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INTRO TO NURSE ANESTHESIA > Anesthesia Machine > Flashcards

Anesthesia Machine Flashcards

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1
Q

Function of the Anesthesia Machine

A

Provides delivery of medical gases and vapors of volatile anesthetics in known concentrations to a common gas outlet

These gases enter a breathing system

Delivered to the patient during either spontaneous or mechanical ventilation

Exhaled gases are removed from the breathing system

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2
Q

Standards of the anesthesia machine is are governed by?

A

American National Standards Institute (ANSI) Prior to 2000

American Society for Testing and Materials (ASTM) since 2000

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3
Q

Contemporary Components of the machine are?

A 
Electrical supply
Battery back- 30 minutes
Alarms- High, medium, low priority
Required monitors
-inspired O2
-expired CO2
-Oxygen Supply failure
-Hypoxic guard system
-Anesthetic vapor concentration
-Vital signs
Oxygen supply
Flowmeter
O2 Flush valve
Vaporizers
-Calibrated
Waste gas system
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4
Q

Systematically how does Nagelhout categorized the machine

A

Nagelhout

Supply, processing, delivery, Disposal

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5
Q

Systematically how does Barash categorized the machine

A

Barash

Checkout of the anesthesia workstation

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6
Q

Systematically how does Miller categorized the machine

A

Miller’s

High, intermediate, low-pressure system

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7
Q

The High Pressure system includes segments exposed to high pressure of auxiliary gas cylinders of how much pressure?

A

< 2000 psi

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8
Q

Components of the high-pressure system are?:

A
  1. Auxiliary E – Cylinder
  2. Yoke assembly
  3. Burdon gauge
  4. High pressure regulator
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9
Q

Describe Cylinder sizes A-E

A

Sizes A – E
Back up
Size E most common

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10
Q

Describe cylinder sizes G-H

A

Sizes G – H
Banks
Back up for hospital supply

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11
Q

How are cylinders sized and material they are made of:

A

Vary in sizes A-H
Steel
Aluminum- For MRI environment

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12
Q

DOT issues regulations for O2 tanks, who sets purity of medical gases?

A

United Stated Pharmacopeia/ National Formulary (USP/ NF)

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13
Q

Carbon Dioxide Color code

A

US Grey

ISO Grey

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14
Q

Medical Air Color code

A

US Yellow

ISO Black and White

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15
Q

Nitrogen Color code

A

US Black

ISO Black

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16
Q

Nitrous Oxide Color code

A

US Blue

ISO Blue

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17
Q

Oxygen Color code

A

US green

ISO white

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18
Q

Vacuum (Suction) Color code

A

US white

ISO Yellow

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19
Q

WAGD (EVAC) Color code

A

US Purple

ISO Purple

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20
Q

Describe the Yoke Assembly

A
  1. Orient tanks
  2. Gas tight seal
  3. Unidirectional flow for gases
  4. Contains a filter
    5Check valve
    - stops leaking into atmostphere
    -Stops transfer between tanks
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21
Q

Pin Index Safety System (PISS) for

Air, O2, Nitrous Oxide

A

Air-1,5
O2- 2,5
N2O-3,5

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22
Q

E- cylinder capacity

A

660 L

1900 PSI

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23
Q

H cylinder Capacity

A

6900 L

2200 PSI

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24
Q

Properties of O2 physical state (room temp) and full tank pressure

A

Gas at room temp 2200 psi full tank capacity

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25
Q

Properties of Nitrous Oxide physical state (room temp) and full tank pressure

A

Liquid and gas at room temp

750 psi full tank

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26
Q

Describe the Nitrous Cylinder

A

750 PSI
1590 Liters of Gas
Liquified gas…
Have to weigh the cylinder to figure out amount of gas left
Pressure remains constant until all the liquid has turned to gas
Pressure does not start to drop until about 75% of the tank is used
About 250 - 400 ml’s remain

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27
Q

What are the safety systems a cylinder

A
  1. Frangible disk
    Burst under extreme pressure
  2. Fusible plug
    Melts at a predetermined temperature
    Made of bismuth, lead, tin & cadmium
    BLT with cheese
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28
Q

What is the function of the high pressure regulator?

A

Reduces the high and variable pressure delivered from a cylinder to a lower and more constant pressure suitable for the anesthesia machine.

29
Q

High Pressure regulators are preset at the factory at? and what does that ensure?

A

Typically between 40 -45 psig

This ensures the pipeline gas is used preferentially to the cylinder

30
Q

Hospital Oxygen supply

A

Typically stored as a liquid -184 degrees Celsius.
Supplied to the hospital as a gas @50 psi.
50 psi is the working pressure of the anesthesia machine
Multiple shut off valves between supply and anesthesia machine

31
Q

How is nitrous stored?

A

Typically in stored in H cylinders

32
Q

Hospital Supply Connections uses what safety system

A

Diameter Index Safety System (DISS).

33
Q

Explain the Diameter Index Safety System (DISS).

A

Ensures only the correct anesthesia gas can be connected

34
Q

What does the Diameter index safety system (DISS) contains/ components?

A 
Contains:
Filter-Stop contaminants
Check valve
Ensures unidirectional flow
Pressure gauge   
Pipeline pressure 
Sized and threaded differently
Body, nipple, and nut combination
35
Q

Describe the Hospital Supply Connections

A 
Quick connections – older 
Gas specific
Typically to wall outlets 
Are manufacture specific
-Problem….
-Ohmeda will not connect to Chemeron
36
Q

Oxygen Flush Valve provides?

And where is it attached?

A

100% oxygen to the anesthesia circuit at 35-75 L/minute.

Enters the circuit downstream from the vaporizers – directly to common gas outlet.

37
Q

How is the 2 Oxygen Flush Valve protected

A

Protected by rim to lessen the chance of accidental activation

38
Q

What are the hazards of the O2 flush valve

A

*Barotrauma
-Stuck valve
If used during inspiratory phase of mechanical ventilation
-Older - Ventilator relief valve closed & APL out of circuit
-Newer - Fresh gas decoupling valve
*Awareness
-Dilute anesthetic gases

39
Q

Describe the electrical system of the anesthesia machine and how the anesthesia machine is powered?

A

Electrical power is supplied to the gas machine through a single power cord.
Must have a battery backup that lasts at least 30 minutes of limited operation!
Each machine is different
Typically, patient monitors are discontinued

40
Q

Explain the Pneumatic Safety Systems

A

Engineered to help prevent the delivery of a hypoxic gas mixture to the patient
Oxygen influences the flow of all other gases

41
Q

How did manufacturers incorporate the pneumatic safety systems?

A

The anesthesia gas supply device shall be designed so that whenever oxygen supply pressure is reduced below the manufacturers specified minimum, the delivered oxygen concentration shall not decrease below 19% at the common gas outlet.”

42
Q

Explain oxygen supply failure alarms on older ohmeda machines

A
  • Audible indications when pneumatic system is turned on (oxygen filling whistle)
  • When oxygen pressure drops below 38 psig the oxygen failure whistle valves opens
  • Whistle sounds until oxygen pressure drops below 6 psig
  • At 30 psig, the supply of anesthesia gases are stopped.
43
Q

What Fail-safe devices and explain how they work?

A
  1. Fail safe valves are designed to prevent the delivery of hypoxic gas mixtures from the machine in the event of failure of oxygen supply
  2. PRESSURE not flow!
  3. Protects against unrecognized exhaustion of oxygen delivery from either the pipeline or attached oxygen tank
  4. Fail safe devices either proportionally decreases the flow of all gases or shuts off (threshold) flow of all other gases except oxygen based on manufacture set pressures
    Limits:
    Does not prevent anesthesia gases from flowing
    Works even if the wrong gas is supplied (pneumatic devices – stupid)
44
Q

What are the 2 limitation of fail safe devices?

A

Does not prevent anesthesia gases from flowing

Works even if the wrong gas is supplied (pneumatic devices – stupid)

45
Q

Explain the Fail safe device: Oxygen failure protection device in Drager

A

O2 supply is at 50 psig pushes the piston which inturns pushes the spring load nozzle open and which allows N2O . As O2 supply decreases the spring loaded nozzle closes of N2O

46
Q

Explain the Fail safe device in: Datex Ohmeda

A

Oxygen supply is greater than 20 psig pushes the diaphragm of the open which allows N2O to flow. As the O2 supply gets bellow 20 psig the diaphragm closes and the flow of N2O is stopped.

47
Q

What is Auxiliary Oxygen Flowmeter

A

Not a mandatory requirement, but on almost all anesthesia machines
Allows for the use of low flow oxygen without using the anesthesia circuit
Typically used for monitored anesthesia care
Most often accessible when the pneumatic power switch is off
Can be used in an emergency, even without machine power
However uses same pipeline supply or attached E – cylinder
Even if contaminated…
May serve as potential source of oxygen for jet ventilation

48
Q

Functions of the Second Stage Pressure Regulator

A
  1. Ensures that oxygen is the last gas flowing.
  2. Supply constant pressure to the flow control valves and the link proportioning system
  3. Protects against fluctuations of pipeline pressure
    *Located downstream from the gas supply sources in the intermediate pressure system
    Lowers the pressure to 14 - 35 psi
    Depends on the workstation
    Typically:
    Oxygen: 14 psi
    Nitrous oxide: 26 psi
49
Q

Where is the Low Pressure System located

A

Located between the flow control devices and common gas outlet
Pressure in this section is slightly above atmospheric

50
Q

What are the components of the low pressure system?

H U F P A C

A
  1. Hypoxia prevention safety devices
  2. Unidirectional valves (info only)
  3. Flowmeters
  4. Pressure relief devices (info only)
  5. Anesthesia vaporizers/vaporizer manifold (info only)
  6. Common gas outlet
51
Q

Describe the purpose of the flowmeters

A

Regulates the flow of gases entering the breathing circuit

52
Q

Flow meter contains

A
  1. Flow control valves

2. Flow tubes

53
Q

How are the flow valves and in the flowmeters linked?

A

The oxygen and nitrous flow valves are linked mechanically or pneumatically to prevent a hypoxic mixture

54
Q

Flowmeters control the flow of gases Traditional vs. electronic

A

Traditional are mechanically controlled

Newer are an electronic interface

55
Q

Flowmeter consists of

A 
Consists of:
Flow control knob
A tapered needle valve
Valve seat
Valve stops
Float
Float stops
56
Q

What are the types of flow tubes? Describe them.

A

Variable orifice or Thorpe tubes
Narrow at bottom and widens vertically
Annular space: between float and tube

Calibrated for SPECIFIC GAS
Indicator float – hovers at equilibrium
Placed in series

57
Q

What is Laminar flow vs. Turbulent flow

A

Laminar – low flow – viscosity of gas

Turbulent – high flow – density of gas

58
Q

Flow tubes chamber of know volume

A

Chamber of know volume – the amount of heat required to maintain the set temperature is proportional to specific heat and gas flow rates.

59
Q

Flow tubes on newer machines

A

Newer machines use electronic flow sensors
Multiple different methods to measure
Depend on electrical power to provide display
Must have a backup to control; display O2 flows

60
Q

What are Hypoxia prevention devices

A

A proportioning system is to prevent the creation and delivery of hypoxic mixtures
Designed to prevent an operator selected delivery of oxygen concentration below 21%
The machine automatically limits the amount of nitrous oxide so a hypoxic mixture cannot be delivered
Accomplished with a pneumatic-mechanical interface between the oxygen and nitrous oxide flows
Specific devices vary among anesthesia machine manufactures

61
Q

Sensitive oxygen ratio controller system (Drager)

A

Pneumatic – mechanical interlock
Opening the oxygen flow creates a backpressure in the chamber opening the nitrous oxide flow
Maintains a ratio of 25% oxygen to 75% nitrous oxide flow into breathing circuit
Needs at least 200 mL/min to operate

62
Q

Common gas outlet receives all gages and vapors from?

A

from the machine and delivers the mixture to the breathing circuit.

Is a 15 mm female slip joint fitting.

Should not be used to administer supplemental oxygen to a patient

63
Q

5 pathways of oxygen

A
  1. Flow to the fresh gas flowmeter
  2. Powers the oxygen flush valve
  3. Activates the fail-safe valve/ mechanism
  4. Activates the oxygen supply low pressure alarm
  5. Compresses the bellows of the ventilator
64
Q

How and when should Anesthesia Machine Checks be completed?

A

Two checks

  1. Complete and thorough daily check
  2. Circuit check is performed before each new surgical case
65
Q

The Intermediate Pressure System receives gases from?

A

from the pressure regulator or pipeline inlet

66
Q

Components of the Intermediate Pressure System are:

A
  1. Hospital supply (pipeline inlet)
  2. Oxygen flush valve
  3. Pneumatic safety systems/electrical system (on switch)
    Oxygen supply failure alarms
    Oxygen failure protection devices
  4. Auxiliary oxygen flowmeter
  5. Second stage regulator
67
Q

Where is the second stage regular located?

A

*Located downstream from the gas supply sources in the intermediate pressure system

68
Q

What are Hypoxia prevention devices

A

A proportioning system is to prevent the creation and delivery of hypoxic mixtures

Designed to prevent an operator selected delivery of oxygen concentration below 21%

The machine automatically limits the amount of nitrous oxide so a hypoxic mixture cannot be delivered

Accomplished with a pneumatic-mechanical interface between the oxygen and nitrous oxide flows

Specific devices vary among anesthesia machine manufactures

INTRO TO NURSE ANESTHESIA (10 decks)

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