Transcript ARC Medical, Inc. | ThermoFlo™ In

ARC Medical, Inc.
ThermoFlo™
In-service Presentation
Presented by
ARC Medical, Inc.
800.950.2720
www.arcmedical.com
EXCEEDING THE STANDARD FOR
NEARLY 25 YEARS.
ARC was formed in 1990 to address the
needs of providing in line humidification.
Our goal is to replace the need for heated
water bath humidifiers.
NOT ALL HMEs ARE CREATED EQUAL
PAPER, FOAM, SPONGE
What happens when they get wet?
They Absorb!
WHY IS THIS IMPORTANT?

THE TERM HYGROSCOPIC REFERS TO THE ABILITY OF A
M AT E R I A L T O A B S O R B H U M I D I T Y F R O M T H E A I R .
( H Y G R O S C O P E I N D I C AT E S C H A N G E S I N H U M I D I T Y . )

H Y D R O P H I L I C R E F E R S T O S U B S TA N C E S T H A T A B S O R B W A T E R .

H Y D R O P H O B I C M A T E R I A L S H A T E W A T E R A N D R E P E L I T.
WHICH TERM(S) DO YOU THINK APPLIES TO THERMOFLO™?
THIS IS WHY WE ARE DIFFERENT FROM THE COMPETITION!
Zero!
When used from Intubation to Extubation
NEVER a reported endotracheal
tube occlusion, or pneumothorax
with ThermoFlo™.
CONSTRUCTION
MEDIA: Spun
Polypropylene with a
calcium chloride
coating
HME media
Filter with
hydrophobic
membrane
Unitized
Construction
FILTER: 3M Filtrete
with a hydrophobic
membrane
UNITIZED
CONSTRUCTION:
The device will not fit
together if the filter is
not properly in place
within the wall of the
device.
Exceeds Standards @ 20L VE
Conventional
“Passive
33 Humidifiers”
ThermoFlo™
31
27
@ 20L VE
28
@ 10L VE
29
@ 20L VE
30
@ 10L VE
Mg H20 / L Air
32
Data on file
THERE IS SAFETY IN OUR
NUMBERS
No others match our
performance record
KK Stout, Poster Presentation, American College of Chest Physicians Nov. 1994
COMPARISON OF LONG TERM USE OF A HYGROSCOPIC
CONDENSING HUMIDIFIER VERSUS HEATED WIRE CIRCUIT
Duke University Medical Center, Durham, NC
Sharon Day, RRT, Robert McConnell, RRT, Heather Fredericksen, RRT, Neil R. Maclntyre, MD
BACKGROUND: A hygroscopic condensing humidifier (HCH) is a passive humidification device that collects heat and
humidity from expired gas of a patient on a mechanical ventilator and conditions inspired gas as it passes back through the
device. A heated wire circuit (HWC) actively adds heat and humidification to the inspiratory limb of a warmed circuit after
passing through a heated water canister.
METHODS: All patients requiring mechanical ventilation between 2/22/96 and 4/24/96 were eligible for the study. Patients
were randomly assigned to receive either a hygroscopic condensing humidifier (ThermoFlo™ ARC Medical, Inc) or a heated
wire circuit (Bear 5 circuit by Marquest). Sputum was categorized on each day of the mechanical ventilation as: watery
(sputum that can be suctioned like water, after suction is terminated no secretions remain attached to the inner surface of the
suction catheter), moderate (sputum of moderate viscosity, after suction is terminated, some secretions remain attached to the
inner surface of the suction catheter) or tenacious (thick sputum, after suction is terminated, most secretions are still attached
to the inner surface of the Catheter, and they cannot be easily removed by suctioning water through the catheter). If during
different suctioning episodes on the same day, sputum was judged differently, both categories were used. Chi square analysis
was used to compare sputum categories in each group with P < .05 taken as significant.
RESULTS: Fifty-eight patients were recruited and 286 patient-days of sputum categorization were performed (125 in the
HWC group, 161 in the HCH group). Sputum categories in each group (percentage of patient-days):
Watery
Moderate
Tenacious
HCH 12.4%
79.5%
11.2%
HWC 11.2%
88%
13.6%
There was no significant difference is sputum categories between the two groups.
CONCLUSION: Sputum consistency was similar using either HCH or HWC humidification systems.
OF-96-111
Presented at the AARC, November, 1996
RELATIVE CLINICAL
PRACTICE GUIDELINES

Humidification is recommended on every patient receiving
invasive mechanical ventilation.

When providing passive humidification to patients undergoing
invasive mechanical ventilation, it is suggested the HME
p r o v i d e a m i n i m u m o f 3 0 m g H 20 / L .

Passive humidification is not recommended for noninvasive
mechanical ventilation.

Condensation from the patient circuit should be considered
i n f e c t i o u s w a s t e a n d d i s p o s e d o f a c c o r d i n g t o h o s p i t a l p o l i c y,
using strict universal precautions.
AARC Clinical Practice Guideline
Humidification During Invasive and Noninvasive Mechanical Ventilation: 2012
Ruben D. Restrepo, MD, RRT, FAARC & Brian K. Walsh, RRT-NPS FAARC
Why connect your ET tube
to red bag waste…
...when you can use
ThermoFlo™ and have a
clean, dry circuit?
“Condensation from the patient circuit
should be considered infectious waste
and disposed of according to hospital
policy, using strict universal precautions.”
AARC Clinical Practice Guideline 2012
Ruben D. Restrepo, MD, RRT, FAARC &
Brian K. Walsh, RRT-NPS FAARC
ThermoFlo™ ENDS WATER
PROBLEMS BY PROVIDING
A CLEAN, DRY CIRCUIT.
NO more water on
the bed, floor, or
your shoes, when
the circuit is
disconnected!
NO more
water traps
to drain!
NO more Peep
Spray!
ELIMINATES ADDITIONAL COSTS

Eliminates the need for
water columns.

Eliminates water traps in
line.

Eliminates infectious peep
spray while disconnecting
the circuit.

Eliminates the need to
p u r c h a s e c o s t l y w a t e r.
RECOMMENDATIONS
Use on NEW
patients when
possible.
Conversion with
existing patients
requires
additional effort,
and psychiatric
preparation.
MDI or Neb
treatments may be
given between
patient and filter.
Check for
increased
resistance after
treatment.
Follow
manufacturers’
directions for
lavaging using
closed suction
devices.
Do not allow
lavaging solution
to flow into the
device.
TAKE CARE NOT TO GET
LAVAGING SOLUTION INTO THE
ThermoFlo™ SYSTEM.
If the drugs are introduced via
MDI, or nebulizer into the
circuit between the patient and
the device, be aware of
potential increased resistance.
If there is an increase in
resistance deemed clinically
significant, replace the device.
CLOSED SUCTION WITH AN
MDI ADAPTER

Lavage the patient, being careful to
keep the solution away from the
ThermoFlo™ device.

Hold unit at a 45o angle, and advance
the catheter 4”- 6” into the endotracheal
tube; a very nice guide into the ET tube
is created.

Administer lavage, hold suction, and
complete procedure. It is acceptable to
use an MDI adapter on the patient side
of the ThermoFlo™. If you are using
the MDI into the circuit, remove the
ThermoFlo™ and replace after
treatment.
CLOSED SUCTION SYSTEM
NEBULIZATION
An HME must be removed
from the patient circuit
during aerosol treatments
when the nebulizer is
placed in the patient circuit.
When the HME is removed from
the circuit during aerosol
treatment, place the device so
that the patient connection is
facing up, reducing the chances
of contaminating patient
connection.
RELATIVE
CONTRAINDICATIONS
 Copious amounts of bloody secretions
 Body temperature less than 30 ° C
 Respiratory volume 25% less than
inspiratory volume ( possible fistula )
 Pulmonary edema
 Hypohydration (dehydration)
June 2005
“HMEs should be used
in all patients in whom
there is no
contraindication.”
Richard D. Branson MSc RRT FAARC
RELY ON THE SIGNS
Regardless of what type of
system is being used, the
clinician should question the
effectiveness.
Since no system reports the
actual amount of humidity being
delivered, other signs must be
relied upon.
YOU WILL SEE MOISTURE
Moisture is a good thing!
 Any visible moisture may be
Visible moisture will not be
absorbed into the filter
media potentially causing
resistance.
removed, should you choose.
 In this demo, any liquid poured into
our device may be poured out. Any
sputum in the device will not be
absorbed by the media.
 Position the device horizontal or
above the patient.
 No visible moisture will be transferred
back to the patient unless the device
is turned completely upside down. (As
shown in the photo on the bottom
left.)
ThermoFlo™ PROTOCOL AND SPUTUM EVALUATION
Put us to the test,
and document your
secretions.
IDENTIFYING SPUTUM
CHARACTERISTICS
1. Watery: Sputum that can be suctioned like water. After suctioning, no
secretions remain attached to the inner surface of the suction
catheter.
2. Moderate: Sputum of moderate viscosity. After suctioning, some
secretions remain attached to the inner surface of the suction
catheter, but they can be easily washed out by suctioning water
through the catheter.
3. Tenacious: Thick sputum. After suctioning, most secretions are still
attached to the inner surface of the suction catheter.
Suzukawa, et. al., Respiratory Care November 1989
MANUFACTURER RECOMMENDATION
TO AVOID BACTERIAL COLONIZATION
CHANGE EVERY 24 HOURS
Our exclusive “change on” label makes it easy.
DISPOSAL
No need to touch the device.
SAFE DISPOSAL
After disconnecting, place the
device in your one hand, and
remove your glove from the other
while wrapping it around the used
device.
Dispose according to hospital
policy .
The End