HYBRID OPERATING ROOM

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


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


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


SPACE PLANNING

7-8 METRES

8-1

0 M

ETR

ES


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


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


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…


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



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



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


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


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


• 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)


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


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.


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


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


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

HYBRID OPERATING ROOM

Education

Transcript of HYBRID OPERATING ROOM