Welcome to the new Outpatient Surgery website! Check out our login FAQs.
Thinking of Buying...Fluid Waste Management Devices
Here's how to protect your staff and choose the system that's right for you.
Lindy Hockersmith
Publish Date: October 10, 2007   |  Tags:   Waste Management

You have more choices than ever when it comes to purchasing devices that collect, contain and dispose of irrigants, blood and other fluids from your OR floors. Some are high-tech and high-priced, such as the closed systems that vacuum fluid from the floor and dispose of it into the sanitary sewer. Others are simpler and less expensive, such as suction mats, wicking devices and floor discs that sop up fluid. But how do you know which system is right for you? Read on as we sort through what's available.

Closed suction and disposal systems
Closed disposal systems suction and vacuum fluid from the floor, deposit the fluid into a canister or some sort of holding device and then drain the canister's contents into the sanitary sewer. You can either dispose of or disinfect and reuse the canisters; either way, staff avoid contact with the fluids and limit their exposure to contaminants.

A closed system offers other, less obvious benefits. For one, there's no splash, such as the kind that might come from pouring fluid down a hopper. "You eliminate virtually any contact with fluid and contaminants," says Lisa Austin, RN, the vice president of operations for Pinnacle III, a development and management services company.

Also, there's no need for heavy lifting, such as from maneuvering red bag waste. "Heavy lifting is a major issue for our facility," says Tammy Treutel, RN, CN4, the product specialist for operating rooms at St. Joseph's Hospital in Marshfield, Wisc. "We have huge fluid containers, and the gel that we use to solidify the waste makes them even heavier. There is a concern of back injuries."

Consult your state's regulatory compliance laws when considering purchasing a closed system. Some states are more liberal than others, and you need to know the waste disposal requirements of your area - "what can go down the drain and what cannot," says Beverly Primeau, RN, CRNFA, MBA, the director of Concord Ambulatory Surgery Center in Concord, N.H. The CDC, EPA and AORN recommend that systems empty directly into the sanitary sewer. "Even if your regulations are lax now, this could change over time, and you want to make sure the system you employ now will be compliant in the future," says Ms. Treutel.

Closed suction systems can cost up to $50,000. If your center performs many orthopedic, gynecological or plastic surgeries and deals with a large amount of fluid waste on a daily basis, then a closed system might save you time and money, says Christine Therrien, RN, administrator of the Short Hills Surgery Center in Millburn, N.J. Beth Crew, RN, director of surgical services at Gordon Hospital in Calhoun, Ga., says she thought about a closed system and looked at a couple. "But," she says, "you have to have a certain amount of fluid volume to make [a closed system] worth it in terms of cost."

Don't forget to factor in expenses beyond the cost of a closed system itself, say experts. "Sometimes people only focus on the up front costs of capital equipment and forget about the operational costs, such as changing the disposable filters in a closed suction system," says Ms. Crew. "The more fluid you have, the more they need to be changed. This is an extra cost that needs to be figured into what your center wants to spend."

Another extra cost to consider is the possibility that you may need to upgrade your OR to support a closed system. "When we were trying to decide what type of fluid management device to purchase, we realized that we would need to install pipes and run those pipes in the OR [to carry out the waste]," says Ms. Treutel. "This extra cost was too much for us at the time."

Should you have to upgrade your OR, your vendor should work with your contractor and plumber to see you through the process, says Ms. Austin. Also, depending on the system, you might have to purchase canisters only from the manufacturers of the system, which decreases flexibility of choice.

Also consider the size of the equipment. "One reason that we decided against the closed system was because of the size of it," says Ms. Crew. Some products can be wall-mounted, but others take up a lot of floor space.

"If it's in your budget and your center disposes of a lot of fluid, then it's worthwhile to purchase a closed suction system," says Ms. Primeau, whose facility uses one.

Solidifying and red bagging
Another common fluid waste disposal method is to red bag the waste. Once fluid waste is suctioned into canisters, you treat it with a solidifying agent that turns the waste into a gel. You red-bag the gel, then either incinerate it or pay a medical waste disposal company to haul it away for you. Red bagging can be ideal for centers with a small volume of fluid waste or budgetary concerns, say those we interviewed. The cost of the solidifier can be less than $3 per added 3,000cc of fluid waste.

The ease of using a solidifying agent also works well for Ms. Crew and her facility. "It is easy to measure the solidifier, and some canisters even come with the solidifier already in the canister," she says. Some solidifiers even sanitize the fluid waste. That way, depending on state regulations, you can dispose of this treated waste as white bag trash, which is much less expensive to haul away than red bag trash. Many suction canisters have sealed lids where fluid is suctioned into, thus minimizing exposure to waste. You can even pour some solidifying agents into the container before it's filled so there's no need to open the container once the waste is inside.

Disposable canisters could then be desposited directly into red bag trash, which would eliminate any direct contact with fluid waste during disposal. If you don't use disposable canisters, you can place suction liners in canisters to absorb liquid and keep it from getting into the canister.

In addition, when using a solidifier and disposable canister, there's no wait time that can sometimes come with a closed system. "With some closed systems that don't use disposable canisters, you might only have two canisters to use for an entire procedure," says Ms. Crew. "Once those are full, you need to wait until they're cleaned and sanitized before you can use them again." With solidifying and red bagging, you can go through as many canisters as you have and you don't need to wait for the fluid to be evacuated.

Also, solidifying waste can be less labor intensive than using other alternatives. With a closed system, someone needs to collect, transport and process the waste as well as clean, disinfect and redistribute the canisters; people need to be trained on the system. If you're red bagging your waste using disposable canisters, you only need to collect the fluid, pour in the solidifier and put the canister in the trash.

However, when it comes to disposing of solidified waste, you must follow many rules and regulations, which can increase time and costs. U.S. Department of Transportation regulations require packing suction liners in individual rigid packaging before placing them in red bags. Every suction canister must be wrapped with sufficient absorbent material to absorb the entire contents of the canister before you place the canister in a rigid, watertight non-bulk outer packaging, such as reusable plastic boxes or sealable cardboard boxes with heavy-duty liners.

If you decide to red bag your waste, you'll incur costs related to purchasing canisters and solidifying agents and disposing of the waste. "We pay about 32 cents per pound to dispose of red bag waste and the average canister weighs about 8 pounds, but we also have to figure in the cost of the canister and the cost of taking it to the landfill," says Ms. Crew. Even if you have an incinerator on the property, like St. Joseph's Hospital, environmental concerns could make this practice obsolete. "[The incinerator] works for us now," says Ms. Treutel, "but in the future the hospital will most likely not keep the incinerator open."

Another point to consider is staff safety. "How much are they coming into contact with potentially harmful waste because of using canisters and solidifiers?" asks Ms. Austin. "Accidents can occur (such as releasing chemicals when pouring in a solidifier). A closed system can help avoid accidents."

Suction mats, wicking devices and floor discs
For lesser volumes of fluid, you can also use suction mats, wicking devices and floor discs to collect and dispose of fluid waste. Although they all involve disposing of waste through suction canisters, the method that each employs to collect the waste can, in some cases, be more versatile than traditional tube suction.

With suction mats and wicking devices, you simply place them on the floor of the OR and hook them up to suction. Fluid waste is absorbed into the mat or device and then is evacuated via suction tubing into canisters, which you then dispose of. The mats and wicking devices are disposable, which prevents cross-contamination and can cut down on turnover time, says Brian Lewis, ORT, case coordinator and first assistant at the Bone and Joint Surgery Center in Franklin, Tenn. Mats can cost between $30 and $50 and, although wicking devices are not quite as expensive, both products can only be used once. Also, there is still a safety risk for employees in disposing of the fluid canisters, says Ms. Austin.

Floor discs are another inexpensive form of fluid collection. You attach these small discs, usually around 12 to 18 inches in diameter, to suction and kick them over to where a spill is. According to Cory Dorman, RN, the OR nurse manager of Intermountain Surgery Center in Boise, Idaho, a disposable floor disc comes in handy in his ORs. However, these discs will only suck up the area where they're moved to and have to be moved manually to the area, which can be a distraction for surgeons and staff. The risk of tripping over the disc is also a concern, as is the safety of staff when disposing of the fluid that the discs collect.

Cut the Risk of Extravasation Without Losing Control of Irrigation

A pair of new devices could give you more control over fluid management.

The threat of extravasation gives surgeons one more thing to worry about when the procedure is scheduled to take two or more hours to perform. It sometimes becomes a race against the clock to complete the operation before the soft tissue around the cannula absorbs too much irrigation fluid, because the swelling can make the surgery more difficult to perform and cause complications. Two new devices may help you avoid this problem by giving you more control over how much fluid flows during hip and shoulder arthroscopic surgery. What's more, they're completely compatible with your preferred techniques and existing equipment, according to manufacturer Cannuflow.

The EntreVu EX instrument cannula (below) is designed to actively drain escaping fluids at the source through a process the manufacturer calls extravastat while performing all the standard functions of a cannula. It has a transparent body to give surgeons an unobstructed view of the process and is ergonomically designed for an easier grip. It also features a proximal seal design to prevent fluid from squirting during surgery.

The TwoVu EX scope sheath (right) offers this extravastat technology for Cannuflow's existing line of TwoVu scopes. This soft polymer, low-profile device slips easily over an arthoscope's own sheath to provide a dedicated outflow channel from the joint spaces. It eliminates the need for a switch to change from inflow to outflow via its stopcocks to remove debris and regain image clarity. Its design incorporates a separate channel for draining the escaping joint irrigation fluids before they infiltrate the interstitial tissues.

The EntreVu EX and the TwoVu EX are sold separately for $250 per box of five units. The TwoVu EX comes in two sizes: ST (for a 5.8mm to 6.3mm/81mm scope) and L (for 5.8mm to 6.3mm/123mm scope). For more information, visit www.cannuflow.com or call (866) 484-5400.

- Nathan Hall

AVEC Scientific Design Corporation
Black Hole Flash
(800) 944-2525
Price: $12 each
FYI: The Black Hole Flash is a suction device used to evacuate fluids from the OR floor. The two-foot long strip works through a capillary wicking action, so it makes no noise and wicks up to 80 liters of fluid, says the company.

Bemis Health Care
Bemis Quick-Drain
(800) 558-7651
Price: $6,995 to $8,995
FYI: The Quick-Drain provides safe and cost-effective disposal of liquid infectious waste, says the company. The system, which connects easily to existing plumbing and requires no electricity, drains fluid into the sanitary sewer at a rate of 500cc per second. The product reduces red bag waste and eliminates the need for solidifiers.

Cardinal Health
SAF-T Pump
(800) 964-5227
Price: Not disclosed
FYI: Cardinal Health's SAF-T Pump system directly disposes of liquid medical waste into the sanitary sewer with no pouring required, says the company. The SAF-T Pump connects directly to existing plumbing and lets healthcare workers quickly and safely dispose of liquid medical waste. The SAF-T Pump system is powered entirely by tap water, so there are no moving parts to wear out, adds Cardinal.

Colby Manufacturing Corporation
WaterBoom Quiet Floor Suction Strip
(800) 969-3718
Price: Not disclosed
FYI: Colby Manufacturing's WaterBoom Quick Floor Suction Strip provides an effective way to control the flow of fluid waste on the operating room floor, says the company. The system creates a dam to hold back, contain and quietly suction an unlimited amount of waste fluid. The low-profile design lets the product be stepped on without a loss of suction and also helps protect healthcare professionals from contact with contaminated substances, adds Colby.

DeRoyal Aqua Box
(800) 251-9864 or (888) 938-7828
Price: $3,900 to $9,900
FYI: The Aqua Box is a compact, stand-alone, wall-mounted waste fluid evacuation unit that optionally adds a disinfectant before safely and efficiently discarding waste fluid into existing sewer facilities, says the company. The Aqua Box empties and discards fluid from any suction canister, liner, collection bag, kick bucket or any other fluid collection source, regardless of the brand of canister or container, adds DeRoyal.

Dornoch Medical Systems, Inc.
Transposal Infectious Fluid Waste Management System
(888) 466-6633 ex. 108
Price: $8,000 to $33,000
FYI: The Transposal System is designed to safely serve the entire hospital from ER to OR, and matches fluid collection requirements with clinically appropriate and cost-effective solutions, says the company. The Transposal is an environmentally friendly system that collects fluids in reusable containers for convenient on-site disposal, says Dornoch.

MD Technologies, Inc.
Environ-mate DM6000-2
(800) 201-3060
Price: $5,000 per procedure room
FYI: The Environ-mate DM6000 Series Suction-Drain Systems offer direct fluid disposal to drain without staff exposure, according to the company. The DM6000-2 (pictured) provides two field inlets for endoscopy (EGD, ERCP, bronch). The DM6000 and DM6000-2A models are also available for reprocessing rooms and surgery (cystoscopy, urology and arthroscopy), respectively. These silent wall-mounted units eliminate costly canisters and disposable supplies, adds MD Technologies.

Stryker Surgical
Neptune Fluid Waste Management System
(800) 800-4236 ex. 3574
Price: Not disclosed
FYI: The Neptune is a completely closed fluid management system and smoke evacuation unit in one compact package. It eliminates exposure risks, environmental issues and excessive disposal costs and runs off of its own powerful, consistent suction; and it has an automated IV pole for the OR staff, says the company. The Neptune eliminates red bag fluid waste and all subsequent costs, while requiring facilities to inventory just one disposable, adds Stryker.