4. Anesthetic Equipment

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4. Anesthetic Equipment

  1. 1. Anesthetic Equipment The purpose, function, use, and maintenance of machines and equipment used to administer inhalation anesthetics Chapter 4
  2. 2. Endotracheal Tubes (ET Tubes) <ul><li>Flexible tube placed in the trachea </li></ul><ul><li>Delivers anesthetic gases directly from the anesthetic machine to the lungs </li></ul><ul><li>Advantages </li></ul><ul><ul><li>Open airway </li></ul></ul><ul><ul><li>Less anatomical dead space </li></ul></ul><ul><ul><li>Precision administration of anesthetic agent </li></ul></ul><ul><ul><li>Prevents pulmonary aspiration </li></ul></ul><ul><ul><li>Responds to respiratory emergencies </li></ul></ul><ul><ul><li>Monitors respirations </li></ul></ul>
  3. 3. Types of Endotracheal Tubes <ul><li>Murphy tubes </li></ul><ul><ul><li>Beveled end and side holes </li></ul></ul><ul><ul><li>Possible cuff </li></ul></ul><ul><li>Cole tubes </li></ul><ul><ul><li>No side hole or cuff </li></ul></ul><ul><ul><li>Abrupt decrease in diameter of the tube </li></ul></ul><ul><ul><li>Used in birds and reptiles </li></ul></ul>
  4. 4. Types of Endotracheal Tubes (Cont’d)
  5. 5. Properties of Endotracheal Tubes <ul><li>Materials </li></ul><ul><ul><li>Polyvinyl chloride: clear and stiffer </li></ul></ul><ul><ul><li>Red rubber: flexible and less traumatic, absorbent, and may kink or collapse </li></ul></ul><ul><ul><li>Silicone: pliable, strong, less irritating, resist collapse </li></ul></ul><ul><li>Length </li></ul><ul><ul><li>Standard lengths </li></ul></ul><ul><ul><li>Scale marks distance from patient end (centimeters) </li></ul></ul><ul><li>Size </li></ul><ul><ul><li>Measured by internal diameter (ID) </li></ul></ul><ul><ul><li>Range from 1 mm to 30 mm </li></ul></ul>
  6. 6. Parts of the Endotracheal Tube <ul><li>Patient end </li></ul><ul><li>Machine end </li></ul><ul><li>Connector </li></ul><ul><li>Cuff </li></ul><ul><li>Pilot balloon and valve </li></ul>
  7. 7. Parts of the Endotracheal Tube (Cont’d)
  8. 8. Laryngoscope <ul><li>Used to increase the visibility of the larynx while placing an ET tube </li></ul><ul><li>Parts </li></ul><ul><ul><li>Handle containing batteries </li></ul></ul><ul><ul><li>Blade to depress tongue and epiglottis </li></ul></ul><ul><ul><li>Light source to illuminate the throat </li></ul></ul><ul><li>Sizes </li></ul><ul><ul><li>Small animal 0 to 5; large animal up to 18-inch blade </li></ul></ul><ul><li>Types </li></ul><ul><ul><li>Miller blades </li></ul></ul><ul><ul><li>McIntosh blades </li></ul></ul>
  9. 9. Laryngoscopes (Cont’d)
  10. 10. Masks <ul><li>Cone-shaped devices used to administer oxygen and anesthetic gases to nonintubated patients </li></ul><ul><li>Used for induction and maintenance of anesthesia in very small animals </li></ul><ul><li>Plastic or rubber </li></ul><ul><li>Variety of diameters and lengths </li></ul><ul><li>Rubber gasket </li></ul>
  11. 11. Anesthetic Mask
  12. 12. Anesthetic Chambers <ul><li>Clear, aquarium-like boxes used to induce general anesthesia </li></ul><ul><li>Used in feral, vicious, or intractable animals to reduce stress </li></ul><ul><li>Acrylic or Perspex </li></ul><ul><li>Removable top with two ports </li></ul><ul><li>Cannot monitor patient closely </li></ul>
  13. 13. Anesthetic Chamber (Cont’d)
  14. 14. Anesthetic Machines <ul><li>Used to deliver precise amounts of oxygen and volatile anesthetic under controlled conditions </li></ul>
  15. 15. Principles of Operation of Anesthetic Machines <ul><li>Carrier gas: oxygen or nitrous oxide </li></ul><ul><li>Liquid inhalant anesthetic: to be vaporized </li></ul><ul><li>Mixed gases delivered to patient </li></ul><ul><li>Exhaled gases removed from patient: scavenging system or recirculated </li></ul>
  16. 16. Components of the Anesthetic Machine <ul><li>Compressed gas supply </li></ul><ul><li>Anesthetic vaporizer (precision or nonprecision; VOC or VIC) </li></ul><ul><li>Breathing circuit (rebreathing or nonrebreathing) </li></ul><ul><li>Scavenging system </li></ul>
  17. 17. Components of the Anesthetic Machine (Cont’d)
  18. 18. Components of the Anesthetic Machine (Cont’d)
  19. 19. Compressed Gas Supply <ul><li>Oxygen </li></ul><ul><ul><li>Used to increase inspired air to at least 30% oxygen </li></ul></ul><ul><ul><li>Level necessary to maintain cellular metabolism under anesthesia </li></ul></ul><ul><ul><li>Used to carry vaporized anesthetic to patient </li></ul></ul><ul><li>Cylinders (tanks) </li></ul><ul><ul><li>Contain large volume of gas under high pressure </li></ul></ul><ul><ul><li>E tanks (small), attached directly to anesthetic machine </li></ul></ul><ul><ul><li>H tanks (large), attached remotely to anesthetic machine </li></ul></ul>
  20. 20. Compressed Gas Supply (Cont’d) <ul><li>Control valve (outlet port) </li></ul><ul><ul><li>Located on top of the tank </li></ul></ul><ul><ul><li>Left loose (open), right tight (closed) </li></ul></ul><ul><li>Pressure-reducing valve </li></ul><ul><ul><li>Reduces outgoing pressure to a usable level </li></ul></ul>
  21. 21. Compressed Gas Cylinders
  22. 22. Size H Compressed Gas Cylinder
  23. 23. Safety Issues with Compressed Gas <ul><li>Combustibility </li></ul><ul><li>Yoke attachment </li></ul><ul><li>High-pressure release </li></ul><ul><li>Storage </li></ul><ul><li>Color coding </li></ul><ul><ul><li>Oxygen: green (United States) or white (Canada and Europe) </li></ul></ul><ul><ul><li>Nitrous oxide: blue </li></ul></ul><ul><ul><li>Medical air: yellow (United States) or white and black (Canada and Europe) </li></ul></ul><ul><ul><li>Carbon dioxide: gray </li></ul></ul>
  24. 24. Carbon Dioxide and Oxygen Tanks
  25. 25. Tank Pressure Gauge <ul><li>Indicates the pressure of gas remaining in a compressed gas cylinder </li></ul><ul><ul><li>Measured in pounds per square inch (psi) (United States) or kilopascals (kPa) (Canada and Europe) </li></ul></ul><ul><li>Determine the number of liters remaining in a tank </li></ul><ul><li>Label tanks: full, in service, or empty </li></ul><ul><li>Keep backup full tank on the machine </li></ul>
  26. 26. Labeling Cylinders
  27. 27. Pressure-Reducing Valve (Pressure Regulator) <ul><li>Reduces gas pressure to a constant 40-50 psi (275-345 kPa) </li></ul><ul><li>Color coded </li></ul>
  28. 28. Line Pressure Gauge <ul><li>Indicates pressure in the gas line between the pressure-reducing valve and flowmeter </li></ul><ul><li>Should read 40-50 psi after the oxygen tank is opened </li></ul><ul><li>After turning the tank off, use the oxygen flush valve to evacuate line pressure until the gauge reads 0 psi. </li></ul>
  29. 29. Flowmeter <ul><li>Indicates gas flow expressed in liters per minute (L/min) </li></ul><ul><li>Reduces pressure of gas to 15 psi (~100 kPa) </li></ul><ul><li>Specific for each type of gas </li></ul><ul><li>Flow rate is controlled by anesthetist </li></ul>
  30. 30. Flowmeters (Cont’d)
  31. 31. Oxygen Flush Valve <ul><li>Delivers a short, large burst of pure oxygen directly into the rebreathing circuit or common gas outlet </li></ul><ul><li>Bypasses vaporizer and flowmeter </li></ul><ul><li>Used to refill breathing bag, to deliver pure oxygen to a patient, or to dilute the anesthetic gas remaining in the circuit at the end of anesthesia </li></ul>
  32. 32. Vaporizer Inlet Port <ul><li>Where carrier gas (usually oxygen) enters a vaporizer from the flowmeter </li></ul>
  33. 33. Anesthetic Vaporizer <ul><li>Converts liquid anesthetic agent to a gaseous state </li></ul><ul><li>Adds a controlled amount of vaporized agent to the carrier gas </li></ul><ul><li>Gas mixture leaves vaporizer through the outlet port </li></ul><ul><li>Mixture is known as fresh gas and enters the breathing circuit </li></ul><ul><li>Variable-bypass, flow-over vaporizers </li></ul>
  34. 34. Types of Anesthetic Vaporizers <ul><li>Nonprecision vaporizer </li></ul><ul><ul><li>Used to deliver low vapor pressure anesthetics </li></ul></ul><ul><ul><li>Rarely used </li></ul></ul><ul><li>Precision vaporizers </li></ul><ul><ul><li>Used to deliver a precise amount of anesthetic to the patient </li></ul></ul><ul><ul><li>Expressed as a percent of total gases leaving the vaporizer </li></ul></ul><ul><ul><li>Used to deliver high-vapor pressure anesthetics </li></ul></ul><ul><ul><li>Anesthetist controlled </li></ul></ul>
  35. 35. VOC vs. VIC Vaporizers <ul><li>VOC = Vaporizer-out-of-circuit </li></ul><ul><ul><li>Not localized within the breathing circuit </li></ul></ul><ul><ul><li>Oxygen from the flowmeter enters the vaporizer prior to entering the breathing circuit </li></ul></ul><ul><ul><li>Precision vaporizers </li></ul></ul><ul><ul><li>High resistance gas flow </li></ul></ul><ul><li>VIC = Vaporizer-in-circuit </li></ul><ul><ul><li>Oxygen enters the breathing circuit from the flowmeter </li></ul></ul><ul><ul><li>Exhaled gases pass through the vaporizer </li></ul></ul><ul><ul><li>Nonprecision vaporizers </li></ul></ul><ul><ul><li>Low-resistance gas flow </li></ul></ul>
  36. 36. Factors That Affect Vaporizer Output <ul><li>Vaporizer setting </li></ul><ul><ul><li>The primary determinant of output in both compensated and noncompensated vaporizers </li></ul></ul><ul><ul><li>Controlled by anesthetist </li></ul></ul><ul><li>Carrier gas flow influences the concentration of anesthetic in breathing circuit in both compensated and noncompensated vaporizers </li></ul>
  37. 37. Factors That Affect Vaporizer Output (Cont’d) <ul><li>Factors that affect output of noncompensated vaporizers </li></ul><ul><ul><li>Temperature </li></ul></ul><ul><ul><ul><li>Ambient room temperature </li></ul></ul></ul><ul><ul><ul><li>Temperature of carrier gas </li></ul></ul></ul><ul><ul><li>Carrier gas flow rate </li></ul></ul><ul><ul><li>Respiratory rate and depth (nonprecision only) </li></ul></ul><ul><ul><li>Back pressure </li></ul></ul><ul><ul><ul><li>Due to manual ventilation or activation of oxygen flush valve </li></ul></ul></ul>
  38. 38. Use of Vaporizers <ul><li>Specific-use vaporizers are color coded </li></ul><ul><ul><li>Isoflurane = purple </li></ul></ul><ul><ul><li>Sevoflurane = yellow </li></ul></ul><ul><ul><li>Halothane = red </li></ul></ul><ul><ul><li>Desflurane = blue </li></ul></ul><ul><li>Induction and maintenance rates </li></ul><ul><ul><li>Isoflurane = 3-5% induction; 1.5-2.5% maintenance </li></ul></ul><ul><ul><li>Sevoflurane = 4-6% induction; 2-4.5% maintenance </li></ul></ul><ul><ul><li>Desflurane = 10-15% induction; 8-12% maintenance </li></ul></ul>
  39. 39. Precision Vaporizer
  40. 40. Safety with Vaporizers <ul><li>Leakage </li></ul><ul><li>Human exposure </li></ul><ul><li>After using a non-rebreathing circuit, always be sure to reattach the connector of the rebreathing circuit to the outlet port or common gas outlet </li></ul>
  41. 41. Vaporizer Outlet Port and Common Gas Outlet <ul><li>Vaporizer outlet port </li></ul><ul><ul><li>Oxygen/anesthetic exits the vaporizer </li></ul></ul><ul><ul><li>Connected to the common gas outlet or directly into the breathing circuit </li></ul></ul><ul><li>Common gas outlet </li></ul><ul><ul><li>Fresh gas outlet </li></ul></ul><ul><ul><li>Connected to the vaporizer outlet port and breathing circuit </li></ul></ul>
  42. 42. Fresh Gas Inlet <ul><li>Where carrier and anesthetic gases enter the breathing circuit </li></ul><ul><li>Connected to the vaporizer outlet port or common gas outlet </li></ul>
  43. 43. Breathing Circuit <ul><li>Carries anesthetic and oxygen from the fresh gas inlet to the patient </li></ul><ul><li>Conveys expired gases away from the patient </li></ul><ul><li>Rebreathing or non-rebreathing </li></ul>
  44. 44. Rebreathing System <ul><li>Circle systems </li></ul><ul><li>Used on all but very small animals </li></ul><ul><li>Carbon dioxide removed from exhaled air </li></ul><ul><li>Exhaled air is inhaled again with added oxygen and anesthetic </li></ul>
  45. 45. Rebreathing System (Cont’d) <ul><li>Air flow: Inhalation unidirectional valve -> Inhalation tube -> Animal -> Exhalation tube -> Exhalation unidirectional valve -> Carbon dioxide absorber canister -> past reservoir bag -> Pop-off valve -> Pressure manometer -> Inhalation unidirectional valve </li></ul>
  46. 46. Rebreathing System (Cont’d) <ul><li>Closed rebreathing system </li></ul><ul><ul><li>Total system </li></ul></ul><ul><ul><li>Pop-off valve is nearly or completely closed and oxygen flow is low </li></ul></ul><ul><ul><li>Used mostly in large animal anesthesia </li></ul></ul><ul><li>Semiclosed rebreathing system </li></ul><ul><ul><li>Partial system </li></ul></ul><ul><ul><li>Pop-off valve is open and oxygen flow is high </li></ul></ul><ul><ul><li>Excess air is released into scavenging system </li></ul></ul><ul><ul><li>Most common configuration </li></ul></ul>
  47. 47. Breathing Systems
  48. 48. Parts of a Rebreathing System <ul><li>Unidirectional valves </li></ul><ul><li>Reservoir bag </li></ul><ul><li>Pop-off (pressure relief) valve </li></ul><ul><li>Carbon dioxide absorber canister </li></ul><ul><li>Air intake valve </li></ul><ul><li>Pressure manometer </li></ul><ul><li>Corrugated breathing tubes </li></ul><ul><li>Y-piece </li></ul>
  49. 49. Parts of a Rebreathing System (Cont’d)
  50. 50. Unidirectional Valves <ul><li>Control the direction of gas flow </li></ul><ul><li>Inspiratory (inhalation) </li></ul><ul><li>Expiratory (exhalation) </li></ul><ul><li>Open and close as patient breathes </li></ul><ul><li>Monitor respiratory rate and depth </li></ul>
  51. 51. Pop-off Valve <ul><li>Also known as the exhaust valve, adjustable pressure limiting valve, or overflow valve </li></ul><ul><ul><li>Allows excess carrier and anesthetic gases to exit the breathing circuit and enter the scavenging system </li></ul></ul><ul><ul><li>Prevents excessive pressure or volume of gases in the circuit </li></ul></ul><ul><li>Closed when manually ventilating a patient </li></ul><ul><li>Controlled by anesthetist </li></ul>
  52. 52. Pop-off Valve (Cont’d)
  53. 53. Reservoir Bag (Rebreathing Bag) <ul><li>Flexible air storage reservoir </li></ul><ul><li>Indicator of respiratory rate and depth </li></ul><ul><li>Confirms proper endotracheal tube placement </li></ul><ul><li>Allows delivery of anesthetic gases or pure oxygen to patient </li></ul><ul><ul><li>Manual ventilation or “bagging” </li></ul></ul><ul><li>Various sizes: 500 mL to 30 L </li></ul><ul><li>Controlled by anesthetist </li></ul>
  54. 54. Reservoir Bags
  55. 55. Manual Ventilation (Bagging) <ul><li>Minimize atelectasis </li></ul><ul><ul><li>Ventilate every 5-10 minutes </li></ul></ul><ul><li>Force fresh gas into alveoli to normalize gas exchange </li></ul><ul><li>Normalize respiratory rate </li></ul>
  56. 56. Carbon Dioxide Absorber Canister <ul><li>Contains absorbent granules </li></ul><ul><ul><li>Primary absorbent ingredient: calcium hydroxide </li></ul></ul><ul><ul><li>Also: water, sodium hydroxide, potassium hydroxide, calcium chloride, calcium sulfate </li></ul></ul><ul><li>Granules react with carbon dioxide to form calcium carbonate </li></ul><ul><li>Heat and water produced </li></ul><ul><li>Becomes more acidic with more use </li></ul><ul><li>Granules must be replaced when depleted </li></ul>
  57. 57. Carbon Dioxide Absorber Canister (Cont’d)
  58. 58. Pressure Manometer <ul><li>Indicates the pressure of gases within the breathing circuit </li></ul><ul><ul><li>Expressed as centimeters of water (cm H 2 O), millimeters of mercury (mm Hg), or kPa </li></ul></ul><ul><li>Used when manually ventilating (bagging) the patient to prevent excessive pressure in the lungs </li></ul><ul><li>Monitored by the anesthetist </li></ul>
  59. 59. Pressure Manometer (Cont’d)
  60. 60. Air Intake Valve <ul><li>Negative pressure relief valve </li></ul><ul><li>Admits room air into the circuit if negative pressure is detected in the breathing circuit </li></ul><ul><ul><li>May be separate or incorporated into inspiratory unidirectional valve or pop-off valve </li></ul></ul><ul><li>Negative pressure is indicated by a collapsed reservoir bag </li></ul><ul><li>Patient will develop hypoxemia </li></ul>
  61. 61. Breathing Tubes and Y-Piece <ul><li>Breathing tubes </li></ul><ul><ul><li>Corrugated breathing tubes or inspiratory and expiratory breathing tubes </li></ul></ul><ul><ul><li>Carry anesthetic gases to and from the patient </li></ul></ul><ul><ul><li>Connected to unidirectional valve and Y-piece </li></ul></ul><ul><ul><li>Three sizes: 50 mm, 22 mm, and 15 mm in diameter </li></ul></ul><ul><li>Y-piece </li></ul><ul><ul><li>Connects breathing tubes </li></ul></ul><ul><ul><li>Connects to mask or endotracheal tube </li></ul></ul>
  62. 62. Breathing Tubes
  63. 63. Non-rebreathing Systems <ul><li>Semiopen system </li></ul><ul><ul><li>Used in very small patients (<2.5 kg) </li></ul></ul><ul><ul><li>Little exhaled gas is returned to the patient </li></ul></ul><ul><ul><li>Exhaled gas is evacuated by the scavenging system </li></ul></ul><ul><ul><li>Fresh gas is routed to the patient directly from the vaporizer </li></ul></ul><ul><ul><li>No carbon dioxide absorber canister, pressure manometer, or unidirectional valves </li></ul></ul><ul><ul><li>Several configurations are available </li></ul></ul><ul><li>Components : Endotracheal tube connector, fresh gas inlet, reservoir bag, overflow valve, scavenger tube, and scavenger system </li></ul>
  64. 64. Configurations of Nonrebreathing Circuits <ul><li>Bain coaxial circuit (modified Mapleson D system) </li></ul><ul><li>Ayres T-Piece (Mapleson E system) </li></ul><ul><li>Magill circuit (Mapleson A system) </li></ul><ul><li>Lack circuit (modified Mapleson A system) </li></ul><ul><li>Jackson-Rees circuit (Mapleson F system) </li></ul><ul><li>Norman mask elbow (Mapleson F system) </li></ul>
  65. 65. Operation of an Anesthetic Machine <ul><li>Daily inspection </li></ul><ul><ul><li>Oxygen and liquid anesthetic levels </li></ul></ul><ul><ul><li>Leaks </li></ul></ul><ul><ul><li>Pop-off valve or overflow valve </li></ul></ul><ul><li>Machine choice is based on patient body weight </li></ul><ul><ul><li>Small animal machine <150 kg </li></ul></ul><ul><ul><li>Large animal machine  150 kg </li></ul></ul><ul><li>Choose rebreathing system </li></ul>
  66. 66. Choice of Breathing System <ul><li>Primarily based on patient size </li></ul><ul><li>Also based on </li></ul><ul><ul><li>Cost </li></ul></ul><ul><ul><li>Control of anesthetic depth </li></ul></ul><ul><ul><li>Conservation of heat and moisture </li></ul></ul><ul><ul><li>Production of waste gas </li></ul></ul><ul><li>Choice of breathing system will determine </li></ul><ul><ul><li>Type of equipment required </li></ul></ul><ul><ul><li>Position of pop-off valve </li></ul></ul><ul><ul><li>Carrier gas flow rates </li></ul></ul>
  67. 67. Carrier Gas Flow Rates <ul><li>Calculating gas flow rate </li></ul><ul><ul><li>Patient body weight </li></ul></ul><ul><ul><li>Tidal volume (V T ) 10 mL/kg/min </li></ul></ul><ul><ul><li>Respiratory minute volume (RMV) = V T × respiratory rate (~20 bpm) </li></ul></ul><ul><ul><li>Type of breathing system </li></ul></ul><ul><ul><li>Expected period of anesthesia </li></ul></ul>
  68. 68. Mask or Chamber Induction Flow Rates <ul><li>High flow rates required </li></ul><ul><li>Mask: ~30 times V T for dogs, cats, neonate large animals, pigs (1-5 L/min) </li></ul><ul><li>Chamber: 5 L/min for small animals </li></ul>
  69. 69. Flow Rates in a Semiclosed Rebreathing System <ul><li>After induction with injectable agent: 50-100 mL/kg/min (SA machine) and 8-10 L/min (LA machine) </li></ul><ul><li>When making changes in anesthetic depth: 50-100 mL/kg/min (SA machine) and 8-10 L/min (LA machine) </li></ul><ul><li>During maintenance: 20-40 mL/kg/min (SA machine) and 3-5 L/min (LA machine) </li></ul><ul><li>During recovery: 50-100 mL/kg/min (SA machine) and 8-10 L/min (LA machine) </li></ul>
  70. 70. Flow Rates in a Closed Rebreathing System <ul><li>Normally used during maintenance only </li></ul><ul><li>Oxygen flow must equal oxygen requirements of the patient </li></ul><ul><li>Minimum requirement = 5-10 mL/kg/min </li></ul>
  71. 71. Safety Concerns with a Closed Rebreathing System <ul><li>Carbon dioxide accumulation </li></ul><ul><li>Increased pressure in anesthetic circuit </li></ul>
  72. 72. Flow Rates in a Non-rebreathing System <ul><li>Require high flow rates per unit body weight during all periods </li></ul><ul><li>Rates are based on patient body weight and Mapleson classification of circuit </li></ul><ul><li>Usually used on patients weighing <7 kg </li></ul>
  73. 73. Care and Maintenance of Anesthetic Equipment <ul><li>Compressed gas cylinders </li></ul><ul><ul><li>Inspected and maintained by company that owns them </li></ul></ul><ul><ul><li>Silicone or Teflon-based lubricants safe for difficult tank valves </li></ul></ul><ul><li>Tank and line pressure gauges, pressure manometer, and oxygen flush valve </li></ul><ul><ul><li>Require no regular maintenance </li></ul></ul><ul><li>Pressure-reducing valve adjusted to 40-50 psi </li></ul><ul><li>Flowmeters require no regular maintenance </li></ul><ul><ul><li>Check accuracy occasionally </li></ul></ul>
  74. 74. Care and Maintenance of Anesthetic Equipment (Cont’d) <ul><li>Vaporizer </li></ul><ul><ul><li>Serviced and maintained by manufacturer or service professional </li></ul></ul><ul><li>Vaporizer inlet port, outlet port, common gas outlet, and fresh gas inlet </li></ul><ul><ul><li>Check and replace hoses as necessary </li></ul></ul><ul><ul><li>Routine low-pressure leak tests </li></ul></ul>
  75. 75. Care and Maintenance of Anesthetic Equipment (Cont’d) <ul><li>Unidirectional valves </li></ul><ul><ul><li>Disassemble, clean, inspect </li></ul></ul><ul><ul><li>Prevent water vapor, mucus, and dust buildup </li></ul></ul><ul><ul><li>Check integrity of the valves </li></ul></ul><ul><li>Pop-off valve </li></ul><ul><ul><li>Check for proper operation and adjust as necessary </li></ul></ul><ul><ul><li>Daily and during an anesthetic procedure </li></ul></ul>
  76. 76. Care and Maintenance of Anesthetic Equipment (Cont’d) <ul><li>Reservoir bag, breathing tubes, and Y-piece </li></ul><ul><ul><li>Remove and clean after each procedure </li></ul></ul><ul><ul><li>Prevents patient-to-patient transfer </li></ul></ul><ul><ul><li>Hang to dry </li></ul></ul><ul><ul><li>Check integrity of each part before use </li></ul></ul><ul><li>Carbon dioxide absorber canister </li></ul><ul><ul><li>Change granules and clean canister as per guidelines </li></ul></ul><ul><ul><li>Wear gloves and a mask when handling granules </li></ul></ul><ul><ul><li>Check integrity of each part before use </li></ul></ul>
  77. 77. Disinfecting Anesthetic Equipment <ul><li>Endotracheal tubes, laryngoscope blades, face masks </li></ul><ul><li>To prevent spread of disease from patient to patient </li></ul><ul><li>Wash with disinfectant, rinse, dry, reassemble </li></ul><ul><li>Check integrity of each part before use </li></ul>
  78. 78. Disinfecting Anesthetic Equipment (Cont’d) <ul><li>Disinfectants </li></ul><ul><ul><li>Chlorhexidine gluconate: not 100% effective </li></ul></ul><ul><ul><li>Glutaraldehyde solutions (2%): short shelf life, toxic, absorbed </li></ul></ul><ul><ul><li>Ethylene oxide gas: special equipment needed, toxic, absorbed </li></ul></ul><ul><ul><li>Steam under pressure (autoclave): damages rubber surfaces </li></ul></ul><ul><li>Discard damaged equipment </li></ul>

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