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LETTER TO EDITOR
Year : 2019  |  Volume : 20  |  Issue : 2  |  Page : 115-116
 

Pressure transducer damage due to broken flush syringe?


1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, Bihar, India
2 Department of Anaesthesia, All India Institute of Medical Sciences, Patna, Bihar, India

Date of Web Publication28-Aug-2019

Correspondence Address:
Dr. Neeraj Kumar
Room No. 216, PG-1, All India Institute of Medical Sciences Campus, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TheIAForum.TheIAForum_42_19

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How to cite this article:
Kumar N, Kumar A, Kumar A. Pressure transducer damage due to broken flush syringe?. Indian Anaesth Forum 2019;20:115-6

How to cite this URL:
Kumar N, Kumar A, Kumar A. Pressure transducer damage due to broken flush syringe?. Indian Anaesth Forum [serial online] 2019 [cited 2019 Nov 13];20:115-6. Available from: http://www.theiaforum.org/text.asp?2019/20/2/115/265655




Sir,

Arterial pressure measurement represents a key step in the evaluation of patients' hemodynamics because it not only gives the primary information about the performance of the cardiovascular system but also the tissue perfusion.[1] Arterial monitoring involves direct measurement of arterial pressure by inserting a cannula needle in a suitable artery. The cannula is to be connected to a sterile, fluid-filled system, which is connected to an electronic patient monitor. The components of an intra-arterial monitoring system have three main parts: measuring apparatus, transducer, and monitor. A pressure bag of heparinized 0.9% saline is pressurized to 300 mmHg and attached to the fluid-filled tubing via a flush system, and slow infusion of fluid at a rate of about 2 ml/h is kept to maintain the patency of the cannula. We describe here a very unusual cause for the malfunction of the transducer and novel technique to prevent this problem.

A 70-year-old male was posted for wide local excision, segmental mandibulectomy with bilateral modified radical neck dissection and free fibular graft with flap reconstruction under general anesthesia. Arterial catheterization was planned to measure invasive blood pressure in view of prolonged duration of surgery, anesthesia, and frequent sampling for arterial blood gases. A 20-gauge radial artery set (Arrow International, Reading, PA, USA) was used for continuous intra-arterial blood pressure monitoring. The sets were connected to a disposable pressure transducer (Medex, Smiths Medical International, USA) using rigid pressure tubing of identical length. Air bubbles were flushed carefully from the system. The zero level for arterial blood pressure was taken at the phlebostatic axis. Meanwhile, in the intraoperative period, a team of plastic surgeons were getting ready to perform the free fibular graft on the patient's left lower limb; however, during the movement of surgeons, accidentally, the 10 ml syringe that was attached to the transducer system was broken from its distal end. The distal hub of 10 ml disposable syringe was found stuck in the transducer [Figure 1]. We replaced the transducer with a new one for continuous blood pressure monitoring and intermittent arterial blood gas sampling. To prevent this situation again, we made an assembly using 10 cm line with three-way stop cock (Life-o-line Technologist, Ahmedabad, Gujarat, India) and connected it to the hub of transducer [Figure 2]. This simple technique can prevent the transducer for accidentally being damaged due to a disposable syringe. On searching the literature, we could not find any such report of transducer damage, however, pressure transducer cable malformation has been reported.[2]
Figure 1: Arrow showing broken hub of syringes into the transducer

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Figure 2: A 10-cm connector with three-way stop cock attached to the transducer

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Acknowledgment

Written informed consent for publication obtained from the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal the identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Antonelli M, Levy M, Andrews PJ, Chastre J, Hudson LD, Manthous C, et al. Hemodynamic monitoring in shock and implications for management. International consensus conference, Paris, France, 27-28 April 2006. Intensive Care Med 2007;33:575-90.  Back to cited text no. 1
    
2.
Ishikawa S, Nakazawa K, Makita K. Malfunctioning transducer cable causes underestimation of arterial blood pressure. Anaesthesia 2004;59:414.  Back to cited text no. 2
    


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