CONTRAfluran gas capture system

Hi Louise,

We are thinking about it, but we are waiting for the rep to give us a talk & take it from there. 

jason

From speaking to the rep, it means the machine needs switching from active  scavenging, and therefore effectively prohibits any use of nitrous. This will be a hard one to get past my colleagues.

Secondly, there is apparently no license for recycled volatile in the UK. I got the impression that the canisters are being stockpiled in Germany awaiting authority to rebottle it, which may or may not come any time soon. I suppose as long as it does not get in to the atmosphere, there is some benefit. 

I would love to hear from anyone who has actually used the system. 

Rich

Just wanted to float another company offering this technology to you which is actually based in the UK.  THey're called SageTech Medical and operate out of Painton, Exeter.  Rather than being big pharma it's been set up by an anaesthetist and vet.

THere are some major advantages of their technology and approach that I can see over Baxter.  I've been down to visit their factory several times and my only (sort of) conflict of interest would be to say that I was invited down by them to be a key opinion leader when Baxter Global visited, ahead of their launch of Contrafluran....the purpose of their visit now being revealed as something other than it was advertised so to speak.

Getting back to business.....SageTech is a UK based company, canisters capture all three volatile agents so you have a mixture within them.  The volatile is extracted from the canisters by a machine which you have on site and is collected into drums of mixed agent that return to the factory for processing.  They are collected by SageTech which means that your canisters are ready to go again within about 20-30 minutes of going into the machine.

This saves loads in terms of carbon.....you're not transporting canisters back and forth but actually saving up the captured volatile into drums to be collected and taken back to the factory for processing...which is in the UK rather than another european country.  The canisters can be reused at least hundreds of times too.

I would urge you to consider them as an alternative, it would be great to be able to get behind a grass roots, UK based company over big pharma and I think there are some superior qualities to their product over Baxter's.

They system is used with anaesthetic machines still attached to scavenging - this is vital not just for nitrous oxide but also because of any waste oxygen that's being vented out of the anaesthetic machines and, without AGSS, would be vented into the operating theatre environment, potentially with disastrous consequences were said environment to become oxygen enriched.

SageTech are working with MHRA around licencing of the purified volatile product, this will take another couple of years at least to attain.

Hope this helps.

Cathy

Hi Cathy,

I have indeed heard of it, but I am not sure they are any where near offering any trial just yet though?

jason

Hi Cathy

I have heard of SageTech and it's a local company (i'm based in Devon). I think an issue is that the processing unit needs to be on site and would require some investment, which unfortunately is a real issue within our trust. The CF system seems more affordable and they seem to be further on in getting a licence to re-use the captured agent, with a licence for sevo already being granted in Germany and Portugal. We only regularly use 1 volatile agent, sevoflurane and ultra-low flow gases so most of the oxygen goes back to the patient within the circuit.

I agree with you that using a UK based local company is preferable, it's a conundrum!

How are you getting on with SageTech?

BW

Louise

Hi Louise. 
Following discussions with Baxter a few months ago I had troubling concerns about CONTRAfluran - firstly you need to have nitrous free theatres (which is obvs a good thing) but they were suggesting that our anaesthetic machines would need to be switched from active to passive mode but depending on the anaesthetic machines it may not be possible to switch them back to active mode ever again...

There may also be issues with warranty on the anaesthetic machines, so you must explore this fully with the companies who supply your anaesthetic machines.  
 
My personal feeling is not to rush this. The most important areas we can focus on is becoming Nitrous free/certainly nitrous manifold free and only using portable cylinders when really required & Removing Desflurane. Sounds like you may have done these 2 things already?

We do need to tackle theses issues as soon as sensibly possible but not if it jeopardises even better solutions within our grasps in the next couple of years . Lots of other "hot spots" to tackle! :) 

Be keen to hear what Baxter explained to yourselves regarding the passive modes & machine warranty etc

BW

Fiona

Hi Louise,

Thanks for raising this - we are in the exact same position as you at our trust.

Baxter, our EME and Drager are having a meeting this week to discuss the potential problems including changing from an active to a passive scavenging system so I will be interested in the outcome of that.

I feel like volatile gas capture is something which will happen in all hospitals eventually so it is in everyone's best interests to make it work but its a matter of when.

I have also spoken with SageTech and have the same issue of the fact it requires a large capital outlay for the processing unit. Cathy, do you have any further information on when it might be available to trial in the UK?

BW

Amy 

Good morning all, 

SageTech is already being trialled and I'm pretty sure should be commercially available in the next year or so.  Certainly the Trust that I've just rotated from has asked for a costing of enough units to cover their theatres suites plus an extraction machine.  There is financial outlay but just looking at the finances is a very traditional approach to procurement.  We must use the entirity of the triple bottom line when assessing procurement and tendering processes of new products.  In terms of net carbon saved, tech like contrafluran will not save anywhere near as much carbon as a lot will be spent in transporting the canisters to/from your sites to Europe for processing.  This financial 'saving' upfront will be lead to a negative impact on your carbon savings fairly rapidly I would imagine.  Not to mention the potential issues with your anaesthetic machines and risks to staff if no AGSS on when nitrous oxide or even an oxygen admixture is used. 

I echo Fiona's comments.  Focus on Des, nitrous oxide and other carbon hotspots in anaesthesia until we have more information about capture systems.  I;ve been recommending SageTech to all Trusts in the North East of England as I personally feel that their product is superior and hits all elements of the triple bottom line which, in my opinon, vastly outweigh any increased financial costs.  It's a big decision to make and must not be rushed into when something like SageTech is just around the corner.

As sustainability fellow in Newcastle I was part of the team that brought SageTech to the Trust to trial.  Very impressed with the product and the team.  I personally think that Baxter have been quite cagey about their product and am wary about its use given the major drawbacks that we know about so far (as Fiona has outlined above).

Cathy

Thanks Cathy. I dont want to spend a lot of time on a product that doesn't have the right credentials

"I have had an answer from our marketing manager about can you still use nitrous with our gas capture technology and the answer is yes you can. We have a Contrafluran Plus version which connects to the AGSS system so you can still continue to use this gas should you need to in any theatre..So still using nitrous with gas capture will not be a problem and will not confine you to using in certain theatres only."

I would still urge a note of caution here.  I personally think SageTech will be a much better solution than Contrafluran.   Please wait so that you can at least test both systems.  As Fiona comments earlier in this thread - there are plenty of other areas to look at in terms of reducing the carbon intensity associated with anaesthesia delivery while you're waiting...especially the nitrous oxide wastage.  Take a look at the nitrous oxide project.  All tools for audit etc are in there.

Hello,

We're looking at introducing some kind of volatile capture device at Imperial - we were initially looking at Baxter's ContraFluran but obviously now I've seen this thread we're also interested to learn about SageTech - Cathy, could you please email me so I can find out a bit more about its introduction in Newcastle?

t.dolphin@nhs.net

Regarding re-use of the captured volatiles, my understanding from the Baxter rep, Rhian, was that they do expect the recycled volatile to be approved for re-use in patients. I'm not clear whether the price per cartridge they will charge us for processing takes account of the anticipated resale value of the volatiles it contains or if the price may change as the cartridges become more valuable to them. If it captures a whole bottle of volatile per cartridge as Rhian suggested then the bottle's contents will be worth more than the quoted cost to us of taking it away from the hospital (provided they're allowed to re-sell it!).

Thank you!

Tom

Anaes Cons at Imperial

I would just like to thank everyone for the really useful comments/advice about the volatile capture technology. I have had a really useful meeting with SageTech and feel very much, like others on this network, that this is the company that we should be looking at using in the UK at least. They are looking at various business models, one of which is to move the extraction process offsite and become more of a service model whereby they would collect the cannisters from each trust and extract the volatile centrally. This then requires much less capital investment which for our trust makes it more workable. I urge you all to meet with SageTech before making any decisions as there are many other advantages over ContraFluran that I won't list here, but equally happy to answer any immediate questions.

Louise

Thank you Louise! I just wanted to echo your comments! I also met with them last week and had a very favourable impression. Like yourself, my colleagues and I are much more keen to use a local company that is specifically dedicated to tackiling the carbon footprint of surgery rather than a multinational that has so far contributed significantly to the problem and never bothered to address the issue before. Having said so we are waiting for co2e figures and financial details still as we have applied for a grant to pay for the VCT...and time is ticking on! will keep you posted!

We have been in contact with both late last year & we are planning to trial ContraFluran 2 months ago....  but due to technical issues, that has been delayed.

We are also planning to trial SageTech but it is difficult to know when it is going to be available for trial however.  I feel that they are still quite a bit behind in terms of infrastructure when compare to Baxter.