ARC Medical, Inc.ThermoFlo™

In-service Presentation

Presented by

ARC Medical, Inc.

800.950.2720

www.arcmedical.com

EXCEEDING THE STANDARD FOR NEARLY 25 YEARS.

ARC was formed in 1990 to address the needs of providing in line humidification.

Our goal is to replace the need for heated water bath humidifiers.

T h e rmo F lo ™ S y s t em was t he f i r s t t o ex c eed A A RC ’s

rec om m ended s t anda rd o f 30+m g H 2 0 /L a i r @ 20L V E .

( A s e v i d e n c e d i n i n d e p e n d e n t s t u d i e s . )

Or i g i na l HM E dev i c es we re des i gned f o r s ho r t t e rm us e i n

I CU , Rec ov e ry, A nes t hes i a , e t c .

M os t s t i l l do no t p rov i de adequa t e m o i s t u re f o r l ong t e rm

pa t i en t us e .

NOT ALL HMEs ARE CREATED EQUAL

They Absorb!

PAPER, FOAM, SPONGEWhat happens when they get wet?

T H E T E R M H Y G R O S C O P I C R E F E R S T O T H E A B I L I T Y O F A

M AT E R I A L T O A B S O R B H U M I D I T Y F R O M T H E A I R .

( H Y G R O S C O P E I N D I C AT E S C H A N G E S I N H U M I D I T Y . )

H Y D R O P H I L I C R E F E R S T O   S U B S TA N C E S T H AT A B S O R B W AT E R .

H Y D R O P H O B I C M AT E R I A L S H AT E W AT E R A N D R E P E L I T.

W H I C H T E R M ( S ) D O Y O U T H I N K A P P L I E S TO T H E R M O F L O ™ ?

T H I S I S W H Y W E A R E D I F F E R E N T F R O M T H E C O M P E T I T I O N !

WHY IS THIS IMPORTANT?

Zero!When used from Intubation to Extubation

NEVER a reported endotracheal

tube occlusion, or pneumothorax

with ThermoFlo™.

CONSTRUCTION

HME media

Filter with hydrophobic membrane

Unitized Construction

MEDIA: Spun Polypropylene with a calcium chloride coating

FILTER: 3M Filtrete with a hydrophobic membrane

UNITIZED CONSTRUCTION:

The device will not fit together if the filter is not properly in place within the wall of the device.

33

32

31

30

29

28

27

Conventional“Passive Humidifiers” ThermoFlo™

@ 1

0L V

E

@ 2

0L V

E

@ 1

0L V

E

@ 2

0L V

E

Mg

H20

/ L

Air

Exceeds Standards @ 20L VE

Data on file

No others match

our performance

record

THERE IS SAFETY IN OUR NUMBERS

KK Stout, Poster Presentation, American College of Chest Physicians Nov. 1994

Duke University Medical Center, Durham, NCSharon Day, RRT, Robert McConnell, RRT, Heather Fredericksen, RRT, Neil R. Maclntyre, MD

BACKGROUND: A hygroscopic condensing humidifier (HCH) is a passive humidification device that collects heat and humidity from expired gas of a patient on a mechanical ventilator and conditions inspired gas as it passes back through the device. A heated wire circuit (HWC) actively adds heat and humidification to the inspiratory limb of a warmed circuit after passing through a heated water canister.

METHODS: All patients requiring mechanical ventilation between 2/22/96 and 4/24/96 were eligible for the study. Patients were randomly assigned to receive either a hygroscopic condensing humidifier (ThermoFlo™ ARC Medical, Inc) or a heated wire circuit (Bear 5 circuit by Marquest). Sputum was categorized on each day of the mechanical ventilation as: watery (sputum that can be suctioned like water, after suction is terminated no secretions remain attached to the inner surface of the suction catheter), moderate (sputum of moderate viscosity, after suction is terminated, some secretions remain attached to the inner surface of the suction catheter) or tenacious (thick sputum, after suction is terminated, most secretions are still attached to the inner surface of the Catheter, and they cannot be easily removed by suctioning water through the catheter). If during different suctioning episodes on the same day, sputum was judged differently, both categories were used. Chi square analysis was used to compare sputum categories in each group with P < .05 taken as significant.

RESULTS: Fifty-eight patients were recruited and 286 patient-days of sputum categorization were performed (125 in the HWC group, 161 in the HCH group). Sputum categories in each group (percentage of patient-days): Watery Moderate Tenacious HCH 12.4% 79.5% 11.2% HWC 11.2% 88% 13.6%

There was no significant difference is sputum categories between the two groups.

CONCLUSION: Sputum consistency was similar using either HCH or HWC humidification systems.

OF-96-111Presented at the AARC, November, 1996

COMPARISON OF LONG TERM USE OF A HYGROSCOPIC CONDENSING HUMIDIFIER VERSUS HEATED WIRE CIRCUIT

¨ H umi d i f i ca t i on i s r ecommended on eve ry pa t i en t r ec e i v i ng i nvas i ve mechan i c a l ven t i l a t i on .

¨ W hen p rov i d i ng pas s i v e humi d i f i ca t i on t o pa t i en t s unde rgo i ng i nvas i ve mechan i c a l ven t i l a t i on , i t i s sugges ted t he H ME p rov i de a m i n imum o f 30 mg H 2 0 / L .

¨ P as s i v e humi d i f i ca t i on i s no t r ecommended f o r non i nvas i ve mechan i ca l ven t i l a t i on .

¨ C ondensa t i on f r om the pa t i en t c i r c u i t shou l d be c ons i de red i n f ec t i ous w as te and d i sposed o f acco rd i ng t o hosp i t a l po l i c y, us i ng s t r i c t un i v e rsa l p rec au t i ons .

RELATIVE CLINICAL PRACTICE GUIDELINES

AARC Clinical Practice Guideline Humidification During Invasive and Noninvasive Mechanical Ventilation: 2012

Ruben D. Restrepo, MD, RRT, FAARC & Brian K. Walsh, RRT-NPS FAARC

...when you can use ThermoFlo™ and have a

clean, dry circuit?

Why connect your ET tube to red bag waste…

“Condensation from the patient circuit should be considered infectious waste and disposed of according to hospital

policy, using strict universal precautions.”

AARC Clinical Practice Guideline 2012Ruben D. Restrepo, MD, RRT, FAARC &

Brian K. Walsh, RRT-NPS FAARC

ThermoFlo™ ENDS WATER PROBLEMS BY PROVIDING

A CLEAN, DRY CIRCUIT.

NO more water on the bed, floor, or your shoes, when the circuit is disconnected!

NO more water traps to drain!

NO more Peep Spray!

E l i m i n a t e s t h e n e e d f o r

w a t e r c o l u m n s .

E l i m i n a t e s w a t e r t r a p s i n

l i n e .

E l i m i n a t e s i n f e c t i o u s p e e p

s p r a y w h i l e d i s c o n n e c t i n g

t h e c i r c u i t .

E l i m i n a t e s t h e n e e d t o

p u r c h a s e c o s t l y w a t e r.

ELIMINATES ADDITIONAL COSTS

Use on NEW patients when possible.

Conversion with existing patients requires additional effort, and psychiatric preparation.

MDI or Neb treatments may be given between patient and filter.

Check for increased resistance after treatment.

Follow manufacturers’ directions for lavaging using closed suction devices.

Do not allow lavaging solution to flow into the device.

RECOMMENDATIONS

TAKE CARE NOT TO GET LAVAGING SOLUTION INTO THE ThermoFlo™

SYSTEM.

I f t h e d r u g s a r e i n t r o d u c e d v i a

M D I , o r n e b u l i z e r i n t o t h e c i r c u i t

b e t w e e n t h e p a t i e n t a n d t h e

d e v i c e , b e a w a r e o f p o t e n t i a l

i n c r e a s e d r e s i s t a n c e . I f t h e r e i s

a n i n c r e a s e i n r e s i s t a n c e d e e m e d

c l i n i c a l l y s i g n i f i c a n t , r e p l a c e t h e

d e v i c e .

CLOSED SUCTION WITH AN MDI ADAPTER

L AVA G E T H E PAT I E N T, B E I N G C A R E F U L T O K E E P T H E S O L U T I O N

AW AY F R O M T H E T H E R M O F L O ™ D E V I C E .

H O L D U N I T AT A 4 5 O A N G L E , A N D A D VA N C E T H E C AT H E T E R 4 ” - 6 ”

I N T O T H E E N D O T R A C H E A L T U B E ; A V E R Y N I C E G U I D E I N T O T H E E T

T U B E I S C R E AT E D .

A D M I N I S T E R L AVA G E , H O L D S U C T I O N , A N D C O M P L E T E

P R O C E D U R E . I T I S A C C E P TA B L E T O U S E A N M D I A D A P T E R O N T H E

PAT I E N T S I D E O F T H E T H E R M O F L O ™ . I F Y O U A R E U S I N G

T H E M D I I N T O T H E C I R C U I T, R E M O V E T H E T H E R M O F L O ™ A N D

R E P L A C E A F T E R T R E AT M E N T.

An HME m us t be re m ov e d f rom the pa t i e n t c i rc u i t dur ing a e ros o l t re a tm e nts w he n the ne bu l i ze r i s p la c e d in the pa t i e n t c i rc u i t .

W h e n t h e H M E i s r e m o v e d f r o m t h e c i r c u i t d u r i n g a e r o s o l t r e a t m e n t , p l a c e t h e d e v i c e s o t h a t t h e p a t i e n t c o n n e c t i o n i s f a c i n g u p , r e d u c i n g t h e c h a n c e s o f c o n t a m i n a t i n g p a t i e n t c o n n e c t i o n .

CLOSED SUCTION SYSTEM NEBULIZATION

Copious amounts of bloody secret ions

Body temperature less than 30° C

Respiratory volume 25% less than inspiratory volume (possible f istula )

Pulmonary edema

Hypohydration (dehydration)

RELATIVE CONTRAINDICATIONS

June 2005

“HMEs should be used in all patients in whom there is no contraindication.”

Richard D. Branson MSc RRT FAARC

R e g a r d l e s s o f w h a t t y p e o f

s y s t e m i s b e i n g u s e d , t h e

c l i n i c i a n s h o u l d q u e s t i o n t h e

e f f e c t i v e n e s s .

S i n c e n o s y s t e m r e p o r t s t h e

a c t u a l a m o u n t o f h u m i d i t y b e i n g

d e l i v e r e d , o t h e r s i g n s m u s t b e

r e l i e d u p o n .

RELY ON THE SIGNS

YOU WILL SEE MOISTURE

Moisture is a good thing!

Any visible moisture may be removed, should you choose.

In this demo, any liquid poured into our device may be poured out. Any sputum in the device will not be absorbed by the media.

Position the device horizontal or above the patient.

No visible moisture will be transferred back to the patient unless the device is turned completely upside down. (As shown in the photo on the bottom left.)

Visible moisture will not be absorbed into the filter

media potentially causing resistance.

Put us to the test, and document your

secretions.

ThermoFlo™ PROTOCOL AND SPUTUM EVALUATION

1. Watery: Sputum that can be suctioned like water. After suctioning, no secretions remain attached to the inner surface of the suction catheter.

2. Moderate: Sputum of moderate viscosity. After suctioning, some secretions remain attached to the inner surface of the suction catheter, but they can be easily washed out by suctioning water through the catheter.

3. Tenacious: Thick sputum. After suctioning, most secretions are still attached to the inner surface of the suction catheter.

Suzukawa, et. al., Respiratory Care November 1989

IDENTIFYING SPUTUM CHARACTERISTICS

TO AVOID BACTERIAL COLONIZATION

CHANGE EVERY 24 HOURS

MANUFACTURER RECOMMENDATION

Our exclusive “change on” label makes it easy.

SAFE DISPOSAL

A f t e r d i s c o n n e c t i n g , p l a c e t h e

d e v i c e i n y o u r o n e h a n d , a n d

r e m o v e y o u r g l o v e f r o m t h e o t h e r

w h i l e w r a p p i n g i t a r o u n d t h e u s e d

d e v i c e .

D i s p o s e a c c o r d i n g t o h o s p i t a l

p o l i c y .

DISPOSALNo need to touch the device.

The End