Fluid Waste Management Made Easy

• Understand your options. Mobile and wall-mounted are the two main types of fluid collection systems. Mobile systems house large internal reservoirs that are designed to hold and store the runoff that’s created during fluid-heavy cases such as joint arthroscopies. The units are wheeled directly into the OR, where staff — in our case the circulator — attach the system’s ports directly to arthroscopy pumps or floor wicking devices. When the reservoirs fill up, which generally occurs after several cases, a staff member wheels the portable unit to a dedicated docking system, which automatically empties the contents into the sewer system.

Wall-mounted systems are another alternative. Collection canisters are positioned on a mobile cart that’s adjacent to the OR table. When the canisters are filled, staff roll the cart to a wall-mounted disposal system that automatically empties the canisters.

Both options are effective and offer clear advantages over the manual handling of standard collection canisters, but we’ve found the mobile units to be a cost-effective, staff-friendly and efficient solution. 

• Analyze your case volume. You must have a clear understanding of your case volume and procedural mix to get an accurate idea of how many mobile units you’ll need to purchase. If you run a busy orthopedic surgery center like ours, which performs around 450 surgeries each month (many of which are fluid-heavy arthroscopies), I recommend purchasing one mobile unit per OR. It’s also a good idea to have an extra unit available to prevent delays if one breaks down or is temporarily out of service for cleaning. Because of our case volume and mix, we have five units — one for each of our ORs, plus an extra that sits on standby.

• Demo before deciding. When trialing a fluid waste management system, don’t bring it in for a day or two; give your staff at least a week, or ideally two weeks, to figure out the kinks and see how they work with the new technology. Also make sure you have the space for whatever system you’re considering. While mobile collection units don’t take up a lot of room on their own, you must account for the docking stations. For a lot of smaller ASCs, space is tight and not having a dedicated location, such as a janitor closet, for the station can present issues.

Sweating the details is a small but crucial part of the purchasing process.

• Involve end users. Staff input is a key part of any major purchasing decision because they’re the ones who use the equipment you’re considering. Devices that look pretty and have the latest bells and whistles are basically useless if they don’t do what your frontline staff needs them to do. When you bring a system in for a demo, poll the staff who use it, asking them for feedback on what works, what they like and what they could do without. You might also want to get feedback from your non-clinical staff. For instance, we made it a point to solicit input from the evening housekeepers who do the long, end-of-the-day cleanings of the units.

Once you’ve gathered insights from staff, go back to vendor reps armed with that info and say, “This is what we like, this is what we don’t like. Can we change this? Is this a possibility?” Sweating the details is a small but crucial part of the purchasing process because certain features that aren’t always included with the demo model might make a huge difference to your frontline staff.

One such option for us was being able to raise and lower the IV pole built into the mobile collection unit with the push of a button. This might not sound like a big deal, but when a circulator is hanging four bags from the pole and trying to lift it up and secure it in place, that push-button capability is a difference-maker. We also wanted to be able to preset the suction that our surgeons need so when the collection unit is turned on, its automatically set to that level.

There have been some major improvements made to the current version of the system we use, so you’ll need to decide whether you want the latest generation or if you’re willing to go with an earlier model. Again, staff feedback is crucial here, because these differences can play a major role in their day-to-day activities — and ultimately their satisfaction. For instance, one source of contention with the earlier generations of the system we use was the noise level. It used to sound like a jet engine was revving in the OR, but the current model is much quieter. Another consideration: Does your facility perform a lot of procedures that generate surgical smoke? If so, some of the newer mobile collection units come with integrated smoke evacuation systems.

• Know the costs. There’s a misconception that switching to a closed fluid collection system is more costly than sticking with single-use containers, but that’s not necessarily true — especially for busy facilities. Mobile units require a significant upfront investment, but traditional three-liter suction canisters full of fluid cost a couple dollars each to dispose of in regulated medical waste. If your facility is performing thousands of procedures each year, that amount quickly adds up. Plus, consider the time savings realized by switching to a mobile system and factor that into the equation.

While it’s easy to focus on the upfront investment of a closed system, don’t lose sight of the cost of disposables. Vendors will often give mobile units to facilities at no cost and charge only for the disposable items used during each case. For instance, the manifolds — the devices that provide a fluid path from the suction tubing to the collection canisters of the system — run about $20 to $30 each and make up the bulk of the costs associated with the system. Every case requires at least one manifold, and larger cases require several. This is another reason why it’s extremely important to have good data on your can volume and procedural mix before making a purchasing decision.