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APEX-Equipment > EQUIPMENT-Breathing circuits > Flashcards

EQUIPMENT-Breathing circuits Flashcards

1
Q

What are 4 classifications of breathing circuits

A
  1. Open
  2. Semi-open
  3. Semi-closed
  4. Closed
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2
Q

Describe the open breathing system

Example

A
  1. Does not allow for controlled ventilation
  2. Doesn’t permit delivery of precise inspired gas concentration
  3. Gas is exchanged with atm

Ex: nasal cannula, simple face mask, open drop

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3
Q

Describe the semi-open system

Example

A
  1. Contains gas reservoir
  2. No rebreathing of exhaled gases

Ex: Mapleson circuit, circle system (FGF > Vm)

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4
Q

Describe the semi-closed system

Example

A
  1. Contains gas reservoir
  2. Contains CO2 absorbent allowing patient to rebreathe

Ex: Circle system (FGF

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5
Q

Describe a closed system

Example

A
  1. Contains reservoir
  2. Contains CO2 absorbent
  3. Amount of gas added to circuit matches gas consumed by pt

Ex: Circle system (very low FGF, APL closed)

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6
Q

How does FGF and Vm determine the type of breathing circuit

A

If FGF is > Vm, it is semi-open

If FGF < Vm, it is semi-closed

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7
Q

What FGF determines a closed system

A

very low FGF with closed APL. This allows for 100% rebreathing

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8
Q

What are 5 advantages of the circle-system breathing circuit

A
  1. Consistent inspired gas concentration
  2. Maintains heat and humidity
  3. Low resistance
  4. Can be used as semi-open, semi-closed, or closed
  5. Minimizes OR pollution
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9
Q

What are 4 disadvantages of the circle-system breathing circuit

A
  1. Multiple places for disconnection
  2. Less portable than non-rebreathing circuits
  3. Unidirectional valve malfunction, stuck open (REBREATHING)
  4. Unidirectional valve malfunction, stuck closed (OBSTRUCTION)
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10
Q

What are the benefits of the reservoir bag

A
  1. Accumulated gas from exhalation is returned to pt during inhalation
  2. Visual and tactile monitor of pt ventilation
  3. Allows manual ventilation with positive pressure
  4. Bag is distensible and doesn’t exceed 60 cmH2O to decrease barotrauma
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11
Q

How does the reservoir bag conserve gas

A

It allows rebreathing and the use of low FGF, which uses less anesthetic gas

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12
Q

What is the purpose of the APL valve

A

It is an adjustable pressure-limiting valve determining how much pressure can be generated inside the breathing circuit during manual ventilation

Gas is diverted to scavenger when circuit exceeds the set APL pressure

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13
Q

Is the APL part of the vent system

A

No

The vent utilizes a spill valve to divert extra gas

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14
Q

Where does dead space begin when unidirectional valves are functioning properly

A

Begins at Y-piece

Ends at terminal bronchioles

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15
Q

What increases dead space in a breathing circuit

A
  1. Anything placed between the y-piece and the pt

2. Malfunction of the unidirectional valve

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16
Q

What is the purpose of unidirectional valves.

When is each valve open and closed throughout the respiratory cycle

A

Purpose = ensure gas moves in one direction

Inspiratory valve:
open = inspiration
closed = expiration

Expiratory valve:
open = expiration
closed = inspiration

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17
Q

How do unidirectional valves affect dead space of the breathing circuit

A

If a valve becomes incompetent, the corresponding limb is converted to dead space, allowing the pt to rebreathe exhaled CO2

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18
Q

Which limb of the breathing system becomes dead space is an inspiratory valve is stuck open

A

The inspiratory limb

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19
Q

Which limb of the breathing circuit becomes dead space if an expiratory valve is stuck open

A

The expiratory limb

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20
Q

Where is dead space in the breathing circuit if both unidirectional valves are stuck open

A

The entire circuit (both inspiratory and expiratory limb)

21
Q

What is the pt at risk for with incompetent inspiratory or expiratory valves

A

Hypercarbia because pt is rebreathing exhaled CO2

22
Q

Why should minute ventilation not be increased in the setting of failed CO2 absorber or incompetent valves

A

It will increase the amount of exhaled CO2 the pt rebreathes

23
Q

What are 2 option if the CO2 absorbent exhausts during a procedure

A
  1. Convert a closed or semi-closed system into semi-open system by increasing FGF >Vm (>5-8 L/min)
  2. Change absorbent but know what to do if it doesn’t seat correctly
24
Q

What are complications that can occur with an inspiratory valve that is stuck closed

A

Airway obstruction

25
Q

What are 3 complications that can occur with an expiratory valve that is stuck closed

A

Airway obstruction
Breath stacking
Barotrauma

26
Q

What are 2 causes of inspired CO2

A
  1. incompetent unidirectional valve (either one is stuck open)
  2. CO2 absorbent is exhausted
27
Q

What are the 6 different Mapleson configuration

A

Mapleson A-F

28
Q

Which mapleson circuit is the Jackson-Rees

A

Mapleson F

29
Q

What types of circuits are Maplesons

A

Semi-open or non-rebreathing

30
Q

What are 5 components of the Mapleson circuit

A
  1. Reservoir bag
  2. Fresh gas inlet
  3. Corrugated circuit tubing
  4. APL valve
  5. Mask
31
Q

What 2 components are not present on a Mapleson circuit

A
  1. Unidirectional valve

2. CO2 absorber

32
Q

What are the disadvantages of the Mapleson circuit

A

Allows rebreathing

Can lead to hypercarbia

33
Q

Which Mapleson circuit does not have corrugated tubing

A

Mapleson C

34
Q

Which Mapleson circuit does not have a reservoir bag

A

Mapleson E

35
Q 
Where is the fresh gas inlet located on each Mapleson
A=
B=
C=
D=
E=
F=
A

A= near bag

B - F = near pt

36
Q 
Where is the APL location on each Mapleson
A=
B=
C=
D=
E=
F=
A

A - C = near pt
D, E = Away from pt
F = none

37
Q

Which Mapleson circuit does not have an APL valve

A

Mapleson F

38
Q

How is rebreathing minimized in Mapleson circuits

A
  1. Use of high FGF to washout exhaled gases
39
Q

What is the drawback to the Mapleson A

A

FGF >20 L/min required with controlled ventilation

40
Q

Which Mapleson circuits are best for spontaneous ventilation

A

A > DEF > CB

41
Q

Which Mapleson circuit is worst for spontaneous ventilation

A

B

42
Q

Which Mapleson circuit is best for controlled ventilation

A

D-FE > BC > A

43
Q

Which Mapleson circuit is worst for controlled ventilation and why

A

A

Because a FGF > 20 L/min is required to prevent rebreathing

44
Q

The Bain system is which modified Mapleson circuit

A

D

45
Q

How does fresh gas flow through the Bain circuit

A

Enters through the thin inner tubing

Exits through the outer corrugated tubing

46
Q

What flow should the Bain circuit be set to prevent rebreathing

A

FGF should be 2.5x Vm

47
Q

What test is performed to ensure the Bain circuit is functional

A

The Pethick test

  1. Occlude elbow of circuit
  2. Close APL valve
  3. Flush O2 to fill circuit
  4. Remove occlusion while flushing circuit
48
Q

How is the incoming fresh gas warmed in the Bain circuit

A

By the exhaled gas

APEX-Equipment (7 decks)

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