My opinion

---

The SSCOR DuCanto Catheter Competition Video [1] demonstrates improved anesthesia practice to protect airways. However, this video has inspired us to look at suction tubing during gastrointestinal endoscopy procedures. Currently, we use 3/16-inch 10-foot suction tubing during anesthesia care and during gastrointestinal endoscopy procedures. We use the same tubing irrespective of whether they are operating at 0-200mmHg suction pressure while connected to central medical vacuum systems [2] during anesthesia care or operating at 50-520mmHg suction pressure while connected to on-site waste management system [3] during gastrointestinal endoscopy procedures. The video has inspired us to change our anesthesia practice universally by using variably long 9/32-inch suction tubing wherein the suction tubing length ranging from 6-foot to 20-foot [4] will depend on whether we continue to use central medical vacuum system-connected suction inlet in our anesthesia machines usually located at head-end of surgical tables or we begin connecting our suction tubing to on-site waste management system usually located at leg-end of surgical tables. Concurrently, we are exploring changing suction tubing to 9/32-inch 3-foot [5] for gastrointestinal endoscopy procedures because on-site waste management system being located adjacent to gastrointestinal endoscopy tower does not need suction tubing to be 10-foot-long thus allowing better volumetric flow rate of suctioned solids-liquids-gases especially from lower gastrointestinal tract.

 

It is unclear if improved volumetric flow rates [6] will increase procedural times for gastrointestinal endoscopy procedures. The insufflator gas flow rate is 2-3 liters per minute [7] during gastrointestinal endoscopy procedures. The higher flow rate of suctioned solids-liquids-gases across 9/32-inch 3-foot suction tubing could interfere with bowel distension for visual inspection and endoscope insertion. Counter-intuitively, the higher flow rate of suctioned gases may allow more rapid return to normalcy for the patients during their recovery period.

 

An additional question is related to turbulence [8] at the connection point risking disconnection and consequent splashing of suctioned solids-liquids-gases when the slower flow from < 4mm size suction channel [9-11] inside the gastrointestinal endoscope meets the faster flow within >7mm (9/32-inch) size suction tubing.

 

Finally, will this change increase cost? The direct cost may increase for supplies, but the overall cost could decrease related to faster patient recovery (less time in recovery units) secondary to more complete evacuation of insufflator gases [12-13]. Additionally, there will be less environmental costs since the volume of plastic will have decreased [14].

 

The readers can perform a simple experiment in their own gastrointestinal endoscopy labs comparing different suction tubing with liquid water. The wider and shorter suction tubing may only increase the volumetric flow rate by a few milliliters of fluid per second. This extrapolates into less than 100 milliliters extra fluid suctioned during the entire procedure clinically. However, when suctioning insufflated gas, this may become clinically significant since the viscosity of suctioned liquid is 100 times larger than the viscosity of suctioned gas [6, 15-17].

 

For creating a do-it-yourself simulator for insufflated gastrointestinal tract, the readers can take a 3-liter breathing bag [18] and insert gastrointestinal endoscope inside that bag. With thumb and index finger encircling the neck of 3-liter breathing bag below its bushing, air-tight seal can be created around this gastrointestinal endoscope. Thereafter, the bag can be over-inflated to 10-liter [19-21] in 5-minutes with insufflator flow rate set at 2 liters per minute. Subsequently, gastrointestinal endoscope can be timed to suction 10-liters of insufflated gas to compare between currently used suction tubing connecting gastrointestinal endoscopy tower to on-site waste management system vs. 9/32-inch 3-foot suction tubing connecting gastrointestinal endoscopy tower to on-site waste management system.

 

The bottom line is that when time is of the essence and when even few seconds can matter for patients by providing extra-protection for their airways during anesthesia care and evacuation of extra-gas [22] during their gastrointestinal endoscopy procedures, wider and shorter suction tubing may come in handy even if anesthesia providers do not choose to change from Yankauer suction tip to SSCOR DuCanto catheter [23] or even when gastrointestinal endoscopy proceduralists cannot change the size of suction channels inside their gastrointestinal endoscopes.       

Reference(s)

---

1. SSCOR DuCanto Catheter Competition Video. https://www.sscor.com/competition
2. VACUUM TECHNOLOGY IN MEDICAL APPLICATIONS. https://www.vacuumscienceworld.com/blog/vacuum-technology-medical-applications
3. Neptune 3 Waste Management System. https://www.stryker.com/us/en/surgical-technologies/products/neptune-waste-management-system.html
4. Sterile Universal Suction Tubing with Straight Connectors. https://www.medline.com/product/Sterile-Universal-Suction-Tubing-with-Straight-Connectors/Suction-Tu bing/Z05-PF96683
5. Patient Connecting Tubing, 9/32" ID x 3'. https://www.medline.com/sku/item/MDPSSZ12000001
6. Flow Rate Calculator. https://www.gigacalculator.com/calculators/pipe-flow-rate-calculator.php
7. CO2MPACT Endoscopic Insufflator® System. https://www.steris.com/healthcare/products/endoscopy-equipment/co2-insufflation/co2mpact-endoscopic- insufflator-system
8. Enhanced liquid–gas mixing due to pulsating injection. https://www.sciencedirect.com/science/article/pii/S0045793014004319
9. Video Colonoscope. https://medical.olympusamerica.com/products/colonoscope/evis-exera-cf-2t160i
10. Endoscope Technology Theory-Lesson 3-Endoscope Parts. https://www.youtube.com/watch?v=kHONXxQK3iE
11. Endoscopy Technology Theory-Lesson 4-Scope specifications. https://www.youtube.com/watch?v=5rYXQ19US6s
12. Air and carbon dioxide volumes insufflated during colonoscopy. https://www.sciencedirect.com/science/article/abs/pii/S0016510703801128
13. Carbon dioxide insufflation for colonoscopy: evaluation of gas volume, abdominal pain, examination time and transcutaneous partial CO2 pressure. https://link.springer.com/article/10.1007/s00535-010-0286-5
14. Volume of a hollow cylinder. https://www.omnicalculator.com/math/cylinder-volume#volume-of-a-hollow-cylinder
15. Water - Dynamic (Absolute) and Kinematic Viscosity vs. Temperature and Pressure. https://www.engineeringtoolbox.com/water-dynamic-kinematic-viscosity-d_596.html
16. Air - Dynamic and Kinematic Viscosity. https://www.engineeringtoolbox.com/air-absolute-kinematic-viscosity-d_601.html
17. THE USE OF SUCTION IN CLINICAL MEDICINE. https://academic.oup.com/bja/article/32/10/486/246296
18. Medline Breathing Bags Breathing Bag, Soft Bushing, 3 L. https://www.medline.com/sku/item/MDPDYNJAA03SH
19. Overdistention of the Rebreathing Bag, A Hazardous Test for Circle-system Integrity. https://pubs.asahq.org/anesthesiology/article/42/3/365/22729/Overdistention-of-the-Rebreathing-Bag-A -Hazardous 
20. A Modified Portable System for Oxygen Supply Using Anesthetic Rebreathing Bags. https://journals.lww.com/anesthesia-analgesia/Citation/1993/05000/A_Modified_Portable_System_for_Oxy gen_Supply_Using.57.aspx
21. Anesthesia rebreathing bags: Physical characteristics and use as portable oxygen reservoirs. https://www.sciencedirect.com/science/article/abs/pii/095281809290135N
22. Overview of intestinal gas and bloating. https://www.uptodate.com/contents/overview-of-intestinal-gas-and-bloating
23. SSCOR DuCanto Catheter®. https://www.sscor.com/ducanto_catheter

Source(s) of Funding

---

NOT APPLICABLE

Competing Interests

---

NOT APPLICABLE