Bell Medical purchased Bay State Anesthesia of New England on April 1, 2022. Bell Medical plans to continue to use the Bay State Anesthesia name and to run the operation with all current sales and service staff with little change in the eye of the customer, according to Kevin Lueders, President. Bay State Anesthesia has been providing anesthesia and respiratory specialty products and services to the New England market since 1970. Bell Medical, headquartered in St. Louis, Missouri, is a national distributor that has specialized in anesthesia sales and service since 1975. Visit the company websites at: www.BellMedical.com and www.bay-state.com or contact Kevin Lueders at 314-772-5600 or [email protected] with questions.
Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative. Wade Weigel, MD at Virginia Mason Medical Center, Seattle, WA
Virginia Mason Medical Center has 28 anesthetizing locations. A total of 20,181 electronic charts and 2,807 manually reviewed charts were examined over a 4 year period (2016-2020)
History of Nerve Stimulator installations at Virginia Mason MC
In 2016, every operating room contained a peripheral nerve stimulator
– Digistim II (Neuro Technologies)
– EZ Stim II (LifeTech)
– TOF-Watch SX (Organon)
– Intellivue NMT (Philips)
In 2017, the STIMPOD NMS450X was introduced in 24 locations, replacing the previously installed stimulators
In 2018, Twtichview monitors were introduced in 4 locations, primarily to cover tucked-arm procedures (robotic, cardiac etc). There was a significant cost implication, estimated at $9600 per annum for the EMG electrodes per Twitchview monitor.
Great example of only using EMG where it is needed. If Virginia Mason had to standardize on Twitchview monitors for all their locations, this would have incurred an additional cost of $230,400 per annum, compared to the $38,400 when using it in only select locations – a great saving for the hospital. Also note that only 4 Twitchview monitors (14% of total sites) were needed to cover tucked-arm procedures.
PACU length of stay was reduced by 7% (p<0.001)
Pulmonary complications overall reduced by 42% (p = 0.011)
Average Sugammadex dosage decreased by 14% (p < 0.001)
Subjective assessment decreased from 82% of cases (pre-implementation) to 5% of cases (post-implementation)
TOF Ratios > 90% increased from 3% of cases (pre-implementation) to 92% of cases (post-implementation)
Continued on next page:
“Frequent error messages and inability to attain measurements historically impeded uniaxial acceleromyography enthusiasm. Introduction of the triaxial monitor (STIMPOD NMS450X), which measured three dimensions of movement, worked more reliably, which facilitated acceleromyography monitor use.”
“In contrast, TwitchView array failures that included failed current delivery, failed signal return, poor-quality signal, and inaccurate readings (e.g., train-of-four count 0 with four visible thumb movements) demotivated providers from using the TwitchView given the cost of each array.”
The takeaway here is not that Twitchview is necessarily bad, but that EMG is difficult. AMG is still the most reliable, consistent and cheapest method of monitoring NMBA’s. Xavant continues to invest in both technologies, as we believe both of these technologies are needed to drive adoption of Objective NMT Monitoring.
Closing statement: “Achieving and documenting a train-of-four ratio greater than or equal to 0.9 after administration of a nondepolarizing neuromuscular blocker is not a quixotic goal. This result was achieved in a busy tertiary hospital. However, attaining this endpoint requires more than just placing a quantitative monitor at each anesthetizing location. Ongoing educational effort and follow-up are required. We think our experience provides a useful road map to this end. Anesthesia providers are solely responsible for properly rescuing patients from the states of paralyses they initiate. This should occur for all patients as verified by quantitative measurement and documentation of train-of-four ratios greater than or equal to 0.9.”
For more information on QTOF monitoring and the Stimpod 450X please contact Bell Medical at [email protected]
Initially created on JANUARY 15, 2022 BY ARIEL KATZ, CEO QINFLOW
Rapid infusers are a great option for treating patients with severe hemorrhage. However, they require significant commitment from the hospitals: they are expensive to purchase, expensive to operate, and expensive to maintain. As importantly, they require significant ongoing investment in training so as to keep the staff adequately comfortable using them. Too often emergency personnel would avoid using their state-of-the-art rapid infusers simply because they are overwhelmed with their complex operation and time-consuming troubleshooting. In today’s environment, that requires hospital to rely on ‘travelling nurses’ to complement their staff. The situation is worsened since continuous education on rapid infusers is simply impractical.
Therefore, a growing number of hospitals are approaching us with a similar request: “we need a bridge to the rapid infusers”, they say. Indeed, there are other more practical solutions to transfuse warm blood fast. When used with flow-inducing devices such as pressure bag, hand pump, push-pull, electro-mechanical pump, or LifeFlow infuser, the Warrior line of next-generation blood warmers is an excellent bridge to the rapid infusers. The following paragraphs introduce some of the key benefits of the Warrior over rapid infusers.
- Speed. It is important to note that in over 95% of the cases rapid infusers are not required. The patient will receive anywhere between 1 and 3 units of blood and rushed to the OR. In such instances, we celebrate that the Warrior delivers 1-3 units of warmed blood to patients much faster than rapid infusers, simply because set up time is reduced to just a few seconds.
- Simplicity. Moreover, unlike rapid infusers, anyone can be trained to operate the Warrior. This removes the pressure that only a few expert nurses can operate the device flawlessly, as is often the case with rapid infusers. In addition, and unlike rapid infusers, troubleshooting the Warrior is fast and easy. The Warrior’s simplicity has even greater value in situations of a mass casualty event since a stretched medical staff will greatly struggle to operate multiple rapid infusing devices concurrently.
- Portability. One additional key advantage of the Warrior over rapid infusers is its portability. With rapid infusers, warm blood cannot be administered during a patient’s transfer to the next level of care, whereas the Warrior has been designed to facilitate patient’s transports (from field to ED, trauma, OR, and ICU). Unlike rapid infusers, the Warrior can be simply attached to the bed during patient’s transfer from ED to OR, thus freeing the hands of caregivers to perform more important stuff.
- Unique Continuum of Emergency Care Proposition. The portability aspect enables a unique continuum of care proposition, whereby the same consumable can be used across the entire continuum of emergency care, thus simplifying patient handoff between emergency settings and reducing costs. If fully adopted by the hospital, further ROI benefits can be attained by streamlining training efforts, reducing dependency on dedicated staff, reducing spare part inventory, and eliminate monthly service calls and calibration endeavors that raid infusers typically require. If the hospital has a critical care transport team, treatment with the Warrior can commence even prior to the arrival of the patient to the ED.
- Pediatric Applications. Another benefit of the Warrior is its ability to operate even with small-size catheters, designed for pediatric patients. Rapid infusers are limited to larger catheters which is part of the reason that a growing number of pediatric hospitals have adopted the Warriors along with the LifeFlow infusion device.
- Maintenance Free. The Warrior does not require any routine service or any annual calibration. It requires just one inspection every 5 years. Rapid infusers typically demand monthly service and calibration endeavors that overload the biomed team.
- Aluminum Free. The Warrior is aluminum free; some rapid infusers contain aluminum in their fluid path.
- Improved ROI. Finally, cost — both capital and consumables — is another huge benefit of the Warrior over rapid infusers. A rapid infuser may cost $30k. At this price you can get approximately 8 Warrior AC devices… A rapid infuser’s consumables are in the range of hundreds of dollars, considerably higher than the Warrior’s Compact Disposable Unit. There are also significant benefits related to reduction of indirect costs, such as simplified training, elimination of spare inventory, and elimination of complex service requirements, to name just a few.
To summarize, even the best-equipped medical centers are too often reluctant to use their rapid infusers due to their complexity. In such cases, therefore, the patients will get cold blood/fluid. While the Warrior is not a rapid infuser, it will outperform rapid infusers in greater than 95% of the cases, when just a few units of blood/fluid are required. In such cases, the Warrior will perform the job faster, more effectively, and more economically than the over-sized, complex, and expensive to operate rapid infusers. Even in those few cases that rapid infusers are required, the Warrior can be used initially so as to accelerate the delivery of the first few units of blood to the patient. In all these cases, the Warrior acts as an optimal bridge to the rapid infusers. Contact us for more information.
- Simple to Operate: Easy one-button operation enhances patient safety
- Immediate Warming: From 4C to 38C (39F to 100F) in just a few seconds
- Fast delivery: KVO to 290ml/min at consistent 38C for 4C fluids and up to 500ml/min for 20C fluids(AC mode)
- Hybrid Power Source: Equipped with both battery (3-5 liters) and AC Power source
- No Calibration or Maintenance: One year warranty, 5 years between service cycles
- Affordable Consumables: Cost effective consumable design
- Self-Regulating: Warming automatically adjusts to address changes in flow rates maintaining 38Coutput temperature
- Portable and light weight: Warrior is ideal for helicopter EMS, Ambulance and ED/OR
- Unique Continuum of Care: Warrior and consumable can be used from field to hospital simplifying patient handoff between EMS, ED and OR thus reducing costs.
- Tested and Compatible by 410 Medical for use with LifeFlow rapid infuser
- FDA, CE and Health Canada approved. ISO certified.
Special tiered pricing for Premier contract members. Give us a call 314-772-5600 or email [email protected] for further information.
Bell Medical is proud to introduce 10 products in the Anesthesia News Buyer’s Guide. The products are: BiteMe, EyePro, NoPress, Insight Video Airway System and iWorkstation, Pi Pillow, Warrior, POM, Stimpod NMS450, Tereboot Nerve Block Support, and Metro Carts.
You may view all of these products on the Buyer’s Guide website here:
We look forward to a fantastic 2022!