Anaesthetic gas monitoring

Re: Anaesthetic gas monitoring

Anthony Todd — Fri, 27 Sep 2013 11:22:00 GMT

[quote user="Martin Atkinson"][quote user="Anthony Todd"]And, as far as I recall, halothane, for example, is associated with reproductive problems in women.[/quote] This is the main risk but as suggested previously N2O is the worst and isoflurane much safer.[/quote]

Sure, iso is, I think, said to be 1000 times safer than halothane but lawyers have made hay with virtually no grass so it'll happen.

Just google references regarding iso; intellectual impairment etc.etc. The claims will be enormous as well as the possible damage to staff health and damages awarded to staff themselves.

It's so obvious that it will happen and it's so frustrating when people [sorry Martin] say "rules is rules" rather than "the rules is stupid and unsafe. We must change them".

Re: Anaesthetic gas monitoring

Martin Atkinson — Fri, 27 Sep 2013 11:05:05 GMT

[quote user="Anthony Todd"]And, as far as I recall, halothane, for example, is associated with reproductive problems in women.[/quote] This is the main risk but as suggested previously N2O is the worst and isoflurane much safer. There is apparently an increased incidence of fertility/reproductive problems in theatre nurses. Re the X-ray thing though, probably more to do with the infinite number of X-rays and CT scans I've had over the years than occupational exposure, I do refuse routine X-rays at the dentist now. If it was a necessary diagnostic exercise of course I'd accept but my dentist wants do a survey X-ray at every routine check.

Re: Anaesthetic gas monitoring

Anthony Todd — Fri, 27 Sep 2013 10:27:19 GMT

[quote user="Martin Atkinson"] But rules is rules![/quote]

Perhaps someone who reads this thread will realise and change the regs. because, sooner or later, someone will sue one of us claiming illness, or worse, as a result of chronic inhalation of anaesthetic gases and pointing out how inadequate one day every so often is as a measure of exposure....

We had a doctor suggest to a staff member that the reason for the lumps in her breast was connected to her exposure to X-rays: "You do X-rays don't you?"

And, as far as I recall, halothane, for example, is associated with reproductive problems in women.

It is only a matter of time before some no-cost lawyer on a percentage sues one of us because of anaesthetic gas exposure and we'll look embarrassingly and expensively stupid if we continue the current monitoring regime.

Golly, Google the problem and hope the lawyers or your staff don't, because it seems the staff may be seriously affected, the lawyers will have a field day and our authorities will look really stupid.

Re: Anaesthetic gas monitoring

Martin Atkinson — Fri, 27 Sep 2013 10:09:59 GMT

[quote user="Anthony Todd"]

Surely the danger is the cumulative effect of inhalation otherwise no one would ever risk an anaesthetic....?

And no servicing will cover the tube coming off the fluosorber [come on, it happens] nor beats the monitoring accuracy of the Mk 1 human nose.

If there's enough iso or what ever in the theatre to be a health risk for anyone, even if it's on the day you choose to sample, you'll smell it; cumulative low levels is surely the real danger?

[/quote] The last time we monitored anaesthetic gases we chose a really busy day, masked some patients down rather than giving them IV propofol or whatever, deliberately occasionally vented Isoflurane to the room rather than the fluosorber and refilled the vapouriser waving the Iso bottle around a bit, and we still were far below the permitted level. When you compare to a shift in a hospital operating theatre even the busiest vet doesn't come near. Plus as most of us don't use N2O which is the worst of the anesthetic gases it is really not an issue. But rules is rules!

Re: Anaesthetic gas monitoring

Anthony Todd — Thu, 26 Sep 2013 22:27:06 GMT

[quote user="Martin Atkinson"]Sods law, we forgot to wear them[/quote]

Just another example of how nonsensical this monitoring regime is.

Surely the danger is the cumulative effect of inhalation otherwise no one would ever risk an anaesthetic....?

And no servicing will cover the tube coming off the fluosorber [come on, it happens] nor beats the monitoring accuracy of the Mk 1 human nose.

If there's enough iso or what ever in the theatre to be a health risk for anyone, even if it's on the day you choose to sample, you'll smell it; cumulative low levels is surely the real danger?

Monitoring should be continuous or check the scavenger connection, or just sniff occasionally!

Re: Anaesthetic gas monitoring

Martin Atkinson — Thu, 26 Sep 2013 18:00:49 GMT

[quote user="Anthony Todd"]

[quote user="bob lehner"]Most people seem to use Coltronics for badge monitoring.[/quote]

If that's the one I'm thinking of [thing stuck on the wall and sent off?]the regs. for a training practice say you monitor on a chosen day every six months. If that happens to be the day the tube falls off the fluosorber and you don't smell it quick enough then you might get a positive.

Ridiculous and stupid reg. which the training supervisor wouldn't recognise.

Surely monitoring should be continuous, like Xray badges?

[/quote] Just received our badges from Coltronics, one each, to be worn for one operating session and sent back. Regs stipulate every 14 months. You're right it should really be every day but that would be prohibitively expensive. It is logical to assume that if you pick an average to busy day, you don't change your technique and your anaesthetic machine is serviced regularly it will be the same each day. Sods law, we forgot to wear them on the one busy day since we got them and its been quiet for ops since!

Re: Anaesthetic gas monitoring

Anthony Todd — Thu, 26 Sep 2013 17:47:59 GMT

[quote user="bob lehner"]Most people seem to use Coltronics for badge monitoring.[/quote]

Ridiculous and stupid reg. which the training supervisor wouldn't recognise.

Surely monitoring should be continuous, like Xray badges?

Re: Anaesthetic gas monitoring

Bob Russell — Wed, 18 Sep 2013 09:16:38 GMT

The O'Neil Medicalia unit is well made and passed its 'independent' anaesthetic service/inspection with flying colours. Never seen a home made system!

Re: Anaesthetic gas monitoring

bob lehner — Tue, 17 Sep 2013 20:38:58 GMT

Yours is 'passive'. 'Active' scavenging requires a mechanical extraction system with a 'pump and air brake' to draw waste gas out of the building. PSS says if you have a 'sophisticated' active system it needs to be serviced annually - and you don't then need to do the badge monitoring. I take 'sophisticated' to exclude a simple home-made system, which one sometimes sees. Most people seem to use Coltronics for badge monitoring.

Re: Anaesthetic gas monitoring

Martin Atkinson — Tue, 17 Sep 2013 18:24:47 GMT

I get a bit confused with what constitutes passive or active. As said we almost exclusively use a circle absorber with cuffed ET tubes, and exhaust gases are directed via a valve, by squeezing the re-breathing bag, to a Fluosorber so no venting to the room. So is that active or passive, or even active passive?! We may use a mask once in while certainly less than once a week and then they are usually the ones with a diaphragm so again very little leakage to the room it is very rare there is a smell of anaesthetic gas noticeable.

Re: Anaesthetic gas monitoring

Bob Russell — Tue, 17 Sep 2013 17:32:41 GMT

Unless things have changed it is acceptable under the PSS to either monitor or use active scavenging plus a service. If you are using passive scavenging speak to O'Neil Medicalia, they make up their own system using computer fans which is really inexpensive but works well (couple of hundred pounds v's nearly a grand).

Active scavenging plus PSS advice plus the badge readings should keep you pretty safe I would have thought!

I hate these staff members with a grudge. We had a 'bad back' problem with an ex-member of staff. Fortunately just had enough paperwork to prevent the claim getting too far!

Re: Anaesthetic gas monitoring

Martin Atkinson — Tue, 17 Sep 2013 16:14:37 GMT

[quote user="Bob Russell"]

Active scavenging plus annual service for me. Otherwise probably pointless unless done on a frequent basis!

[/quote] Well I do the same, don't use NO2 and use only Isoflurane but did once get some little badges the staff all wore and measured the exposure for a day. I chose the busiest day I could and deliberately vented to the room on occasions rather than via the scavenger and we were still far below the acceptable exposure level for Isoflurane so if everything is scavenged properly with a circle absorber (rarely use masks or T pieces) I also feel it is a waste of time. However, I have one disgruntled member of staff I suspect is looking for any excuse to get dismissed and I further suspect will maliciously report me to everyone from DEFRA to HMRC to seek her revenge so want to keep all the t's crossed and the i's dotted.

Re: Anaesthetic gas monitoring

Bob Russell — Tue, 17 Sep 2013 13:24:31 GMT

Active scavenging plus annual service for me. Otherwise probably pointless unless done on a frequent basis!

Re: Anaesthetic gas monitoring

Kay Colquhoun — Tue, 17 Sep 2013 09:36:53 GMT

Coltronics Systems in Bury St Edmunds offer a discount for BSAVA members. http://www.coltronics.co.uk/