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Er du tryg ved trykket?

Er du tryg ved trykket?. Kvalitetssikringsprojekt om cufftryk i larynxmasker. Først og fremmest:. Tag på efterudannelse og få ny inspiration Praksisnært projekt bedrer kvaliteten for patienterne Fordybelse øger den faglige stolthed Vidensdeling giver konsekvens for mange patienter.

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Er du tryg ved trykket?

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  1. Er du tryg ved trykket? Kvalitetssikringsprojekt om cufftryk i larynxmasker Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  2. Først og fremmest: • Tag på efterudannelse og få ny inspiration • Praksisnært projekt bedrer kvaliteten for patienterne • Fordybelse øger den faglige stolthed • Vidensdeling giver konsekvens for mange patienter. • Opbakning fra ledere giver energi til at fortsætte Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  3. Betyder cufftrykket noget for pt? SoreThroat Ondt i halsen Skader på slimhinden Utilsigtede hændelser Nerveskader Smagsforstyrrelser Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  4. Cufftrykmåling? Er det nødvendigt at måle cufftryk i LMA? Hvordan bliver cuffen i LMA tæt? Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  5. Pilotprojekt på 15 patienter • Vi målte på det vi gjorde dengang • Hos 13 af de 15 patienter blev trykgrænsen på 60 cm H2Ooverskredet . • Altså havde vi et problem, som burde løses • Det gjorde projektet vigtigt for ændring af vores praksis Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  6. Projekt nr. 1 • Projektbeskrivelse • Valg af patientkategori og opstilling af kriterier • Oprettelse af Google regneark til indsamling og bearbejdning af data på 2 matrikler • Bedside dataindsamling og registrering • Data fra 85 patienter fra sept. 2010 til marts 2011 Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  7. 2 anlæggelsesmetoder Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  8. Just Seal versus Standard Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  9. Resultater af projekt nr 1 91% af ptt. fik reduceret cufftryk til under 60 cm H2O ved Just Seal metoden. Nogle LMA blev tætte ved at reducere cuffvolumen Var der færre LMA med blod på ved fjernelse? 9 ptt fik lagt større LMA, 1 blev intuberet Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  10. Clinical Question: Intracuff Pressure - 60cm H2O limit Who initially recommended the ICP of 60cmH2O. Was there any specific study published to support our recommendation before we introduced the ICP of 60cmH2O into our IFU? Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  11. Svar fra dr. Brain Thank you. I introduced the 60 cm H2O limit because I found that if you insert the device into an awake unparalysed subject, inflation is reported as painful only when this pressure is exceeded. with kind regards, Archie Brain Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  12. Projekt nr. 2 • Kan vi reducere cuffvolumen og cufftryk ved at vælge større LMA i forhold til vægt? • Ny projektbeskrivelse • Inddragelse af LMA str 2 - 2,5 – 3 – 4 – 5 og str. 6 • Baseline: referencer for voksne projekt 1 • Referencer fra litteraturen mht. børnene Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  13. LMA cuff pressure Producerrecommendedsize versus thelocalrecommendations Hanne Mølgaard, CRNA Department of Anaesthesiology • Day Surgery Centre • Nørrebrogade Aarhus University Hospital • Denmark

  14. LMA cuff pressure Producer recommended size versus local recommendations 70-105 kg Hanne Mølgaard, CRNA Department of Anaesthesiology • Day Surgery Centre • Nørrebrogade Aarhus University Hospital • Denmark

  15. LMA • size•pressure•volume•weight•age Hanne Mølgaard, CRNA Department of Anaesthesiology • Day Surgery Centre • Nørrebrogade Aarhus University Hospital • Denmark

  16. The LMA ’Best Practice’ revolves around size Recommendations producer Unique™ 10-20 kg 20-30 kg 50-70 kg 30-50 kg 70-100 kg LMA 2 LMA 2.5 LMA 3 LMA 4 LMA 5 LMA 2.5 LMA 2 LMA 3 LMA 4 LMA 5 LMA 6 90 → kg 70-90kg <12 kg 22-35 kg 35-70 kg 12-22 kg Recommendations • Day Surgery Centre • Aarhus University Hospital • March 2012 • Recommendations • Day Surgery Centre • Aarhus University Hospital • March 2012 • Hanne Mølgaard, CRNA Department of Anaesthesiology • Day Surgery Centre • Nørrebrogade Aarhus University Hospital • Denmark

  17. Cufftrykmåling? Er det nødvendigt at måle cufftryk i LMA? Hvordan bliver cuffen i LMA tæt? Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  18. POINTS • Brug Just Seal metoden for at reducere cufftrykket og undgå Sore Throat • Vælg en større LMA for at reducere cuffvolumen og cufftryk • Reducer cuffvolumen hvis cuffen ikke bliver tæt ved at fylde mere luft i. • En blødere cuff har bedre pasform • Just Seal gør trykmåling overflødig Hanne Mølgaard, CRNA Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  19. Referencer • Loke GPY, Tan SM, NG ASB. Appropriate size of Laryngeal Mask Airway for children. Anaesth Intensive Care 2002;30:771-4 • Ungern-Sternberg BSv, Erb TO, Chambers NA, Heaney M. Laryngeal Mask Airways – to inflate or to deflate after insertion? Pediatric Anaesthesia 2009; 19:837-43 • Seet , Edwin et al. Use of Manometry for Laryngeal Mask Airway Reduces Postoperative • Pharyngolaryngeal Adverse Events. Anaesthesiology 2010; 112:652-7 • Higgins, PP. et al. Postoperative sore throat after ambulatory surgery. British Journal of Anaesthesia 2002; 88:582-4 • McHardy, FE, Chung, F. Postoperative sore throat : cause, prevention and treatment. Anaesthesia 1999; 54:444-53. • Matta, Basil F. Laryngeal Mask Airway : a More Successful Method of Insertion. Journal of Clincal Anesthesia 1995; 7:132-35 • Keller, C et al. Calculated vs measured pharyngeal mucosal pressures with the laryngeal mask Aiway during cuff inflation : assessment of four locations. BJA 1999;82:399- 401 Hanne Mølgaard, CRNA, Day Surgery Centre, Department of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

  20. Først og fremmest: • Tag på efteruddannelse og få ny inspiration • Praksisnært projekt bedrer kvaliteten for patienterne • Fordybelse øger den faglige stolthed • Vidensdeling giver konsekvens for mange patienter. • Opbakning fra ledere giver energi til at fortsætte Hanne Mølgaard, CRNA Depardment of Anaestesiology,Nørrebrogade, Aarhus University Hospital, Denmark

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