mcgraths

[Bostonredsox]

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what are your thoughts on these. Been unsuccessful in getting admin to buy us a 15k glidescope for MICU but I understand these are quite nice and far cheaper with I presume, disposable blades. Was putting in fem lines in ED helping out the night doc during a code and I watched the CRNA pull one of these guys out and change out the King. Never have used one before but seems like it would be a step in the right direction for administration that is very cost consienctous.

 

[Dejavu]

what are your thoughts on these. Been unsuccessful in getting admin to buy us a 15k glidescope for MICU but I understand these are quite nice and far cheaper with I presume, disposable blades. Was putting in fem lines in ED helping out the night doc during a code and I watched the CRNA pull one of these guys out and change out the King. Never have used one before but seems like it would be a step in the right direction for administration that is very cost consienctous.

We don't seem to have the same tightness in budget that you are dealing with, but we had McGraths all over the place for a couple of years, ditched them all and now are extremely happy with Glides.

To the point that our residents are beginning to complain that they are not getting enough fiberoptic intubations because you can intubate just about everyone who used to be a FO with a Glidescope.

Almost everyone...

 

[ProwlerturnGas]

My experience with McGrath.

1. When they worked, they worked very well.
2. Company says you can use a regular ET stylette. I found this to be untrue and you need a glidescope or similar rigid stylette.
3. Battery use went very fast and McGrath failed at most unopportune times. Thought they should engineer a battery indicator-maybe in new models they have?
4. Contact points of blade and handle would "corrode" and would need cleaning and debriding frequently.
5. Sometimes hazy view and end would need to be defogged
6. Always concerned that they would "walk off".
7. Reps were somewhat smug and annoying.

PTG

 

[drccw]

I hate them.. hate them...
BAsically not dependable in the situations that you need them to be...
Pretty much everything ProwlerturnGas said..

drccw

 

[periopdoc]

My experience with McGrath.

1. When they worked, they worked very well.
2. Company says you can use a regular ET stylette. I found this to be untrue and you need a glidescope or similar rigid stylette.
3. Battery use went very fast and McGrath failed at most unopportune times. Thought they should engineer a battery indicator-maybe in new models they have?
4. Contact points of blade and handle would "corrode" and would need cleaning and debriding frequently.
5. Sometimes hazy view and end would need to be defogged
6. Always concerned that they would "walk off".
7. Reps were somewhat smug and annoying.

PTG

You are not talking about the current generation McGrath (the McGrath Mac) which is an excellent tool. Much better than the previous version. The current generation has a much improved battery, a battery indicator, and does not have the contact points that were the biggest issue with the previous generation.

Compared to the Glidescope it has a couple of issues that I find to be insignificant, but not all of my partners agree with me.

The video quality is not quite as good. It is like the Glidescope is high def and the McGrath Mac is standard def. I can see the target just fine. Do you really need to have 1080p to intubate?

It is more susceptible to fogging than a properly prepared Glidescope. However, it is rare that one takes the time to properly warm up the Glidescope. It takes a couple of minutes to warm up if you want to prevent fogging. From a cold start, like they are typically used, both are susceptible to fogging. In reality, this has never been bad enough with either one to be an issue for me.

I use my standard stylet and approximate the shape of the Glidescope stylet. Works great and allows you to direct the tip as needed with just a twist of the wrist. If you use a super-flexible, mini stylet, invest in some cheap, thicker and slightly more rigid disposable stylets. They work great.

They are tons cheaper, as in 10:1 or so. They give you a pretty good break if you buy several at once.

I love the McGrath Mac. Not quite as good as a Glidescope, but perfectly adequate. I do not mean to imply that there are airways that you could get with the Glidescope that you couldn't get with the McGrath Mac, you just will have a slightly better picture with the Glidescope. There is good enough (McGrath Mac), then there is better than necessary (Glidescope).

- pod

 

[periopdoc]

This 👍👍

Not this 👎thumbdown

- pod

 

[ProwlerturnGas]

You're right. My experience was with the original McGrath. Havent used the McGrath MAC. Looks like they corrected some flaws.

 

[Bostonredsox]

thanks for the responses guys, gonna see if we can get 2-3 to have in the unit.

 

[periopdoc]

Just call up the rep. They will give you a free trial so you can check them out for yourself. There are about a half dozen similar competing devices like this, all of which are available for free trial. Check the buyers guide on Anesthesiologynews.com.

-pod

 

[MTGas2B]

Anybody airtraq fans? I've tried it in mannequins, I think they'd be great to keep in each OR and for offsite.

http://www.airtraq.com/

 

[Oggg]

+1 on the McGrath MAC.

 

[Hernandez]

This 👍👍

Not this 👎thumbdown

- pod

I HATED, HATED the original version, the post above hit all the same issues I saw, horrible unit that would die in the middle of an intubation. And I likely won't even bother trying the new one due to the horrible experience with the original.

 

[aredoubleyou]

Biggest problem are they can get misplaced and carried off to various other units.

In the unit Im a big fan of the glide - as it is easier to get into a mouth of a spontaneously ventilating patient to slip in an ett. Plus I feel like the ett can be placed easier with less bending, wiggling, and general struggling in fatties not in a good sniffing position (most ICU peeps) with the glide but less so for the mac style scopes. That being said, it could be my lack of experience with these and familiarity with the glide...and I havent touched a mac blade for years 🙂

 

[cincincyreds]

We had such a high failure rate with our McGraths in our group we just traded them in for glidescopes. Everyone in the group is so much happier with the glidescopes. The bigger screen just makes things easier and the preformed stylet makes it easy to guide the tube.

 

[periopdoc]

Previous generation with the sliding blade or current generation with the fixed blade? I would bet $100 you are talking about the former.

- pod

 

[Oggg]

+1 to McGrath MAC being a completely different and successful cheaper-than-glidescope video laryngoscope, nothing like the old crappy McGrath Series 5

 

[drccw]

My experience was with the previous generation... we had one glidescope and 5 of the MacGraths.. so undependable that we traded them in and now have 6 glidescopes... no looking back... sure the new ones might be good but we've got all our video laryngoscope needs met...

Just curious, how many video laryngoscopes do most people have?
We have 1 on OB, 3 in our Main OR and 1 in each of our ancillary ourpatient OR areas.

Total of 32 anesthesizing areas....

drccw

 

[periopdoc]

Can't blame you for the once bitten twice shy attitude, but the new McGraths Fixed the issues with the original.

We have three anesthetizing locations (not including off-site) with a total of 16 potential OR's (if you include the two backup OR's that are never used). We have two Glidescopes and one McGrath. I would like to get a dedicated OB Glidescope.

-pod

 

[AlmostJesus]

Anybody airtraq fans? I've tried it in mannequins, I think they'd be great to keep in each OR and for offsite.

http://www.airtraq.com/

I have a couple of expired airtraq's at home, Ive used them many times to show friends my epiglottis/vocal cords.

We have a McGrath at work (paramedic). I attempted to use it once in the OR for a tube and it did not go very well, but I had no problem with DL. Likely due to the stylet.
I have noticed when practicing with it that the contacts are very poor, and its not uncommon to have it lose video at inopportune times.. It isn't so bad when you have bored paramedics that will clean the contacts frequently, but I would not trust it if I had it on my hospital crash cart, Id likely go for the new McGrath or glidescope over that.

 

[periopdoc]

Once again, you are talking about a previous generation of the McGrath. The current generation does not have contacts that can degrade over time.

- pod

 

[CambieMD]

The McGrath is inferior to the Glidescope. The newer version of the McGrath is much better than the old version but it is not superior to the Glidescope.

Cambie

 

[pseudoknot]

The Kingvision is pretty nice for the price although I haven't used it on a patient. Still, it's $1000.

 

[Bostonredsox]

The McGrath is inferior to the Glidescope. The newer version of the McGrath is much better than the old version but it is not superior to the Glidescope.

Cambie

obviously. The question was how good are the macgraths as my institution will not purchase a glidescope for our MICU. Trying to get some sort of video assisted laryngoscopy tools for the MICU.

 

[MTGas2B]

obviously. The question was how good are the macgraths as my institution will not purchase a glidescope for our MICU. Trying to get some sort of video assisted laryngoscopy tools for the MICU.

How much will they be used? One advantage of the airtraq is that they are disposable and not very expensive. Potentially a better option for low use back up item.

 

[Bostonredsox]

How much will they be used? One advantage of the airtraq is that they are disposable and not very expensive. Potentially a better option for low use back up item.

Not sure, they would be my go-to for anyone I cannot see cords on after DL with a standard mac. My experience with the airtract isnt great. something about looking downward into the viewfinder and then trying to slide the tube just feels odd to me. A more standard approach and passage of a tube while looking at a screen seems easier to me. But on the whole, i would assume I would only be using it for anyone I cannot tube with standard equipment. Having one on hand in the difficult airway box would be enough for me though as you have to crack that box to get to the airtract anyway.

 

[periopdoc]

The McGrath is inferior to the Glidescope. The newer version of the McGrath is much better than the old version but it is not superior to the Glidescope.

Cambie

Agreed. I just get annoyed with people talking about a discontinued product as if it has some relationship to the current one. It is like those damn flammable anesthetic gas signs... Uh yeah, we don't use cyclopropane or methoxypropane anymore.

The Glidescope is still what I grab when I have a potentially difficult laryngoscopy coming my way, but saying that it is better is kind of like saying a grade 1 view is better than a good solid grade 2 view where you see 3/4 of the cords. Sure it is nice to see the anterior commisure of the vocal cords, but it likely makes no difference in intubating success. I can't honestly say that intubation success is higher with the Glidescope.

In the OP's situation, I think the McGrath Mac is a good device to consider.

- pod

 

[Bostonredsox]

Agreed. I just get annoyed with people talking about a discontinued product as if it has some relationship to the current one. It is like those damn flammable anesthetic gas signs... Uh yeah, we don't use cyclopropane or methoxypropane anymore.

The Glidescope is still what I grab when I have a potentially difficult laryngoscopy coming my way, but saying that it is better is kind of like saying a grade 1 view is better than a good solid grade 2 view where you see 3/4 of the cords. Sure it is nice to see the anterior commisure of the vocal cords, but it likely makes no difference in intubating success. I can't honestly say that intubation success is higher with the Glidescope.

In the OP's situation, I think the McGrath Mac is a good device to consider.

- pod

So it has taken a few months, but we are getting McGrath macs next month. Several CRNAs wanted there own and were willing to buy (~$2200) and we got a deal for buying 10 so the hospital bought one for us in MICU and one for the ED. Glide was the same cost as 8 of these so well take what we can get. I setup some OR time for my co residents who have never used one and the anesthesia folks obliged to spend some time showing everyone how to use them. Excited to finally have my own video laryngoscope for my MICU airways and be part of the 21st century. I think when I move to my next shop I may buy one of those myself. Comes in nice carrying case and 2k isn't bad to have something I need if they don't have a glidescope at the hospital.

Ill post some feedback mid July after some time using them regularly

 

[Bostonredsox]

Update.

Been trialing the McGrath Mac for 2 weeks. Really really pleased with it. Screen a lot smaller than a glide so its not as useful for teaching interns, but for personal use, I love it. Will probably buy my own.

 

[periopdoc]

Good to hear. If it was my own personal money, I would go that route. Hospital's money... Glidescope with the pedi and adult wands.

- pod

 

[B-Bone]

I would not pass judgement on the McGrath until you've used one that's been around for awhile. They tend to wear out pretty quickly, with the screen frequently failing after a year or so of use. I've had this happen with multiple devices at multiple institutions. They are great for portability, but the longevity just isn't there. Bad electrical connections, maybe? Anyway, I'd talk to the manufacturer and look closely at warranties/service plans if you're going to buy your own.

 

[Bostonredsox]

I would not pass judgement on the McGrath until you've used one that's been around for awhile. They tend to wear out pretty quickly, with the screen frequently failing after a year or so of use. I've had this happen with multiple devices at multiple institutions. They are great for portability, but the longevity just isn't there. Bad electrical connections, maybe? Anyway, I'd talk to the manufacturer and look closely at warranties/service plans if you're going to buy your own.

Thanks for the info will keep that in mind

 

[periopdoc]

I would not pass judgement on the McGrath until you've used one that's been around for awhile. They tend to wear out pretty quickly, with the screen frequently failing after a year or so of use. I've had this happen with multiple devices at multiple institutions. They are great for portability, but the longevity just isn't there. Bad electrical connections, maybe? Anyway, I'd talk to the manufacturer and look closely at
warranties/service plans if you're going to buy your own.

The device you are talking about is the old, no longer manufactured McGrath, NOT the new McGrath Mac. The old one had a serious and irredeemable engineering flaw that led to corrosion where the screen attached to the sliding portion of the handle and ultimately failure of the unit.

After that debacle, why they would ever choose to re-use the name McGrath for an airway device is beyond me.

- pod