A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Chris Rosenthal
Published: 10/10/2007
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
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.
Disposal
Fluid control
For more on fluid-control products old and new, see "Fluid-disposal Roundup" on page 78.
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
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.
Patient monitoring
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.
Lighting
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
Drapes and gowns
Miscellaneous
Some neat things that didn't really fit into any category:
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