Sunday, October 23, 2011

Some Days I Long For the Boyle Machines

I mentioned some time ago that our department in a moment of stupidity bought two Drager Primus machines to be used in Obstetrics. That was until we discovered that if somebody turned them off, there was a 30 minute boot-up. Not very useful for obstetrics. Therefore they were exiled to our Day Surgery OR where they will never ever see and emergency. Last year the hospital tried to force us to buy 8 more of these machines but we were able to block that.

About a month or so ago the Drager rep made a visit to our site to install a software update. It went for the most part un-noticed until about two weeks ago, of our anaesthesiologists pushed the wrong button. The Drager Primus has a number of "soft keys" with which you select the various modes of ventilation, spontaneous, volume controlled, pressure controlled etc. To the right of the buttons was a unlabelled button. Most people know better than to push unlabelled buttons, no good can come from that. This was the case. Immediately the gas flow ceased and patient could not be ventilated, nor could he by pushing any of the labelled soft keys restore things back to where things had been. Fortunately it was not in the middle of night, he didn't panic, he got an ambu bag and hand ventilated the patient while switching him to TIVA. The machine was taken out of the room and one of the older machines brought in.

After much investigation, we figured out that the following happened. The Drager Primus comes with the option of using a Mapleson D, E, F or Bain circuit which we never use and therefore when the machine was installed the connection was "tied off" and the software was adjusted so that the option of using the Bain circuit could not come up. When the software update was installed this disabling of the Bain option ended and when my colleague pushed to unlabeled button, the machine went into Bain mode, discovered that the Bain lines were "tied off" and basically shut down the machine.

Our biomed people reprogrammed the machine to disable the Bain option again and the machine worked okay. About a week or so later Drager got around to sending someone to fix the machine.

This all makes me long even more for the Boyle machine. Simple, powered by compressed gas from the central supply or from the cylinders if the central supply failed. No need to plug in. Everything mechanical with ingenious inventions like the interlink and the fail-safe valve. No software. Ready to use as soon as you were. And with a pulse oximeter on your patient, just as safe (actually safer if you have Drager Primus).

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