(posted on behalf of Alison Herdman)
The next Ansafe Meeting will be held on the Friday after Easter which is April 21st.
The meeting will be held as usual at the Southport Anaesthetic Services HQ at Minnie St and will start at 6pm promptly.
If you have any agenda items for Pindara, GCPH, GCSH or any issue which is bothering you please email me directly, or;
- For Pindara James Derrick
- For GCPH Adrian Skidmore or Stuart Green
- For the GCSH Phil Lo
- JFH have their own Anaesthetic Meetings which are chaired by Di Sapwell but very often Pindara issues are Ramsay issues so items overlap. Andrew Cairncross is the Anaesthetic MAC representative at JFH
You can also submit agenda items online from the GCAPE AnSafe page.
At a recent clinical meeting, our local allergy guru Helen Crilly spoke about the growing and potentially lethal problem of chlorhexidine allergy. Helen has graciously provided the source documents for the chlorhexidine allergy kits that have recently been added to the red anaphylaxis boxes.
Please find attached docs from the Friday night meeting as promised. Other than the ANZCA Docs these aids are not endorsed – just what I use to manage chlorhexidine free when I have a case. We are going to develop this and ultimately get it up on ANZAAG website.
The documents are mostly in word format so that they can be customised according to local needs.
- Drug infusion guidelines for JFH
- Docs for chlorhex free management including ANZCA docs
- Chlorhex stickers – Wipes sticker is meant to be placed near all injection points to prevent wiping of IV line access points. The Chlorhexidine anaphylaxis label can be used on cover of chart or other documents that you want to highlight chlorhex allergy, on patient wrist bands (or patient forehead if necessary!) These should be printed on 14 sticker (7×2) Avery template L7163FP – available from Officeworks in a variety of colours (I prefer the fluoro pink).
- Chlorhex signs – sent as word docs in case anyone wants to customise. Best if they are laminated.
I have uploaded a new colour coded CICO flowchart and equipment pack PDF, reflecting the move from the Enk to Rapid-O2 device. You can download a copy from the CICO page.
With the CICO “pink” packs (cannula crico/tracheotomy) nearing expiry at many hospitals, I have decided to update them with new equipment. The Enk kits will be replaced by the “Rapid O2” device and 14ga insyte cannulas. This brings us in line with Andy Heard’s recommended equipment for use with his algorithm.
Further information may be found here;
In short, they are easier to use than the Enk, cheaper, and give better feedback if there is obstruction. Roll out of this device will occur across facilities as packs expire.
The Rapid O2 rep will be at GCPH from 10:00 to 14:00 on Thursday 20th July to conduct education with the device.
Please contact me if you have any concerns, or would like further information.
FDA Drug Safety Communication: FDA review results in new warnings about using general anesthetics and sedation drugs in young children and pregnant women.
The U.S. Food and Drug Administration (FDA) is warning that repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children’s brains.
Full article at http://www.fda.gov/Drugs/DrugSafety/ucm532356.htm
Implementation of non-luer, non-interconnectable neuraxial connectors
The International Organization for Standardization (ISO) standard for device connectors used for neural applications has been published. The devices on which these connectors will be used are neuraxial, including spinal and epidural access, cerebral intraventricular drainage and access devices, peripheral nerve anaesthesia devices and associated equipment required such as syringes, infusion connectors (patient end) etc. See ISO 80369-6 Small bore connectors for liquids and gases in healthcare applications – Part 6: Connectors for neuraxial applications.
ANZCA’s position on CICO
ANZCA has clarified its position on can’t intubate, can’t oxygenate (CICO) front of neck access in response to the release of the Royal College of Anaesthetists’ (RCoA) statement “Anaesthetists and surgeons reach agreement on front of neck emergency techniques in life-threatening ‘CICO’ situations”, associated with a BJA editorial “Surgical intervention during a can’t intubate can’t oxygenate (CICO) event: emergency front of neck airway (FONA)?”. The College does not “mandate” one approach to FONA over the other for a number of reasons. For more information, please see here.
New airway assessment resource
A new resource, Airway Assessment, has been produced for use by ANZCA Fellows and trainees to improve understanding and to guide management of airway assessment and difficult airways. It is the first of a series of airway resources and complements the Transition to CICO resource document (and ANZCA professional document PS61).
Practice points: postoperative monitoring
Understanding the time periods of highest risk and individual patient risk factors for respiratory depression may assist in efficient resource allocation in postoperative patients. Drug-induced respiratory depression is associated with significant morbidity and mortality in the postoperative period and medical devices such as telemetry systems are a valuable resource often used for monitoring patients after surgery. Read the full article on the TGA website.
(Posted on behalf of Alison Herdman)
The next AnSafe Meeting will be a combined business meeting and M&M.
It will be on Friday October 14th 5.30pm to start at 6pm.
The venue is once again the SAS HQ which is 84 Minnie St Southport.
Please email me with any M&M case you think would be of interest to present.
The GCPH Emergency Alarm issue will be discussed and we hope that representatives from the GCPH Exec will be present.
For other items to go on the agenda please contact me, Stuart Green, Adrian Skidmore, or Ian Cameron, or submit via the AnSafe web page.
Here are some selected links from the most recent ANZCA bulletin;
Hydroxyethyl starch (Voluven and Volulyte) – “In addition to the potential risks for patients with sepsis (detailed below), the updated review found that the increased risk of death and kidney injury that may need kidney replacement therapy (such as dialysis) applies to all critically ill patients, such as those typically admitted to the intensive care unit of a hospital.”
Marcain Spinal 0.5% Heavy and reports of failed or incomplete spinal anaesthesia – “In August 2015, the TGA received notification from one hospital that there had been five occasions where hyperbaric Marcain failed to achieve adequate spinal anaesthesia, despite administration by experienced clinicians…. Failure of spinal blockade is a recognised complication of this type of anaesthetic, with incidences suggested in the medical literature of between 2-4%… products tested were found to be within specification, and results concurred with those from testing conducted by AstraZeneca…. These investigations were closed out without requiring any further action.”
AnSafe is now an approved site for webAIRS. Incidents can be entered under AnSafe and this information will be fed back to the Committee and the relevant hospitals.
You can earn 2 credits per hour for Incident Reporting/Monitoring under the difficult to obtain Practice Evaluation category.
How to sign up to webAIRS
When it comes to registering with a site, choose the first option, “Register with an existing Hospital, Private Practice or other organisation.” Then drill down through Australia, QLD, Gold Coast, and select AnSafe.
If you are already registered, then the process of registering with AnSafe is exactly the same.