PS Documents Flashcards
Name 10 pieces of equipment from PS 56 (difficult airway)
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
What are the rules of bronchoscopes in PS 56?
Need a light and ancillary equipment
Available within 5 minutes
How should difficult airway equipment be stores as per PS 56?
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
PS 51, what should be considered when purchasing?
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
PS 51, what should be considered with storage?
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
PS 51, what are the considerations for drug drawing and checking?
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
PS 51, what considerations are there for storage during anaesthetic?
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
PS 51, what considerations are given to infusions?
Ideally syringe driver/pump
One way valves
Label pt end of line
Different infusion device or colour for different routes of admin
PS 55, what are the minimum staff requirements?
Anaesthetist
Anaesthetic assistant
Minimum of 3 staff to position patient
Relevant procedural staff
List 15 pieces of equipment according to PS 55, that must be present.
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)
PS 55, what must be present if inhalational anaesthetic used?
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
PS 55, list 10 items which must be available?
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
PS 55, what are 5 other requirements for safe anaesthesia?
Good lighting Emergency call system Fridge Emergency power Temp management of room between 18-28 Transfer aides
PS 55, drug requirements?
Common drugs
Available for the management of all emergencies
Initial dantrolene supply (x24)
PS 55, problems with obstetrics areas?
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
PS 55, equipment on the neonate resus unit?
Oxygen delivery Clearing airway Intubation Ventilation IV and drug admin Temp care
PS 55, problems with ECT?
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
PS 55, problems with dental?
Chair must be able to go rapidly head down
PS 56, 5 pieces on ancillary bronchoscope equipment?
Ain tree Light source Intubating airway (berman) Endoscopy mask Swivel connector Anti fog Bite block Nadal vasoconstriction
PS 54, 15 safety requirements?
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
PS 54, what are the maintenance requirements?
Ongoing for life
Appropriate staff carry this out
Log for each equipment
Replace if affecting clinical use
PS 31, what are the levels of checks?
1: detailed check prior to use or after service or repair
2: start of each list
3: before each anaesthetic case
PS 31, what personnel can complete each check?
1: trained person attended manufacturers course or program developed with a biomed engineer
2 + 3: trained and accredited in these checks
PS 31, who is responsible for this check?
Anaesthetist but can be delegated to suitably trained person
PS 28, define asepsis, disinfection and sterile?
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
PS 28, differentiate between critical, semi-critical and non-critical equipment?
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
PS28, describe the points of hand hygiene
Soap/water if dirty Also alcohol solution hand rub Ideally 60-95% alcohol Ideally coupled with antiseptic 5 moments of hand hygiene
PS28, what are the points around mask use?
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
PS28, what are the hat and attire points?
Hat must completely cover hair
Fresh scrubs daily - change if soiled
Dedicated footwear or overshoes
Hand hygiene after removal
PS28, what are the rules around sharps?
Do not resheath Do not bend or manipulate Dispose immediately Needle-free system encouraged Local needle stick protocol
PS 28, what are other measures of reducing infection?
Timely AB prophylaxis
Normothermia
Restrictive transfusions
Vaccinating staff
PS 28, how should laryngoscopes be cleaned?
Blade is critical so needs sterilisation
Handle should be cleaned with soapy water between cases. If contaminated with blood should be disinfected after washing.
PS 28, how is the breathing system cleaned?
Multiple uses if an HME is used
Internally/externally soiled or high-risk infection then change
Breathing bags cleaned with soapy water between cases
PS 28, how is the gas sampling line cleaned?
Sampled gas not returned to the system unless passed through a 0.2 micron filter
PS 28, how is the anaesthetic machine cleaned?
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
PS 28, how is a non-critical ultrasound cleaned?
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
PS28, how is a semi-critical ultrasound cleaned?
(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
PS28, how is a critical ultrasound probe cleaned?
(Eg TOE)
Disinfection and sterilisation of tip and shaft
Decontamination and disinfection of handle, cable, external parts - soapy water and then disinfectant
PS 28, how should IV cannulation be handled?
Hand hygiene
Gloves
Skin disinfection such as 70% alcohol with chlorhexidine
PS 28, how should CVL insertion be handled?
Aseptic technique Full body drape Full PPE - sterile Skin disinfect of alcohol and antiseptic Sterility checklist recommended
PS 28, how should vascular access ports be handled?
Aseptic technique
Wiping surface with 70% alcohol and allow to dry
PS 28, how should RA be handled?
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,
PS 28, what precautions should be taken for drug use?
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
PS 18, what are the principles of this document?
Clinical observation and measurement
Duration by clinical judgement
Alarms must be ON (except bypass)
Regular recordings
PS 18, what regular assessment and recording should be included?
Circulation by detection of pulse and supplemented by device - <10mins
Ventilation continually monitored
Oxygenation - adequate lighting needed
PS 18, what monitors must be in use?
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
PS 03, what can increase the risk of incorrect blocks?
Time delay from checkin Time pressure Distracting environment Covering the mark Turning the patient
PS 52 important points.
Minimal delay
Minimum nurse, orderly and practitioner
Sufficient equipment for journey
PS 04, what are the rules about the area?
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
PS 04, what must be present in each bay?
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
PS 04, what equipment must be in the area?
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
PS 04, what must a bed have?
Firm base Moveable Sit up Iv pole Tilt ends 15 degrees Brakes Rails Somewhere to mount equipment
PS 04, what is the staffing requirements?
Always present
RN in charge
1:1 ratio until protective reflexes have returned and then 1:3
Anaesthetist must be contactable
PS 43, what are some points?
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
PS 60, what are the recommendations?
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
PS 26, what are the ideas?
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
PS 03, what are the principles of this document?
Experienced practitioner Informed consent prior Requires assistant (PS8) Environment (PS55) lipid available Infection control (PS28) COAG check patient IV obtained prior Monitoring Block timeout
PS 03, what monitoring should be included?
NIBP RR Conscious state ECG and pulse ox available O2 if sedated
Continue for 30min or until stable
PS 03, what is the block timeout?
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
PS 03, what are the requirements of the proceduralists presence?
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
PS 03, what methods help reduce risks in the ward?
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
PS 03, what is different with the OBS RA guidelines?
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
PS 08, what are the main points of this document?
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
What checks do biomed do?
Leak check Connections Valve function Accuracy of flow Electrical safety Failure alarm and cut off Alarms Scavenging and suction
