Safe Hysteroscopy Fluid Management: Distension Media, Deficit and Pump Selection

Hysteroscopy distension media and fluid types

Hysteroscopy fluid types fall into two groups. Isotonic, electrolyte-containing media such as normal saline are used with mechanical instruments and bipolar energy. Hypotonic, electrolyte-free media such as glycine or sorbitol solutions are needed when monopolar energy is used, because saline would conduct current away from the electrode.

The choice of medium links to the energy source, and so to the resectoscope. A hybrid resectoscope such as the Richard Wolf Princess works with both monopolar and bipolar energy, which means the medium has to be selected per case. Always follow your hospital protocol and the instructions of the instruments.

Why fluid deficit matters

During hysteroscopy some of the distension fluid enters the circulation through the open vessels of the uterus and through the tubes. Fluid deficit is the difference between the volume put in and the volume recovered. A growing deficit signals absorption, and with hypotonic media it can cause dilutional hyponatraemia; with any medium excess volume can overload the circulation.

Hospitals therefore define deficit limits and a stop rule, and the team monitors the deficit continuously, not only at the end. The limits differ with the medium and the patient, so they are set by local policy and should be agreed with anaesthesia. Pressure should be kept as low as gives an adequate view, and not above the patient's mean arterial pressure.

• Know the medium and the energy in use
• Set a deficit alarm and a stop rule
• Keep the pressure as low as possible for the view
• Record the total inflow and outflow

Hysteroscopy pump versus gravity or pressure bag

A gravity bag or a pressure cuff provides a simple distension and is used in many diagnostic cases. It cannot regulate flow, and it tells you nothing about deficit unless someone counts bags and collects drainage by hand. A hysteroscopy pump regulates inflow to a set pressure or flow, supports suction and, in some models, measures the deficit by weighing the fluid bags.

Pumps matter most in operative hysteroscopy and long procedures, where bleeding and tissue chips reduce the view and the fluid exchange needs to be quick. They also provide a documented record of fluid use.

Richard Wolf FLUID CONTROL 2225

The FLUID CONTROL 2225 is a suction and irrigation pump for gynecology, urology and general surgery. The surgeon selects the discipline before each procedure, with no additional licence fees. It offers a maximum irrigation flow of 1800 ml/min and a maximum suction flow of 2000 ml/min, an integrated vacuum function for quick fluid exchange, standard profiles for other manufacturers' endoscopes and a large colour touchscreen.

Fluid deficit is shown continuously when the optional mobile balancing module with two weighing cells is used. This is the feature that turns a pump into a safety device, so ask for it to be included in the quotation. See the manufacturer's range on the Richard Wolf brand page.

Checklist for choosing a pump and next steps

When you compare hysteroscopy pumps, ask about the pressure and flow range, how deficit is measured, alarms and automatic stop, ease of cleaning, tubing sets and their cost, compatibility with your hysteroscopes and the training and service available locally. Include the pump in your complete list as in our office hysteroscopy equipment guide, and teach beginners using the notes in hysteroscopy for beginners.

To discuss a fluid management solution for your department, contact Beckfinity for a consultation or a quotation.