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Archive January 2021 XXII, No. 1

Thinking of Buying... C-arms

The latest options combine top-notch imaging with user-friendly features.

Karen Reiter

Karen Reiter, RN, CNOR, RNFA

BIO

With so many mobile C-arms available from numerous vendors who offer a wide variety of functionality and unique features, picking the right one for your facility can feel overwhelming. Start by collecting substantial feedback from your OR team and surgeons on what they're looking for from a clinical perspective, and also consider these important factors.

  • Cost. I've bought several of these devices throughout my career, and you should start your search by determining how much you can, or want to, spend. You can go with brand-new C-arms, which can be quite expensive, or refurbished devices, which are available for less.

This year, we bought a secondhand C-arm and had issues with it. We'd purchased the machine, which was made by a well-known manufacturer, from a reseller. That company insured it for a year, but when the warranty expired, I had issues insuring the device with its original manufacturer, who made our facility's other C-arm and with whom our preventative maintenance staff and managers had solid relationships. The manufacturer checked out the C-arm and told us the reseller had made aftermarket modifications, including a larger screen that we liked, that needed to be removed before they would insure it. Fourteen thousand dollars later and after much related activity, the C-arm was insured. My point: It sometimes pays to buy new.

  • Procedural mix. Our spine and pain management C-arms have nine-inch image intensifiers. But when we started doing hip replacements, we needed a 12-inch intensifier so our surgeons could look at both hip bones in one picture. The message here is to fully understand what you'll be using the C-arm for in order to zero in on the device that matches up best with your procedural priorities and budget.
  • Image quality. Flat panel image detectors on newer machines provide higher-quality pictures, but the key is to protect everyone in the OR from radiation exposure while getting useful images. Most C-arms have low-dose modes that use the least amount of radiation for the best possible image. For example, C-arms with a pulsed-image feature are a safer option than models equipped for only continuous live imaging.
  • Power draw. Most mobile C-arms need to be plugged into an electrical outlet, and the draw on that circuit is substantial when the devices are activated. A facility I once managed had two or three shared circuits in the OR. Randomly one day, the blanket warmer, C-arm, surgical microscope and other devices were all on the same circuit. When staff activated the C-arm, the circuit blew. Everyone thought it was a power outage, and waited for the generator to kick in, but nothing came on, so we had to race to the electrical room to reset the circuit.

When we built our newest surgery center, we included a dedicated plug and circuit for the C-arm, as well as a wall plug for uploading images to our digital integration system and ultimately to the cloud. (C-arms can store a limited number of images, so check both storage space and digital integration capabilities.)

  • Upkeep. Even if you have your own X-ray techs, make sure to designate a nurse or surgical tech to be responsible for the machine, the required training and radiation safety education, weekly testing and general upkeep. Proper and consistent maintenance will extend the longevity of a C-arm.

A final point: If your C-arm goes down, cases will grind to a halt. It might be a good idea to purchase multiple units, so you'll always have a back-up available. OSM

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