Advice
The technology
The technology
Ambu aScope 4 Broncho (Ambu Ltd) is a sterile, flexible and single-use endoscope that is connected to the portable aView 2 Advance monitor to display the images. Ambu aScope 4 Broncho is available in 3 sizes: slim, regular and large. The slim bronchoscope is used for difficult intubation, placement and control of double lumen tubes and bronchial blockers, and use with an Aintree Intubation Catheter. The regular and large bronchoscopes can both be used for tracheal intubation, percutaneous dilatational tracheostomy, bronchoalveolar lavage (BAL), bronchial wash (BW), protected specimen brush sampling and training in bronchoscopy skills. The Ambu aScope 4 Broncho can also be used for direct visualisation and airway examination, collection of bronchoscopic biopsies and removal of secretions and clots. The bronchoscopes need to be connected to the portable aView 2 Advance monitor to display the images. According to the company, the technology can be used for adults in hospital settings, including on the ward, in theatre, in the emergency department and in critical care.
The Ambu aScope 4 BronchoSampler, an add-on technology to Ambu aScope 4 Broncho, is a sterile single-use device for use during BAL and BW. The Ambu aScope 4 Broncho Sampler Set is a combination of Ambu aScope 4 Broncho and aScope 4 BronchoSampler. It is attached to the Ambu aScope 4 Broncho to enable aspiration and collection of fluid samples from the bronchioles or alveoli.
Innovations
According to the company, the single-use bronchoscope reduces the risk of cross-infection and eliminates the need for complex and potentially costly reprocessing. The Ambu aScope 4 Broncho Sampler Set is a closed-loop system, which reduces the risk of contamination and sample loss during BAL and BW.
Current care pathway
Bronchoscopy procedures are used to help diagnose, and sometimes treat, conditions of the airways and lungs. Most bronchoscopy procedures in the NHS are done with reusable flexible bronchoscopes. Single-use flexible bronchoscopes have been reported to be used in some cases. Reusable flexible bronchoscopes have been reported to carry a 2.8% risk of cross‑infection (Mærkedahl et al. 2020).
Population, setting and intended user
The technology is intended for people aged 18 and over having routine diagnostic and therapeutic bronchoscopy procedures of direct visualisation and airway examination, BAL, BW, collection of bronchoscopic biopsies and patient samples, tracheal intubation, percutaneous dilatational tracheostomy, and removal of secretions or blood and blood clots. This device can be used in hospital settings, including on the ward, in theatre, in the emergency department and in critical care. According to the company no formal staff training is needed, although product training is highly recommended.
Costs
Technology costs
The cost of Ambu aScope 4 Broncho plus the aScope 4 BronchoSampler (Broncho Sampler Set) is £185 per unit, and £925 for a box of 5 (excluding VAT). The cost for the aView 2 Advance monitor is £4,000. The cost per procedure of using Ambu aScope 4 Broncho has been reported as £220 (Mærkedahl et al. 2020).
Resource consequences
The technology is used in 229 NHS trusts. The NHS purchased 57,724 units of Ambu aScope 4 Broncho between June 2021 and June 2022. Evidence on Ambu aScope 4 Broncho from a published budget impact analysis by Russell and Ockert (2019) showed that at 500 procedures per year, the technology may be cost-minimising. The study claims potential cost savings of £115 per procedure in direct costs and £358 when including costs associated with a 1.6% risk of cross-infection. NICE's medical technologies guidance recommends Ambu aScope 4 Broncho for use in unexpected difficult airways.