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NURG 7017 > test 3:Anesthesia Delivery System Part 2 > Flashcards

test 3:Anesthesia Delivery System Part 2 Flashcards

1
Q

What is the purpose of waste gas scavengers?

A

Dispose of gases that have been vented from the breathing circuit by the APL valve and ventilator spill valve.

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2
Q

What organization regulates how exhaled gases are removed?

A

National Institute for Occupational Safety and Health - OSHA

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3
Q

In the United States what type of scavenging systems are used?

A

active scavenging system

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4
Q

Trace gas levels are usually measured in?

A

parts per million (ppm)

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5
Q

Reported trace gas concentrations in operating rooms can be influenced by which variables?

A

Fresh Gas Flow

Ventilation System

Length of time that anesthesia has been administered

measurement site

anesthetic technique

ventilation quality of operation and PACU

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6
Q

Trace Gas Levels tend to be higher with ______ patients, why?

A

pediatric patients, because they are typically inducted using a mask versus TIVA

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7
Q

NOSH recommendation of Maximum level for Halogenated agent alone?

A

2 ppm

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8
Q

NOSH recommendation of Maximum level for nitrous oxide?

A

25 ppm

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9
Q

NOSH recommendation of Maximum level for combination of halogenated agent plus nitrous oxide, what is the appropriate level of the halogenated agent?

A

0.5 ppm

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10
Q

NOSH recommendation of Maximum level for combination of halogenated agent plus nitrous oxide, what is the recommended level of the nitrous oxide?

A

25 ppm

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11
Q

NOSH recommendation of Maximum level for nitrous oxide alone in dental facilities?

A

50 ppm

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12
Q

To achieve the goal of NOSHA which is to reduce concentrations to the lowest level consistent with a reasonable expenditure of effort and money. To achieve this, attention should be focused on four areas which are?

A

scavenging systems

equipment leaks

work Techniques

Room ventilation system

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13
Q

An anesthesia provide must work to limit trace gases to protect themselve and other staff, because trace gases have been shown in epidemological studies and animal studies to do what?

A

Spontaneous abortions

infertility

birth defects

impair performance

however, the main thing dr badeaux emphysized was reproductive problems in women

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14
Q

the possible teratogenic effects caused by trace gas exposure in anesthetics shown in epidemological and animal studies have shown these effects primarily affect what population?

A

women pregnant and women trying to get pregnant

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15
Q

name techniques that could increase the pollution of trace gases?

A

failure to turn off gas flow control valves at the end of an anesthetic

poorly fitting masks, flushing the circuit

filling anesthetic vaporizers

use of uncuffed tracheal tubes

use of breathing circuits such as Jackson-Rees (modification of Ayre’s T-piece/ Mapleson E rebreathing circuit) which are difficult to scavenge.

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16
Q

name 11 ways the CRNA can limit the exposure of waste gases?

A

good mask fit

turn on anesthetic gas only after achieving a good mask fit

prevent fresh gas from entering the atmosphere

turn off anesthetic gas before suctioning patient

evacuate anesthetic gases into the scavenger at the end of the case

use cuffed endotracheal tubes

monitor the anesthetic agent

use TIVA

avoid nitrous oxide

use low fresh gas flows

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17
Q

name the five components for a gas scavenging system?

A

gas collecting assembly

transfer means

scavenging interface

gas-disposal assembly tubing

active or passive gas-disposal assembly

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18
Q

scavenging systems have been shown to lower ambient concentrations of exhaled gas by up to ____%

A

90%

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19
Q

the outlet connection for the gas collecting assembly must be a ____ or ____ mm male fitting

A

19 mm

30 mm

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20
Q

name the two components that form the gas collecting assembly?

A

the APL valve

or

the ventilator relief valve

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21
Q

what does the transfer means tubing do?

A

takes gas from gas collecting assembly to the scavenging interface

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22
Q

name the two types of scavenging interfaces in a scavenging system are?

A

open or closed

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23
Q

what is the purpose of the scavenging interface?

A

serves to prevent pressure increases and decreases in the scavenging system from being transmitted to the breathing system and ventilator

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24
Q

US and international standards require that the pressure immediately downstream of the gas collecting assembly be limited to between _____ and ______ during normal operating conditions.

A

-0.5 cm H2O

+3.5 cm H2O

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25
Q

US and international standards require that the pressure immediately downstream of the gas-collecting assembly be limited to ______ with obstruction of the scavenging system

A

+15 cm H2O

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26
Q

The interface inlet must have a ____ or ___ mm male connector

A

19 mm or 30 mm

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27
Q

Irrespective of what type of disposal system is used, positive pressure relief must be provided to do what?

A

protect the equipment and patient if occlusion of the scavenging system occurs.

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28
Q

if a active disposal system what types of pressure relief is needed?

A

negative and positive pressure relief

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29
Q

The active disposal system is used, negative pressure relief is needed, why?

A

to limit subatmospheric pressure

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30
Q

Why is the reservoir necessary?

A

to match the intermittent flow from the gas-collecting assembly to the continuous flow of the disposal system.

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31
Q

A reservoir is needed to hold the surges of gas that enter the interface until the active disposal system removes them?

A

because the discharge of waste gases is usually intermittent and flow through an active disposal assembly is continous

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32
Q

describe an open scavenge interface system?

A

an open scavenge interface system has one or more openings to atmosphere and contains no valves.

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33
Q

describe a closed scavenge interface system?

A

makes its connections to atmosphere through valves.

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34
Q

A reservoir is not required with a closed interface and should not be used unless a _____ disposal system is used.

A

active

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35
Q

in some machines the ventilator drive gas is vented throught the _____ ______.

A

scavenging system

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36
Q

the transfer meaning tubing should be ______ and _____ to prevent kinking and occlusion

A

short and rigid

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37
Q

occlusion of the transfer means tubing can cause breathing circuit pressure to _______ and can result in ______.

A

increase

barotrauma

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38
Q

transfer means tubing is part of the scavenging system and is ______ from pressure-buffering features of the scavenging interfaces

A

upstream

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39
Q

Positive pressure relief is ______ irrespective of the type of disposal system.

A

mandatory

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40
Q

open interface systems should be used only with what?

A

active disposal systems that use a central evacuation system.

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41
Q

when may pollution occur with a active open interface system?

A

if the reservoir does not have sufficient volume (when a pt exhales and expires more than the reservoir can hold, this will lead to excess air being released, poluting the OR)

42
Q

which type of gas disposal system is more effective?

A

Active because if any leaks are present the gas will remain in the system because of the negative pressure, whereas a passive system the has positive pressure encouraging outward leaks

43
Q

open interfaces allow for what kind of pressure relief?

A

positive and negative through holes at the top of the canister

44
Q

the efficiency of an open interface depends on what three things?

A

vacuum flow rate per minute must equal or exceed the volume of excess gases to prevent spillage

spillage will occur if the volume of a single exhaled breath exceeds the capacity of the reservoir

Flow characteristics of the system are important because gas leakage can occur long before the volume of waste gas equals the reservoir volume if significant turbulence occurs within the interface.

45
Q

a reservoir bag should be used with a active or passive system?

A

active system

46
Q

a reservoir bag must be used with what kind of active system?

A

open

it is optional with the closed active system

47
Q

a closed interface communicates with the atmosphere through _______.

A

valves

48
Q

A reservoir is not required for a open or closed system?

A

closed system

49
Q

closed interfaces must have a _______ pressure relief valve to vent excess system pressure if obstruction occurs downstream from the interface.

A

positive

50
Q

a negative pressure relief valve is mandatory to protects the breathing system from subatmospheric pressure if an ______disposal system is used.

A

active

51
Q

valves in the closed interface are _____________.

A

unidirectional

52
Q

a passive closed interface scavenging system has _____ pressure relief valves and does this system require a reservoir bag?

A

positive

no

53
Q

positive pressure relief valves open at a preset value of ____ cm of H2O if an obstruction between the interface and the disposal system occurs.

A

5

54
Q

name the components of a active closed interface scavenging system?

A

positive pressure relief valve

negative pressure relief valve

reservoir

55
Q

The reservoir bag in an active closed system should not be _____ or completely _____.

A

overinflated or completely deflated

56
Q

How is the correct volume in the reservoir bag maintained in an active closed system?

A

the operator maintains correct inflation by adjusting the vacuum control valve

57
Q

the flow control valve is used to?

A

regulate the scavenging flow

58
Q

if the system in the scavenging system exceeds positive pressure of +5 in a active closed system the gas is?

A

vented to the atmosphere through the positive relief valve.

59
Q

in a closed active interface system if the system pressure is less than -0.5 cm H2O what happens?

A

room air is entrained through the negative pressure relief valve.

60
Q

the effectiveness of an open scavenging system is based on what two concepts?

A

volume of the reservoir

Flow characteristics within the interface

61
Q

the effectiveness of a closed scavenging system is based on what three concepts?

A

rate of waste gas inflow

the evacuation flow rate

size of the reservoir

62
Q

leakage of a closed scavenging system occurs when the reservoir bag becomes fully inflated and?

A

the pressure increases sufficiently to open the positive pressure relief valve

63
Q

describe the purpose of the gas disposal assembly conduit?

A

conducts waste gas from the scavenging interface to the gas disposal assembly

64
Q

gas disposal assembly conduit should be _______ proof.

A

collapse

65
Q

how can accidental occlusions be prevented in the gas disposal assembly conduit?

A

run overhead with the tubing.

66
Q

what is the purpose of the gas-disposal system?

A

remove waste gases from the anesthetizing location, the gases must be vented at a point that is isolated from personnel and any air intakes.

67
Q

describe a active gas-disposal system?

A

a vacuum pump serves as the mechanical flow inducing device that removes the waste gases

68
Q

in an active system a reservoir is desirable and the larger the reservoir the ______ the suction flow rate?

A

lower

69
Q

excess waste in a passive assembly can be eliminated via venting to?

A

walls, ceiling, floor, or to room exhaust grill of a non recirculating air conditioning system.

70
Q

passive assemblies move waste gas using?

A

pressure raised above atmospheric by the patient exhaling, manually squeezing the reservoir bag or by a ventilator.

71
Q

name three hazards that could happen with scavenging systems?

A

excess positive pressure

excessive negative pressure

fire hazard d/t oxygen enriched gas being pumped to machine rooms in hospitals and then vented to atmosphere

72
Q

name a concerns with excess negative pressure d/t scavenging systems?

A

hypoventilation

73
Q

name a concern from excess ventilation of scavenging systems?

A

barotrauma

74
Q

anesthesia machines are classified based on what four criteria?

A

power source

drive mechanism

cycling mechanisms

bellows type

75
Q

name the types of power sources in anesthesia ventilators?

A

electrical

pneumatic

76
Q
A
77
Q

describe the functioning of the bellows-in-the box ventilator during inspiration (break it up into beginning, middle, and end of inspiration)

A

Beginning: Driving gas begins to be delievered into the space between the. bellows and its housing. The exhast valve and the spill valve are both closed.

Middle: As driving gas continues to flow into the space around the bellows, its pressure increases, exerting a force that causes the bellow to be compressed. The exhaust and spill valves remain closed. If the pressure of the the driving gas exceeds the opening pressure of the safety relief valve, the valve will open and vent driving gas to the atmosphere.

End: The bellows are fully compressed. The exhaust and spill vavles remain closed

78
Q

Describe the functioning of the bellows-in-box ventilator in expiration (describe the beginning, middle, and end of expiration)

A

Beginning: the ascending bellow will go up while the drive gas goes out. Breathing system (exhaled and fresh) gases flow into the bellows, which begins to expand. The expanding bellows displace driving gas from the interior of the housing. The exhaust valve opens, and driving gas flows through it to the atmosphere. The spill valve remains closed.

Middle: The bellows is nearly fully expanded. Driving gas continues to flow to the atmosphere (flowing out). The spill valve remains closed.

End: Continued flow of gas into the bellows after it is fully expanded creates a positive pressure that causes the spill valve at the base of the bellows to open. Breathing system gases are vented through the spill valve into the scavenging system.

79
Q

Describe double circuit ventilators

A

one circuit contains the patient gas

one circuit contains the drive gas

80
Q

the drive mecahnism for most ventilators is ___________. which means what?

A

pneumatic

meaning the driving force is pressurized gas that compresses the ventilator bellow (analogous/similar function to a reservoir bag)

81
Q

Driving gas may be composed in what three configurations?

A

oxygen

air

mixture

82
Q

beside pneumatically driving ventilator what is the other option?

A

mechanically driven ventilators, AKA. piston type ventilators

83
Q

describe a piston type ventilator

A

computer controlled stepper motor to move gas through the breathing system.

84
Q

piston type ventilator systems contain how many circuits?

A

single patient gas circuit, doesnt need a circuit for drive gas because a motorized component pushes down the bellow

85
Q

Describe the number one benefit of a mechnaically driven (piston) ventilator?

A

consumes less compressed gas than pneumatic ventilators b/c not using gas as a driving force.

AKA more cost effective

86
Q

what type of ventilator would you want if pipeline gas was not available?

A

mechanically driven (piston) ventilator

87
Q

How are bellows classified?

A

based on the direction of movement during the expiratory phase determines the bellows classification.

thus ascending or descending

88
Q

describe ascending bellows?

A

the bellows rise during expiration

89
Q

describe descending bellows?

A

bellows descend during the expriatory phase.

90
Q

what type of bellow is considered the safer option? and why?

A

the ascending bellow.

Because the bellow will not rise if the patient becomes disconnected.

Whereas the descending bellow would rise on the exhalation phase due to gravity and entrain room air (this may trick the low volume and low pressure alarms, so you would be unaware if the bellows was filling with the patient’s exhaled tidal volume or entraining room air) and compress due to the drive gas circuit remaining connected.

91
Q

Describe the relationship between the drive gas and bellows?

A

inverse relationship

As the drive gas increase the bellows decrease

92
Q

describe what can occur with a bellows leak and complications

A

a leak in the bellows may transmit the high gas pressure to the breathing circuit

increased breathing circuit pressure may cause barotrauma

if there is a bellows leak and oxygen is used as the ventilator drive gas, the FIO2 in the breathing circuit may increase

Alternatively, if the ventilator drive gas uses air or an air-oxygen mixture and you are running a high FIO2, then a hole in the bellows may cause FIO2 to decrease.

93
Q

factors that can influence the relationship between the set tidal volume and exhaled tidal volume depending on the machine include ? (5)

A

FGF setting

inspiratory time

compliance of the breathing circuit

external leakage

location of the tidal volume sensor

94
Q

describe a mushroom flap valve?

A

this valve contains a maushroom-style diaphragm that tis inflated when the pressure in the pressure channel increases. This occurs during inspiration. When the mushroom is inflated, it blocks the exhalation channel, allowing the lungs to be inflated. When the pressure inside the mushroom drops at the end of inspiration, it opens the channel and allows the exhaled gases to pass out of the exhalation channel. The flap valve prevents backflow of exhaled gases into the bag.

95
Q

an incompetent ventilator relief valve may result in? why?

A

Hypoventilation b/c anesthetic gases are delivered to scavenging instead of patient during inspiratory phase

96
Q

improper seating of a bellow housing can result in ? why?

A

inadequate ventilation

b/c drive gas leaks to atmosphere

97
Q

hypoventilation may be cause by what things involved in a bellow system?

A

disconnected pilot line

ruptured valve spill valve

damaged flapper valve (spill valve)

meaning anesthetic gases are delivered to scavenging instead of patient during inspiratory phase

98
Q

a ventilator relief valve stuck in the closed or partially closed position may produce?

A

barotrauma or excess PEEP

99
Q

a ventilator relief valve could be stuck due to what?

A

excess scavenging

100
Q
A

NURG 7017 (7 decks)

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