HOW OFTEN DO YOU DISCONNECT A PATIENT FROM THE CIRCUIT?
A 64-year-old patient with cardiac failure and a fever arrived to the ER intubated for ventilator failure.
The patient was disconnected 16 times in the first 24 hours after arriving to the hospital:
Sent for a chest CT – 4 Disconnections
Transferred from the ER to the ICU – 2 Disconnections)
Sent to the Cath Lab – 4 Disconnections
Transitioned from dry circuit to heated wire – 1 Disconnection
MDI adapter placed in line – 1 Disconnection
Nebulized Tobramycin placed in line – 1 Disconnection
Expiratory filter changed daily due to delivery of Tobramycin – 2 Disconnections
Nitric Oxide placed in line – 1 Disconnection
Circuit disconnects are often thought of as brief or infrequent, however, with each disconnect, the patient’s lungs are put at risk for injury from collapse and re-expansion. In addition, the clinician is exposed to airborne pathogens with every disconnect.
A 2018 study published in the American Journal of Respiratory and Critical Care Management concluded abrupt deflation after sustained inflation can cause acute lung injury.
Every disconnect has the potential to undo the progress that has already been made to heal the patient’s lungs, causing barotrauma, volutrauma and Ventilator Induced Lung Injury. These conditions, in turn, can cause long-term respiratory disability, recurring pulmonary infections, multi-organ failure as well as an increase in morbidity and mortality.
Keeping the PEEP is key to protecting patients’ lungs.
The Mechanical and Aerospace Engineering Department at Carleton University recently reviewed the current standard procedures for patient transport with a three-circuit disconnection. The study found a leakage of 25% to 46% of particles emanating (such as bacteria) or delivered aerosols to the patient (such as pharmaceuticals) were dispersed in the room within a 5-inch area in which the clinical staff is exposed.
Even when a ventilator is put on standby during a disconnection, there is still passive exhalation from the patient that can expose staff to airborne contaminants. It is clear that keeping the circuit closed can protect staff and enhance infection control.
HOW MANY DISCONNECTIONS CAN BE AVOIDED?
Historically, there have been only two solutions for hospitals to reduce circuit disconnects: when delivering inhaled meds and when suctioning.
THE SOLUTION: The FLUSSO BY PASS ADAPTER = Safer Circuit Disconnects
The Flusso By Pass Adapter facilitates the disconnection of the patient from the mechanical ventilator during a circuit change, HME change, or for transport. Flusso allows the patient’s PEEP to be maintained and reduces exhaled aerosols during a ventilator circuit disconnect, enhancing patient and staff safety.
The Flusso By Pass Adapter features proprietary Swing Valve Technology™, a patient port, by pass port, a ventilator port, a tethered cap and an integrated swivel to reduce torque. When the ventilator port is in use, the by pass port is sealed and when the by pass port is in use, the ventilator port is sealed. The innovative swing valve is designed to redirect the gas flow without interruption of positive pressure ventilation to the patient. The Flusso has standard ISO connections, adds minimal dead space and works with all modes of ventilation.
Use the Flusso By Pass Adapter for the following procedures
Implementation / removal of MDI into circuit
Implementation / removal of nebulizer into circuit
Change expiratory filter on the ventilation
Change humidity systems (i.e. wet to dry)
Implementation / removal of Aerogen SVN
Implementation / removal of nitric oxide
Manually bagging for delivery of inhaled medications
Ventilator circuit change
Add ETCO2 monitoring adapter
Move IV lines to opposite side of patient
The Flusso By Pass Adapter is on Premier Contract Number PP-DS-743 and Vizient Contract Number DM0170.
MED Alliance Group is an ISO 13485 certified medical device distributor and has been dedicated to meeting the needs of our clinical customers and manufacturing partners since 1998. We specialize in the sales, marketing, importation, logistics and distribution of innovative, high-quality and cost-effective products found in anesthesia and respiratory, blood and transfusion therapy, EMS and emergency room, interventional radiology and cath lab, iv and vascular, NICU/PICU and pharmacy.