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HYBRID OPERATING ROOMPRESENTED BY:SUFYAN AHMADNAZIA KHANAM
CONTEMPORARY TECHNOLOGY
FACILITY WITHIN HOSPITAL WHERE SURGICAL OPERATIONS ARE CARRIED OUT IN A STERILE ENVIRONMENT.
FEATURES OF AN OPERATION THEATRE:• Generally windowless• Controlled temperature and humidity.• Special air handlers filter • The air and maintain a slightly elevated pressure.• Rooms are supplied with wall suction, oxygen, and possibly other,
anesthetic gases.
OPERATION THEATRE: INTRODUCTION
1/20Presented by : Nazia Khanam
AnesthesiologistSurgeonscrub nursecirculating nurse
WORK ZONE IN OPERATION THEATRE
HYBRID OPERATION THEATRE…A hybrid operating theatre is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scannersExamples : 1.Cardiac 2.Vascular 3. Neurosurgery hybrid operation room
1. Surgical Lights, Recessed & Extended Length
2. Video / Audio OR Integration
3. Ceiling Mounted Booms4. Equipment Carriers5. Anesthesia Booms6. Surgical Displays7. Mobile Surgical Tables8. Stainless Cabinetry &
Supply Storage Solutions9. Space for Nurse Assistant10. C-Arm11. Anesthesia Machine,
Transesophageal Echo, Intracardiac Echo
4 1
2
3
45 6
7
8911
10
2/20Presented by : Sufyan Ahmad
SALIENT FEATURES: HYBRID OPERATION THEATRE
Patient safety Cost saving for the patient State-of-the-art imaging during surgery It allows us to do more complex procedures Physicians with different skills can work simultaneously
ADVANTAGES OF HYBRID OT
The main advantages of hybrid OT are :
Minimized procedural and patient risk Optimized success rates Enhanced complication management Advanced workflow efficiency
3/20Presented by : Nazia Khanam
Hybrid OR with CT
Orthopaedic and surgeon for trauma
Hybrid OR with MRI
Neurosurgery
Hybrid OR with Angiographie Cardiovascular
surgeons and cardiologists Neurosurgery and
neuroradiologist
Interventional Team• Interventional cardiologist(s)• Interventional cardiology fellow(s)
Echocardiography Team• Echocardiographer• Echo tech
Nursing/Support Staff• Scrub nurse(s)• Cathnurse(s)• OR nurse(s)• Radiology tech(s)
Surgical Team• Cardiothoracic surgeon(s)• Cardiothoracic fellow(s)
Anesthesiology Team• Anesthesiologist• Nurse Anesthetist
Perfusion Team• Perfusionist• Possible second
4/20Presented by : Sufyan Ahmad
PLANNING OF HYBRID OR
Hybrid OR
Corridor
Clean Core
Electronics
Procedure(60-90 sqm)
MaterialSupport
Control Room & Electronic Equipment
Scrub &Gurney
IR/Cath/ Hybrid
Use
Subsequent Use
Control RoomFlex Zone
ProcedureZone
5/20Presented by : Sufyan Ahmad
SPACE PLANNING
7-8 METRES
8-1
0 M
ETR
ES
6/20Presented by : Sufyan Ahmad
DESIGN CONSIDERATIONS – CARDIOVASCULAR
1
2 3
4
3
4
3
2
1
Assisting Surgeon
Surgeon
Anesthesiologist
Assisting Nurse
6
7
8
9
10
Anesthesia Machine
5
Anesthesia Cart
6 Control Pedestal7
Ultrasound (IVUS)
8
Contrast Injector9
Patient Warmer
10
5
11
11 Heart Lung Machine
7/20Presented by : Sufyan Ahmad
DESIGN CONSIDERATIONS – NEUROSURGERY
1
2
3
4
3
4
3
2
1
Assisting Surgeon
Surgeon
Anesthesiologist
Assisting Nurse
5
6
7
8
9
10
Anesthesia Machine
5
Anesthesia Cart
6
Control Pedestal7
Ultrasound (IVUS)
8
Contrast Injector
9
Patient Warmer
10
11 Navigation
11
12 Microscope
12
8/20Presented by : Sufyan Ahmad
AM
AC
EEG
AN
N
AS S
N
USINJ
AM
AC
EEG
AN
N
AS
S
US
INJ
Surgeon
Assisting Surgeon
Nurse
Anesthesiologist
Contrast Injector
Ultrasound (IVUS)
Physiologic Monitoring
Anesthesia Machine
Anesthesia Cart
TYPICAL VASCULAR PROCEDURE…
9/20Presented by : Sufyan Ahmad
AM
AC
EEG
AN
N
S
INJ
AM
AC
PCW
AN
PA
AS
S
NAV
INJ
Surgeon
Assisting Surgeon
Nurse
Anesthesiologist
Contrast Injector
Navigation
Patient Cooler/Warmer
Anesthesia Machine
Anesthesia Cart
PCW
NAV
MIC
MAS Mobile Aspirator
MIC Microscope
N
TYPICAL VASCULAR PROCEDURE…
10/20Presented by : Sufyan Ahmad
AM
AC
EEG
AN
N
S
INJ
AM
AC
PCW
AN
PA
AS
S
NAV
INJ
Surgeon
Assisting Surgeon
Nurse
Anesthesiologist
Contrast Injector
Navigation
Patient Cooler/Warmer
Anesthesia Machine
Anesthesia Cart
PCWNAV
MIC
MAS Mobile Aspirator
MIC MicroscopeN
TYPICAL VASCULAR PROCEDURE…
11/20Presented by : Sufyan Ahmad
CONSIDERATIONS WHILE CONSTRUCTING HYBRID ORHybrid OR Room Specifications
Specifications Catheterization Lab Cardiac OR Hybrid OR
Square Meter 37-56 56-70 60-90
Ceiling Height (In meter) 3 3 3-3.6
Ceiling Type Lay-in type ceiling permitted Monolithic, scrubbable,capable of withstandingchemicals
Monolithic, scrubbable,capable of withstandingchemicals
Ceiling Structural Reinforcement/Design
Support for ceiling-mounted C- arm
Support for boom-mounted equipment, sufficient space for HVAC duct-work
Support for boom-mounted equipment, and uni-strut reinforcement for ceiling mounted C-arm, sufficient space for HVACduct-work
Room Shielding Lead Lined N/A Lead Lined
Optimal Temperature (F) 70-75 68-73 68-75
Air Exchange Rate 20-25 15-20 20-25
Illuminance (Lux) 300 500-1,000 500-1,000
Special Lighting Needs Dimmable, ambient lighting, minor surgery task light
External surgical field, fiber optic, microscope illumination systems
External surgical field, fiber optic, microscope illumination systems
Number of Electrical Outlets 8 24 >24
12/20Presented by : Nazia Khanam
14
UNDERSTANDING ALL THE EQUIPMENTS IN HYBRID O.R.
C-ARM Carbon FibreTable
Surgical LightsEcho Technology Audio-Video Integration
• An X-ray image intensifier (XRII)an image intensifierthat converts x-raysinto visible light at higher intensity
• Transesophagealecho
• Transthoracic echo• Intracardiac echo• Intravascular
ultrasound
• To optimize the usefulness of the radiographic equipment
• provide complete clearance beneath a panning x-ray system.
• Top priority features: lighting intensity, color temperature, heat control, shadow control, and flexibility
• Touch screens• Voice activated
controls• Video conferencing
13/20Presented by : Nazia Khanam
21
UNDERSTANDING ALL THE EQUIPMENTS IN HYBRID O.R.
Other Essentials for the Hybrid Operating Room
Anesthesia Equipment
• Anesthesia becoming standard of care in hybrid ORs for cath, hybrid, and EP procedures alike
• If not mounted, is space-intensive, and must be in close proximity to the patient/table
Lead Shielding
Power Injectors
Hemodynamic Monitoring
• Used to reduce the risk of exposure to radiation beams, ionizing radiation
• May be incorporated into the lab’s infrastructure—both within the walls and within the lab via side table drapes, door- or ceiling-mounted acrylic shields, and lead aprons
• Angiographic injectors should be able to attach to catheters from the cath table and at any catheter introduction site
• Ceiling-mounted injectors are preferable (lower risk of contaminating the sterile field, occupy less space than floor- mounted systems)
• Systems should interface with a lab’s documentation systems to record and store information for later review
14/20Presented by : Nazia Khanam
• Designed for maximum safety and efficiency, these Interlock Systems are configured to provide automatic shut-off of the laser beam if safety doors, covers or blinds are opened.
• Interlock Systems are able to operate laser interlocks, laser power, beam shutters and warning signs and can be fitted with entry/exit overrides and emergency stop switches. A key-lock prevents unauthorised use.
• Wipe clean for excellent infection control
• Flexibility to accommodate design changes with ease
• Easy upgrade to accommodate future services Proven reliability
• Compact size where operating roomspace is at a premium
• Modern appearance complements today’s high tech operating rooms
• Ability to incorporate third party interfaces
Electronic Touch Screen Panel
Laser Interlock systems
• saves space
• enhancing the multi-disciplinary use of the OR
• wide variety of distribution modules, extensions and optional accessories makes it easy
• fewer cables and devices on the floor surrounding the operating table, doctors benefit from better access to the patient.
Ceiling supply units (CSUs)
15/20Presented by : Nazia Khanam
29
BEHIND-THE-SCENES CONTROLS
Ancillary Controls in the Hybrid OR
Temperature
• Full-scale temperature and humidity control
• Pediatrics patients must be kept at a relatively high temperature such that they do not acquire hypothermia (leading to cardiac arrest)
• Room temperature shouldremain between 68 and 80degrees fahrenheit
• Anesthetic gases—oxygen, air, suction, nitrous, gas scavenge—housed on a single boom (column) with network/electrical connections
• Gases to support a heart-lungmachine in the room may behoused on a single boom
• Be aware of source of thegases, lengths of the hoses required—select procedures require nitrogen as does a sternal saw if needed
• Careful planning should ensure that high- and low- voltage connections are converted in the ceiling—and not mounted behind monitors—and pulled through a boom
• High-voltage connections must be housed in shielded conduits
• Booms should be designated as either high- or low-voltage
Gases Electricity
16/20Presented by : Sufyan Ahmad
SERVICES OF HYBRID OR
VENTILATION:• There should be +ve pressure ventilation with
lowering pressure gradient from sterile to protective zone laminar flow.
• All anaesthetic gases to be vented out to exhaust.• Flow of air 2 to 3 cu meter minute.
AIR CONDITIONING:• Control asepsis, controlled air flow, positive
pressure.• Maintenance of temperature 22 degree Celsius
for comfort.• Humidity 55% + or – 5 % only.• 100% fresh air with 20 changes per hour.• Filter of 1 to 3 micron size to be used.• Control air-conditioning system.• False ceiling 1 meter below the roof.
17/20Presented by : Sufyan Ahmad
STRUCTURAL COMPONENTS OF HYBRID OPERATION THEATRE:
Walls:• Melanin facing walls for easy cleaning.• The inner surface walls will be constructed with
1.60mm thick EGP steel panels backed by 12-mm gypsum board
• Pale colour to be used.• Resistant to minor damage or impact.• All the sharp edges and corners will be in radius
to avoid bacteria contamination.• Door opening should be min. 1.5 M wide,
swinging and 2.1 M height.
Roof:• Should take the load of OT lights, X-rays unit, TV
camera, Gas and electric panels.
Floors:• Easily washable, non staining, impervious.• The floor finish in the operating room should be
Conductive PVC tiles, laid on a semi conductive adhesive base.
• The floor finish should continue up the wall for 100mm.
http://pdt.com.au/u/lib/mob/20150317161414_3c7c241034454de62/sawmh-ot10-03a-low-res.jpg
18/20Presented by : Sufyan Ahmad
Advantages Disadvantages
1. Shorter patient recovery time2. Decreased length of stay3. Streamlined delivery of care4. Overall lower cost of care5. Potential for revenue growth6. Minimized risk for communication-related
errors clinical specialities7. Effectiveness and efficiency in training,
teaching and research8. High quality imaging vastly superior to
portable systems9. Promotes the multidisciplinary process
and allows for efficient use of staff and equipment
1. Cost2. Infection risk3. Prolonged general anaesthetic4. Prolonged radiation exposure
ADVANTAGES AND DISADVANTAGES OF HYBRID OR
• Companies dealing in HYBRID OR: Philips, skytron, seimens, maquet
19/20Presented by : Sufyan Ahmad
REFERENCES
• http://cathlabdigest.com/articles/Cardiovascular-Hybrid-Surgical-Room-Evolving-Future-Cardiovascular-Surgery#sthash.pyufaslw.dpuf
• http://hybridoperatingroom.com/hybrid-or-operating-room-skytron-surgical-lights-booms-monitors-tables-equipment-anesthesia/
• http://static.squarespace.com/static/50305915e4b00d577d14e583/50a52d36e4b0e80bad99a190/50a52d37e4b0f7142090aed5/1353002295944/Hybrid-OR-Operating-Room-Layout-Drawing-Siemens-Zeego-vs-Philips-FlexMove-Imaging-Systems-SKYTRON.jpg
• http://hybridoperatingroom.com/hybrid-operating-room-layouts-3d-design-mockups/
• http://www.maquet-hybridoperatingroom.com/slide-show/
• http://www.ctsnet.org/portals/endovascular/nutsbolts/Nollert_HypridOR_fig5
• http://www.youtube.com/watch?v=Oeg8wIhrn5w
• http://www.christusspohn.org/hybridsurgicalsuite
20/20Presented by : Sufyan Ahmad & Nazia Khanam
THANKYOU