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HYBRID OPERATING ROOM
A hybrid operating room is a surgical theater equipped with advanced medical imaging devices like C-arms, CT scanners, or MRI scanners. It allows for complex procedures to be done with physicians of different specialties working simultaneously. Key features include equipment for imaging, lighting, audio/video integration, and space for medical tools. Special considerations go into room design and equipment placement to accommodate imaging needs while maintaining sterility. A hybrid OR enables minimized risk, improved success rates, and enhanced workflow efficiency compared to traditional operating rooms.
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More from Hamzah Meraj, Faculty of Architecture, Jamia Millia Islamia, New delhi
HYBRID OPERATING ROOM
- 1. HYBRID OPERATING ROOMPRESENTEDBY: SUFYAN AHMAD NAZIA KHANAM CONTEMPORARY TECHNOLOGY
- 2. FACILITY WITHIN HOSPITALWHERE SURGICAL OPERATIONS ARE CARRIED OUT IN A STERILE ENVIRONMENT. FEATURES OF AN OPERATION THEATRE: • Generally windowless • Controlled temperature and humidity. • Special air handlers filter • The air and maintain a slightly elevated pressure. • Rooms are supplied with wall suction, oxygen, and possibly other, anesthetic gases. OPERATION THEATRE: INTRODUCTION 1/20Presented by : Nazia Khanam Anesthesiologist Surgeon scrub nurse circulating nurse WORK ZONE IN OPERATION THEATRE
- 3. HYBRID OPERATION THEATRE… Ahybrid operating theatre is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners Examples : 1.Cardiac 2.Vascular 3. Neurosurgery hybrid operation room 1. Surgical Lights, Recessed & Extended Length 2. Video / Audio OR Integration 3. Ceiling Mounted Booms 4. Equipment Carriers 5. Anesthesia Booms 6. Surgical Displays 7. Mobile Surgical Tables 8. Stainless Cabinetry & Supply Storage Solutions 9. Space for Nurse Assistant 10. C-Arm 11. Anesthesia Machine, Transesophageal Echo, Intracardiac Echo 4 1 2 3 4 5 6 7 8 911 10 2/20Presented by : Sufyan Ahmad
- 4. SALIENT FEATURES: HYBRIDOPERATION THEATRE Patient safety Cost saving for the patient State-of-the-art imaging during surgery It allows us to do more complex procedures Physicians with different skills can work simultaneously ADVANTAGES OF HYBRID OT The main advantages of hybrid OT are : Minimized procedural and patient risk Optimized success rates Enhanced complication management Advanced workflow efficiency 3/20Presented by : Nazia Khanam
- 5. Hybrid OR withCT Orthopaedic and surgeon for trauma Hybrid OR with MRI Neurosurgery Hybrid OR with Angiographie Cardiovascular surgeons and cardiologists Neurosurgery and neuroradiologist Interventional Team • Interventional cardiologist(s) • Interventional cardiology fellow(s) Echocardiography Team • Echocardiographer • Echotech Nursing/Support Staff • Scrubnurse(s) • Cathnurse(s) • ORnurse(s) • Radiology tech(s) Surgical Team • Cardiothoracic surgeon(s) • Cardiothoracic fellow(s) Anesthesiology Team • Anesthesiologist • Nurse Anesthetist Perfusion Team • Perfusionist • Possible second 4/20Presented by : Sufyan Ahmad
- 6. PLANNING OF HYBRIDOR Hybrid OR Corridor Clean Core Electronics Procedure (60-90 sqm) Material Support Control Room & Electronic Equipment Scrub &Gurney IR/Cath/ Hybrid Use SubsequentUse Control RoomFlexZone Procedure Zone 5/20Presented by : Sufyan Ahmad
- 7. SPACE PLANNING 7-8 METRES 8-10METRES 6/20Presentedby : Sufyan Ahmad
- 8. DESIGN CONSIDERATIONS –CARDIOVASCULAR 1 2 3 4 3 4 3 2 1 Assisting Surgeon Surgeon Anesthesiologist Assisting Nurse 6 7 8 9 10 Anesthesia Machine 5 Anesthesia Cart 6 Control Pedestal7 Ultrasound (IVUS) 8 Contrast Injector9 Patient Warmer 10 5 11 11 Heart Lung Machine 7/20Presented by : Sufyan Ahmad
- 9. DESIGN CONSIDERATIONS –NEUROSURGERY 1 2 3 4 3 4 3 2 1 Assisting Surgeon Surgeon Anesthesiologist Assisting Nurse 5 6 7 8 9 10 Anesthesia Machine 5 Anesthesia Cart 6 Control Pedestal 7 Ultrasound (IVUS) 8 Contrast Injector 9 Patient Warmer 10 11 Navigation 11 12 Microscope 12 8/20Presented by : Sufyan Ahmad
- 10. AM AC EEG AN N AS S N USINJ AM AC EEG AN N AS S US INJ Surgeon Assisting Surgeon Nurse Anesthesiologist ContrastInjector Ultrasound (IVUS) Physiologic Monitoring Anesthesia Machine Anesthesia Cart TYPICAL VASCULAR PROCEDURE… 9/20Presented by : Sufyan Ahmad
- 11. AM AC EEG AN N S INJ AM AC PCW AN PA AS S NAV INJ Surgeon Assisting Surgeon Nurse Anesthesiologist Contrast Injector Navigation PatientCooler/Warmer Anesthesia Machine Anesthesia Cart PCW NAV MIC MAS Mobile Aspirator MIC Microscope N TYPICAL VASCULAR PROCEDURE… 10/20Presented by : Sufyan Ahmad
- 12. AM AC EEG AN N S INJ AM AC PCW AN PA AS S NAV INJ Surgeon Assisting Surgeon Nurse Anesthesiologist Contrast Injector Navigation PatientCooler/Warmer Anesthesia Machine Anesthesia Cart PCW NAV MIC MAS Mobile Aspirator MIC Microscope N TYPICAL VASCULAR PROCEDURE… 11/20Presented by : Sufyan Ahmad
- 13. CONSIDERATIONS WHILE CONSTRUCTINGHYBRID OR Hybrid OR Room Specifications Specifications CatheterizationLab CardiacOR HybridOR Square Meter 37-56 56-70 60-90 Ceiling Height (In meter) 3 3 3-3.6 Ceiling Type Lay-in type ceiling permitted Monolithic, scrubbable, capable of withstanding chemicals Monolithic, scrubbable, capable of withstanding chemicals Ceiling Structural Reinforcement/Design Support for ceiling-mounted C- arm Support for boom-mounted equipment, sufficient space for HVAC duct-work Support for boom- mounted equipment, and uni-strut reinforcement for ceiling mounted C-arm, sufficient space for HVAC duct-work RoomShielding LeadLined N/A LeadLined Optimal Temperature (F) 70-75 68-73 68-75 Air Exchange Rate 20-25 15-20 20-25 Illuminance (Lux) 300 500-1,000 500-1,000 Special Lighting Needs Dimmable, ambient lighting, minor surgery task light External surgical field, fiber optic, microscope illumination systems External surgical field, fiber optic, microscope illumination systems Number of Electrical Outlets 8 24 >24 12/20Presented by : Nazia Khanam
- 14. 14 UNDERSTANDING ALL THEEQUIPMENTS IN HYBRID O.R. C-ARM Carbon Fibre Table Surgical LightsEcho Technology Audio-Video Integration • An X-ray image intensifier (XRII) an image intensifier that converts x-rays into visible light at higher intensity • Transesophageal echo • Transthoracic echo • Intracardiac echo • Intravascular ultrasound • To optimize the usefulness of the radiographic equipment • provide complete clearance beneath a panning x-ray system. • Top priority features: lighting intensity, color temperature, heat control, shadow control, and flexibility • Touchscreens • Voiceactivated controls • Video conferencing 13/20Presented by : Nazia Khanam
- 15. 21 UNDERSTANDING ALL THEEQUIPMENTS IN HYBRID O.R. Other Essentials for the Hybrid Operating Room Anesthesia Equipment • Anesthesia becoming standard of care in hybrid ORs for cath, hybrid, and EP procedures alike • If not mounted, is space- intensive, and must be in close proximity to the patient/table Lead Shielding Power Injectors Hemodynamic Monitoring • Used to reduce the risk of exposure toradiation beams, ionizing radiation • May be incorporated into the lab’s infrastructure— both within the walls and within the lab via side table drapes, door- or ceiling-mounted acrylic shields, and lead aprons • Angiographic injectors should be able to attach to catheters from the cath table and at any catheter introduction site • Ceiling-mounted injectors are preferable (lower risk of contaminating the sterile field, occupy less space than floor- mounted systems) • Systems should interface with a lab’s documentation systems to record and store information for later review 14/20Presented by : Nazia Khanam
- 16. • Designed formaximum safety and efficiency, these Interlock Systems are configured to provide automatic shut-off of the laser beam if safety doors, covers or blinds are opened. • Interlock Systems are able to operate laser interlocks, laser power, beam shutters and warning signs and can be fitted with entry/exit overrides and emergency stop switches. A key-lock prevents unauthorised use. • Wipe clean for excellent infection control • Flexibility to accommodate design changes with ease • Easy upgrade to accommodate future services Proven reliability • Compact size where operating roomspace is at a premium • Modern appearance complements today’s high tech operating rooms • Ability to incorporate third party interfaces Electronic Touch Screen Panel Laser Interlock systems • saves space • enhancing the multi-disciplinary use of the OR • wide variety of distribution modules, extensions and optional accessories makes it easy • fewer cables and devices on the floor surrounding the operating table, doctors benefit from better access to the patient. Ceiling supply units (CSUs) 15/20Presented by : Nazia Khanam
- 17. 29 BEHIND-THE-SCENES CONTROLS Ancillary Controlsin theHybrid OR Temperature • Full-scale temperature and humidity control • Pediatrics patients must be kept at a relatively high temperature such that they do not acquire hypothermia (leading to cardiac arrest) • Room temperature should remain between 68 and 80 degrees fahrenheit • Anesthetic gases—oxygen, air, suction, nitrous, gas scavenge— housed on a single boom (column) with network/electrical connections • Gases to support a heart-lung machine in the room may be housed on a single boom • Be aware of source of thegases, lengths of the hoses required— select procedures require nitrogen as does a sternal saw if needed • Careful planning should ensure that high- and low- voltage connections are converted in the ceiling—and not mounted behind monitors—and pulled through a boom • High-voltage connections must be housed in shielded conduits • Booms should be designated as either high- or low-voltage Gases Electricity 16/20Presented by : Sufyan Ahmad
- 18. SERVICES OF HYBRIDOR VENTILATION: • There should be +ve pressure ventilation with lowering pressure gradient from sterile to protective zone laminar flow. • All anaesthetic gases to be vented out to exhaust. • Flow of air 2 to 3 cu meter minute. AIR CONDITIONING: • Control asepsis, controlled air flow, positive pressure. • Maintenance of temperature 22 degree Celsius for comfort. • Humidity 55% + or – 5 % only. • 100% fresh air with 20 changes per hour. • Filter of 1 to 3 micron size to be used. • Control air-conditioning system. • False ceiling 1 meter below the roof. 17/20Presented by : Sufyan Ahmad
- 19. STRUCTURAL COMPONENTS OFHYBRID OPERATION THEATRE: Walls: • Melanin facing walls for easy cleaning. • The inner surface walls will be constructed with 1.60mm thick EGP steel panels backed by 12-mm gypsum board • Pale colour to be used. • Resistant to minor damage or impact. • All the sharp edges and corners will be in radius to avoid bacteria contamination. • Door opening should be min. 1.5 M wide, swinging and 2.1 M height. Roof: • Should take the load of OT lights, X-rays unit, TV camera, Gas and electric panels. Floors: • Easily washable, non staining, impervious. • The floor finish in the operating room should be Conductive PVC tiles, laid on a semi conductive adhesive base. • The floor finish should continue up the wall for 100mm. http://pdt.com.au/u/lib/mob/20150317161414_3c7c241034454de62/sawmh- ot10-03a-low-res.jpg 18/20Presented by : Sufyan Ahmad
- 20. Advantages Disadvantages 1. Shorterpatient recovery time 2. Decreased length of stay 3. Streamlined delivery of care 4. Overall lower cost of care 5. Potential for revenue growth 6. Minimized risk for communication-related errors clinical specialities 7. Effectiveness and efficiency in training, teaching and research 8. High quality imaging vastly superior to portable systems 9. Promotes the multidisciplinary process and allows for efficient use of staff and equipment 1. Cost 2. Infection risk 3. Prolonged general anaesthetic 4. Prolonged radiation exposure ADVANTAGES AND DISADVANTAGES OF HYBRID OR • Companies dealing in HYBRID OR: Philips, skytron, seimens, maquet 19/20Presented by : Sufyan Ahmad
- 21. REFERENCES • http://cathlabdigest.com/articles/Cardiovascular-Hybrid-Surgical-Room-Evolving-Future- Cardiovascular-Surgery#sthash.pyufaslw.dpuf • http://hybridoperatingroom.com/hybrid-or-operating-room-skytron-surgical-lights-booms-monitors- tables-equipment-anesthesia/ •http://static.squarespace.com/static/50305915e4b00d577d14e583/50a52d36e4b0e80bad99a190/50 a52d37e4b0f7142090aed5/1353002295944/Hybrid-OR-Operating-Room-Layout-Drawing-Siemens- Zeego-vs-Philips-FlexMove-Imaging-Systems-SKYTRON.jpg • http://hybridoperatingroom.com/hybrid-operating-room-layouts-3d-design-mockups/ • http://www.maquet-hybridoperatingroom.com/slide-show/ • http://www.ctsnet.org/portals/endovascular/nutsbolts/Nollert_HypridOR_fig5 • http://www.youtube.com/watch?v=Oeg8wIhrn5w • http://www.christusspohn.org/hybridsurgicalsuite 20/20Presented by : Sufyan Ahmad & Nazia Khanam
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