Anaesthetic gas monitoring

Re: Anaesthetic gas monitoring

Anthony Todd — Wed, 06 Oct 2010 15:49:24 GMT

[quote user="Anthony Todd"]We have been told that, in order to maintain our training practice status, we must monitor anaesthetic gases.[/quote]

An update, more comments welcome please.

This is an extract from the email I sent our training supervisor.

I have made enquires with various companies providing this service and have been amazed at the disparity of instruction.

I am told that the monitor has to be worn for an eight hour period once every 6, 12 or 14 months [the COSHH instruction].

This is patently nonsensical as exposure at high levels could have occurred at other times in 14 months!

I have also spoken to a scientist who analyses the monitors and he tells me that they actually end up with a weight of the gas [say isoflurane] and extrapolate that weight as a concentration over 8 hours, giving a result in ppm.

He seemed to think that there was no reason why the monitor could not be in place continuously which, he agreed, would give a more sensible and meaningful result.

I would be grateful for your observations as I fully support monitoring danger but do not support token regulations which actually give a false sense of safety in a potentially dangerous environment.

Re: Anaesthetic gas monitoring

Anthony Todd — Fri, 01 Oct 2010 23:04:17 GMT

[quote user="Laurence Webb"]It did on the test we did last year when I discovered an unconnected scavenging tube for the circuit at the end of one of the ops. Of all the days to do[/quote]

Exactly my point! How long had it been disconnected?! Continuous monitoring would have shown higher levels even if the leakage had been less obvious, and not corrected immediately.

And, in this case it was discovered before you'd even sent the test thingy off to be analysed!

Re: Anaesthetic gas monitoring

Laurence Webb — Fri, 01 Oct 2010 17:26:13 GMT

[quote user="Anthony Todd"]

It is the unlikely excess exposure that we should be monitoring for which is unlikely to turn up in the one day out of 180.

[/quote]

It did on the test we did last year when I discovered an unconnected scavenging tube for the circuit at the end of one of the ops. Of all the days to do that...

Re: Anaesthetic gas monitoring

Bob Russell — Fri, 01 Oct 2010 15:59:17 GMT

For Tier 1 at least a sophisticated active scavenging system does appear to obviate the need for personal dosimetry. Annual certification required. Not sure if this applies to tier 2 and above and teaching practices

Re: Anaesthetic gas monitoring

Bob Russell — Fri, 01 Oct 2010 12:48:32 GMT

[quote user="Anthony Todd"]

[quote user="svn"]

We wait until a busy ops day and have the lead theatre/anaesthetic nurse wear the monitor for the day.

[/quote]

Yes, that's what my training nurse was told but that seems to be pretty ineffective monitoring to me. It is the unlikely excess exposure that we should be monitoring for which is unlikely to turn up in the one day out of 180.

Seems to me that the monitoring should be continuous as i surmise that cumulative exposure is the toxicity factor, if there is one with isoflurane.

I wonder what they do in the human field??

[/quote]

Spend a lot of money on routine testing I suspect!

Re: Anaesthetic gas monitoring

Anthony Todd — Thu, 30 Sep 2010 22:25:43 GMT

[quote user="svn"]

We wait until a busy ops day and have the lead theatre/anaesthetic nurse wear the monitor for the day.

[/quote]

Seems to me that the monitoring should be continuous as i surmise that cumulative exposure is the toxicity factor, if there is one with isoflurane.

I wonder what they do in the human field??

Re: Anaesthetic gas monitoring

svn — Thu, 30 Sep 2010 21:11:16 GMT

We wait until a busy ops day and have the lead theatre/anaesthetic nurse wear the monitor for the day.

Re: Anaesthetic gas monitoring

Rob Loxley — Wed, 29 Sep 2010 23:35:32 GMT

[quote user="Anthony Todd"]Practice Standards say it must be done on an annual basis and quotes max. gas concentrations. The training inspector said it must be done every 6 months[/quote]

What does your risk assessment say? Get back to the Training Inspector and ask them to explain the basis for this requirement above that of the RCVS? Not the only place where TP inspections seem to run to different criteria to the RCVS, but hey it keeps another box ticking bod off the streets...

[quote user="Anthony Todd"]There must be a directive document somewhere[/quote]

COSHH Regulations

[quote user="Anthony Todd"]definitely "annually" but what and how no one seems to know except 50ppm of iso what ever that relates to.....[/quote]

50ppm as per http://www.hse.gov.uk/coshh/table1.pdf

[quote user="Bob Russell"]Structure and maintenance of equipment together with working practices are what count.[/quote]

Agreed, but without monitoring staff exposure how can you assess whether what you are doing is acceptable? Our monitoring is done through Salus QP, who periodically send out a dosimeter that is worn by a representative member of staff for the 8hr period, or could be placed in a representative area e.g. operating theatre, for the period.

Re: Anaesthetic gas monitoring

Bob Russell — Wed, 29 Sep 2010 21:45:28 GMT

This was taken from O'Neil Medicalia - occasional monitoring is almost completely pointless. Different days, different procedures, different species - one day will be different to another. Structure and maintenance of equipment together with working practices are what count.

The RCVS Practice Standards section 5.12 paragraph 4 states:

"If a sophisticated active scavenging system is in operation, it must be serviced annually. A test certificate must be available and is an acceptable alternative to personal dosimetry."

Re: Anaesthetic gas monitoring

Anthony Todd — Wed, 29 Sep 2010 18:03:50 GMT

[quote user="Bob Russell"]

I was under the impression that active scavenging with annual servicing was acceptable.

[/quote]

Not my information, definitely "annually" but what and how no one seems to know except 50ppm of iso what ever that relates to.....

Re: Anaesthetic gas monitoring

Bob Russell — Wed, 29 Sep 2010 17:09:39 GMT

I was under the impression that active scavenging with annual servicing was acceptable.