Oxford Meeting - November 2002

The Re-Use of Equipment Between Patients Receiving Total Intravenous Anaesthesia (TIVA) Anaesthesia: A Postal Survey of Current Practice.

Dr Matthew Halkes, Specialist Registrar in Anaesthesia. Department of Anaesthesia, Torbay Hospital, Torquay, Devon, TQ9 6SJ, UK

 Introduction: Anaesthetists vary in their practice with regard to which components of infusion systems used to administer TIVA are changed between patients (personal observation, [1]).

Aims: To identify current practice amongst consultants who regularly use TIVA.  A secondary aim was to establish if the consultants were aware of any relevant national or local guidelines.

Methods: An anonymous postal survey was conducted of consultants in ten district general hospitals in the South West and the membership of SIVA UK.

 Results:

Table 1: Analysis of responses 

  Table 2: Equipment changed between cases                                             

* One consultant responded to both surveys. Only counted once in totals.

   Table 3: Awareness of guidelines

Discussion: Just under half of the consultants (46%) change all equipment between cases, presumably because they are concerned that the infective risk [2] of re-using equipment out ways the cost benefit. The remainder (54%) re-use some components of the infusion system. The majority of this group (69%) appear to believe that the use of a one way valve confers additional protection against contamination. However failure of one way valves has been reported [3] and it has been proposed that pathogens may be able to migrate upstream even in the presence of a functioning valve [1]. A minority simply change the distal components of the infusion system and do not use a one way valve. A literature search has failed to find any published cases of cross infection secondary to the reuse of TIVA equipment or any experimental data that might help quantify the level of risk.

Only 13% of consultants were aware of any published guidelines. The most frequently quoted was the product datasheet for pre-filled propofol syringes, which states that they are for “single patient use only” and should not be regarded as multi-dose vials. Not all the consultants who quoted this standard complied with it. The Medical Devices Agency guidance counsels against the re-use of equipment [4], pointing out that the practitioner then becomes legally liable for any consequences. This advice has been reiterated by the RCA and AAGBI, but none of these bodies has issued specific guidance with regard to TIVA. Three hospitals apparently have local policies in place. One of these was in our DGH survey, but none of the other consultants from this department appeared aware of this policy.

Summary: We have identified that guidelines do exist advising against the re-use of TIVA equipment. Our survey shows that this is far from universal practice and that knowledge of the guidelines is poor. Having a specialist interest in intravenous anaesthesia does not significantly affect clinical practice or knowledge of guidelines. The level of risk associated with the re-use of equipment is impossible to quantify. However, it is clear that should a disaster occur the practitioner (or their employer) bears the legally liability and financially compensating a patient is likely to completely negate any cost saving.

[1]  www.doctors.net.uk/forum

[2] Munchen K P.  Spritzen-oder Leitungswechsel bei TCI?   Anaesthetist 1998: 47:434-436

[3] Crosby E.  Intravenous infusions and one way valves.   Canad J Anaes  1991: 38: 6: 799-800

[4] Medical Device Agency. Single Use Medical Devices: Implications and consequences of re-use.  Device Bulletin (04): August 2000