TEMED Gas Diffuser

The TEMED Gas Diffuser “is intended for use by cardiovascular surgeons in open heart surgery procedures for the insufflation of carbon dioxide gas into the thoracic cavity to reduce the risk of air 

embolism which can result in organ damage.”

Why use the TEMED Hydrophobic CO2 Gas Diffuser

“Introduction of CO2 through open-ended tubes is an unsatisfactory method of displacing the air”

Selman et al. Journal of Thoracic and Cardiovascular Surgery. 1966.

“When an open ended tube is used as a disperser of CO2, the gas is introduced as a jet. When the gas stream strikes the bottom of the cavity, the change in momentum promotes turbulence. Convection currents are established with air sweeping in over the sides”. 

Selman et al. Journal of Thoracic and Cardiovascular

Surgery. 1966.

“The air content was below 1% 4 cm below the surface of the open wound model during continuous carbon dioxide inflow of 2–10 L/min with the mini diffuser. In comparison, carbon dioxide insufflation via the open ended tube resulted in a mean air content between 10 and 75%. The mean air content of the wound model remained below 1% at a carbon dioxide flow rate of 3–5 L/min during intermittent application of a suction device” Nyman et al. Journal of Cardiothoracic Surgery (2019) 14:12.

For efficient de airing, CO2 has to be delivered from within the wound cavity. The gas-diffuser was the most efficient device. In contrast to a gas-diffuser, a multi perforated catheter or a gauze sponge is unsuitable for CO2 de airing because they will stop functioning when they get wet in the wound.

(Persson M, Svenarud P, van der Linden J.Department of Cadiothoracic Surgery and Anesthesiology, Huddinge University Hospital,

Karolinska Institute, Stockholm, Sweden. m.persson@labmed.ki.se).

Gauze sponge and the multi perforated catheter immediately became inefficient (70% and 96% air, respectively), whereas the gas-diffuser remained efficient (0.4% air). During surgery, the gas-diffuser provided a median air content of 1.0%. (J Cardiothorac Vasc Anesth. 2004 Apr;18(2):180-4.

With the tube the median air content in the wound model was 19.5% to 51.7% at the studied carbon dioxide flows, whereas with the gas diffuser the median air content was no greater than 1.2% at 5 L/min and no greater than 0.31% at 10 L/min (P <.001). (J Thorac Cardiovasc Surg. 2003 May;125(5):1043-9.).

“The use of CO2 in minimal invasive cardiac surgery is probably more important compared with open cardiac surgery, as minimal invasive cardiac surgery does not permit normal de-airing maneuvers.”

Nyman et al. Journal of Cardiothoracic Surgery (2019) 14:12.

More than fifty years ago it was recognised that having a single tube did not provide effective deairing of the chest cavity. They found that the most effective way of de-airing was to have four tubes that were all pointing at the area requiring de-airing. They also found that de-airing was more effective when the tubes were outside of the cavity. Thorax (1968), 23, 194. Carbon dioxide in the prevention of air embolism during open-heart surgery. W. SHANG NG AND MICHAEL ROSEN.

Using a Gas Diffuser it has been shown that the time taken for there to be detectable micro emboli fell from 19 minutes to 7 minutes. Therefore a 12 minute reduction in de-airing time. Circulation. Volume 109,

Issue 9, 9 March 2004, Pages 1127-1132).