JPP PG Sept 2017 (Vol:06 Issue:04)

Journal of Perioperative Practice

PROCUREMENT GUIDE September 2017 01423 881300

Volume 06 Issue 04 www.afpp.org.uk

01423 881300 www.afpp.org.uk

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Journal of Perioperative Practice PROCUREMENT GUIDE September 2017 Volume 06 Issue 04 www.afpp.org.uk

Contents

Welcome to your September 2017 Guide 04

11 VIO3 from Erbe -

“plug and operate”

The Macintosh laryngoscope – is there a pretender to the crown?

12 desderman® pure -

10-15

12 Getinge solutions for

10 PROACT Professional

14 Nihon Kohden

Product News: Laryngoscopes

10 Biogel PI Micro

© Intersurgical

for gentle but effective hand disinfection operating rooms

15 Medi plus innovative medical devices

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.

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

Medical Device Companies.

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:

November 2017 Sharps Safety/Patient Safety/ Swabs Safety/Patient Handling Equipment January 2018 Patient Warming/ Patient Monitoring March 2018 Medical Instruments 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 September 2017 Volume 06 Issue 04 www.afpp.org.uk

Airway management

The Macintosh laryngoscope – is there a pretender to the crown?

Over 70 years after Sir R R Macintosh first described it in his landmark study published in The Lancet in 1943, the Macintosh laryngoscope remains universally popular (Macintosh 1943).

The dominant position of the Macintosh cannot be attributed to a lack of alternatives.

Dorsch and Dorsch (2008), in their huge 1,000+ page book, Understanding anesthesia

equipment, list over 45 types of laryngoscope blade. Although some of these are described as modifications of the Macintosh, including the Oxiport Macintosh, Polio, Fink, Tull Macintosh,

Bizarri-Giuffrida, Upsher Low Profile, Upsher ULX Macintosh, Improved vision Macintosh and the Left Handed Macintosh, the list of alternatives also includes a significant number of other designs, including the Wisconsin, Schapira, Soper, Guedel, Bennett, Seward, Phillips, Alberts, Robertshaw and the Bainton. This list is not exhaustive. If you don’t have easy access to a copy of Dorsch and Dorsch, an extract is included in Annex D of the international standard, ISO 7376:2009: Anaesthetic and respiratory equipment – Laryngoscopes for tracheal intubation (IOS 2009).

In current practice, the two major types of Macintosh blade are generally considered to be the American, also called the ‘standard’, and the English, sometimes known as the ‘classic’ or ‘e-type’. The latter description is a particular favourite, conjuring up the image of the classic E-Type Jaguar, once described by Enzo Ferrari as, ‘The most beautiful car ever made’ (Jaguar Land Rover Limited 2016). Such a comparison may seem a little tenuous, but surely they can both be considered design classics?

The primary differences between the English or German and the American Macintosh are the shape, height and

length of the proximal flange and the distance from the light to blade tip. The performance of both types was compared in a 2003 study by Asai et al, published in the British Journal of Anaesthesia, entitled Comparison of two Macintosh laryngoscope blades in 300 patients (Asai et al 2003). There was a difference in the view of the glottis in 80 patients. Among these patients, the view was better for the English blade for 63 patients and the standard blade was better for 17 patients. The authors concluded, ‘In patients in whom laryngoscopy was unexpectedly difficult, the English blade provided a better glottic view significantly more frequently than the standard blade’.

Probably the closest rival to the Macintosh in terms of popularity is the Miller blade. Described two years earlier than the Macintosh, the 1941 paper by Miller in Anesthesiology and simply entitled, A new laryngoscope, described a straight blade which when compared to an ‘old style medium sized blade’, was ‘rounded on the bottom, smaller at the tip, and has an extra curve beginning about two inches from the end (Miller 1941). The internal diameter of the base is shallow, but adequate to permit the

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Incidence of SSIs (% of patients)

Incidence of SSIs (% of patients)

8

p=0.02 7.3

8 6

7.3

6 4

4 2

4.0

4.0

2 0

0

Alcoholic povidone iodine (n=575) ChloraPrep (n=572)

2% CHG / 70% IPA didn’t 2% CHG / 70% IPA didn’t deliver a 45% reduction deliver 45% reduction TM did in SSIs: aChloraPrep TM

did in SSIs: ChloraPrep Preparing patients for caesarean delivery

with ChloraPrep cut for SSIscaesarean by almostdelivery half, Preparing patients 1 compared with alcoholic iodine with ChloraPrep cut SSIspovidone by almost half, compared with alcoholic povidone iodine1

Alcoholic povidone iodine (n=575) ChloraPrep (n=572) Prescribing Information ChloraPrep® & ChloraPrep with Tint 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Refer to the Summary of Product Characteristics before prescribing.

Presentation: ChloraPrep – each applicator contains 0.67ml, 1.5ml, 3ml, 10.5ml or 26ml of 20 mg/ ml chlorhexidine & 0.70 ml/ml isopropyl alcohol; ChloraPrep with Tint – each applicator contains Prescribing Information ® 3ml, 10.5ml or 26ml with of 20Tint mg/ml 0.70 ml/ml alcohol. alcohol Indication: & ChloraPrep 2% chlorhexidine chlorhexidine &gluconate w/visopropyl / 70% isopropyl v/v ChloraPrep Disinfection of skin priortoto invasive medical of procedures. & administration: Applicator cutaneous solution.

Refer the Summary Product Dosage Characteristics before prescribing. volume dependent on –invasive procedurecontains being undertaken.

May 3ml, be used for all age groups and Presentation: ChloraPrep each applicator 0.67ml, 1.5ml, 10.5ml or 26ml of 20 mg/ patient populations.

Use with care inalcohol; newborn babies and those prematurely. ml chlorhexidine & 0.70 ml/ml isopropyl ChloraPrep with Tint born – each applicatorApplicator contains squeezedorto26ml break of ampoule and release antiseptic&solution onto sponge.

Solution applied by gently 3ml, 10.5ml 20 mg/ml chlorhexidine 0.70 ml/ml isopropyl alcohol.

Indication: pressingofsponge against and moving and forth for 30 seconds.

The area coveredApplicator should be Disinfection skin prior to skin invasive medicalback procedures.

Dosage & administration: allowed to air dry. Contra-indications: Patients with known hypersensitivity to ChloraPrep or volume dependent on invasive procedure being undertaken. May be used for all age groups and ChloraPrep with Tint or any of its components, especially those with a history of possible patient populations. Use with care in newborn babies and those born prematurely. Applicator Chlorhexidine-related allergic reactions. Warnings and precautions: Solution is flammable. Do not squeezed to break ampoule release onto sponge.allow Solution applied by gently use with ignition sourcesand until dry. Doantiseptic not use insolution excessive quantities, to pool in patient skin pressing sponge against skin andinmoving forth for 30Remove seconds.any Thesoaked area covered should be folds or drip on materials contactback withand patient skin. materials before allowed to air dry.

Patients with known proceeding withContra-indications: the intervention. Ensure no excess producthypersensitivity is present prior toto ChloraPrep application or of ChloraPrep with Tint or of its history of orpossible occlusive dressing.

Forany external usecomponents, only on intact especially skin, do notthose use onwith openaskin wounds broken Chlorhexidine-related allergic reactions.

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Do not or damaged skin. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin use with ignition sources until dry. not use in excessive quantities, allow membranes, to pool in patient reactions.

Avoid prolonged skinDo contact.

Avoid contact with eyes, mucous middleskin ear folds and or drip ontissue. materials in contact skin. Remove anygeneralised soaked materials before neural Chlorhexidine may with inducepatient hypersensitivity, including allergic reactions proceeding with the shock. intervention.

Ensure no excess present prior application of and anaphylactic May cause chemical burns inproduct neonates,iswith a higher risktoin preterm infants occlusive external useofonly intact skin,&dolactation: not use on open skin or broken and dressing. within theForfirst 2 weeks life.onPregnancy Although no wounds studies have been Very conducted, effects are anticipated as systemic exposure or damaged skin.no Over-vigorous use on fragile or sensitive skinisornegligible. repeated Undesirable use may leadeffects: to local skin allergicprolonged or irritation skincontact. reactions to chlorhexidine, alcoholmembranes, or sunset yellow (E110, rare; Avoid reactions. skin Avoid contact withisopropyl eyes, mucous middle ear present in ChloraPrep with Tint including erythema,including rash, pruritus and blisters or application and neural tissue.

Chlorhexidine mayonly), induce hypersensitivity, generalised allergic reactions site vesicles,shock. other local have burns included skin burning sensation, and inflammation. and anaphylactic May symptoms cause chemical in neonates, with a higherpain risk in preterm infants

and within the first 2 weeks of life. Pregnancy & lactation: Although no studies have been conducted, no effects are anticipated as systemic exposure is negligible. Undesirable effects: Very

Frequency not known; hypersensitivity including anaphylactic shock, dermatitis, eczema, urticaria, chemical burns in neonates. Discontinue use at the first sign of local skin reaction. Per applicator costs (ex VAT) ChloraPrep: 0.67ml (SEPP) – 30p; 1.5ml (FREPP) – 55p; 1.5ml – 78p; 3ml – 85p; 10.5ml – £2.92; 26ml – £6.50. ChloraPrep with Tint: 3ml – 89p; 10.5ml – £3.07; 26ml – £6.83. Legal category: Marketing Authorisation Numbers: ChloraPrep, PL31760/0004 ChloraPrep Frequency GSL. not known; hypersensitivity including anaphylactic shock, dermatitis,&eczema, urticaria, with Tint, PL31760-0001.

Marketing Authorisation CareFusion UK 244 Ltd, ThePer Crescent, chemical burns in neonates.

Discontinue use at theHolder: first sign of local skin reaction. applicator Jays Basingstoke, Hampshire, RG22 4BS.–Date Preparation: 2016.– 78p; 3ml – 85p; costsClose, (ex VAT) ChloraPrep: 0.67ml (SEPP) 30p;of1.5ml (FREPP) February – 55p; 1.5ml 10.5ml – £2.92; 26ml – £6.50. ChloraPrep with Tint: 3ml – 89p; 10.5ml – £3.07; 26ml – £6.83. Legal ReportingGSL. suspected adverse reactions is important monitor thePL31760/0004 benefit/risk balance category: Marketing Authorisation Numbers:toChloraPrep, & ChloraPrep of the product.

ReportingAuthorisation forms and information can be found www.mhra. with Tint,medicinal PL31760-0001.

Marketing Holder: CareFusion UK at 244 Ltd, The Crescent, gov.uk/yellowcard. Adverse events should also be reported to CareFusion Freephone Jays Close, Basingstoke, Hampshire, RG22 4BS. Date of Preparation: February 2016. number: 0800 0437 546 or email: CareFusionGB@professionalinformation.co.uk

adverse reactions is important toand monitor the benefit/risk balance © Reporting 2016 BD. BDsuspected and BD Logo are property of Becton, Dickinson Company.

ChloraPrep logo is of the medicinal Reporting forms and information can be found at www.mhra. registered trademarkproduct. of CareFusion Corporation. gov.uk/yellowcard. Adverse events should also be reported to CareFusion Freephone

number: 0800 546 email: CareFusionGB@professionalinformation.co.uk al.or N Engl J Med 2016; 374(7): 647-55.

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© 2016 BD. BD andgluconate BD Logo are property of Becton, Dickinson and Company. ChloraPrep logo is CHG: chlorhexidine registered trademark IPA: isopropyl alcohol of CareFusion Corporation.

SSI: surgical site infection Reference: 1. Tuuli MG et al. N Engl J Med 2016; 374(7): 647-55.

CHG: chlorhexidine gluconate

0000CF02997 1 IPA: isopropylIssue alcohol Date of preparation: November 2016 SSI: surgical site infection

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Journal of Perioperative Practice PROCUREMENT GUIDE September 2017 Volume 06 Issue 04 www.afpp.org.uk

>>

passage of a 38 catheter.’

This landmark study is free to access on the Anesthesiology web-site. Miller (1946) also described a modification of his adult laryngoscope for children in, A new laryngoscope for intubation of infants published in Anesthesiology in March 1946.

The Miller blade remains popular for children, with straight blades in general having been described as ‘superior in elevating the tongue, removing it from the field of view to facilitate a better visualization of the infant larynx than the curved blade laryngoscope’ (Doherty et al 2009).

In 2009, the UK NHS Purchasing & Supply Agency’s Centre for Evidencebased Purchasing (CEP) produced a Buyer’s Guide for Laryngoscopes (CEP08048).

The scope of this guide only extended to Macintosh blades sizes 3 and 4. No Miller or other alternative blades were included, perhaps reflecting the fact that ‘The Macintosh is the most popular [blade] for use with adults in the United Kingdom...’

In the 4th National Audit Project (NAP4) – Major complications of airway management in the

© Intersurgical

Airway management The primary differences between the English or German and the American Macintosh are the shape, height and length of the proximal flange and the distance from the light to blade tip.

UK, it is confirmed in relation to tracheal intubation that, ‘Direct laryngoscopy with a Macintosh blade remains the technique of first choice if not actively contraindicated when difficulty is not anticipated’ (RCoA & DAS 2011).

Given the huge variety of options available, why is the popularity of the Macintosh so enduring?

Scott and Baker (2009) provide some answers in their review article, How did the Macintosh laryngoscope become so popular? In a very informative and entertaining article the authors, New Zealanders like Macintosh, suggest that poor straight blade laryngoscopy technique prior to the widespread use of muscle relaxants, commercial availability, Macintosh’s connections in the industrial sector and unprecedented influence on the development of anaesthesia, as key factors in the success of the Macintosh blade that can be traced back to ‘prevailing circumstances’ in the 1940s. They conclude that, ‘Despite being able to achieve superior laryngoscopy with paraglossal straight blade technique and the multiple alternatives available, the

Macintosh laryngoscope remains ubiquitous and is regarded as the gold standard of direct laryngoscopy’.

In 1984, over 40 years after publication of the original description of the Macintosh laryngoscope and 25 years before the review article published by Scott and Baker (2009), Jephcott published, A historical note on its clinical and commercial development (Jephcott 1984). It was estimated by Jephcott that well over one million Macintosh blades had been made and sold in the previous 40 years.

With regard to the origin of the design, Jephcott confirmed Macintosh’s own account from a letter he received from him: ‘I had a bit of luck and the nous to take advantage of it.

On opening a patient’s mouth with a Boyle-Davis gag I found the cords perfectly displayed.

Richard Salt (a really excellent chap) was in the theatre with me: before the morning had finished he had gone out and soldered a Davis blade on to a laryngoscope handle and this functioned quite adequately as a laryngoscope. The important point being that the tip finishes up proximal to the epiglottis.’

Interestingly, he continued by noting that, ‘The curve, although convenient when intubating with naturally curved tubes, is not of primary importance as I emphasised subsequently’.

Jephcott confirms the Macintosh laryngoscope was originally produced by Medical and Industrial Equipment Ltd (MIE), quickly followed

by The Longworth Scientific Instrument Company Ltd. In the USA, Foregger of New York started to make the device in 1943. Jephcott concluded his article by noting that, ‘Today the Macintosh laryngoscope is known throughout the world and is made by many firms in many countries. The technique discovered by Macintosh and the instrument he designed for

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Journal of Perioperative Practice PROCUREMENT GUIDE September 2017 Volume 06 Issue 04 www.afpp.org.uk

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its achievement has survived translation into plastic and the adoption of the fibre-light. No doubt they will endure other developments in years to come’.

Jephcott’s prediction was correct. Since his article in 1984, the Macintosh blade has also survived translation in to single use metal blades and is incorporated in to the design of a number of video laryngoscopes. The Macintosh blade remains the dominant blade for direct laryngoscopy in the 21st century, with no obvious pretender to the crown.

References Asai T, Matsumoto S, Fujise K, Johmura S, Shingu K 2003 Comparison of two Macintosh laryngoscope blades in 300 patients British Journal of Anaesthesia 90 (4) 457-460

Airway management Doherty JS, Froom SR, Christopher D, Gildersleve MB 2009 Pediatric laryngoscopes and intubation aids old and new Pediatric Anesthesia 19 (s1) 30–37 Dorsch JA, Dorsch SE 2008 Understanding Anesthesia Equipment 5th edition Lippincott Williams & Wilkins, US International Organization for Standardization 2009 ISO 7376:2009 Anaesthetic and respiratory equipment – Laryngoscopes for tracheal intubation 2009-08 IOS, Geneva

on its clinical and commercial development Anaesthesia 39 (5) 474-479 Macintosh RR 1943 A New Laryngoscope The Lancet 241 (6233) 205 Miller RA 1941 A new laryngoscope Anesthesiology 5 Vol.2, 317-320 Miller RA 1946 A new laryngoscope for intubation of infants Anesthesiology 3 Vol 7, 205-206

Jaguar Land Rover Limited 2016 https://www.jaguar.co.uk/ about-jaguar/jaguar-classic/ etype-reborn.html [Accessed August 2017]

NHS Purchasing and Supply Agency. Centre for Evidence-based Purchasing 2009 Buyers’ guide Laryngoscopes CEP08048, Centre for Evidence-based Purchasing, London

Jephcott A 1984 The Macintosh laryngoscope. A historical note

Scott J, Baker PA 2009 How did the Macintosh laryngoscope

become so popular? Pediatric Anesthesia 19 (Suppl 1) 24-29 The Royal College of Anaesthetists and the Difficult Airway Society 2011 4th National Audit Project (NAP4) Major complications of airway management in the UK. Report and Findings, Chapter 12 Tracheal intubation, page 96 http://www.rcoa.ac.uk/nap4 [Accessed August 2017] This article was first published as a blog post at http:// daveairways.wordpress.com Dave Chapman Intersurgical Group Product Manager - Airway Management www.intersurgical.co.uk Email: info@intersurgical.co.uk Tel: 0118 9656 300 Fax: 0118 9656 356

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Product news

Professional Laryngoscopes PROACT have been providing innovative Laryngoscope solutions for over 20 years.

Project2_Layout 1 01-Aug-17 4:19 PM Page 1

With many unique features our full metal disposable Laryngoscopes offer industry leading reliability, strength and no compromise in performance or safety.

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Journal of Perioperative Practice PROCUREMENT GUIDE September 2017 Volume 06 Issue 04 www.afpp.org.uk

Product news

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

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Journal of Perioperative Practice PROCUREMENT GUIDE September 2017 Volume 06 Issue 04 www.afpp.org.uk

Product news

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Journal of Perioperative Practice PROCUREMENT GUIDE September 2017 Volume 06 Issue 04 www.afpp.org.uk

Product news

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Journal of Perioperative Practice PROCUREMENT GUIDE September 2017 Volume 06 Issue 04 www.afpp.org.uk

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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

Our quality is your protection.

Delivering value and quality outcomes We focus on quality because high quality means fewer glove failures1 Contact us today to find out more Non-Biogel gloves are

3.5 times more likely to fail than Biogel gloves1

www.molnlycke.co.uk

100% Every Biogel glove is air inflation tested2

References: 1. In Use Surgical Gove Failure Rate Comparison. Study G009-005.2009. Data on file. 2. MKT004. Why Choose Biogel. 2009. Data on file *Acceptance Quality Level Mölnlycke Health Care Ltd, Unity House, Medlock Street,Oldam, OL1 3HS UK. Tel. 0800 731 1876 Email: info.uk@molnlycke.com The Mölnlycke Health Care and Biogel trademarks, names and logo types are registered globally to one or more of the Mölnlycke Health Care Group of Companies. © 2017 Mölnlycke Health Care AB. All rights reserved. UKSU0071

Telephone: 0800 917 4918

Industry-leading AQL* result of 0.652