Reusable Anesthesia Breathing Circuits
Opportunity
Implementation of reusable anesthesia breathing circuits is a feasible way to reduce waste per case and permit a stable inventory of anesthesia breathing circuits in the event of supply chain issues that can occur with disposable varieties. The anesthesia breathing circuit tubing, reservoir bag, and Y-piece can be reused and reprocessed safely within the hospital. North York General Hospital has successfully maintained the reusable anesthesia breathing circuit system for almost 20 years.
Benefits
Reduce waste per case in the disposal of the anesthesia breathing circuit, reservoir bags, and Y-pieces. The lifespan of the anesthesia breathing circuit is approximately 1 year which would eliminate ongoing costs of equivalent materials in disposable form. The reusable circuit system reduces institutional vulnerability to supply chain issues that can occur with single-use/disposable systems.
Solution
Acquire Smooth-Bor anesthesia respiratory tubing, neoprene reservoir bag, reusable plastic Y pieces, +/- facemask.
Implement a robust system with MDRD/CPD, perioperative staff for cleaning/processing, reassembly, and daily rotations on anesthesia gas machine.
The system at NYGH does require some ongoing disposables: HME filter, adult anesthesia face mask (pediatric face masks are reusable masks)
Process
Anesthesia Circuits are changed daily before OR start by anesthesia tech / anesthesia assistant prior to the machine check
Disposable anesthesia adult face mask and HME filter changed per case
Average lifespan of tubing is approximately 12 months
“Dirty” Anesthesia circuits send to CPD for reprocessing – dismantled and sorted in specific washing apparatus and programmed wash/rinse sequence
Circuit components are separated and placed on the washing apparatus in designated areas
Breathing circuits are pasteurized automatically in washer disinfectors at 160 deg. F under preset program
Hang dry circuit pieces in designated anesthesia dryers by component parts
Assemble circuits for anesthetic gas machines when dry
History of implementation
Institutional knowledge indicates reusable circuits were in use at NYGH since the early 2000s, originally intended to reduce storage volume requirements of disposable items in the OR core.
In 2017-2018 organization implemented the CDS Modules (OR On-time delivery of Custom packs ready-made for case picking). In these modules, single-use Anesthesia Equipment (Breathing bags, Circuits and Masks) was introduced. With NYGH feedback and preference to continue with reusable materials, Medline removed single-use breathing circuits from the modules except for the HME filter and disposable adult face mask.
Anticipated Challenges
Initial purchase cost
Acquisition of component-specific washer, processing equipment, development of processing protocol in CPD
Training of personnel to recognize equipment and component parts to avoid loss / accidental disposal
Resources
Reusable Anesthesia Breathing Circuits Information Sheet
Contacts
Dr. Melissa Ho, Staff Anesthesiologist, NYGH
Natalia Damphousse, Clinical Team Manager, CPD, NYGH
Camelia Munteanu, CSR Supervisor, NYGH
Contributed by Dr. Melissa Ho