HYBRID OPERATING ROOM

A hybrid operating room is where major procedures that combines a conventional surgical and interventional procedure guided by fluoroscopic or MRI imaging in a hybrid room without interruption.

Traditional fixed C-arms produce 2D fluoroscopy or 3D rotational angiography but with the advanced technology nowadays, C-arms are able to acquire CT-like 3D images and used for image guided surgery and also in intra-operative imaging like flow analysis. With these newer fluoroscopic C-arms where the device image intensifiers are of the digital flat panel detectors has thus enabled the fluoroscopy techniques to transit into three dimensional CT-like imaging capability.

Hybrid operating rooms are currently used mainly in cardiac, vascular and neurosurgery, but could be suitable for a number of other surgical disciplines.

PLANNING THE HYBRID ROOM

Before planning a hybrid operating room, a clear vision of the utilization should be established. It should address the requirements and the needs of various surgical specialties, procedures and workflow. To ensure a smooth workflow in the room, all parties working together should state their needs and requirements, which will impact the room design and determining various resources like space, medical, and imaging equipment. This may require professional project management and several iterations in the planning process with the vendor of the imaging system, as technical interdependencies are complex. The result is always an one solution tailored to the needs and preferences of the interdisciplinary team and the hospital.

Reference: hybridoperatingroom.com

LIGHTS, MONITORS AND OTHER DEVICES

Multiple movable and flexible booms need to be installed in the OR. If there are 2 booms to be installed, a boom of every side of the operating table should be considered to serve the operating team. Collision of the ceiling mounted display with the surgical lights or other ceiling mounted devices should be avoided. Large displays are now available and capable of integrating multiple video inputs on various sizes and therefore decreasing the needs for multiple screens. A dedicated ceiling plan with all ceiling-mounted components including air conditioning should be drawn to ensure the function and usability of all devices. 

The hybrid OR facilitates a whole new spectrum of cardiac surgical therapies, and will therefore become an essential resource of every cardiovascular centre. The trend towards hybrid OR is more of a revolution than an evolution due to the rapid integration into the surgical techniques. The hybrid OR itself represents an extreme complex working environment that demands careful planning by all stakeholders. Bundling all clinical, technical and architectural expertise as well as a realistic view of what is achievable is key for a successful hybrid OR project. 

Reference: cardenjennings.metapress.com & hybridoperatingroom.com & www.maquet-hybridoperatingroom

Wireless Telemetry System

The Philips MX40 Telemetry device combined with the PIIC iX central monitoring system, is an excellent choice for most hospitals that can expect to leverage the broad networking capabilities and configurability of the system. It may be especially advantageous for larger hospitals that want to access telemetry data and manage system configurations from multiple care areas.

The MX40 device offers most of the features that we believe transmitters with integrated displays should offer to enhance patient safety in many of today's telemetry settings, including:

• The option to have alarms annunciated, and messages displayed, at the device;
• A color display with up to two waveforms, and numeric patient data with alarm limits;
• The ability to silence and pause alarms at the MX40;
• The ability for the MX40 to transition to the functionality of a mini-arrhythmia detection capability and alarms.

Telemetry systems were developed to monitor patients who are at risk for cardiac events but not acutely ill enough to warrant continuous bedside monitoring. Today, they often offer additional measurements that can be used to monitor conditions like hypoxia and compromised respiratory status. Patients on telemetry monitoring are often ambulatory for part of the day.

The IntelliVue MX40 telemetry system comprises the following:

a) The patient-worn MX40 telemetry device, which is used to acquire patient data and relay it wirelessly using Philips' IntelliVue Smart-hopping 1.4 GHz WMTS network or the hospital's industrial, scientific and medical (ISM) 802.11a/b/g/n wireless network.

• The device is powered interchangeably by either a rechargeable Li-ion battery or three AA alkaline batteries and is equipped with a 1.70 × 2.26-inch color display.

• The MX40 monitors ECG, detects arrhythmias, and displays continuous ST and QT segments, SpO2, and impedance respiration, when connected to the PIIC iX or when communication is lost between the device and PIIC iX.

• The display on the MX40 can show numerics and up to two waveforms (i.e., ECG, SpO2, or impedance respiration).

b) The PIIC iX platform, which can be used to control multiple types of Philips monitors across multiple care areas. The PIIC iX includes a telemetry central station, consisting of a PC and one or two flat-panel screens for clinical review. In a networked, multi-care-area configuration, the PIIC iX can be used to easily transfer patients from one care area to another or to allow overview monitoring of multiple care areas.

• The PIIC iX can accommodate up to 32 patients (either single or dual displays, depending on PC screen size).

• Central stations are usually located at unit nursing stations and hallways. Some facilities consolidate patient monitoring in remote areas, where a team of technicians is given responsibility for monitoring central station screens. The PIIC iX is adaptable to either of these models.

• The following diagram depicts the workflow of the PIIC iX platform. Note that the "IBE" shown in the diagram is the IntelliBridge Enterprise, a bidirectional interface between the Philips clinical informatics system and the hospital information systems; it is used to  exchange admission/discharge/transfer (ADT) information, laboratory information, patient orders, and data between the Philips system and the electronic health record. (Image courtesy of Philips).

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.
 
Source: ecri institute

SOTERA WIRELESS ViSi MOBILE SYSTEM

The Sotera Wireless Vital Signs Mobile system continuously monitors patient vital signs, including pulse rate (PR), heart rate (HR), respiration rate (RR), NIBP, and pulse oximetry (SpO₂), as well as level of motion on adult patients in inpatient lower-acuity care settings. Continuous noninvasive blood pressure (cNIBP) is achieved by taking a baseline measurement with a standard NIBP cuff and then using pulse arrival time to estimate changes from baseline. The system analyzes and interprets vital signs data to alert clinicians to emergent events like high HR or low SpO₂. The system also displays trending data to help clinicians detect early signs of patient deterioration. 

This system offers optional 3- or 5-lead ECG for monitoring purposes (i.e., not diagnostic, and no arrhythmia detection). 

 Central workstation is available and allows control of system for up to 32 patients at a time. Just like the cetntral monitors in the ICU, it can used to:



- Admit and discharge patients
- View graphical and list trends for 3- or 5-lead ECG, SpO₂, temperature, PR, and RR
- View real-time data, including visible and audible alerts and alarms
- Communicate to secondary alarm notification systems or middleware for clinician notification
- Send patient vitals data and alarms to patient electronic medical record (EMR) via an HL7 (Health    
  Level 7) interface.

Remote viewing screen is available for viewing of near-real-time patient data, trending information, and alerts/alarms through WLAN, etc.



The Sotera Wireless Vital Signs Mobile system is a good choice for low-acuity continuous vital signs monitoring applications on a medical-surgical floor. The system has simple patient setup. Trending information is potentially helpful to detect patient deterioration. 
The use of continuous noninvasive blood pressure (cNIBP) is impressive and potentially much more comfortable for the patient than periodic NIBP cuff inflation. Sotera provides the widest variety of alerts for emergent events and status changes. This system is not designed to provide trend alerts or early warning scoring. It is probably best suited to sick patients who need constant monitoring and alerting for emergent events. Battery life is short; two wrist units are required per bed for 24-hour coverage.

System components of the Sotera ViSi Mobile System

Information on this page is provided for interest only on a "best efforts" basis and does not 
constitute personal advice. Always discuss medical conditions and related matters with your doctor.
 
Source: ecri institute