. It features a Coolux port to prevent heat migration and a lamp-life indicator. I liked its compact size.
Headlight cords can be a pain. The same goes for searching for a headlight with the desired brightness. The Halo Cordless Surgical Headlight might answer both problems. It is illuminated by LED technology, rather than xenon or halogen bulbs, equivalent to a 300-watt xenon light. The light won't die in the middle of a procedure; it lasts for about 10,000 hours, its manufacturer, Enova Medical, says. The rechargeable lithium ion battery lasts about 200 charging cycles; battery life is four hours on the high setting (50,000 watts) and as much as eight hours on a lower setting. It's totally hands-free. The headset, a charger, two batteries and a carrying case are sold as a set for $4,995 to $6,495. I put it on, and found the Halo to be very lightweight and well-balanced.
Sterilization, disinfection, reprocessing
Three reprocessing trays that aimed to make sterilization more convenient were on display in the exhibit hall. The first one I saw was the One Tray from Sterile Containment Technology, a sealed sterilization container that can be used for rapid reprocessing or instrument storage. With a dedicated entry port and two exit ports, steam is displaced top-down, and you get twice the vapor exchange, according to the company. It is validated for both gravity and pre-vacuum cycles for loads up to 25 pounds gross weight. I liked the design of this - the interior was angled downward to prevent moisture's remaining after sterilization; there were no sharp corners that pose a safety risk to staff; and there were two easy-to-open tamper-evident seals to ensure sterility is not compromised. Aesculap/BBraun debuted its PrimeLine sterile container system, a line of filterless containers that last up to 5,000 cycles. The high-grade polymer lid is impact- and scratch-resistant. The lids are color-coded for different types of instruments, and are compatible with all container bottom parts manufactured since 1988. There are no filter-processing costs, and mechanical reprocessing of the containers is possible. I really like the idea of the long-term use these containers provide. One was a specialty tray - the Care System Ophthalmic Instrument Basket, from Medisafe America. The stainless steel tray system provides protection and irrigation capabilities; the company's flushing manifold allows irrigation of up to seven cannulated microsurgical instruments with interchangeable male and female luer connectors for custom connections to your specific instruments.
Perhaps the neatest product I saw in this category came from Ruhof: the Endozime Instrusponge. This is a long, flexible plastic wand with a sponge on the end; the sponge is impregnated with the company's Endozime AS Triple Plus. Instead of using a wire brush - which can scrape the channels of your flexible endoscope - to loosen and clear debris, you dip the sponge in water to activate the enzymes, then push it through your scope's lumens to perform the all-important mechanical cleaning step of scope reprocessing.
Instruments and supplies
- First stop for instruments and supplies: scalpels. BD debuted a new metal reusable handle for its Protected Blade System. The blade comes in a cartridge, and you just click it on without ever touching the blade. The handle was a good weight, and I found the one-handed removal of the blade to be very simple and safe. BD also showed larger blade sizes on its Protected Disposable Scalpels. DeRoyal had the Canica-Safety Reusable Retractable/Ejectable Scalpel Handle, which accepts most conventional carbon and stainless steel blades, allows for touchless disposal of used blades and is designed for both right- and left-handed surgeons. This, too, had a nice weight. The company's IonFusion disposable scalpel blades last longer than conventional blades, according to a representative, and therefore necessitate fewer blade switches, enhancing safety.
- There was also some new mesh on display. Ethicon's Proceed Mesh for ventral hernia repair is very thin and pliable - a 6-inch-by-8-inch piece can be deployed through a 10mm trocar. According to the company, the design allows fluid to flow through the mesh, which lets the body better incorporate it, resulting in less internal scarring. Atrium's ProLite Ultra Mesh, a monofilament polyproplene mesh, is bio-inert and biocompatible, and uses 25 percent less material than the company's other meshes. I was impressed by how strong it seemed and the fact it was practically see-through.
- For inserting that mesh, Ethicon Endosurgery had its new Xcel Trocars, which can accommodate instruments from 4.7mm to 12.9mm. The tip is bladeless, increasing staff safety; a stability sleeve keeps it from dislodging; and you can pop off the outer seal to remove larger specimens.
- Weck/Teleflex Medical had a new, smaller size clip in its Hem-o-lok line of ligation clips. The inert, non-toxic, radiolucent polymer mini-clip is 40 percent smaller than the company's current smallest size.
- For prepping, 3M introduced the One-Step Patient Prep, which can be used on both skin and mucosal tissue. The patented film-forming solution bonds to skin and provides the efficacy of a five-minute scrub followed by a paint in a single two-minute povidone iodine scrub that keeps the bacterial count below baseline for up to 24 hours.
- Richard Wolf had two new instruments: the PowerGrip Bipolar Forceps and the HySafe System with flushable forceps and scissors. The new forceps are reusable, with a variety of easy-assembly modular-design rotatable tips. The PowerGrip scissors allow precise cutting with minimal thermal spread, the company says. The HySafe System can be taken apart and is reusable because the instruments can be flushed for cleaning and are fully autoclavable.
Drapes and gowns
- Medline and Kimberly-Clark both introduced color-coded gowns that let you quickly and easily select the right gown for the procedure. Medline's Proxima line of gowns come with yellow on the collar for minimal fluid, green for low, purple for moderate and blue for high. KC's Instant Gown Recognition comes in three colors: yellow for non-reinforced gowns, green for fabric-reinforced, and red for zoned or fully reinforced gowns. Molnlycke showed its Barrier Fluid Protection Plus AAMI level three gowns, which are highly fluid-repellant.
- There were also two specialty drapes. Medline had the OrthoMax Surgical Drape, a longer, wider drape specially designed for orthopedic procedures that include wider anesthesia screens for creating a sterile field with one drape. For ophthalmic procedures, Alcon had the Viseo, which is designed specifically to reduce the amount of lint released into the OR, as lint can cause irritation and infection, clog air filters and damage equipment. In addition, the purple drape has an adhesive the company says provides a firm fluid barrier with less discomfort to the patient upon removal. As cataract patients tend to be older and have thinner skin, this is a plus.
Some neat things that didn't really fit into any category:
- Irrimax Corp.'s Irrimax OR for wound irrigation seems as though it would be very handy. The bottle, which now comes with sterile packaging, holds 500ccs of sterile saline. Simply squeeze the soft plastic of the ergonomically designed bottle to deliver 23 pounds of pressure for irrigation of the wound; a splash guard around the nozzle helps direct the flow. For $11 a bottle ($9 for non-sterile packaging), this product seems quite reasonable.
- To get cords off the OR floor and out of staff's way, HG Solutions has devised HG Solutions Cord Management, a clamp with an arm that hangs under the OR table. You hook the device on the table, run cables through, and keep them suspended but still accessible. A great little idea.
- To help you quickly and easily handle soiled sponges in the OR, AMD Ritmed offers the Countaway System. It is comprised of a bucket on a pedestal into which you put the central bag; the outer edge of the bag flops over, giving you several sponge-counting panels, each with five pockets and individual covers, and a split to hold two small or medium-sized sponges. The pedestal adjusts from two-and-a-half feet to four feet high to accommodate OR staff's varying heights. The central bag used for sponge collection is also used at the end of the procedure as a disposal bag for the soiled sponges and counting panels.
- GE Healthcare has extended its Centricity Acute Care Platform to include Centricity Anesthesia, an advanced application builder with three layers: a flexible, configurable user interface, an application logic and clinical rules engine, and a document management system. Centricity covers all phases of perioperative care, integrating the scheduling system and gathering data from pre-op holding to eliminate duplication of information, letting you forward information from the OR to post-op in order to compile a more complete record of patient data.
- For infection control, IsolTech had its Global Cleanroom Systems, which are semi-rigid corners and transitions for the walls of your ORs, procedure rooms, reprocessing department or storage area - any part of your facility that requires seamless floor-wall-ceiling coverage. The idea is to eliminate seams that might harbor bacteria in clean areas. The company says the panels are easy to clean and stand up to the harsh cleansers used in healthcare facilities.