|Beitragstitel||The Accuracy of Arthroscopic Fluid Pump Systems in Shoulder Surgery. A Comparison of five different Pump Systems and Settings|
Potential fluid management complications, including extraarticular fluid extravasation, can arise during shoulder arthroscopy. This risk relates directly to fluid pressure and operative time. The pressure ranges recommended by different arthroscopic pump manufacturers vary widely, creating confusion over this important safety issue. The purpose of this study was to compare the pressure measurement accuracy of three common arthroscopic fluid pump systems in five different settings.
Patients (n=25) undergoing shoulder arthroscopy were randomly selected for this study. Based on where the patient was having surgery, one of three arthroscopic fluid pump systems in our hospitals (Conmed 24K, Stryker Crossflow, Arthrex Dual Wave) was present in the operating theatre. The Stryker pump was tested in bothe its available modes: standard and dynamic. The Conmed pump was tested with and without the TIPS (extra tubing detecting intra-articular pressure). Each pump at each setting (30 – 90mmHg in 10mm Hg increments) was tested on 5 different patients. The set pump pressure was documented and the equivalent intra-articular fluid pressure was measured at the beginning of the surgery using an intra-articular spinal needle connected to the anaesthetic machine via an artery line.
The mean intra-articular pressure was not different to the set pressure for Conmed 24K with TIPS (0.98 ± 0.02 fold) and Stryker Crossflow in standard mode (0.98 ± 0.02), however it was significantly higher than the set pressure for Conmed 24K without TIPS (1.30 ± 0.13 fold), Stryker Crossflow in dynamic mode (1.82 ± 0.08) and Arthex Dual Wave (2.19 ± 0.06; all P<0.001).
The mean differences between the displayed pump pressure and measured intra-articular pressure in mmHg were as follows: Conmed 24K with (2.9 ± 2.6) or without (29 ± 16) TIPS, Stryker Crossflow in dynamic (80 ± 19) or standard (7.7 ± 2.6) mode and Arthex Continuous Wave III (76 ± 25).
Actual intra-articular pressure can be more than double the set pressure on some arthroscopic pumps. Measuring intra-articular pressure can aid in adjusting the set pressure. To achieve a ‘true’ pressure of 60 mmHg, we suggest setting the Arthrex pump to 25-30 mmHg, the Stryker pump to 55-60 in standard mode and the Conmed pump to 55-60 if using the TIPS. This could minimize the risk of fluid extravasation into the soft tissues and any further related complications.