Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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expanding a joint. Historically, we'd hung 5 liter bags of the irrigation fluid on an IV pole and relied on gravity to feed the contents down through IV tubing into the joint. Occasional strategic raisings and low- erings of the bags on the poles let us control the inflow pressure. Managing the outflow was catch-as-catch-can with suction and absorbent materials on the floor. The development of mechanical arthroscopy pumps has automat- ed this process, however, and brought an internal benefit as well. They've proved to be an effective method of keeping the joint open, and they don't require your circulating nurse to interrupt her duties to keep a close eye on or routinely switch out bags of fluid. They help to maintain a consistent pressure in the joint, something that can be a struggle to accomplish with bags and gravity. Under the right conditions, this consistent pressure can also serve as a tamponade against intraoperative bleeding in the joint. During arthroscopy, your visualization can be obscured by just a few drops of blood, and even the most advanced HD camera will do you no good if you can't see. A pump that keeps the fluid pressure just above that of main arterial pressure works just like a mini tourniquet. It tampon- ades the vessels to keep runaway bleeding in check. Newer models of pumps feature a dynamic fluidic system in which the inflow can automatically adjust to and balance the pressure against a changing outflow. The more jobs you're undertaking during an arthroscopy, the more important this becomes. If you're just taking pictures, consistent pressure is all you'll need. But if you're working with a shaver, for instance, which has its own suction, you're draining more fluid and potentially having to maintain a turbulent flow and the Bernoulli effect — that is, when the speed of horizontal flow through a fluid increases, the pressure decreases. A dynamic fluidic system is more efficient. It helps to keep the fluid 1 1 0 O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY 2 0 1 5