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Anaesthesia > PS Documents > Flashcards

PS Documents Flashcards

1
Q

Name 10 pieces of equipment from PS 56 (difficult airway)

A 
Oropharyngeal
Mac 3+4
Intubation LMA with ET and stabilising rod
LMA 
Selection of specialised ET
Stylet 
Bougee (tip at 35 degree) 
Long airway exchange catheter 
Means to detect CO2
Cricothyroodotomy set
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2
Q

What are the rules of bronchoscopes in PS 56?

A

Need a light and ancillary equipment

Available within 5 minutes

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3
Q

How should difficult airway equipment be stores as per PS 56?

A 
Dedicated trolley 
Labelled
Should be portable 
Essential available within 1 min
Contents easy to ID 
Contents listed on external label
Checked daily and documented
Location tracking (whiteboard)
Orientate staff with location
Designated staff member responsible
Seek expert advice on any changes
Scope stored clean and straight 
Paediatric equip separate
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4
Q

PS 51, what should be considered when purchasing?

A 
Reduce errors
Designated pharmacist liaise with dedicated drug officer
Avoid similar packaging 
Package allows easy drug ID
Change of packet communicated
Stock only one conc of same drug
Avoid drugs requiring dilution
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5
Q

PS 51, what should be considered with storage?

A

Clean and tidy
Standardised aposition of drug throughout
Dangerous/infrequent drugs kept separate
Similar sound/look kept apart
Stored in a way to facilitate ID

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6
Q

PS 51, what are the considerations for drug drawing and checking?

A

Check drug and dose
Department should have system for expiry checks
Draw only one drug at a time
No interruption - discard
Ideally double check with second person prior to admin - must for IT
One ampoule per patient

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7
Q

PS 51, what considerations are there for storage during anaesthetic?

A

Interval between drawing and admin minimum
Syringes placed in logical order in tray
Different routes not in same tray
Emergency drugs kept in separate receptacle

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8
Q

PS 51, what considerations are given to infusions?

A

Ideally syringe driver/pump
One way valves
Label pt end of line
Different infusion device or colour for different routes of admin

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9
Q

PS 55, what are the minimum staff requirements?

A

Anaesthetist
Anaesthetic assistant
Minimum of 3 staff to position patient
Relevant procedural staff

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10
Q

List 15 pieces of equipment according to PS 55, that must be present.

A 
Range of face mask
Magills + throat pack
Oro/naso pharyngeal and LMA 
2 laryngoscope with blade range 
Range of ET and connector 
Suction with handles/catheters - exclusive 
Syringe for ET cuff 
Stylet and bougee 
Stethoscope 
IV infusion, cannulation and fluid 
Range of tapes 
PPE 
Monitoring (Ps18) 
Safe disposal of wastes 
Scavenging 
Means to inflate lungs - appropriate size and separate oxygen source 
(Scissor, lube)
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11
Q

PS 55, what must be present if inhalational anaesthetic used?

A

System capable of accurate oxygen delivery
Calibrated vaporiser
Infusion device for IV agents
Range of breathing systems with methods of sterility of gases
Breathing system suitable to paeds

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12
Q

PS 55, list 10 items which must be available?

A 
DI
Arterial line/CVL
Rapid infuser
Defibrillator with sync capability 
Intra pleural drain
Equipment to Warm/humid gases 
Cooling
Warming
Block equipment 
Positioning equipment 
Automatic ventilator
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13
Q

PS 55, what are 5 other requirements for safe anaesthesia?

A 
Good lighting
Emergency call system
Fridge
Emergency power
Temp management of room between 18-28
Transfer aides
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14
Q

PS 55, drug requirements?

A

Common drugs
Available for the management of all emergencies
Initial dantrolene supply (x24)

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15
Q

PS 55, problems with obstetrics areas?

A 
Midwife competent on epidural management
Any inhalational delivery system must deliver >30% 
Exclusive suction to mother + baby
Exclusive oxygen to mother + baby
Appropriate drugs
Neonate resus
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16
Q

PS 55, equipment on the neonate resus unit?

A 
Oxygen delivery
Clearing airway
Intubation
Ventilation
IV and drug admin
Temp care
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17
Q

PS 55, problems with ECT?

A

Anaesthetic delivery system not essential
Need breathing system capable of 100% O2 for SV/IPPV plus alternate system
Filter/new equipment per patient
Adequate oxygen available plus back up

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18
Q

PS 55, problems with dental?

A

Chair must be able to go rapidly head down

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19
Q

PS 56, 5 pieces on ancillary bronchoscope equipment?

A 
Ain tree
Light source
Intubating airway (berman)
Endoscopy mask
Swivel connector
Anti fog
Bite block 
Nadal vasoconstriction
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20
Q

PS 54, 15 safety requirements?

A

Pin index cylinder connections
Reserve oxygen incase fail that is easy to activate
NIST connections
Gas supply pressure display visible from front
If high P system, O2 supply failure alarm
If gas flow meter bank, Oxygen last gas to enter, most left knob
If mechanical, 1 control knob per gas
Anti hypoxic mechanism
If >2 mountable, interlock vaporisers
Anti-clockwise vaporiser dial turn on
FGO 22mm and 15mm connection
High P relief mechanism in ABS
Scavenging different connect size
Automatically activated alarms
High airway P alarm
Low airway P alarm (<10 for >1sec)
O2 flush protect from accident push
On/off protect from accident push
Backup power for 30 mins - alarm and state of reserve power displayed

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21
Q

PS 54, what are the maintenance requirements?

A

Ongoing for life
Appropriate staff carry this out
Log for each equipment
Replace if affecting clinical use

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22
Q

PS 31, what are the levels of checks?

A

1: detailed check prior to use or after service or repair
2: start of each list
3: before each anaesthetic case

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23
Q

PS 31, what personnel can complete each check?

A

1: trained person attended manufacturers course or program developed with a biomed engineer

2 + 3: trained and accredited in these checks

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24
Q

PS 31, who is responsible for this check?

A

Anaesthetist but can be delegated to suitably trained person

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25
Q

PS 28, define asepsis, disinfection and sterile?

A

Asepsis: prevention of microbial contamination of tissue or sterile material
Disinfect: inactivation of non-sporting microbes using thermal/chemical
Sterile: complete destruction of all microbes and spores

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26
Q

PS 28, differentiate between critical, semi-critical and non-critical equipment?

A

Critical: penetrates skin, vascular, membrane etc so must be sterilised
Semi-critical: contact with membranes or non-intact skin so need high level disinfect or sterile
Non-critical: contact with intact skin or so need disinfecting or cleaning

27
Q

PS28, describe the points of hand hygiene

A 
Soap/water if dirty
Also alcohol solution hand rub 
Ideally 60-95% alcohol 
Ideally coupled with antiseptic 
5 moments of hand hygiene
28
Q

PS28, what are the points around mask use?

A 
For sterile procedures
Local policy for wearing in the OT
Must cover nose and mouth and be tied 
Change between patient/procedure
Hand hygiene once removed 
Don't wear around neck
29
Q

PS28, what are the hat and attire points?

A

Hat must completely cover hair

Fresh scrubs daily - change if soiled
Dedicated footwear or overshoes
Hand hygiene after removal

30
Q

PS28, what are the rules around sharps?

A 
Do not resheath
Do not bend or manipulate 
Dispose immediately
Needle-free system encouraged
Local needle stick protocol
31
Q

PS 28, what are other measures of reducing infection?

A

Timely AB prophylaxis
Normothermia
Restrictive transfusions
Vaccinating staff

32
Q

PS 28, how should laryngoscopes be cleaned?

A

Blade is critical so needs sterilisation

Handle should be cleaned with soapy water between cases. If contaminated with blood should be disinfected after washing.

33
Q

PS 28, how is the breathing system cleaned?

A

Multiple uses if an HME is used
Internally/externally soiled or high-risk infection then change
Breathing bags cleaned with soapy water between cases

34
Q

PS 28, how is the gas sampling line cleaned?

A

Sampled gas not returned to the system unless passed through a 0.2 micron filter

35
Q

PS 28, how is the anaesthetic machine cleaned?

A

If HME used internal components don’t need cleaning
Bellows, Uni-directional valves and absorbers should be cleaned regularly
Surfaces and screens cleaned with soapy water between cases

36
Q

PS 28, how is a non-critical ultrasound cleaned?

A

Remove gel and debri with towel
Wipe with wet detergent cloth
Wipe with disinfectant - including cable and machine surfaces

Any gel used should be sterile or single use-packaged

37
Q

PS28, how is a semi-critical ultrasound cleaned?

A

(Eg block, IV)
Probe and cable should be protected by sterile cover, sterile gel

Remove cover without contaminating probe and clean as per non-critical
If blood contaminated- clean as per critical probe

38
Q

PS28, how is a critical ultrasound probe cleaned?

A

(Eg TOE)
Disinfection and sterilisation of tip and shaft
Decontamination and disinfection of handle, cable, external parts - soapy water and then disinfectant

39
Q

PS 28, how should IV cannulation be handled?

A

Hand hygiene
Gloves
Skin disinfection such as 70% alcohol with chlorhexidine

40
Q

PS 28, how should CVL insertion be handled?

A 
Aseptic technique
Full body drape
Full PPE - sterile
Skin disinfect of alcohol and antiseptic
Sterility checklist recommended
41
Q

PS 28, how should vascular access ports be handled?

A

Aseptic technique

Wiping surface with 70% alcohol and allow to dry

42
Q

PS 28, how should RA be handled?

A

Single shot, non-CNA:
Aseptic with skin prep, hand hygiene and sterile gloves, no-touch technique, sterile U/S and gel

CNA, catheter:
Full aseptic technique and maximal barrier as per CVL, 0.5% chlorhexidine in alcohol,

43
Q

PS 28, what precautions should be taken for drug use?

A

One ampoule per patient
Care with glass
0.2 micron filter needle recommended when drawing from non-sterile
Wipe surface of rubber stoppers and dry prior to drawing from

44
Q

PS 18, what are the principles of this document?

A

Clinical observation and measurement
Duration by clinical judgement
Alarms must be ON (except bypass)
Regular recordings

45
Q

PS 18, what regular assessment and recording should be included?

A

Circulation by detection of pulse and supplemented by device - <10mins
Ventilation continually monitored
Oxygenation - adequate lighting needed

46
Q

PS 18, what monitors must be in use?

A 
O2 analyser must for patient on ABS
Pulse ox must for GA/Sed 
Disconnect/fail alarm for any automatic ventilator 
CO2 monitor must for GA; avail for Sed 
Inhalational agent monitor must for GA where inhalational is present 
ECG - available, should for GA/RA
NIBP - available 
AL, EEG, temp, NMT - available 
ALL ALARMS ON AND AUDIBLE
47
Q

PS 03, what can increase the risk of incorrect blocks?

A 
Time delay from checkin
Time pressure
Distracting environment
Covering the mark
Turning the patient
48
Q

PS 52 important points.

A

Minimal delay
Minimum nurse, orderly and practitioner
Sufficient equipment for journey

49
Q

PS 04, what are the rules about the area?

A 
Designated area
Close to anaesthetising site
Part of operating suite
Easily accessed by staff
Provisions for evacuation
Ventilation like OT
Space for each bed (1.5x OT) 
Uninterrupted view of patients
Storage space
Scrub facility
Wall clock displaying seconds visible
Emergency call 
Emergency power
50
Q

PS 04, what must be present in each bay?

A 
Adequate space at head
Pulse ox, BP, steth, temp
O2 outlet and delivery, flow meter
Suction (handles, catheters)
2x power outlet
Light and colour for observation 
Emergency lighting 
Room for equipment and charting
51
Q

PS 04, what equipment must be in the area?

A 
Means to manually ventilate with oxygen with 1 available per 2 beds 
Drugs and equip to intubate
Emergency drugs
Pain drugs 
Iv equipment and fluid
Syringe and needle
Warming
EtCO2 device
52
Q

PS 04, what must a bed have?

A 
Firm base
Moveable
Sit up
Iv pole
Tilt ends 15 degrees
Brakes
Rails
Somewhere to mount equipment
53
Q

PS 04, what is the staffing requirements?

A

Always present
RN in charge
1:1 ratio until protective reflexes have returned and then 1:3
Anaesthetist must be contactable

54
Q

PS 43, what are some points?

A 
Reduces vigilance and performance
Equivalent to intoxication
Need 8 hours sleep
Care when changing from day to night shift
Sleep debt is accumulative 
Consider proper meals, naps, breaks and sleeping ASAP after shift
Stimulants not recommended 
Take regular A/L and leisure/rest time 
Consider alternative cover
55
Q

PS 60, what are the recommendations?

A 
Any query allergy patients treat as this
Avoid
Remove products from room
Put up signs
Label patient bed
Consider medic-alert
Clearly handover 
Facility should have a product register
56
Q

PS 26, what are the ideas?

A

Voluntary without coercion
Withdraw is an option
Young, reduced mental capacity, unconscious, sedated not ok
Legal guardian, EPA
If not: Must be in pt best interest, steps taken to obtain pt view
Emergency: discussion with pt or family ASAP
Informed information of risks/benefit
Document discussion
Discussion with anaesthetist performing is essential

57
Q

PS 03, what are the principles of this document?

A 
Experienced practitioner 
Informed consent prior
Requires assistant (PS8)
Environment (PS55) lipid available 
Infection control (PS28) 
COAG check patient
IV obtained prior
Monitoring 
Block timeout
58
Q

PS 03, what monitoring should be included?

A 
NIBP
RR
Conscious state
ECG and pulse ox available
O2 if sedated

Continue for 30min or until stable

59
Q

PS 03, what is the block timeout?

A

Verify site/side with other
ID pt, check surgical consent, ID surgical mark, discuss with pt, place a block mark close to site and keep visible
Pause prior to needle insert to confirm block mark, site and side verbally
Pause before needle insertion for each new site of position changes or separate blocks done

60
Q

PS 03, what are the requirements of the proceduralists presence?

A

Remain immediately available until block achieved, pt stable and immediate complications diminished. Can handover/delegate to appropriate trained personnel thereafter

If for anaes also then must remain

61
Q

PS 03, what methods help reduce risks in the ward?

A

Labeled and unique coloured tubing
Dedicated pumps labeled
Maximums set on pumps
No injection ports
Regular assessment - monitoring, pt pain feedback, catheter check
Review by proceduralist/delegate daily
Protocol for catheter removal including coag restart and analgesic cover

62
Q

PS 03, what is different with the OBS RA guidelines?

A

From moment block in, pt must be in care of OBS practitioner who can assess baby and deliver
Ensure consented prior
Skilled staff and monitor required
Continue monitor post delivery until block affects subside

63
Q

PS 08, what are the main points of this document?

A

Present for preparation, induction and emergence. Remain until instructed ok to leave. Immediately available during maintenance.
Under direct supervision
Assistant available for every case
Supervision level 1-3
Exclusively responsible to one anaesthetist
Minimum 12 month clinical experience
Participate in CPD

64
Q

What checks do biomed do?

A 
Leak check
Connections
Valve function
Accuracy of flow
Electrical safety
Failure alarm and cut off
Alarms
Scavenging and suction

Anaesthesia (8 decks)

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