Displaying the source of the page Instrument equipment of the anesthesiology workplace/High School (nurse)


 * Ensuring patient safety during anesthesia is a basic and general requirement

anesthesiology workplace. The workplace must have adequate and fully functional technical equipment for performance, meeting current professional and technical requirements.


 * Equipment includes:
 * anesthetic machine,
 * ventilator,
 * aids to ensure and maintain DC permeability, extraction system,
 * monitoring and diagnostic devices,
 * aids for IV application of pharmaceuticals, solutions, blood derivatives,
 * devices and aids to ensure the safety of anesthesia or to solve possible complications (aids for CPR, manual self-expanding bag, etc.).

Anesthesiology machine
= technical equipment intended for mixing and dosing anesthetic gases and vapors of liquid inhalation anesthetics.

Gas input control part

 * source of medical gases O 2, N 2 O, air,
 * pressure cylinders – color-coded, with different volumes (2, 5, 10, 15, 20, 40 liters) with a reducing valve allowing to adjust the working pressure to values ​​of around 0.4 Mpa,
 * central gas distribution – the gas pressure is reduced to the so-called working pressure of 0.35 – 0.45 Mpa,
 * the outputs of the central gas distribution are terminated by color-differentiated ends of the so-called quick couplings, which cannot be interchanged (different shapes for individual gases).


 * Rotameters (flow meters),
 * enable accurate dosing and constant flow to the anesthesia system,
 * it is a calibrated glass tube in which a float or ball moves inside → the gas lifts the float and its upper edge indicates the amount of gas in l/min on a calibrated scale.


 * Vaporizers
 * enable the transformation of liquid anesthetic into vapors that are released into the carrier breathing mixture,
 * placed between the rotameters and the breathing circuit in the flow of supplied gas,
 * selective for individual anesthetics, each vaporizer is labeled with the name of the inhalation anesthetic, possibly color-coded according to the ISO/DP 5358 standard,
 * Halothane - red,
 * Isoflurane – magenta,
 * Sevoflurane – yellow,
 * contact – part of the carrier gas mixture comes into contact with the liquid inhalation anesthetic,
 * bubbling – the carrier gas is forced into the liquid anesthetic in the form of bubbles,
 * nozzle – a suspension of inhalation anesthetic droplets is sprayed into the carrier mixture by a nozzle,
 * injectable – liquid anesthetic is injected into the anesthetic system.

Ventilation control section

 * monitoring unit for monitoring ventilation parameters,
 * BP, P, SpO 2, ECG, capnometry.

Respiratory systems

 * A mixture of anesthetic gases and vapors is administered directly to the patient through the breathing system.
 * The types of inhalation devices are divided according to whether the patient inhales back something from the mixture that was exhaled during the previous exhalation = re-inhalation when breathing during anesthesia.
 * open – inhaling from an open atmosphere, exhaling also into a free atmosphere,
 * example from history: Schimmelbusch mask for ether administration);
 * Ayre T.
 * Large consumption of feed mixture, usually double the breath. volume.
 * Large exhalation into the surroundings with contamination op. hall.
 * Impossibility of controlled breathing.


 * semi-open – the inhalation anesthetic is transported by a mixture of anesthetic gases through a one-way system, while fresh gases are strictly separated from exhaled ones through a valve (it will prevent re-inhalation);
 * the system usually includes a storage bag - a reservoir for collecting breathing mixture,
 * the mixture supply is smaller here, usually the same as the min. volume German,


 * semi-closed – the breathing system can be one-way (system according to Waters) or arranged in an anesthesia circuit,
 * partial rebreathing of exhaled gases occurs, so a CO 2 absorber must be included.


 * Absorber,
 * a cylindrical container filled with an absorbent mixture - soda lime in granular form to increase the absorption surface → carbon dioxide binds to the granules of the mixture - the resulting product is reaction heat and water - the soda lime is exhausted → the absorber's exhaustion is signaled by a colored indicator,
 * Natrocalcid – white, the granulate changes color to purple.
 * Sodasorb - white, granulate changes color to purple.
 * Durasorb – pink, granulate changes color to white.
 * Its size should correspond to the size of the breath. volume,
 * for small children – 100 ml,
 * for school children – 300 ml,
 * over 10 years – 500 ml,


 * closed – the respiratory system is organized into an anesthesia circuit → the gas mixture is the supply of fresh gases corresponding to the patient's metabolic consumption.

Anesthesiology circuit

 * It is a system of hoses arranged in a circle, in which a CO 2 absorber is connected and the direction of gas flow is determined by valves.
 * inspiratory and expiratory part → such an arrangement allows partial or complete re-inhalation of exhaled air, thereby reducing the consumption of anesthetics and the loss of water vapor and heat.
 * Anesthesia with a low input of fresh gases can be administered through the anesthetic circuit (semi-closed system with a high degree of rebreathing):
 * Low-flow anesthesia – fresh gas consumption 1 l/min, still significantly exceeds patient consumption;
 * Minimal-flow anesthesia – consumption of fresh gases 0.5 l/min, close to the actual consumption by the patient.


 * The transition of the anesthesia line with a low gas input can only take place after a sufficient depth of general anesthesia has been achieved.


 * Volumemeter (ventilometer) – it is located in the expiratory arm of the breathing circuit, it measures the one-time and minute respiratory volume of exhaled air.
 * Manometer – it is located in the exhalation arm of the breathing circuit, it measures the pressure generated during UPV, an acoustic signal warns of too low or too high values ​​(limits are set individually).
 * Bacterial filter – preventing the introduction of infection into the patient's DC, preventing contamination of the expiratory arm.
 * Measurement of oxygen content – the sensor checks the concentration of oxygen in the inhaled mixture and warns if it falls below the critical limit.
 * Suction system – an important part of anesthesia equipment, it must always be ready for use, it is used to suction secretions from the DC, stomach contents, ...
 * extraction of anesthetic gases – prevention of air contamination by inhalation anesthetics in the operating room.

Fans

 * They are used for UPV during anesthesia, they are mostly multi-microprocessor controlled and allow the selection of different ventilation modes.
 * Each device for UPV is equipped with a number of alarms, the condition being the APNOE alarm.
 * Depending on the type of ventilator, feedback data on ventilation, the composition of the breathing mixture, capnography, etc. are available.

Other instrumentation

 * EKG, defibrillator, BP, P, stethoscope, manual breathing apparatus, ...
 * Infusion pumps and injectors.
 * Oximeter, glucometer, capnometer.
 * Suction cup and suction tubes, aids for bladder catheterization.
 * Heating or cooling pad.
 * Device for heating or cooling infusions and blood products.
 * Extracorporeal circulation, controlled hypothermia.
 * Laryngoscopes and ETRs of all sizes, other aids to ensure DC.
 * Aids for the introduction of venous access (CVK, peripheral) and the application of drugs.

Documentation

 * It is written up for every operation and must be clear, legible and clearly arranged, and contain:
 * anesthesiology record, anesthesiology book, medical record, anesthesiology questionnaire.


 * Opiate book, reporting and handing over opiates, transfusion diary.
 * Operating logs of devices, log of minor accidents, log of faults and repairs.
 * Consent to anesthesia and consent to surgery.

Anesthetist nurse fill

 * Checking the safety and readiness of the anesthetic machine.
 * Before using the anesthetic device, its reliable function must be checked:
 * a) connection to the electrical network, intact grounding,
 * b) functionality of rotameters (measuring the supply of fresh gases), functionality of the bypass valve,
 * c) preparation of a functional and filled vaporizer, with the selected volatile anesthetic,
 * d) functionality of breathing hoses and reservoir, bag (tightness, dryness), holding the pressure of the reservoir bag filled with gas even during manual compression, functionality of warning signals,
 * e) functionality of the CO 2 absorber (filling status, freshness of the filling, color of the filling),
 * f) the functionality of the suction system, the availability of suction tubes of suitable size,
 * g) the correctness of the anesthetic gas suction connection,
 * h) overall preparation of the device according to the anesthesiologist (breathing circuit, UPV type).

Source

 * MGR. ANDREA MILTNER,. Diagnostic and therapeutic procedures for lung diseases [lecture on the subject Anesthesiology Module, field of Intensive Care Nurse – postgraduate study, Higher Vocational School of Health, Secondary and Higher Health School of Ústí nad Labem]. Usti nad Labem. 10.02. 2011