Breathing Circuit Leak Flashcards
What is a breathing circuit leak?
An unexpected leak of gas from the breathing circuit. A leak becomes significant if unable to maintain positive pressure ventilation.
What are the clinical features of a breathing circuit leak in someone breathing spontaneously?
higher than normal fresh gas flow rates required to inflate reservoir bag between breaths
odor of volatile anesthetics present
signs of light anesthesia
What is the management of a breathing circuit leak?
maintain adequate oxygenation and ventilation
test integrity of the circuit
check for machine leak
check for ETT leak
How would you manage a breathing circuit leak in a spontaneously breathing patient?
close the APL valve
increase the fresh gas flow into the circuit
if reservoir bag does not refill, press the O2 flush button and listen for major leak and fix
check and tighten circuit connections, O2 sensor, inspiratory/expiratory valve covers, EtCO2 sampling line
How would you manage a breathing circuit leak in a mechanically ventilated patient?
Increase the fresh gas flows into the circuit
stop the ventilator
switch to spontaneous ventilation and test ability of reservoir bag to deliver positive pressure breath
feel complaince of reservoir bag while assessing chest rise and breath sounds
if able to deliver positive pressure breath with manual ventilation, leak is in the ventilator
How would you test the integrity of the circuit if you suspect a breathing circuit leak?
disconnect Y piece from patient and occlude while holding O2 flush. If positive pressure is maintained, problem is with patient or ETT.
if still leaking, and no disconnection found, use alternative mode of ventilation (and anesthesia) and replace machine at earliest convenience.
How do you check for a leak in the machine if you suspect a breathing circuit leak?
check O2 pipeline pressure and function of O2 flowmeter
check for vaporizer leak–> turn off and assess for continued leak
may be internal problem with the machine
How would you check the ETT if suspecting a breathing circuit leak?
listen carefully over mouth while applying positive pressure in circuit
check inflation of pilot balloon
if cuff appears defective, consider feasibility and risk to replacing ETT
if not advisable to extubate, consider replacing with LMA or packing pharynx temporarily.
