The quantitative monitor for neuromuscular blockade.
QUANTITATIVE NEUROMUSCULAR MONITORING
Removing the subjectivity from the assessment and the onus from the clinician.
Standardized use of quantitative neuromuscular monitors reduces residual neuromuscular block and the associated risks, but the lack of reliable, easy-to-use monitors has limited adoption… until now.
Introducing TwitchView, the future of quantitative neuromuscular monitoring. Utilizing gold standard electromyography (EMG), TwitchView precisely and reliability quantifies the depth of a patient’s neuromuscular block.
WHY IS TWITCHVIEW IMPORTANT?
Despite use of peripheral nerve stimulators and improved neuromuscular blocking and reversal agents, 40% or 15M patients arrive to the PACU with residual neuromuscular block (RNMB) each year(1). RNMB increases the likelihood of critical respiratory events such as desaturation and reintubation, increases patient length-of-stay and has been linked to the development of pneumonia—creating both safety and economic implications.
Many believe the most salient factor contributing to residual block is failing to use quantitative intraoperative monitoring. With a quantitative monitor to guide dosage, patients will undergo safer procedures with less drugs and fewer side effects. The average surgical cost for patients without respiratory complications is $5,015, increasing 12-fold to $62,704 for patients who experience respiratory complications(2)—common sequelae of residual neuromuscular block.
Extreme respiratory complications require reintubation and ICU admission. In the US alone, it is estimated that postoperative complications lead to an additional 92,000 ICU admissions and incur a cost of $3.42 billion each year(3).
Even without considering respiratory complications, quantitative neuromuscular monitors increase care efficiency by facilitating quick and effective reversal. Studies show that a patient with residual neuromuscular blockade stays in the PACU an additional 80 minutes on average—that’s $560 per patient at the hospital’s expense(4,5)!
Residual paralysis is avoidable. As shown at the University of Iowa, routine use of EMG quantitative neuromuscular monitoring can reduce RNMB and post-operative reintubations enabling safer and more efficient patient care(6).
(1) Murphy GS, Brull SJ. Residual neuromuscular block: Lessons unlearned. Part 1: Definitions, incidence, adverse psychological effects of residual neuromuscular block. Anesth Analg 2010;111:120-128
(2) Farhan H, Moreno-Duarte I, McLean D, Eikermann M. Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery? Current anesthesiology reports. 2014;4(4):290-302.
(3) Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531–537.
(4) Butterly A, et al. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth. 2010; 105: 304-309
(6) Todd MM, Hindman BJ, King BJ: The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department. Anesth Analg 2014; 119:323–31
With an intuitive touch-screen interface, TwitchView is easily integrated into any workflow or clinical scenario. The monitor optimizes its performance based on the patient's level of block, so it can be utilized either pre- or post-paralytic administration.
A Quickstart sequence provides accurate data in seconds, and automated support ensures optimal monitor settings. In addition to real-time TOF count, TOF ratios and post-tetanic count (PTC), the monitor displays a time plot of the patient’s recovery over the duration of the case.
TwitchView utilizes a single-patient use Electrode Array that secures to either the left or right hand (or foot) in seconds. The one-piece, auto-centering design minimizes placement errors—a common cause of intra-operative system failure and measurement inaccuracies, and is easily adopted into the pre-surgical workflow.
With an electromyography (EMG) based measurement, monitoring requires no physical motion of the monitored site. What does that mean? Clean, stable, artifact-free data. TwitchView simply works, regardless of patient positioning—even when the arms are tucked.
Understanding that space is limited, every TwitchView comes equipped with a ready-to-install pole mount that can be easily converted to accommodate any mounting requirement.
TwitchView simplifies clinical workflow by connecting to your facility’s electronic medical record . A variety of clinical data are readily charted, including the TOF count and TOF ratio, and the data can be tailored to your hospital’s needs.