JPP PG Jan 2018 (Vol:06 Issue:06)

Journal of Perioperative Practice

PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 01423 881300 www.afpp.org.uk

01423 881300 www.afpp.org.uk

JPP_138x188_BMS_sharps_JAN 28/11/2017 14:19 Page 1

safety

in mind first time, everytime In response to the EU Sharps Directive 2010/32/EU Swann-Morton have launched the KLEEN Blade Management system consisting of their standard blade enclosed within a protective cartridge thus supporting safe handling when fitting and removing the blade from your existing surgical handles. Complimented by Retractable Safety Scalpels, single use Blade Removers and “Cygnetic” they can now offer a complete range of compliant safety solutions.

Swann-Morton can offer in house sharps safety training in line with the new Directive so contact us on sharpssafety@ swann-morton.com for more information.

For more information on the complete range of surgical blades, handles, scalpels, disposable, fine and retractable scalpels please go to our website.

EMS 633531

All medical devices are CE marked in accordance with the Medical Device Directive (93/42/EEC)

FM 73368

Owlerton Green, Sheffield S6 2BJ Telephone: 0114 2344231, Sales: 0114 2344223, Fax: 0114 2314966 uksales@swann-morton.com, exportsales@swann-morton.com www.swann-morton.com ‘Swann-Morton’ and the ‘Ring Pattern Logo’ are the registered trade marks of Swann-Morton Limited and related companies.

www.swann-morton.com

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

Contents

Welcome to your January 2018 Guide 04

Temperature monitoring for surgical patients

06

Keeping surgical patients warm

10 Wardray Premise:

Replacing old trolleys for new!

11 Angloplas 11 Surgitrac® Instruments:

custom-made procedure packs

09-15

12 VIO3 from Erbe -

09 Swann Morton

14 New! Diathermy Abbey

Product News: Qlicksmart SnapIT

09 Innovative medical

devices from Mediplus

“plug and operate” Needle with Suction from Single Use Surgical

15 Central Medical Supplies

Journal of Perioperative Practice Procurement Guide information In print within the AfPP Journal of Perioperative Practice covering national AfPP members, but also with a dedicated print and e-distribution to supplies and purchasing managers.

March 2018 Medical Instruments

Key Sectors: NHS Supply Chain, Independent Hospitals, Higher Education.

Medical Device Companies.

July 2018 Consumables/Innovation/ Patient Trolleys

Published 6 times a year we will focus on procurement issues in every edition as well as specialist subjects which for the following year include:

May 2018 Infection Control/Prevention/ Decontamination

Contact Information: Advertising, Sponsorship & Partner Packages Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk Editorial Chris Wiles Head of Publishing/Editorial AfPP T: 01423 882950 E: chris.wiles@afpp.org.uk

PR & press material.

All press releases welcome and we will feature as many as we can in each issue, all press releases need to be submitted to: Frances Murphy Account Manager Open Box M&C T: 0121 200 7820 E: frances.murphy@ob-mc.co.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

Patient Monitoring

Temperature monitoring for surgical patients In 2016 NICE clinical updated Clinical Practice Guideline G65 (2008) the management of inadvertent perioperative hypothermia in adults. One of the key points concerns temperature monitoring for the surgical patient and should prompt a review of how and when core temperature is monitored.

Why core temperature matters for the surgical patient Hypothermia, defined as a core body temperature of less than 36.0°C, is a common but preventable complication of surgery. It is associated with a number of adverse outcomes (Figure 1).

Although hypothermia may need to be deliberately induced

during some cardiac surgical procedures, inadvertent perioperative hypothermia (IPH) will affect as many as 70% of patients undergoing routine surgery unless active steps to keep them warm are taken.

As hypothermia occurs, heat from the core body is redistributed to the periphery, which in turn increases the mean skin temperature.

Figure 1 Adverse effects of hypothermia in surgery

• • • • • • • •

Increased perioperative blood loss Longer post-anesthetic recovery Increased length of hospital stay Unanticipated readmission to high dependency units Cardiac events including arrhythmia, myocardial ischemia Changes in the metabolism of drugs Increased risk of surgical site infection Postoperative shivering and thermal discomfort (patient satisfaction)

Table 1 Sites of core temperature measurement - As well as considering accuracy in measuring core temperature, the ability to continuously monitor temperature and invasiveness of the device should also be taken into account

Site of measurement

Type of measurement

Accuracy

Continuous measurement

Invasiveness

Infrared Tympanic

Indirect estimate

Low

No

Low

Infrared Temporal

Indirect estimate

Low

No

Low

Infrared forehead

Indirect estimate

Low

No

Low

Forehead strips

Indirect estimate

Low

No

Low

Pulmonary artery catheter

Direct measurement

High

Yes

High

Distal oesophagus

Direct measurement

High

Yes

High

Urinary bladder

Direct measurement

High

Yes

High

Sublingual*

Direct estimate

Moderate

No

Low

Axilla*

Direct estimate

Moderate

No

Low

Rectal

Direct estimate

High

Yes

Moderate

* Be aware of possible inaccuracies in core temperature estimation when using peripheral sites, such as sublingual or axilla, in patients whose core temperature is outside the normothermic range (36.5°C to 37.5°C).

Note: Nasopharyngeal is regarded as a good direct estimation of core temperature; however no evidence was identified comparing nasopharyngeal site of measurement to any of the three reference sites (pulmonary artery catheter, oesophageal or urinary bladder) therefore no recommendation was made about this site of temperature measurement.

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

Patient Monitoring

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This can result in the patient feeling warm, even though cooling is actually taking place. Obtaining an accurate measurement of core temperature is essential to identify patients affected

by IPH before, during and after surgery and to ensure perioperative warming is commenced as soon as possible.

Measuring core temperature There are a range of devices that are able to measure core temperature, with varying degrees of accuracy to; • directly measure core temperature or • directly estimate core temperature to within ±0.5°c.

NICE identifies that the pulmonary artery catheter;

distal oesophageal and urinary bladder are considered the most accurate sites for direct core temperature measurement or direct estimation of core temperature. However, these sites may not always be appropriate for use due to their invasive nature. If an invasive method of core temperature monitoring is not appropriate, other direct methods to estimate core temperature should be used (see Table 1).

It is common to use several different monitoring systems for all vital signs depending on individual patient journey. This updated NICE guidance supports a review of when and how core temperature is measured for a surgical patient. Accuracy at an early preoperative

stage provides an ability to evaluate the warming method used to maintain normothermia and reduce adverse effects.

Measure patient’s core temperature:

Preoperatively Within 1 hour prior to induction of anesthesia

Intraoperatively Every 30 minutes

Postoperatively Every 15 minutes in recovery Every 4 hours on the ward

Reference National Institute for Health and Care Excellence (2008, updated 2016) CG65 Clinical practice guideline: The management of inadvertent perioperative hypothermia in adults Online: https://www.nice.org.uk/ guidance/cg65 [Accessed 30 November 2017] Kathryn Topley Clinical Efficiency Manager, Infection Prevention Division, UK and Ireland, 3M United Kingdom PLC

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

Patient Warming

Keeping surgical patients warm Hypothermia, defined as a core body temperature of less than 36.0°C, is a common but preventable complication of surgery.

It is associated with a number of adverse outcomes such as: • increased perioperative blood loss • longer post-anaesthetic recovery • increased length of hospital stay • unanticipated readmission to high dependency units • cardiac events including arrhythmia, myocardial ischemia • changes in the metabolism of drugs • increased risk of surgical site infection • postoperative shivering and thermal discomfort (patient satisfaction).

Although hypothermia may need to be deliberately induced during some cardiac surgical procedures, inadvertent perioperative hypothermia (IPH) will affect as many as 70% of patients undergoing routine surgery unless active steps to keep them warm are taken (NICE 2008).

NICE (2008, pages 511-567) has estimated costs associated with IPH, which contribute to an overall increase in the cost of care.

Cost per adverse event

Cost

Surgical wound infection (minor surgery)

£950

Surgical wound infection (major surgery)

£3,858

Transfusion

£24

Morbid cardiac event

£1,906

Mechanical ventilation

£1,144

Pressure ulcer

£1,064

It is not unusual for the patient’s core temperature to drop to below 35°C within the first 30 minutes of anaesthesia if steps are not taken to maintain normothermia (Sessler 2000).

Preoperative warming All patients having a surgical procedure should be actively warmed from at least 30 minutes prior to induction of anesthesia.

All patients should have a body temperature above 36oC before being transferred to theatre.

Devices that can be used to actively warm patients Active warming is a process that transfers heat to the patient rather than passively keeping them warm. Active warming is essential for patients undergoing surgery in order to prevent them developing IPH. This should be based on convection (forced air warming) or conduction (resistant heated mattress or blanket), see Box 1.

Although conduction methods may be easier to use preoperatively, forced air warming is considered to be more effective and is recommended for active warming throughout the surgical procedure and during recovery (NICE 2008, updated 2016).

Due to the effects of general anaesthesia and cold environmental conditions, the patient is susceptible to IPH throughout the perioperative phase. Warming a patient reduces the gradient between the periphery and core, and therefore increases the overall

Box 1 Active warming devices

Warming using convection Forced air warming: This draws ambient air through a filter, warms the air to a specified temperature and delivers it through a hose to a blanket or gown onto the patient’s skin.

Warming using conduction warming devices Circulating water mattress: placed underneath the patient to conduct heat to the front and/or back of the body.

heat content of the body. The aim of warming throughout the intra and postoperative phases is to maintain a normothermic temperature, and thereby reduce the risk of adverse effects associated with IPH. Intra and postoperative warming

2016) indicate an increase in pre-warming activity. NICE identified that intraoperative forced-air warming was likely to be cost effective compared with intraoperative resistive heating mattresses alone and intraoperative resistive heating blankets alone.

The intraoperative phase is defined as the total anaesthesia time, whilst the postoperative phase is defined as the 24 hours after entry into the recovery area in the theatre suite (which will include transfer to and time spent on the ward).

Maintaining normothermia for the surgical patient should be considered as a whole system approach to ensure the most clinically and economically effective outcomes.

Patients should be actively warmed, if: • they are assessed as at high risk of perioperative hypothermia OR have a core temperature below 36oC • OR whose surgery is expected to last longer than 30 minutes.

National Institute for Health and Care Excellence (2008, updated 2016) CG65 Clinical practice guideline: The management of inadvertent perioperative hypothermia in adults Online: https://www.nice.org.uk/ guidance/cg65 [Accessed 30 November 2017]

Active warming using forced-air should be implemented for these patients. If forced-air devices are considered unsuitable for a specific patient or procedure then a resistive heating mattress or blanket can be used instead.

Consideration of updates in NICE guidelines (2008, updated

References

Sessler DI 2000 Perioperative heat balance Anesthesiology 92 (2) 578-90 Kathryn Topley Clinical Efficiency Manager, Infection Prevention Division, UK and Ireland, 3M United Kingdom PLC

WORKING WITH YOU

When you’ve been designing and manufacturing specialist storage equipment for as long as ZARGES has, you get to understand what it takes to deliver racking and mobile trolleys that are ideally suited for use in theatre departments.

188 page procurement catalogue available.

Packed full of specialist storage solutions including: HTM 71 Storage Trolleys | Trays | Racking | Cupboard Trolleys Tel. 01908 641118 | Email. medicalsystems@zarges.co.uk | Web. zarges-medical.co.uk

Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

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Product News

Swann Morton Qlicksmart SnapIT Qlicksmart SnapIT which is a “simply safer” way to open glass ampoules and avoid painful and dangerous sharps injuries is a further extension to the range of safety solutions offered by Swann-Morton.

This easy-to-use multi-use ampoule opener helps to avoid unacceptable sharps injury rates seen when ampoules are opened by hand. Opening ampoules is a particularly high-risk event with 26% of needle stick and sharps injuries (NSIs) being caused by opening an ampoule or by broken ampoules.

You can then eject the glass ampoule lid directly into a sharps container.

Personal and trolley versions are available in the range so contact Swann-Morton at info@ swann-morton.com for more information.

You simply insert the ampoule lid into the multiuse SnapIT making sure you have the correct size.

If there is a dot on the ampoule then align this with the dot on the SnapIT. Snap “away” from your body to open the ampoule.

Innovative medical devices Mediplus was established in the United Kingdom 1986. It is a manufacturer of innovative medical devices, providing solutions that meet the needs of patients and clinicians within anaesthetics, urology, gynaecology, and general surgery.

The Company’s philosophy is to provide high quality products at fair prices supported by excellence in customer service.

With extensive experience in anaesthetics, Mediplus offers several high quality products dedicated for peripheral IV delivery, particularly for obstetrics, orthopaedics, intensive care and total intravenous anaesthesia.

The company’s range of TIVA (total intravenous anaesthesia) sets and multi-lumen peripheral connectors are considered the Gold Standard by clinicians throughout Europe.

These sets and connectors were developed with the help of clinicians and TIVA enthusiasts, and therefore include all necessary features for safe, convenient and cost effective TIVA delivery.

The connectors, namely the Chalfont and Coventry were designed specifically by obstetric anaesthetists and allow for safe and effective drug delivery during labour thanks to anti-siphon and HIGH-FLOW anti-reflux valves.

The detachable bridge aids ease of use and maximises patient comfort.

Website: www.mediplus.co.uk Tel: +44 (0) 1494 551200 Fax: +44 (0) 1494 536333

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

Product News

Wardray Premise:

Replacing old trolleys for new!

If you’re planning to replace your MR trolley(s) this financial year the latest offer from Wardray Premise may be of interest to you.

They are offering a special trade in discount of £1,000 off their list price when you purchase a new MR5501 (adjustable height trolley) for orders placed between now and 31 March 2018.

For every new MR5501 trolley purchased, the offer includes the removal and scrapping of your old trolley, regardless of the age, make or trolley condition.

Wardray’s MR5501 trolley is designed and made in the UK, ensuring they deliver a quality product ready for the rigours of hospital life. In addition, it is MR conditional to 7T, making it suitable and safe for use in all medical MR environments.

The trolley is height adjustable with a maximum table top height of 920mm down to a minimum height of 520mm. It has a power assisted adjustable back rest, Trendelenberg positioning, fold down cot sides, fixing points for IV poles, 150mm low rolling castors all fitted with lockable brakes.

Wardray have a successful track record, having sold more than 1,000 adjustable height trolleys (MR5501) worldwide.

Contact Wardray’s sales staff at sales@wardray-premise.com or telephone 0208 398 9911 for quotations, further details and to secure your discount.

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

Product News

Angloplas Angloplas specialises in producing antimicrobial protected products for industries at home and abroad that demand the highest standards of cleanliness and hygiene.

Their products achieve this by being manufactured wherever possible from the world’s first proven antimicrobial PVC using silver ion technology which is exclusive to Angloplas.

If you can’t find what you’re looking for (December’s catalogue is available by using the QR code in the advert or by typing ‘angloplas catalogue’ into your search engine) please contact them (email: sales@angloplas.co.uk) as they are always happy to consider producing you a new product, usually at no extra charge.

Surgitrac® Instruments: custom-made procedure packs We recognise how important it is to have the correct consumables and instruments for a procedure. Our custom-made packs are ready to use and assembled to your specifications, CE certified and manufactured to internationally recognised standards.

Procedure specific packs can help to reduce set up time and waste.

Should you wish to change from your current pack supplier, we offer a pack matching service. Our inhouse forecasters can help you to maintain the correct levels of stock, ensuring that your procedures can be carried out as planned.

Contact sales@surgitrac.co.uk to discuss your procedure pack requirements.

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Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

Product News Peripheral IV Connectors

..............................

Increasing efficiency with the coventry connector When routine becomes emergency, and a second infusion of phenylephrine is required, time is paramount to the safety of both the mother and baby.

Maximum and EFFICIENT delivery of fluid plays an essential part of effective treatment.

The use of multi component devices can have a detrimental affect on rates of infusion.

Flow Rate Comparisons of Peripheral IV Connector Devices* 300 250

The Mediplus Coventry connector offers clinicians a dedicated, fully integrated 3-way peripheral connector.

200 150

It is 152% more efficient than competitor products due to the HIGH-FLOW IV fluid valve.

100 50 0

Mediplus Coventry

Competitor A Competitor B Competitor C Competitor D

* The Effect of Peripheral Access Devices on Intravenous Infusion Rate Philip Jackson (NHS Grampian), Aberdeen Maternity Hospital

Mediplus Ltd Unit 7 The Gateway Centre, Coronation Road, Cressex Business Park, High Wycombe, Bucks, HP12 3SU Tel: +44 (0)1494 551200 | Fax: +44 (0)1494 536333 | Email: help@mediplus.co.uk | Web: www.mediplus.co.uk

VIO3 from Erbe - “plug and operate” Erbe have shaped electrosurgery, developing it into today’s leading-edge operating theatre technology, making Erbe an essential and reliable partner for many users worldwide.

VIO® 3 plug and operate

VIO3 is yet another of our milestones in electro-surgical technology, following the ICC series and alongside VIO200/300.

With its logical and intuitive interface the VIO3 is designed to ensure optimally userfriendly operation. The size of the touchscreen display alone speaks for itself; from the operating field the team always have a clear view of all control elements.

Electrosurgery with maximum convenience Handling of the VIO 3 with stepGUIDE, the new modes, and the highest level of flexibility in the selection of instruments, all make for maximum ease of use.

Then there are the other advantages: ☑ Reliably reproducible tissue effects thanks to state-of-the-art processor technology ☑ Selection of up to 6 different settings for your procedure from the operating field

VIO3 provides via “stepGUIDE”, guidance by suggesting experienced starting settings used in various clinical applications.

This results in less setting adjustment or modification.

For further information please visit: vio.erbe-med.com

“Plug and Operate”. It couldn’t be easier.

Tel: 0113 253 0333 Email: sales@erbe-uk.com

VIO3 has the right mode for your surgical application, supporting monopolar and bipolar techniques and our proprietary hybrid technology.

Erbe Medical UK, The Antler Complex, 1A Bruntcliffe Way, Morley, Leeds LS27 0JG.

Patient Warming with AlphaCore5 Every patient, every time.

Compact • Ergonomic, lightweight and transportable • Connect up to five warming accessories to one AlphaCore5 Controller • Full-colour touchscreen for easy navigation

Convenient • Quick and easy to use with 5-second start-up sta time • Compatible with existing Inspiration Healthcare mattresses and warming accessories • Silent in operation to reduce background noise levels

Complete • The holistic perioperative solution: can be used from anaesthetics to recovery room • Economical, with low ongoing running costs and low-energy usage • Suitable for use on patients of all ages and sizes

Contact Inspiration Healthcare now to find out how patient warming systems with the AlphaCore5 could help you save money while warming every patient, every time.

Inspiration Healthcare Limited Gildor House, West Street, Earl Shilton, Leicester LE9 7EJ, UK T +44 (0)1455 840 555 F +44 (0)1455 841 464 E info@inspiration-healthcare.com W inspiration-healthcare.com

Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

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Product News

AfPP’s Theatre access course Who’s it for?

This course has been tailored specifically for medical device representatives but may also be suitable for students wanting to get a ‘taste’ of theatres.

Where is it held?

Either at AfPP HQ in Harrogate or onsite at your offices (a minimum of 10 delegates are required for onsite courses).

What do you get out of it?

- An understanding of theatre etiquette, correct protocol and the roles and responsibilities of those within theatres.

What does it cost?

- £250+VAT for medical device representatives - £150+VAT for students

- A certificate and theatre access course ID pass card.

The course can also be ‘tailor made’ to your specifications.

How long does it last?

The course is valid for two years, after which you will be required to complete a refresher module.

To book your place or for further information, please call Kelly Squires on 01423 882969 or visit www.afpp.org.uk/events/theatreaccess

New! Diathermy Abbey Needle with Suction from Single Use Surgical Improve visibility for your surgical procedures with a unique combination of precise cauterisation and targeted suction. As part of their extensive ENT range, UK Company Single Use Surgical has introduced the new Diathermy Abbey Needle with integrated suction for use in Submucosal Diathermy to turbinates.

The Diathermy Abbey Needle with Suction offers smoke extraction at the point of cauterisation, whilst reducing the number of instruments needed at the surgical site.

Single use reduces the risk of patient to patient crosscontamination, as well as saving the time and cost that would be required to reprocess instruments; each suction is made to the highest

quality providing a costeffective alternative to reusable without the compromise.

P Stainless steel P Latex and DEHP free Contact us today for your free sterile sample: t. 02920 767 800 e. info@susl.co.uk www.susl.co.uk

Journal of Perioperative Practice PROCUREMENT GUIDE January 2018 Volume 06 Issue 06 www.afpp.org.uk

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Product News

Central Medical Supplies Central Medical Supplies Ltd, specialists in Patient Warming for over 25 years are the official partners of The 37 Company delivering innovative solutions for Patient Temperature Management; it’s all about 37ºC, keeping patients at a healthy core temperature.

Fluido® Compact is an easy to use, accurate, safe for daily low flow blood and fluid warming.

The unit rapidly warms fluids to the target temperature.

As it requires no maintenance, Fluido® Compact is also a cost effective system.

CMS also supplies the Fluido® AirGuard System, which warms blood and fluids quickly, safely and easily by using infrared technology. As it is a dry method, it eliminates the threat of contamination, which can result when using water based systems. The System is suitable for all applications; from standard anaesthesia to high flow trauma.

The 37° Company’s Mistral Air System is a convective warm air system consisting of an electrical blower, which provides warmed air via a flexible hose to a permeable blanket draped

over or under a patient. The warming blanket then distributes warm air to the patient safely and effectively to maintain normothermia. There are a wide range of blankets available making it suitable for all types of surgery including patient warming suits that can be used for pre/peri and post-surgical warming using both active and passive methods.

To support their products The 37 Company is proud to offer their “Virtual37 Temperature Management Tool”, which is a simulation tool providing an innovative and easy way to educate staff and understand the impact on warming balance decisions taken with different patients and surgeries For more information contact Central Medical Supplies Ltd: E-mail: info@centralmedical.co.uk Web: www.centralmedical.co.uk

The widest range of single use suctions. www.susl.co.uk

t. 02920 767 800 e. info@susl.co.uk

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