Sources of Error when Tracking Irrigation Fluids During Hysteroscopic Procedures

Abstract

Study Objective To evaluate the ability of circulating nurses to estimate input and outgo of irrigating fluids used during hysteroscopic procedures in a hospital operating room. Design Simulation of intraoperative measurements (Canadian Task Force classification II-1). Setting Operating room. Intervention Circulating nurses estimated fluid volumes under circumstances simulating actual conditions of hysteroscopic ablative or resection procedures. Measurements and Main Results Three-liter glycine irrigation bags were overfilled by an average of 2.8% (62–125 ml). Estimates of fluid remaining in partially emptied bags were in error by an average ranging from 4% to 50%/bag (largest error 10–55%, 157–401 ml). Estimates of fluid in kick buckets were in error by an average of 10% to 39% (largest error 22–66%, 232–903 ml). Visual estimates of fluid on the operating room floor were in error by an average of 56% to 67% (largest error 65–81%, 182–840 ml). Estimates of fluid in suction canisters were consistent among nurses. The accuracy of measurements for partially filled suction canisters primarily depended on the accuracy of canister calibration. Volume contained in cascaded suction canisters from an actual surgical procedure was grossly different from rated capacity. Conclusion Accurate tracking of irrigation fluid during hysteroscopic procedures is difficult. Even with a mechanical measuring system, fluid lost on the floor can introduce sizable errors. Estimation errors can easily and quickly accumulate to clinically significant volumes. Use of an automated mechanical fluid-tracking system with devices to capture fluid lost from the surgical field is recommended.