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Reducing sodalime consumption in theatre

Thierry Chausse, Dr
9 August, 2012  
As part of a profitability analysis, Thierry Chausse, Head of Nursery for the Anaesthesia Department(1) at the University Hospital Centre of Limoges, France, compared conventional sodalime absorbent systems with the Drägersorb® CLIC system in spring 2005.(2) By using this disposable solution, the sodalime in the anaesthesia machines can be changed without interrupting the patient’s controlled breathing during surgery. During the study, Thierry Chausse examined aspects such as service life, costs, ease of use and safety. The results: despite higher initial costs of acquisition, the Drägersorb CLIC can nevertheless offer savings when all costs are taken into account. Overall consumption of sodalime was reduced by almost 60%.
Dräger: What is so special about the Drägersorb CLIC? 
Thierry Chausse: In contrast to other systems the sodalime in the anaesthesia machines used with this system can be swapped with a saturation point of 100% without having to interrupt the controlled breathing of patient under general anaesthesia during surgery. Previously, replacing the sodalime during a surgical operation meant interrupting the patient’s controlled breathing and administering halogenated anaesthetics. This can lead to a drop in the concentration of the inhaled anaesthetic and the patient may regain consciousness. Possible consequences are haemodynamic changes and perioperative memories.
What was the quality control plan like before you tested the CLIC? 
The sodalime was either swapped at the end of a working day when all the surgery was finished and when the first signs of saturation arose – independent of the percentage of actual saturation. And that meant higher consumption of sodalime.
What prompted you to carry out the study? 
Costs! When we carried out the study we were using comparatively inexpensive granular sodalime packed in 5-litre canisters. I wanted to find out if the impact of the new system on our work processes would be positive enough to compensate for the higher cost of acquisition.
Any other aspects?
Yes, the health of patients and people working here. The sodalime we use contains a lot of dust. This meant there was a danger that medical personnel could breathe in dust when refilling the canisters. The possible consequences are erythema, oedema, toxic effects or damage to the eyes. To prevent this, nursing staff always had to wear surgical masks and disposable gloves. In addition, dust disperses through the anaesthesia equipment and shortens its service life because of impurities and oxidation of components, in particular the motor.
How does the Drägersorb CLIC System work?
The Drägersorb CLIC adapter is a consumable article fitted with a flap valve and is screwed on to the anaesthesia equipment. A disposable cartridge is attached to the adapter, which is filled with sodalime (for example, Drägersorb 800PLUS). It is easy to fit and does not require a technician’s assistance. You simply press a button. When the sodalime reservoir is opened, the flap mechanism is activated. This means the patient’s breathing can be maintained while swapping the sodalime.
How often did you have to replace the absorber during your study?
Using this flap valve meant that the sodalime did not have to be changed until it reaches a 100% saturation point. This maximised service life. During the study, we observed that sodalime in the traditional system had to be replaced about every 17 hours whereas with the Drägersorb system the sodalime had to be replaced about every 27 hours. This was a significant optimisation of service life by almost 60% and a reduction of sodalime consumption in same proportion.
How did that affect costs?
The sodalime we used previously was delivered in 5-litre canisters. It contained a high proportion of dust, which meant we had to calculate a volume loss of about 22%. There were also additional costs for safety devices such as gloves, masks or safety glasses. Overall the Drägersorb Clic means savings of about 3.3%.
But other cost factors that we have not examined during the study so far should also be taken into consideration, including increasing safety for personnel and patients when replacing the sodalime and improving work processes. For example, when using a conventional sodalime absorbent system, we had to call a nurse anaesthetist to replace the sodalime. That meant unscrewing the canister, removing the used sodalime, disposing of it, refilling the adapter with fresh sodalime and putting the canister back in its place. That all takes time – time we could spend looking after a patient.
Our work with the clinical engineers
showed something else, too. We actually found sodalime dust on the inside of the motor blocks of anaesthesia equipment. This means extra costs for maintenance. Having these aspects in mind I would expect a total savings of around 10%. All this speaks for the Drägersorb CLIC adapter with a high-grade sodalime such as the Drägersorb 800 PLUS.
Reference
  1. Original French term: Infirmier Anesthésiste Cadre de Santé du Département d’Anesthésie.
  2. For further information about the study please contact Thierry Chausse: Thierry.Chausse@chu-limoges.fr