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Leung LW, Evranos B, Grimster A, Li A, Norman M, Bajpai A, Zuberi Z, Sohal M, Gallagher MM. Remanufactured circular mapping catheters: safety, effectiveness and cost. J Interv Card Electrophysiol 2018; 56:205-211. [PMID: 30588568 PMCID: PMC6848800 DOI: 10.1007/s10840-018-0497-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/10/2018] [Indexed: 12/02/2022]
Abstract
Background The use of remanufactured single-use devices (SUDs), including cardiac electrophysiology catheters, has become established in the USA and other health care systems but without much published scientific evaluation on the relative safety or efficacy of these devices. In the United Kingdom (UK), the use of remanufactured SUDs has not been routine. We performed a structured evaluation of the safety and efficacy of a remanufactured circular mapping catheter (Stryker® remanufactured Lasso NAV 2515) during its introduction in our centre. Methods We prospectively evaluated the performance of a remanufactured circular mapping catheter in 100 consecutive patients undergoing an AF ablation. Operator feedback was obtained, assessing the device appearance, ease of use and function. As an indirect measurement of efficacy, acute procedure metrics were compared to those in 100 propensity-matched cases performed by the same operators using a new device. Cost savings were calculated. Results No complication occurred in association with the remanufactured device. There was one reported failure of device malfunction—the flexion-extension mechanism of a remanufactured catheter and none in the matched-control group. There was satisfactory communication with the electro-anatomic mapping system. Ease of use of the remanufactured catheter was reported to be similar to a newly manufactured device. Procedural duration was similar with remanufactured devices and matched controls. With 100 cases using the remanufactured device, cost savings amounted to £30,444. Conclusions The use of remanufactured circular mapping catheters is safe, efficient and reliable. Widespread use of remanufactured SUDs offers the possibility of significant economic benefit.
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Affiliation(s)
- Lisa Wm Leung
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
| | - Banu Evranos
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Alexander Grimster
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Anthony Li
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Mark Norman
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Abhay Bajpai
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Zia Zuberi
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Manav Sohal
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Mark M Gallagher
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, St. George's, University of London, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
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Petrovsky B, Monnet E. Evaluation of efficacy of repeated decontamination and sterilization of single-incision laparoscopic surgery ports intended for 1-time use. Vet Surg 2017; 47:O52-O58. [DOI: 10.1111/vsu.12761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 09/24/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Petrovsky
- Department of Clinical Sciences, College of Veterinary Medicine; Colorado State University; Fort Collins Colorado
| | - Eric Monnet
- Department of Clinical Sciences, College of Veterinary Medicine; Colorado State University; Fort Collins Colorado
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Tessarolo F, Torres S, Ballesteros LM, Rigoni M, Piccoli F, Caola I, Caciagli P, Montoya Y, Nollo G. Surface and Thermal Characteristics of Single-Use Electrosurgical Pencils After Clinical Reuse and In-Hospital Reprocessing. J Med Device 2017. [DOI: 10.1115/1.4038145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Safety and efficacy issues are associated with reprocessing of single-use electrosurgical pencils (EPs), requiring methods for assessing the reprocessing protocol before clinical reuse. This study aimed at monitoring the surface characteristics of single-use EPs subjected to multiple clinical use and in-hospital reprocessing. A total of 24 single-use-labeled EPs were divided in five test groups and one control group. The test groups were subjected to a different number of clinical uses, ranging from one to five. A multitechnique approach based on optical stereomicroscopy (OM), scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDXS), differential scanning calorimetry (DSC), and thermogravimetric analysis (TGA) was applied. The silicon coating of the tip was significantly reduced, and foreign bodies were occasionally found on reprocessed EPs. The amount of biological debris and chemical residuals increased with the number of reprocessing cycles in critical areas. The degradation temperature of the EP handle polymer showed a progressive significant reduction. Cable cord showed no modification after reprocessing. EP tip could undergo major surface modifications that can affect functionality. The efficacy of the reprocessing protocol in removing debris from the EP handle should be carefully assessed. Surface and thermal characteristics have to be considered for validating a reprocessing protocol of single-use labeled EP.
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Affiliation(s)
- Francesco Tessarolo
- Department of Industrial Engineering, University of Trento, via delle Regole 101, Mattarello, Trento I-38123, Italy
- Healthcare Research and Innovation Program (IRCS-PAT-FBK), Bruno Kessler Foundation, Trento 38123, Italy e-mail:
| | - Sebastian Torres
- Department of Biomedical Engineering, Antioquia School of Engineering—CES University, Sabaneta 055450, Colombia
| | - Luis Miguel Ballesteros
- Department of Biomedical Engineering, Antioquia School of Engineering—CES University, Sabaneta 055450, Colombia
| | - Marta Rigoni
- Healthcare Research and Innovation Program (IRCS-PAT-FBK), Bruno Kessler Foundation, Trento 38123, Italy
| | - Federico Piccoli
- Department of Laboratory Medicine, Azienda Provinciale per i Servizi Sanitari, Trento 38123, Italy
| | - Iole Caola
- Department of Laboratory Medicine, Azienda Provinciale per i Servizi Sanitari, Trento 38123, Italy
| | - Patrizio Caciagli
- Department of Laboratory Medicine, Azienda Provinciale per i Servizi Sanitari, Trento 38123, Italy
| | - Yesid Montoya
- Department of Biomedical Engineering, Antioquia School of Engineering—CES University, Sabaneta 055450, Colombia
| | - Giandomenico Nollo
- Department of Industrial Engineering, University of Trento, Trento I-38123, Italy
- Healthcare Research and Innovation Program (IRCS-PAT-FBK), Bruno Kessler Foundation, Trento 38123, Italy
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Finn R, Morris L. An experimental assessment of catheter trackability forces with tortuosity parameters along patient-specific coronary phantoms. Proc Inst Mech Eng H 2016; 230:153-65. [PMID: 26721906 DOI: 10.1177/0954411915623815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/01/2015] [Indexed: 11/15/2022]
Abstract
Coronary artery disease is one of the leading causes of cardiovascular deaths worldwide. Approximately 70% of patients requiring coronary revascularisation receive endovascular stents. The endovascular procedure is the preferred option due to its minimally invasive nature when compared to open heart surgery. Stent delivery is paramount for the success of the endovascular procedure. Catheter delivery forces within tortuous blood vessels can produce vasoconstriction and injury, resulting in reactive intimal proliferation or distal embolisation associated with end-organ ischaemia and infarction. Trackability is evaluated by most medical device companies for further development of their delivery systems. Relevant device design attributes must be tested in settings which simulate aspects of the intended use conditions, such as vessel geometry and compliance. Various tortuosity parameters are used to facilitate endovascular intervention planning. This study assessed the significance and correlation between the trackability forces for a coronary stent system with various geometrical parameters based on patient-specific geometries. A motorised delivery system delivered a commercially available coronary stent system and monitored the trackability forces along three phantom patient-specific thin-walled, compliant coronary vessels supported by a cardiac phantom model. The maximum trackability forces, curvature and torsion values ranged from 0.31 to 0.87 N, 0.06 to 0.22 mm(-1) and -11.1 to 5.8 mm(-1), respectively. The trackability forces were significantly different between all vessels (p < 0.002), while the tortuosity parameters were not significantly different (p > 0.05). A new tortuosity parameter-coined tracking curvature which considers the lumen radius as well as the curvature along the centreline was statistically different (p < 0.002) for all vessels and correlated with the trackability forces. There was a strong correlation between the cumulative trackability force and the cumulative tracking curvature. Tracking curvature could be used as a predictive clinical tool to aid stent delivery to the vicinity of the lesion.
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Affiliation(s)
- Ronan Finn
- Galway Medical Technologies Centre (GMedTech), Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway, Ireland
| | - Liam Morris
- Galway Medical Technologies Centre (GMedTech), Department of Mechanical and Industrial Engineering, Galway-Mayo Institute of Technology, Galway, Ireland
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Morris L, Fahy P, Stefanov F, Finn R. The Effects That Cardiac Motion has on Coronary Hemodynamics and Catheter Trackability Forces for the Treatment of Coronary Artery Disease: An In Vitro Assessment. Cardiovasc Eng Technol 2015; 6:430-49. [PMID: 26577477 DOI: 10.1007/s13239-015-0241-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/06/2015] [Indexed: 01/09/2023]
Abstract
The coronary arterial tree experiences large displacements due to the contraction and expansion of the cardiac muscle and may influence coronary haemodynamics and stent placement. The accurate measurement of catheter trackability forces within physiological relevant test systems is required for optimum catheter design. The effects of cardiac motion on coronary flowrates, pressure drops, and stent delivery has not been previously experimentally assessed. A cardiac simulator was designed and manufactured which replicates physiological coronary flowrates and cardiac motion within a patient-specific geometry. A motorized delivery system delivered a commercially available coronary stent system and monitored the trackability forces along three phantom patient-specific thin walled compliant coronary vessels supported by a dynamic cardiac phantom model. Pressure drop variation is more sensitive to cardiac motion than outlet flowrates. Maximum pressure drops varied from 7 to 49 mmHg for a stenosis % area reduction of 56 to 90%. There was a strong positive linear correlation of cumulative trackability force with the cumulative curvature. The maximum trackability forces and curvature ranged from 0.24 to 0.87 N and 0.06 to 0.22 mm(-1) respectively for all three vessels. There were maximum and average percentage differences in trackability forces of (23-49%) and (1.9-5.2%) respectively when comparing a static pressure case with the inclusion of pulsatile flow and cardiac motion. Cardiac motion with pulsatile flow significantly altered (p value <0.001) the trackability forces along the delivery pathways with high local percentage variations and pressure drop measurements.
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Affiliation(s)
- Liam Morris
- Galway Medical Technologies Centre, Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland.
| | - Paul Fahy
- Galway Medical Technologies Centre, Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland
| | - Florian Stefanov
- Galway Medical Technologies Centre, Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland
| | - Ronan Finn
- Galway Medical Technologies Centre, Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland
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Fernandes CR, Fonseca NM, Rosa DM, Simões CM, Duarte NMDC. Brazilian Society of Anesthesiology Recommendations for Safety in Regional Anesthesia. Rev Bras Anestesiol 2011; 61:668-94, 366-81. [DOI: 10.1016/s0034-7094(11)70077-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Capelli C, Nordmeyer J, Schievano S, Lurz P, Khambadkone S, Lattanzio S, Taylor AM, Petrini L, Migliavacca F, Bonhoeffer P. How do angioplasty balloons work: a computational study on balloon expansion forces. EUROINTERVENTION 2010; 6:638-42. [PMID: 21044919 DOI: 10.4244/eijv6i5a106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Claudio Capelli
- Cardiovascular Unit, UCL Institute of Child Health, London, United Kingdom
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Amarante JMB, Toscano CM, Pearson ML, Roth V, Jarvis WR, Levin AS. Reprocessing and reuse of single-use medical devices used during hemodynamic procedures in Brazil: a widespread and largely overlooked problem. Infect Control Hosp Epidemiol 2008; 29:854-8. [PMID: 18647118 DOI: 10.1086/590357] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Several medical devices used during hemodynamic procedures, particularly angiographic diagnostic and therapeutic cardiac catheters, are manufactured for single use only. However, reprocessing and reuse of these devices has been reported, to determine the frequency of reuse and reprocessing of single-use medical devices used during hemodynamic procedures in Brazil and to evaluate how reprocessing is performed. DESIGN National survey, conducted from December 1999 to July 2001. METHODS Most of the institutions affiliated with the Brazilian Society of Hemodynamic and Interventional Cardiology were surveyed by use of a questionnaire sent in the mail. RESULTS The questionnaire response rate was 50% (119 of 240 institutions). Of the 119 institutions that responded, 116 (97%) reported reuse of single-use devices used during hemodynamic procedures, and only 26 (22%) reported use of a standardized reprocessing protocol. Cleaning, flushing, rinsing, drying, sterilizing and packaging methods varied greatly and were mostly inadequate. Criteria for discarding reused devices varied widely. Of the 119 institutions that responded, 80 (67%) reported having a surveillance system for adverse events associated with the reuse of medical devices, although most of these institutions did not routinely review the data, and only 38 (32%) described a training program for the personnel who reprocessed single-use devices. CONCLUSIONS The reuse of single-use devices used during hemodynamic procedures was very frequent in hospitals in Brazil. Basic guidance on how to reuse and reprocess single-use medical devices is urgently needed, because, despite the lack of studies to support reusing and reprocessing single-use medical devices, such devices are necessary in limited-resource areas in which these practices are current.
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Sloan TW. Safety-cost trade-offs in medical device reuse: a Markov decision process model. Health Care Manag Sci 2007; 10:81-93. [PMID: 17323656 DOI: 10.1007/s10729-006-9007-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Healthcare expenditures in the US are approaching 2 trillion dollars, and hospitals and other healthcare providers are under tremendous pressure to rein in costs. One cost-saving approach which is gaining popularity is the reuse of medical devices which were designed only for a single use. Device makers decry this practice as unsanitary and unsafe, but a growing number of third-party firms are willing to sterilize, refurbish, and/or remanufacture devices and resell them to hospitals at a fraction of the original price. Is this practice safe? Is reliance on single-use devices sustainable? A Markov decision process (MDP) model is formulated to study the trade-offs involved in these decisions. Several key parameters are examined: device costs, device failure probabilities, and failure penalty cost. For each of these parameters, expressions are developed which identify the indifference point between using new and reprocessed devices. The results can be used to inform the debate on the economic, ethical, legal, and environmental dimensions of this complex issue.
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Affiliation(s)
- Thomas W Sloan
- College of Management, University of Massachusetts Lowell, Lowell, MA 01854, USA.
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