Safety features Flashcards
Why is the solution SAGM added to RBC?
{Sodium
Adenine
Glucose
Manitol}
It extends the shelf life of RBC up to 42 days of increased functional viability
What size are the connectors for a breathing circuit?
15mm and 22mm
Why is a breathing circuit corrugated?
Less prone to kinking and increased flexibility
How can you raise concerns of ideas during the crisis?
Your input may be crucial
Probe – make observation or ask clarifying question
Alert – suggest problem and offer possible alternative
Challenge – address person using their name, directly question plan or decision
Emergency – get their attention – say you must listen. Give direct order to avoid immediate harm to patient
What should your checks be during any crisis?
Oxygen delivery FiO2, FGF, bellows or bag moving
Airway – ETT or LMA patent
Breathing – Sats ETCO2 waveform, tidal volumes and rate
Circulation – Rate, rhythm, ischaemia, BP, Peripheries
Depth – MAC or TIVA value, BIS or entropy
Surgery – ask how is the operation going? Review blood loss
What are the preliminary checks before starting a level 2 machine check?
Wash hands
Check bulk gas warning lights and medical gas alarm panel
Turn machine + monitor on
Check machine is plugged into a UPS
Check service dates on machine and patient monitor
Check scavenging is on, and ball float is in the green zone
Depress condenser drain
Check machine moves freely
Attack circuit and gas sampling line
Check sampling line and d-fend are clean and free of defects
Confirm gas analyser registers 21% +/- 3% oxygen
Check low oxygen alarm is set to 21%
Check Aladdin cassettes are full and ports are closed and locked in vaporiser bay and correct agent is identified on the ASD
Check AMBU bag
What does UPS stand for?
Uninterruptible power supply
What level should you replace the emergency reserve oxygen cylinder on the back of the anaesthetic machine?
<5000 kPa
Residual Current Device
An electrical device that monitors current leakage and shuts off if excess, unexpected current is detected
Line insulation Monitor
An electrical device that monitors a decrease in electrical resistance and alerts to any change
True or False: a small current may be sufficient to induce ventricular fibrillation
True
True or false: body protection is sufficient protection from micro shock
False
True or false: micro shock requires a conducting pathway to the heart
True
True or false: macro shock cannot cause ventricular fibrillation
False
True or false: Cardiac protection is sufficient protection from both micro shock and macro shock
True
An operating theatre should be equipped with electrical ________ protection
Cardiac
What is the size of the cylinder on our anaesthetic machines?
Size A
What is the pin index for medical air
1, 5
What is the pin index for oxygen?
2, 5
What is the pin index for nitrous oxide?
3, 5
What is the pin index for cardon dioxide
1, 6
What is the pin index for Entonox?
7
What cylinder has blue and white shoulders?
Entonox
What cylinder has black and white shoulders?
Medical Air
What cylinder has white body and white shoulders?
Oxygen
What cylinder has blue body and blue shoulders?
Nitrous oxide
What is the name for the combination of nitrous oxide and oxygen?
Entonox
What is the Bodox seal made of?
Neoprene
True or false – serial number is engraved on the medical gas cylinder BODY
True
True or false – owner identification is not engraved on the medical gas cylinder BODY
False
True or false – tare weight is engraved on the medical gas cylinder BODY
True
True or false – test pressure is on the medical gas cylinder SHOULDER LABEL
False
True or false – dangerous goods classification is listed on the medical gas cylinder SHOULDER LABEL
True
True or false – the gas content is not listed on the medical gas cylinder SHOULDER LABEL
False
True or false – manufacturers perform a visual endoscopic examination of cylinders
True
True or false – Manufacturers do not perform impact test on cylinders
False
True or false -tensile strength and/or bending tests are performed by the manufacturer
True
What are cylinders traditionally made of?
Molybenum Steel
After how many years of use must a cylinder be tested?
5
True or false – cylinder’s ability to not be flattened will be tested
True
What is the micron size range for a blood filter?
170-200
Who is the universal blood donor?
O Negative
Who is the universal blood recipient?
AB positive
What does SAGM stand for?
Saline, adenine, glucose and mannitol
Who is the universal plasma recipient?
O
In normal use, how many units of blood should be given through a blood filter?
4
true or false – in a massive transfusion, it is acceptable to give more units than 4 through a filter
True
Can rhesus positive blood be given to rhesus negative patients?
No
What blood products should not be given in the same line as RBC’s
Platelets
A haemolytic transfusion reaction causes destruction of what?
Haemoglobin
What is the energy dose for paediatric defibrillation? J/kg
4 J/Kg
What is the energy dose for adult defibrillation?
200J
What does DRSABCD stand for?
Check for DANGER
Check for a RESPONSE
SEND for help
Check the AIRWAY
Check for BREATHING
Start CPR
DEFIBRILLATION
What does VIE stand for?
Vacuum Insulated Evaporator
What are 3 safety features of a Bulk Gas?
Colour coded Pipelines
Non-interchangeable screw thread hose
Colour coded wall connectors
Gas pressure and contents visible on the front of the machine
Second stage regulators: control pipeline pressure surges
What are the 4 tests done on a reserve cylinder?
Internal endoscopic exam
Impact, Bend, and flattening test
Pressure test at 22000kPa
Tensile test: Strips cut and stretched
What are 5 labels on the reserve cylinder?
Name, Chemical and symbol
Substance identification number
Batch number
Hazards warning and safety instructions
Max contents (Litres)
Pressure
Cylinder size code
Storage and Handling
Filing date, shelf life and expiration date
What are 5 safety features of a flowmeter on the anaesthetic machine?
Gas knobs are colour coded for each gas
Oxygen knob is positioned on the left and is fluted and larger than the other knobs as it will now be easily recognised.
Oxygen is the last gas to be added to the common gas manifold
One knob for each gas
Each knob is calibrated for that specific gas
Doesn’t allow N2O to be given without O2
O bobbin will rise with N2O: anti-hypoxic device
Does not allow oxygen to have a concentration of less than 25% when giving N2O
What are 4 safety features of a vaporiser?
Colour coded
Vapour specific
Specific key filling port
Ani-spill/antipollution cap on bottles
Bottles only opens when full inserted into the vaporiser
Content window
Interlock system
Magnetic coding
What does MAC stand for?
Minimum alveolar concentration
What does APL stand for?
Adjustable Pressure limiting valve
What are 5 safety features of an anaesthetic machine?
Anti-static wheels
Colour coded pipeline
Recessed oxygen flush with spring loaded activation
Cover on the on/off switch to prevent accidental on/off
Anti-Hypoxic device
Oxygen failure alarm/nitrous cut off
Universal connectors for a breathing system are 22mm and 15mm
Scavenging has a different connector to breathing system which is 30mm
Back-up power supply
High pressure relief valve which prevents high airway pressure
What are the 5 must haves of monitoring during anaesthesia?
SpO2
EtCO2
Oxygen analyser
Agent Analyser
Ventilator alarms
What are the 10 patient rights?
Rightto be treated with respect
Right to fair treatment and freedom from discrimination
Right to dignity and independence
Right to service of an appropriate standard
Right to be listened to and understood
Right to receive information: benefit and risks of treatment
Right to make informed choice
Right to support
Right to teaching and research
Right to complain
What is involved in the ‘Sign in’?
Confirm surgeon available
Before induction of anaesthesia, confirm with patient: Identity, Site and side, Procedure, Consent
Site marked or not applicable
Does the patient have: Known allergies, Difficult airway or aspiration risk, Risk of >500 ml blood loss recorded.
Anaesthesia safety checklist completed
Check and confirm prothesis/ special equipment to be used
What is involved in the ‘Sign out’
Verbally confirm with the team after final count:
The name of the procedure recorded
That instrument, needle, sponge, and other counts are correct
How the specimen is labelled (including patient name)
The plan for ongoing VTE prophylaxis
Whether there are any equipment problems to be addressed
Postoperative concerns/plan for recovery and management of this patient
What is CO2 measured in?
kPa and mmHg
What is side stream CO2?
Connected to adapter at patient end
Small increase of dead space
Time delay
Moisture trap
What is Mainstream CO2?
Sample chamber positioned within patient’s gas stream
Increased dead space
Heated to prevent condensation
No time delay
What are 7 features of an Endotracheal tube?
Radio opaque lines
Single use
Latex free
Sterile
Anatomical shape
Internal diameter on tube
Outer diameter on tube
Pilot balloon with self-seal valve
Low-pressure, high-volume cuff
Depth in CM
Black line to position vocal cords
PVC clear
15mm connector
Murph’s eye
Left bevelled edge
Five common causes of anaphylaxis?
Latex
Colloid
Antibiotics
Muscle relaxant
Chlorhexidine
Patient blue
sugamadex -[likelihood appears to be dose-related]
What is the definition of Decontamination?
Process of removal of unwanted matter or infectious tissue on an object or area
What is the definition of Disinfection?
Process of elimination of all or many micro-organisms not including spores
What is the definition of Sterilisation?
Process of elimination of all micro-organisms including spores
What is the definition of Contact precautions?
To prevent transmission of infectious agents which are spread by direct or indirect contact with a patient, their environment, or patient care items
What is the definition of Droplet precautions?
Prevent transmission of infectious agents which are spread by close respiratory or mucous membrane contact with respiratory secretions
What is the definition of Airbourne Precautions?
Prevent transmission of infectious agents that remain infectious over long distances when suspended in the air and are transmitted person to person by inhalation of airborne particles
What are 4 methods of sterilisation?
Autoclaving
Ionising radiation
Dry heat
Ethylene oxide
What is Moment 1 in the 5 Moments of Hand Hygiene?
Before patient contact
When: before approaching and touching a patient
Why: To protect the patient from harmful germs on your hands
What is Moment 2 in the 5 Moments of Hand Hygiene?
Before performing a procedure
When: Immediately prior to performing a procedure
Why: To protect the patient from harmful germs, including their own from entering their body
What is Moment 3 in the 5 Moments of Hand Hygiene?
After procedure or exposure to bodily fluid
When: Immediately are procedure or exposure of bodily fluid and after removal of gloves
Why: to protect you and the health care environment against harmful patient germs
What is Moment 4 in the 5 Moments of Hand Hygiene?
After patient contact
When: Immediately after touching the patient and touching patient surroundings once leaving the patient’s side
Why: to protect you and the health care environment against harmful patient germs
What is Moment 5 in the 5 Moments of Hand Hygiene?
After contact with patients’ surroundings
When: immediately after contact with objects that have been in the same area as the patient, even if you have not touched the patient
Why: to protect you and the health care environment against harmful patient germs
What does TACO stand for and what is it?
Transfusion Related Circulatory Overload
Pulmonary oedema primarily caused by volume excess
Symptoms = acute respiratory distress, cough, pink sputum, decreased SpO2, nausea, pulmonary oedema, raised CVP.
What does TRALI stand for and what is it?
Transfusion Related Acute Lung Injury
Repaid onset of excess fluid in the lungs.
Symptoms = acute respiratory distress, fever, bilateral infiltrates on chest
What is the relationship between standard preacautions and infection control?
Universal precautions are in place to prevent infections and contamination
Following standard precautions, we can minimise infection spreading which allows for better infection control
Define microshock
A small electric current passing directly through the heart and directly sending the patient into ventricular fibrillation
Define macroshock
Larger electrical current passes through the body
What is the formula for estimating the size of both cuffed and uncuffed ETT for a paediatric patient?
Cuffed – age/4 + 3.5
Uncuffed age/4 + 4
What is sodalime composed of?
94% calcium hydroxide
5% sodium hydroxide
1% potassium hydroxide
What is the flow rate of a 14g cannula?
Just gravity - 250ml/min
Pressurized – 380ml/min
What are some examples of colloid substances?
RBC
Albumin
FFP
What are some examples of crystalloid substances?
Heartmans
Sodium Chloride
Plasmalyte
Dextrose saline
manitol
What temperature is FFP stored at?
-30’C
What temperature is RBC stored at?
2- 6’C
List fractionated blood products available;
Plasma
Cryoprecipitate
Platelets
Immunoglobins
Albumin
Irradiated and leuko depleted red blood cells
What are leukocytes and what is their main purpose?
White blood cells
Main immune system cell
What are the 5 R’s of drug administration?
Right drug
Right patient
Right dose
Right route
Right time
Why are patients in Trendelenburg for an internal jugular central line insertion?
To reduce the chance of causeing an air embolism
What pressure should a tourniquet be set to?
Inflated to above 100mmHg above systolic pressure for lower limbs
Inflated to above 50mmHg for upper limb
What are some complications associated with tourniquet use?
Nerve damage
Tissue damage
Pain
Overuse can cause limb to become ischemic
Define scatter regarding radiation;
Radiation that spreads out in different directions from a radiation beam when it encounters an object or tissue
What are three methods of radiation protection/
Time
Distance
Shielding
Expand the acronym LASER
Light
Amplification
Stimulated
Emission
Radiation
What items can contain latex in operating theatres?
Some surgical gloves
Some catheters and other tubing
Sticky tape or electrode pads
What items can contain chlorhexidine in operating theatres?
Skin antiseptic wipes
Hand gels and hand wash solutions
Surgical skin disinfectants
Pre-surgery wash sponges and wipes
Lubricant preparations
Central venous lines
Surgical dressings and mesh
Mouth wash
List four methods of heat loss;
Conduction
Convection
Radiation
Evaporation
Why do children have a difficult time regulating their temperature?
They have thin skin and less body fat
High body surface area to volume ratio and loose heat quicker
They have a high metabolic rate which consumes more oxygen and energy
They are not as developed to develop shivering/vasoconstriction/piloerection/sweating.
Outline the guidelines for fluid maintenance relating to body weight in paediatric anaesthesia;
0-10kg = 4ml/kg/hr
10-20kg = 2ml/kg/hr
> 20kg = 1ml/kg/hr
4-2-1 rule
What are the fasting requirements for children for surgery?
6 hours – milk and food
4 hours – breastmilk
2 hours – clear fluids
List 5 different places a patient’s temperature can be measured from;
Nasal
Oral
Rectal
Catherter
Skin
Ear
Explain the advantages and disadvantages of the use of a Jackson Rees modification of a T-Piece;
Low resistance with minimal dead space and acts as a manual ventilator
Allows for spontaneous breathing and controlled ventilation
No pressure relief valve
No scavenging
Inaccurate capnograhy
No rebreathing and requires higher fresh gas flow
What is the formula for estimating body weight?
2 x [age x 4]
What is the formula for estimating ET tube depth to both lips and nostril?
Lips - [age/2] + 12cm
Nasal - [age/2] + 15cm
Define the coroner’s clot
Occult hidden clot of blood remaining in the nasopharynx behind the soft palate following surgery or trauma which can cause a fatal airway obstruction following extubation
What is the reason for the 15’ left tilt for a LSCS?
Reduces aortocaval compression and inferior vena cava compression
List equipment required for an intravenous regional block;
Double cuff tourniquet
Sterile preperation pack
IV access equipment
Standard monitoring
Local anaesthetic agent [lidocaine or prilocaine]
Fluids primed and ready
Emergency drugs available
Intralipid to treat local anaesthetic toxicity
Syringe and needles
Define diagnosis of compartment syndrome;
Increased pressure in a confined space that causes significant pain and can decrease blood flow
Explain Cushing’s triad;
Refers to a set of signs that are indicative of increased intracranial pressure
Consists of bradycardia
Irregular respirations
Widened pulse pressure
Increase between systolic and diastolic pressure
Define RCD;
Residual control device
What is the normal range for CO2?
35-45 mmHg
What are some components of a VIE?
Thermally insulated double walled steel tank with a layer of perlite in a vacuum
Pressure regulators allow gas to enter a pipeline and maintain pressure of 410 Kpa
Safety valve opens at a pressure of 1700kpa
Control valves
What size are the gas cylinders in a cylinder manifold?
Size J
What are some safety features of a bulk gas?
Colour coded pipelines
Non-interchangeable screw thread hose
Colour coded wall connectors
Gas pressure and contents visible on the front of the machine
Second stage regulators which controls pipeline pressure surges
Why might a pipeline fail?
High demand of oxygen
Fault in the Schrader valve connector
Fault in the manifold room
Broken/failure in the pipeline
What markings are engraved on a cylinder?
Test pressure
Date the test was performed
Chemical symbol and name
Tare weight when empty
What are some tests performed on a gas cylinder?
Internal endoscopic exam
Impact, bend and flattening test
Pressure test at 22,000 kPa
Tensile test – strips cut and stretched
What are some labelling featured on a gas cylinder?
Name, chemical symbol
Substance identification number
Batch number
Hazards warning and safety instructions
Max contents in litres
Pressure
Cylinder size code
Storage and handling
Filling date, shelf life and expiration
direction
What are some safety features of a flowmeter?
Gas knobs are colour coded for each gas
Oxygen knob is always positioned on the left and is larger than the other knobs with a different tactile feel
Oxygen is the last gas to be added to the common gas manifold
Each knob is calibrated for that specific gas
Doesn’t allow N2O to be given without O2
O2 will rise with N2O – anti hypoxic device and ensures no less than 25% oxygen can be delivered when running N2O
What are some types of anti-hypoxic devices?
Mechanical chain link
Pneumatic pressure sensitive device
Paramagnetic oxygen analyser
What are some characteristics of an ideal vaporiser?
Performance is not affected by change in FGF
Low resistance to flow
Light weight and economical
What are some characteristics of an ideal breathing system?
Simple and safe to use
Delivers intended inspired gas mix
Permits spontaneous manual and controlled ventilation
Use low fresh gas flow
Protects patient from barotrauma
Sturdy and light weight
Permits easy removal of gas
What are some safety features of a breathing system?
High pressure relief valve
Soda lime changes colour when exhausted
Airways pressure gauge present
Breathing circuit 22mm and 15mm
What does the acronym HEAMP represent regarding bariatric airway set up?
H-hand hygiene
A – anaesthetic type
E - Environment positioning devices e.g. supports
M – level 2 or 3 machine check
P – sniffing the morning air position
What does MALES BIT MOA represent?
M- mask, Magill’s
A – airway oropharyngeal, nasopharyngeal, Ambu bag, agent
L – laryngoscope, LMA
E – ET tube, emergency drugs
S – Suction under the pillow, syringe, stylet, stethoscope
B – Bag of fluid, bougie
I – IV cannulation
T – tapes, ties
M – Monitoring
O – oxygen cylinder
A – Accessory equipment – air warmers, infusion pumps, fluid warmer
Define asepsis;
It is a process in which microbial agents on a living surface are either killed or their growth is arrested
Define antiseptic;
These are the substances applied on the living tissues to reduce the possibility of infection and growth of microorganisms
Define aseptic processing;
It is defined as the processing and packaging of sterile product into sterilised containers followed by proper sealing with sterilised closure in a manner to control microbiological recontamination
Define microorganism;
Microscopic organisms which may exist in its single celled form or in a colony of cells
Define pathogen;
A pathogen is a tiny living organism such as a bacterium or virus that can produce disease in an individual
Define disinfection;
Antimicrobial process to remove, destroy or deactivate microorganisms on surfaces or in liquids
Define decontamination;
The process by which a person or a surface is made free from all the agents that contaminate the surface and lead to the surface and lead to the spread of infection
Define cleaning;
It is the process of removing all forms of foreign material by employing the mechanical action of washing or scrubbing
