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The Anes. Machine
Kevin's Anesthesia Machine Lecture (SIUE Nurse Anesthesia)
| Question | Answer |
|---|---|
| T/F. Provider is responsible for failing to follow manufacture instructions. | True. |
| Which agency developed the anesthesia machine checkout protocol? | FDA |
| What is the primary source for gases? And at which pressure are they regulated to? | Hospital pipeline. 50 mmHg. |
| What is the pressure of gas that enters machine via cylinders? | 45 mmHg. |
| What is the flow rate for oxygen flush? | 35 to 75 L/min. Avg. around 50 L/min |
| 4 purposes of the anesthesia machine? | 1. Supply 2. Processing 3. Delivery 4. Disposal |
| At which temp is liquid oxygen stored at? | -150 degrees C. |
| How is nitrous oxide usually stored? | In an H cylinder. |
| What are the two types of connections for gases? | 1. DiSS (diameter index safety system) 2. Quick Connect |
| Which type of connection is used from the anesthesia machine to the wall outlet? | DISS. |
| What are the two common sources of leaks for gases | 1. o-rings 2. faulty springs |
| What 3 things are present at the pipeline inlet? | 1. filter 2. check valve 3. pressure gauge |
| What is the purpose of the check valve? | To prevent backflow |
| What is the procedure for loss of pipeline supply of oxygen? | 1. Turn on O2 E cylinder fully 2. Disconnect machine from wall supply 3. Decrease FGF to conserve O2 tank 4. Switch to manual ventilation to conserve O2 tank |
| What part of anesthesia machine may not be available if using cylinder supply? | Aux. flowmeter |
| T/F. The O2 E cylinder on the anesthesia machine should be on at all times. | False. It should only be turned on in case of wall supply failure. Will not be alert to pipeline supply failure if E cylinder on, until tank fully exhausted. |
| How will you know if loss of pipeline pressure? | low O2 pressure alarm will sound. |
| When should O2 E cylinder be changed out on anesthesia machine? | When below 1000 psi. |
| O2 D Tank pressure and volume | 2200 psi and 412 L |
| O2 E Tank pressure and volume | 2200 psi and 660 L |
| O2 H Tank pressure and volume | 2200 psi and 6900 L |
| N2O E Tank pressure and volume | 750 psi and 1590 L |
| N2O H Tank pressure and volume | 750 psi and 16,000 L |
| What is the service pressure for an O2 E cylinder? What is the working pressure for an O2 E cylinder? | 1900 psi 2200 psi |
| Purpose of Hanger Yolk | 1. orient cylinders in PISS 2. provide gas tight seal 3. ensures unidirectional flow |
| PISS setup for Air, O2, N2O? | 1. Air 1 & 5 2. O2 2 & 5 3. N2O 3 & 5 |
| Types of pressure relief valves and advantages/disadvantages? | 1. fusible plug - prevents explosion with increased heat, but vents combustible gas into fire. May be combined with another type of PRV. 2. frangible disk - same as fusible plug. 3. safety relief valve - spring loaded, limits release of gas. |
| Bourdon Gauge | 1. High pressure readings. 2. Works regardless of position of tank. 3. If two tanks are both open it will read the one with the higher pressure. |
| Pressure Regulator | 1. Immediately distal to the hanger yoke. 2. Converts high cylinder pressure to 45 psi. 3. Intentionally slightly less than pipeline pressure. |
| Path of gas through machine | Failsafe valve (except O2) --> Supply point to the FM. --> FM to common gas manifold. (O2 added last) --> gases enter the vapor. --> Gas from the vap. goes to the comm. gas outlet. --> delivery hose to the breathing circuit. |
| Five Task of oxygen | 1. Proceeds to the flowmeter. 2. Powers the oxygen flush valve. 3. Activates fail-safe mechanisms. 4. Activates the low oxygen pressure alarms. 5. Compresses the bellows for mechanical ventilation. |
| Flowmeter safety features | 1. Control knobs color and touch coded. 2. Specific for each gas. 3. hypoxic guard system (fail safe system) 4. Oxygen is furthest to the right. 5. Proportioning system |
| 1. Hypoxic Guard (fail safe system) 2. Proportioning System | 1. prevents hypoxic mixture by turning off N2O in case of O2 failure. 2. will not deliver less than 70/30 concentration of N2O and O2. |
| When can hypoxic guard system fail? | 1. Wrong supply gas in O2 pipeline/cylinder 2. defective mechanics 3. leaks downstream 4. third gas administration. |
| T/F. Will O2 flush bypass all pressure valves? | False. Will bypass 2nd stage valve, but not 1st stage. |
| What happens with excess use of O2 flush? | Dilutes concentration of inhalation agents. |
| What happens when failsafe mechanism triggered? | N2O float drops before O2 float |
| What are the three methods for driving a ventilator? | 1. Oxygen 2. Air 3. Electric Piston |
| Factors which effect rate of vaporization in vaporizer? | 1. Temperature. 2. Vapor pressure of the liquid. 3. Partial pressure of the vapor above the liquid. |
| What are the three types of vaporizers? | 1. Variable-bypass (Iso and Sevo) 2. Measured-flow (Only in Military) 3. Injector or Tec 6 (Desflurane) |
| What happens when you put agent with high vapor pressure into lower vapor pressure vaporizer? | will have higher concentration of agent. (HLH) |
| What happens when you put agent with lower vapor pressure into higher vapor pressure vaporizer? | will have lower concentration of agent. (LHL) |
| Describe Tec6 vaporizer | Tec 6 vaporizer is a heated dual-circuit vaporizer. FGF from the common manifold pass vaporizer in one circuit. These FGF never touches liquid agent. vapor is prepared in the 2nd circuit is added FGF. heated to 39°C. vapor pressure of 1500 mm Hg. |
| Describe variable bypass vaporizer | sm. amt. of the FGF to contact with the liquid to pick up the vapor. Full sat. of the carrier gas is ensured by of wicks and baffles. fully saturated, known conc. of carrier gas is diluted with rest of the FGF that bypass the vap. to prod. final conc. |
| Vaporizer Design | Pumping effect is when vapor output is increased due to back pressure. Unidirectional valves in the vaporizers have minimized this phenomenon. If a vaporizer tips more than 45° the operator’s manual or a field service technician should be consulted. |
| What is the purpose of breathing circuit | Purpose of any breathing circuit is the delivery of oxygen and anesthetic gases and the elimination of carbon dioxide. |
| At what flow is scrubber bypassed? At what flow is scrubber 100% utilized? | greater than 4-5 L. FGF less than 250 mL/min |
| What to interventions can increase CO elimination? | 1. increase FGF 2. absorption by soda lime |
| What are advantages of rebreathing? | 1. Cost reduction. 2. Increase in tracheal warmth and humidity. 3. Decrease in potential occupational exposure. |
| Where does deadspace end? | At the Y piece where it splits. |
| Describe Open system | No mask on face. Anesthetic to patient by insufflation. Room air inhaled and anesthetic diluted. Not used much today. No rebreathing or reservoir bag. No valves. Pollution. Can’t positive pressure ventilate! |
| Describe Semi-Open system | Mask on face/ETT. Reservoir bag; no rebreathing. Room pollution. High gas flow. Unidirectional valve (can increase resistance). |
| Describe Semi-Closed system | Mask on face/ETT. No room air inspired. Expired gas exits through scavenging system, CO2 absorber. Partial rebreathing. Very common. Unidirect. valves and reservoir bag. Conserves moisture and heat. FGF can be less than patients minute volume. |
| Describe Closed system | Agents are in sys. and not vented. Maintains heat and humid. Full rebreathing of gases (pop-off closed). Less pollution. CO2 scrub. Unidirect valves and reservoir. FGF 150-500ml/min for phys.l require.! (150-250ml/min under anesthesia). Low FGF |
| Most common used anesthesia circuit | circle system |
| Two most common causes for increased etCO2. | 1. exhausted scrubber 2. faulty unidirectional valve |
| What should you do if the etCO2 increases? | Increase FGF and if improves, then change scrubber after case. |
| What is the max peak pressure for unsecured airway? | 20 cmH2O |
| At what flow is the circle system providing total rebreathing? | 0.35 to .5 L/min |
| What are the final products of the chemical reaction in a CO2 scrubber and how are they beneficial? | The water and heat energy. The chemical reaction causes by CO2 scrubber help to humidify and heat the air the patient breaths in. |
| What is the chemical which causes the CO2 absorbent to change color and at what pH does it change? | Ethyl violet. 10.3 |
| Name two compounds which are formed via the reaction between inhalational agents and the CO2 absorbent? Which specific agent causes the problem the most? How it is minimized? | 1. Compound A. Sevo & soda lime. Do not run FGF less that 1 L/min for greater than 2 MAC hours. Turn O2 off at end of case. Use low flows to keep absorbent moist. 2. CO Desflurane and soda lime. |
| Name the five components of the scavenger system. | 1. Gas collection assembly 2. Transfer tubing 3. Scavenging interface 4. Gas disposal tubing 5. Gas disposal assembly |
| What are the two types of scavenger interfaces, what are their benefits, and what are their requirements? | 1. Open. Safer for patient. Less safe for provider. No valves. Can only be active. (Do not choose passive on test!!) 2. Closed. Safer for provider. Less safe for patient. Valves (+ & -). Passive or Active. |
| What does an active/passive scavenger mean? | active = suction |
| What are two other names for APL valve and when is it used? | 1. pop-off valve 2. pressure limiting valve. It is used during manual ventilation. |
| In a circle system, when the unidirectional valve fails, what does the corrugated tubing turn into? | Dead space. |
Created by:
toppu2020
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