Disconnect monitors

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Disconnect monitors

Glenn E. Woodworth, MD

A review of studies looking at closed-claims databases indicates that the percentage of total claims related to the gas-delivery system has been steadily decreasing over the past few decades—from 3% in the 1970s to 2% in the 1980s, and representing only 1% of total claims in the 1990s. In the most recent closed claims update on patient injuries from anesthesia gas delivery equipment from 2000 through 2011, there were no claims for breathing circuit disconnects. In addition, the morbidity rate from these claims appears to be decreasing as well. However, major anesthesia-related morbidity and mortality risk is still often related to problems with the patient’s airway and ventilation, including problems with the breathing circuit and, in particular, disconnections of the circuit. Therefore, anesthesia providers must be ever vigilant to prevent and detect breathing-circuit problems. One closed-claims analysis indicated that 78% of breathing-circuit problems were deemed preventable by appropriate monitoring.

One of the most common critical incidents with gas-delivery systems is disconnection of the breathing circuit during mechanical ventilation—the most common disconnection sites are between the breathing circuit and the tracheal tube connection and between the breathing circuit and the heat-moisture exchanger, if one is used. Of note, cost-containment measures often advocate reusing breathing-circuit components; however, sterilization procedures may degrade conical plastic fittings, making them more likely to disconnect.

Risk-reduction measures have focused on three general areas: (1) secure locking of mated components (several devices are available; however, their use increases cost, may inhibit quick disconnection if an emergency disconnection is warranted, and may be undesirable if their use leads to an increased risk of an accidental extubation or barotrauma), (2) education, and (3) the use of disconnect monitors and alarms for detection of disconnects.

Disconnects cannot be completely prevented; therefore, monitoring for such an event is essential. Disconnect alarms can be classified into four categories (Box 12-1).

Box 12-1   Types of Disconnect Alarms

Pressure monitors

Respiratory volume monitors

CO2 monitors

Miscellaneous monitors

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