Handle Fluid Management the Best Way

Closed systems bring safety and efficiency to your staff in an environmentally sound package on a mobile cart.

Keeping fluid off the floors of ORs is obviously a critical safety issue. Staff injuries from slips, trips and falls are among the top culprits causing lost workdays that often result in workers’ comp claims, according to the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. 

What’s often not as obvious is the critical importance of how you opt keep your floors dry and dispose of fluid waste. Facilities that rely on antiquated open disposal systems put staff at risk for infection via exposure to the fluid, spend more time turning over rooms and pay high prices to dispose of the hazardous waste. Closed, cart-based mobile systems, especially for orthopedic cases, hold more fluid, keep floors dryer and easily connect to your facility’s sanitary sewer system with no exposure to staff. 

New Tampa Surgery Center employs the mobile cart suction devices, and Orthopedic Nurse Manager Beth Hoy, MSN, RNFA, ON-C, CNOR, is grateful, as she used to work at places that couldn’t afford such a luxury. “We had hundreds of canisters on little carousels that filled up fast and were cumbersome to change,” says Ms. Hoy. “Before we had solidifiers to put into them, we had to carry them down the hall and empty them into the hopper — and that’s when you got splashed.” Taylor Wadi, RN, OR manager at Lakeland Surgical and Diagnostic Center’s Florida campus, agrees, saying the staff far prefers mobile collection methods for its orthopedic cases. “Our cart suction devices are super-easy to use,” says Ms. Wadi. “Our arthroscopy cases involve the use multiple bags of saline with epinephrine in them, so we’re busy making sure a new bag is ready to run each time it empties. It’s nice to not have to worry about collection canisters filling up.”

New Tampa has six of the carts for its five-room ASC. Each has two large collection reservoirs that must be emptied twice at most during a full day of orthopedic cases. When it’s time for them to be emptied, staff simply wheels them into a decontamination section of the sterile processing department and hooks the system into a docking station. It automatically drains the fluid and cleans the reservoirs with an enzyme spray. After the spray is flushed and emptied, a small amount of the enzymatic cleaner goes into the bottom of the reservoirs before the unit is wheeled back to the OR for the next case. The manufacturer’s instructions for use require that a longer cycle that repeats this process be performed once a week for a deeper cleaning. 

The collection carts are also useful in gynecologic cases, when fluid into and out of the vagina or uterus needs to be measured and monitored, and for general surgery cases during which irrigation is used in the abdomen. 

Up to eight tubes can go into the devices at a time to collect fluid from a variety of sources, including the patient’s trocar, the arthroscopy pump, a floor mat with collection tubing and floor vacuums. There is also an evacuation system built into the device to removes the smoke from surgeons’ cautery pencils. 

Telescopic poles on the devices are useful for gravity-based arthroscopy pumps. When raised higher, the fluid from the IV bags into the pump flows better. You can also hang a suction irrigator on the pole for would debridement. The pole can be raised or lowered by pressing a button on the device’s easy-to-use touchscreen, which also provides readouts on how much fluid has been used in procedures and how full the reservoirs are throughout cases. The screen on the device can be turned toward the circulating nurse or another member of the OR team who needs to monitor readings on the device. The reservoirs can also light up to indicate how full they are. Plus, there are doors on them in the event the patient is awake during surgery and doesn’t want to see the fluid or if the contents make anyone in the room uncomfortable, says Ms. Wadi.

A greener option 

Up to one-third of a healthcare facility’s total waste can be generated right in its operating rooms, according to Practice Greenhealth, a nonprofit that assists the heathcare community in instituting best practices to reduce its environmental footprint. The organization believes that transitioning from traditional ways of removing fluid medical waste can significantly reduce a facility’s regulated medical waste, by far the most expensive waste to process and dispose. By dumping the liquid waste directly to the sanitary sewer system, facilities no longer have to pay for heavy solidified liquids to be part of their pricey red bag waste. Reducing the medical plastics in which the solidified waste is thrown away is better for the environment as well. 

Affordability’s the issue 

HIGH AND TIGHT A telescopic rod on a suction device comes in handy when surgeons use pumps that rely on gravity during arthroscopies.  |  New Tampa Surgery Center

The pros of mobile cart systems seem to overwhelmingly outpace other liquid-waste methods, and the only con seems to be the price tag. Many two-OR multispecialty ASCs say they’re not affordable. 

However, Practice Greenhealth estimates facilities can save an average of $51,000 a year by switching to systems that discharge into the sanitary sewer by saving money on purchasing thousands of one-time-use plastic suction canisters, the chemical solidifiers that go in them and the costs of collecting, transporting and disposing of hazardous waste.

It’s nice to not have to worry about collection canisters filling up.
Taylor Wadi, RN

“While the upfront cost of such systems is higher than the costs of single-use disposable plastic suction containers, long-term benefits include a return on investment in between one and three years,” says Greenhealth’s website. The systems can also reduce room turnover times and save money by using fewer blankets and linens to clean the floor. Long-term savings include paying to treat — or potentially litigate — cross-contamination infections of staff or patients, and fewer costs associated with staff-injury cases.

Useful accessories 

While a fluid-management system is far and away the most important weapon surgical leaders have at their disposal to keep OR floors dry, there are some useful accessories available. For instance, there are drapes on the market with pouches that catch fluid before it hits the floor. A suction tube from the closed suction devices can collect the fluid before the drapes are discarded. There’s also a variety of absorbent disposable floor pads that work in conjunction with the suction devices to keep floors clean and dry and keep the use of towels and blankets to a minimum. Most are squares or rectangles offered in a variety of sizes, and are also available in large rolls, so the mats can be cut to the size you need. The dense antimicrobial foam, as well as impervious low-slip backing of some models, helps prevent the fluid from leaking through to the floor. Consider buying extras for the fronts of scrub sinks in addition to the areas immediately below OR tables.

Other mats, also disposable, feature ergonomic padding to minimize surgeon fatigue and have a tube that can connect to your mobile fluid-collection device. There are also small, flat vacuums that can connect to mobile suction devices that are moved with a long, thin handle, or designed to be moved by whisking it across the floor with your foot. OSM