Indian Journal of Anaesthesia

LETTER TO EDITOR
Year
: 2017  |  Volume : 61  |  Issue : 3  |  Page : 272--273

Is our suction apparatus rightly calibrated?


Shweta Panse, Sheetal Chiplonkar, Tista Ganguly 
 Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Shweta Panse
BARC Hospital, Anushakti Nagar, Mumbai, Maharashtra
India




How to cite this article:
Panse S, Chiplonkar S, Ganguly T. Is our suction apparatus rightly calibrated?.Indian J Anaesth 2017;61:272-273


How to cite this URL:
Panse S, Chiplonkar S, Ganguly T. Is our suction apparatus rightly calibrated?. Indian J Anaesth [serial online] 2017 [cited 2019 Oct 19 ];61:272-273
Available from: http://www.ijaweb.org/text.asp?2017/61/3/272/202175


Full Text

Sir,

Suction apparatus is an important part of operation theatre and anaesthesia. Modern anaesthesia machine check not only includes the cylinders, pipelines, machine proper and breathing circuits but also scavenging systems and suction apparatus.[1],[2] Ensuring that suction apparatus is working appropriately and calibrated precisely is very important to avoid inadvertent, over or underestimation of blood and body fluid losses and unwarranted transfusions.

A 7-year-old 19 kg male child belonging to the American Society of Anesthesiologists physical status 1 was posted for elective adenotonsillar resection. Pre-operative anaesthesia evaluation was unremarkable with haemoglobin 13 g/dL. Intraoperatively, blood loss measured in suction apparatus was 250 mL without any saline wash. The patient was haemodynamically stable without significant tachycardia and was given gelatin of 250 mL in addition to the maintenance volume of Ringer's lactate. On suspicion that the blood loss was reaching the maximum allowable limit for the patient, we counterchecked the blood loss from the suction apparatus with a standard 50 mL Becton Dickinson syringe. To our surprise, it was found that suction apparatus jar was overestimating the blood loss by almost 125 mL. The surgery was uneventful. Post-operatively, we counterchecked the suction jar with 500 mL standard normal saline dyed with methylene blue with the help of ten Becton Dickinson syringes which measured 625 mL in suction jar [Figure 1].{Figure 1}

Blood loss thus overestimated may not be significant in an adult patient, but it can be seriously detrimental for neonates and pediatric patients undergoing surgery.[3] They can be inadvertently given excess fluids or blood transfusion with risk of complications and delay in post-operative recovery.[4] In addition to clinical signs such as tachycardia, hypotension and pallor, various other methods for estimation of blood loss include gravimetric methods (weighing of swabs), weighing of patient pre- and post-operatively, calorimetric methods, measurement of red cell volume by radioactively labeled isotopes, inferior vena cava diameters and collapsibility index.[5]

The suction apparatus in use was manufactured by Jambotkar Medequip Pvt. Ltd. We have notified the manufacturers regarding the calibration errors and their reply regarding this issue is still pending. The need to keep a regular check on such machines in the operation theatre is of utmost importance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1International standard organization. Medical Suction Equipment – Part 3; Suction Equipment Powered by Vaccum or Suction Source ISO 10079-3:2014. Geneva, Switzerland. 2014.
2Dorsch J, Dorsch S. Suction equipments. Understanding anaesthesia equipment. 2007;5:51-73.
3Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anaesthesiology 2008;109:723-40.
4Bailey AG, McNaull PP, Jooste E, Tuchman JB. Perioperative crystalloid and colloid management in children: Where are we and how did we get there? Anesth Analg. 2010;110:375-90.
5Pasquero P, Albani S, Sitia E, Taulaigo AV, Borio L, Berchialla P, et al. Inferior vena cava diameters and collapsibility index reveal early volume depletion in a blood donor model. Crit Ultrasound J 2015;7:17.