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.

Device composition

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