Components of Anesthesia Machines & Oxygen for Cell Functions
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What are the components of the anesthesia machine?
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Compressed Gas Supply Anesthetic Vaporizer Breathing Circuit Scavenging System
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What gas is crucial to cell functions?
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Oxygen
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What percentage of oxygen does anesthesia machines use?
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100%
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oxygen for anesthesia machines are contained in
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compressed gas cylinders or tanks
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What acts as the carrier gas to deliver the anesthetic gas to the patient?
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Oxygen
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What color are the oxygen ports at CVC?
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Green
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What color is the hose that connects the oxygen port to the anesthetic machine?
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Green
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T/F: Oxygen is highly flammable.
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True
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How should oxygen tanks be secured?
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standing position, chained to wall May be stored or transported on a cart designed to transport oxygen tanks Smaller E tanks may be may be secured to yoke of anesthetic machine Keep metal cap over valve when tank is not in use
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Gas is forcefully expelled from tank when valve is opened and can hurt you! Keep valve closed until
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Pressure regulator is attached to tank E tank is attached to yoke of anesthetic machine
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When turning oxygen tank on, open valve
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slowly
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What are some safety features that prevent nitrous oxide tanks form being hooked up as an oxygen tank?
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Color coding Different threading on valves Different diameter connectors Different pin index on yoke piece
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T/F: NEVER try to force attachment of oxygen lines to a tank
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True
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What type of oxygen tanks are hooked up in the oxygen supply room?
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H Tanks
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Full H tank contains __________ L oxygen
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6900
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As oxygen is used, pressure in tank ______ . The tank pressure gauge acts like a fuel gauge to let you know how much oxygen is left in tank.
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decreases
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A Full oxygen tank contains ______ psi, Half full _______ psi
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2200, 1100
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If 3 patients are under anesthesia, receiving oxygen at rates of 0.5 L/min, 1.5 L/min and 2 L/m, how much oxygen is needed for 2 hours? If the tank pressure in an H tank reads 200 psi, do you have enough oxygen for all the patients?
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The oxygen flow rate for all three patients is combined. (0.5L/min + 1.5L/min + 2L/min)=4L/Min We need 2hrs of oxygen at 4L/min or 2hrs * (60min/hr)*4L/Min = 480 L The tank pressure is at 200 PSI. A full tank has a PSI of 2200 and a volume of 9600L so 200psi/2200psi=XL/6900L and x = 627L. You have enough oxygen but not much extra.
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The pressure regulator reduces the high pressure of gas coming from the oxygen tank to ____-_____psi
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40-50
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The tanks in the oxygen supply room are attached to a manifold that includes a _________ ________, a ________ _________ and a ______ ________ _________
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pressure gauge, pressure regulator, line pressure gauge
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What are the two functions of the oxygen flow meter?
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Reduce the pressure of oxygen flowing through the line from 40-50 psi to about 15 psi Regulate the amount of oxygen delivered to the patient
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oxygen flow rate is measured in
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L/min
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The valve that opens and closes the flow meter is fairly delicate so you must turn the knob ________ when you turn the flow meter on and off- especially when you turn it off.
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gently
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The oxygen delivered to the flush valve _________ the flow meter. It is coming straight from the _______ _______.
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bypasses, supply line
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What is the pressure of oxygen coming to the oxygen flush valve?
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40-50 psi
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If the oxygen coming to the flush valve bypasses the flow meter, does it enter the vaporizer? Is it carrying any anesthetic gas?
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no. no.
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Cover the end of the breathing circuit and press the oxygen flush valve while watching the reservoir bag. What happens?
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the bag inflates.
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use this at the end of a procedure to clear anesthetic gas from the system so you can deliver pure oxygen to patient. DO NOT use the flush valve while the patient is ________to the breathing circuit
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oxygen flush valve, attached
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E tanks are _________ than H tanks
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smaller
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A full E tank holds _____L oxygen
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660
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When an E tank is full the pressure is ______ psi, just like a full H tank
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2200psi
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T/F: Newer anesthetic machines have a check valve that prevents gas flowing from one open tank to another. Older machines don't have this valve.
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True
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T/F: Gas flowing from a new tank into an almost empty tank can explode! ALWAYS close one tank before opening a new one
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true
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What is the formula to determine how many minutes of oxygen are remaining?
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Tank Pressure/max tank pressure * max Tank Volume/Oxygen flow rate. For E tanks: 0.3 * Tank pressure/oxygen flow rate For H Tanks: 3 * tank pressure/oxygen flow rate
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What is the tank pressure? If this is attached to an E tank, how much oxygen is in the tank? What is the line pressure?
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tank Pressure: 800 oxygen in tank = line pressure=49 psi
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What is the oxygen flow rate? What units do we use for measuring oxygen flow?
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the rate at which oxygen is flowing to the patient. liters.
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The gas leaving the vaporizer is called "________ ________"- don't get this confused with fresh air, or pure oxygen
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fresh gas
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If there is no air flowing through the vaporizer, there is _______ evaporation of anesthetic
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no
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which vaporizer Allows precise control of % concentration of anesthetic in gases exiting the vaporizer
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precision vaporizer
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T/F: only part of the oxygen that enters the vaporizer flows over the anesthetic agent, the rest bypasses the chamber. The more oxygen enters the chamber, the more anesthetic evaporates.
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True
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Precision Vaporizers are Used for anesthetic agents with _____ ________ ________
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high vapor pressure
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Precision vaporizers are _________ compensated- output doesn't change within normal range of room temperatures
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Temperature
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Precision vaporizers are ________ compensated- output doesn't change within typical range of oxygen flow rates
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flow
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precision vaporizers are ______ ________ compensated- output isn't changed by back pressure from reservoir bag or oxygen flush valve
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Back pressure
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T/F: ONLY use precision vaporizers with the intended anesthetic. Vaporizer is calibrated for use with a particular anesthetic; if a different agent is used, you won't know how much you are actually delivering to the patient
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True
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Isoflurane vaporizers are _________; Sevoflurane vaporizers are _________
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purple, yellow
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VOC stands for
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Vaporizer Out of Circuit
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VIC stands for
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Vaporizer In Circuit
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All precision vaporizers are in a _______ configuration
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VOC
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If the anesthesia level in the vaporizer is less than ______ ______ refill vaporizer
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half full
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anesthetic agent can be introduced into the bypass chamber by ________ or _________ the machine
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overfilling, tipping
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if anesthetic agent is introduced into the bypass chamber, Correct problem by running oxygen at full flow for _____ minutes with the vaporizer turned off. This will evaporate any agent in the bypass chamber.
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15
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A hose leads from the vaporizer outlet port to either the ______ ______ _______of the breathing circuit or the ______ ________ _______
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Fresh gas inlet, Common gas outlet
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What is "fresh gas"?
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The gas leaving the vaporizer
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Is Isoflurane delivered with a precision or a non-precision vaporizer?
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precision
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What is a VOC?
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vaporizer out of circuit.
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What color is the label for Sevoflurane?
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yellow
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Is the vaporizer on your machine precision or non-precision?
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precision
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Is the vaporizer located VIC or VOC?
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VOC
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What is MAC?
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monitored anesthesia care
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The Rebreathing circuit removes ________ from exhaled gases and they are mixed with fresh gas from vaporizer to enter the inhalation tube
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CO2
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oxygen flow rate set to provide just enough for patient needs, no excess gas so pop-off valve stays closed in a ______ rebreathing circuit.
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Closed
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oxygen flow rate set above patient needs; excess gas exits through open pop-off valve; most common system in clinical practice is a ___________ rebreathing circuit.
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Semi-closed
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In a ____________ circuit, Exhaled gases are vented through the open pop-off valve to the scavenging system
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non-rebreathing
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Only fresh gases from the vaporizer enter the inhalation tube in a _________ circuit
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non-rebreathing
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No need to absorb carbon dioxide from exhaled gases since they are not recirculated in a ___________ circuit.
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non-rebreathing
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_________ circuits are Used only for small patients, under 2.5-3 kg
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non-rebreathing
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What is the pressure of oxygen in entering the breathing circuit?(include units)
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15 PSI
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What is the concentration of anesthetic gas entering the breathing circuit?
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Whatever the vaporizer is set to
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This valve prevent air from the breathing tubes from flowing back toward the fresh gas inlet; maintains one way flow of gases through the breathing circuit. What valve is this?
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Unidirectional Valve
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What is the Unidirectional Valve also called?
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flutter valve
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We use _________ ___ circuit tubes so the inhalation tube (colored) is surrounded by the exhalation tube (clear); this arrangement helps reduce heat loss through respiration
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Universal F
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Use standard, or adult breathing tubes (22 mm diam) for small animal patients over _____kg; use pediatric tubes (15 mm diam) for patients _____ - ______kg
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7kg, 2.5-7kg
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This connects the inhalation and exhalation breathing tubes together and has a connector to attach them to the endotracheal tube
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Y-piece
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This carries the gases from the inhalation tube of the breathing tube to the patient, and carries gases from the patient to the exhalation tube of the breathing circuit
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Endotracheal Tube
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T/F: The breathing circuit may be attached to a mask or chamber for induction with gas
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True
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This carries exhaled gases from the patient. Also, in a semi-closed system excess gas from the inhalation tube enters the Y piece, then goes to the exhalation tube if the patient is not inhaling
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Breathing Tube- Exhalation
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Exhaled gases flow through the exhalation unidirectional valve to the ______ ________ __________ canister.
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carbon dioxide absorber
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T/F: Carbon dioxide does not have to be removed from the gases before they are recirculated and returned to the patient
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False: Carbon dioxide MUST be removed from the gases before they are recirculated and returned to the patient
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The Carbon Dioxide Absorber canister is filled with ______ _______ granules.
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soda lime
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What is the main ingredient in soda lime?
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Ca(OH)2 (calcium hydroxide)
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calcium hydroxide reacts with _____ to form __________ (______ __________). you may know it as rock chalk.
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CO2, CaCO3 (calcium carbonate)
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soda lime granules must be replaced after _______ of use.
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8hrs
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At the end of each anesthetic procedure, check off every ______min.
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15
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Should soda lime granules be changed if they are rock hard, rather than easily crumbled?
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yes
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If the pH indicator in the soda lime granules has turned purple, should the soda lime be changed?
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yes
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T/F: the pH indicator in the soda lime is somewhat unreliable because the color change is seen for a short time after anesthesia, then the granules may go back to white;
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true
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Measures the pressure in the breathing circuit
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Pressure Manometer
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T/F: Pressure in the breathing circuit is the same as the line pressure
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False: Pressure in the breathing circuit is NOT the same as the line pressure
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This manometer measures pressure in units of ___ _____, not psi
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cm H20
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pressure in the breathing circuit is Normally _____-____cm H20 when patient breathing spontaneously
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0-2
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Do NOT exceed _____cm H20 when manually ventilating (bagging, sighing) patient
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20
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Keeps a large volume of gas available to the patient for inhalation- the volume of gas in the breathing tubes is limited
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Reservoir Bag
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T/F: Gently squeezing the reservoir bag (with the pop-off valve closed) allows the anesthetist to manually ventilate the patient
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True
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ventilating the patient helps
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Prevent atelectasis Prevent hypercarbia Adjust depth of anesthesia
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patients should be venteliated every _____-_____min
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1-2
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Size of reservoir bag depends on patient ______ ______
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tidal volume
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What is the formula for patient tidal volume?
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VT = 10-20ml/kg
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What is the formula for determining what size reservoir bag to use?
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Reservoir bag size = 6 x VT Wt (kg) x 60 is minimum size to start with
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How full should the reservoir bag be during peak expiration?
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about ¾ full during peak expiration
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How can you tell that the reservoir bag is too small and should be replaced with a larger one?
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patient will completely empty bag during inhalation and pressure increases during expiration- get a bigger bag
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What occurs when a reservoir bag is too big and what should you do if the bag is too big?
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it's hard to see movement of bag to monitor respirations- get a smaller bag
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What are some alternative names for the pop-off valve?
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pressure relief valve, exhaust valve, overflow valve, adjustable pressure limiting (APL) valve
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Excess gases exit the breathing circuit through this valve and enter the scavenging system
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pop off valve
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In a semi-closed rebreathing system this valve should ALWAYS be open when patient is breathing spontaneously
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pop off valve
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A _______-_______ ________ allows you to close the valve so you can ventilate the patient by pressing down, then the valve opens as soon as you let go
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pop-off occlusion valve
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What does PEEP stand for when referring to a PEEP valve?
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positive pressure relief valve
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What does a PEEP valve do?
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allow any pressure above 20 cm H2O to escape This can help avoid patient injury if someone accidentally leaves pop-off valve closed
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Used for small patients less than
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2.5-3 kg
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What components make up a non-rebreathing circuit?
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Fresh gas inlet Breathing tube Endotracheal tube connector Reservoir bag Overflow valve Scavenging port
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What are the two main non-rebreathing circuits?
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Bain Co-axial and Ayre's T-piece
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Rebreathing circuits use a ________ oxygen flow rate than non-rebreathing circuits
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lower
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Flow rates based on _________ _________ __________
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respiratory minute volume (RMV)
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What is the formula for calculating respiratory minute volume?
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RMV= Tidal Volume x Respiratory Rate Ex. 10 ml/kg x 20 breaths/min = 200 ml/kg/min
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Collects gases exiting through the pop-off valve and carries them outside the building
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Scavenging System
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T/F: waste Gases carried by the scavenging system MUST be carried outside the building- not the attic, the basement, the closet, etc.
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true
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vacuum draws gases into scavenging system
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Active system
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Be careful that vacuum in the active scavenging system does not draw out gases from _______ _______ and ______ _________ or patient will be competing with the scavenging system for oxygen
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reservoir bag and breathing circuit
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how far is our scavenging system opened?
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only open ¼ turn
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pressure in breathing circuit pushes air into scavenging system
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Passive System
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If gases must go through more than ____ft of pipe to exit scavenging system, a passive system is not very effective
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20
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Activated Charcoal Canister (F-Air canister) scavenging Absorbs anesthetic gases except
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nitrous oxide
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Activated Charcoal Canister (F-Air canister) Must be replaced
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Every 12 hours or When weight of canister increases by 50 grams
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T.F: Obstruction in the scavenging system will cause increase pressure in the breathing circuit- just like leaving the pop off valve closed
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true
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T/F: Don't overinflate the reservoir bags or they will develop a leak
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True
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What is the normal temperature of all animals (dog, cat, horse, cow) under anesthesia?
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97-100 degrees F
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What is the normal HR per Min in a Dog under anesthesia?
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Sm=70-160 lg=60-140
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What is the normal HR per Min in a cat under anesthesia?
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120-180
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What is the normal HR per Min in a horse under anesthesia?
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28-40
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What is the normal HR per Min in a cow under anesthesia?
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50-80
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What is the normal RR per Min in a Dog and cat under anesthesia?
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8-20
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What is the normal RR per Min in a horse and cow under anesthesia?
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6-12
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What is the normal SPO2 levels in all animals (dog, cat, horse, cow) under anesthesia?
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Over 95%
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What is the normal EtCO2 levels in all animals (dog, cat, horse, cow) under anesthesia?
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40-50 mm Hg
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What is the normal BP in a Dog, cat, and cow under anesthesia?
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over 60 mm Hg
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What is the normal BP in a horse under anesthesia?
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over 70 mm Hg
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Where are the surgery packs?
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on the shelves next to the surgery room.
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DO NOT enter surgery room unless you take off _____ ______and put on _______/________ & ________ __________
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Lab Coat, Cap/Mask, foot covers
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How often should the surgery room shelves be emptied, cleaned & restocked?
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Weekly
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the small piece of tape that looks like masking tape with black stripes is called
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autoclave tape
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What are some types of surgery packs?
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General surgery/ OHE pack Neuter pack Wound pack
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specialized instruments such as ________ & ___________ instruments are packaged individually
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orthopedic instruments opthalmic instruments
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If the pack has been sterilized in the autoclave, the autoclave tape will have _______ stripes. The tape has ______ stripes before it is autoclaved
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black, white
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When was the pack autoclaved? The date should be on the masking tape- if it has been more than ______ days the pack is no longer considered sterile
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30
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How many squares of gauze are in each pack?
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40, 20 in each stack
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How many Backhaus towel clamps are in each pack?
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4, two pairs.
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What are Backhaus towel clamps used for?
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draping the patient during surgery
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How many Allis tissue forceps are in each pack?
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2
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How Many Mayo dissecting scissors are in each pack?
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1
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How many Metzenbaum scissors are in each pack?
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1
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heavy duty operative scissors used primarily for cutting fascia and other more dense tissues. the blades may be straight or curved, blunt or sharp, and plain or serrated.
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mayo scissors
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What are Metzdenbaum scissors? what are they used for?
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fine, straight or curved scissors used for cutting delicate tissue.
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How can you tell the difference between mayos and metzenbaums?
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Compare the width of the blade and the length of the blade (not the shank) A. Metzenbaum B. Mayo
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How many operating scissors are there in each pack?
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1
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Identify the parts of this instrument. What type of instrument is this?
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A- Tip B- Jaw C- Box Lock D- Shank E- Ratchet F- Ring Handle Needle Holders
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which needle holders do not have built in scissors.
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Mayo-Hegar
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Which needle holders do have built in scissors.
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Olsen-Hegar
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What is the procedure for cleaning instruments?
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Rinse immediately after surgery in cool water Soak in dilute instrument cleaning solution Wash in warm water; hold underwater and scrub with soft brush, esp. ratchets, box locks, hinges, jaws Soak or spray with instrument milk Lay on Huck towels and allow to air dry
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T/F: NEVER use bleach, scrubbing powder or other harsh cleaners on instruments- can damage instrument
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True
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__________ cleaning may be used after hand washing to get at hard to reach spots
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Ultrasonic
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___________ cleaning good for delicate instruments
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Ultrasonic
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DO NOT mix instruments of different ________ ________ in ultrasonic cleaner
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metal composition
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Instruments with multiple parts should be _________ before cleaning
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disassembled
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What should be written on the tape of a surgery pack?
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Type of pack Color of instrument bands Today's date Your initials
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used to stop bleeding by crushing tissue & blood vessels
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Hemostatic Forceps
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These are the smallest hemostatic forceps in your pack (3-5 in long). The entire jaw has transverse grooves.
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Halsted Mosquito Hemostats
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What are Halsted Mosquito Hemostats used for?
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occlude small blood vessels
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As surgery tech you should always have a pair of ______ hemostats and 1 piece of ________ in hand
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mosquito, gauze
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These are slightly longer than the Halsted mosquito hemostats (5-6 in long); also have larger jaws. Used to clamp slightly larger vessels or small amounts of tissue; often used to clamp ovarian vessels or spermatic cord
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Kelly and Crile Hemostatic Forceps
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which Hemostatic forceps have transverse grooves along the entire length of jaw and is 5-6 inches long? Hint: _______ goes all the way.
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Crile Hemostatic Forceps
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which Hemostatic forceps have transvers grooves on the distal half of the jaw. 5-6 inches long. Hint: ______ doesn't go all the way.
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Kelly Hemostatic Forceps
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A longer, heavier type of forceps used to clamp larger masses of tissue (6-9 inches). Both have transverse grooves along length of jaw
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Rochester-Pean and Rochester Oschner
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Which forceps have interdigitating teeth at tips that help prevent slippage? 6-9 inches long..
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Rochester Oschner Forceps
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Which forceps do not have interdigitating teeth at tips that help prevent slippage? 6-9 inches long
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Rochester-Pean Forceps
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Which Forceps have grooves run longitudinally along the jaw, rather than transversely. These provide a good secure hold on a thick mass of tissue, like the body of the uterus.
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Rochester-Carmalts Forceps
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These long (often 8-9 inch) forceps have transverse grooves on the jaws, and one jaw has a longitudinal strip that fits into a groove on the opposite jaw Used for clamping and crushing very large masses of tissue
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Ferguson Angiotribe Forceps
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What is the most common type of sterilization in vet medicine?
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Steam sterilization
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Pack must reach temperature of _________ and hold it for _____ minutes to sterilize contents- it takes some time for autoclave to reach this temp
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121 C (250 F), 13
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Always use _______ _________ to fill autoclave
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distilled water
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What is the procedure for using the autoclave?
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Turn white pressure indicator arrow to zero before starting autoclave; be sure temperature is set to 250 F Turn knob to FILL to allow water to enter chamber When it gets to groove at front of autoclave turn to STE (quickly to avoid water overflowing) Then close door Set timer for 45 minutes and turn green switch to Start When timer goes off, turn knob from STE to EXH & DRY (exhaust and dry)- DO NOT OPEN DOOR UNTIL STEAM HAS VENTED. Set timer for 10 minutes Check red pressure indicator arrow- if it has dropped to zero it is safe to open autoclave; still use proper safety procedures Stand to side of autoclave and loosen the handle of the autoclave door DO NOT have your face near door opening; steam may escape even though autoclave has been vented Crack the door open a couple of inches, and set timer for 20 min to allow packs to finish drying Put dry packs away- DO NOT LEAVE IN AUTOCLAVE
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T/F: Gas sterilization (ethylene oxide or hydrogen peroxide gas plasma) are used in some hospitals.
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True
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____________ solution can be used for cold sterilization of instruments that cannot be autoclaved (endoscope, arthroscope). Must soak for at least 20 min, follow manufacturers instructions
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Glutaraldehyde
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kills vegetative bacteria, most viruses, but not bacterial spores; used on instruments, cages, tables, etc
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Disinfectant
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inhibits growth of infectious agents; used on tissue, scrub patient, scrub hands
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Antiseptic
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What are examples of Disinfectants?
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Bleach, quartenary ammonium compounds (Roccal-D, Parvosol), alcohol
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What are examples of Antiseptics?
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Chlorhexidene, povidone iodine
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T/F: Disinfectants can be used for "cold pack" instruments should soak 3 hrs, will be disinfected, but not sterile
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True
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What is the basic function of ALL hemostatic forceps?
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stop bleeding by crushing tissue & blood vessels
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When you are surgery tech, what should you have in hand at all times during the surgical procedure?
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mosquito hemostats and one piece of gauze
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Are the ratchets open or closed when you pack instruments to be autoclaved?
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open
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What do you use to fill the autoclave? Be specific.
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Distilled Water
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In order to sterilize the contents the pack must be held at a temperature of at least _______ for a minimum of _________.
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121 C (250 F), 13
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If the stripes on the autoclave pack are black, do you know that the internal contents of the pack are sterile? Explain your answer.
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Yes, it indicates that the pack was exposed to steam at the right temp for the right amount of time.
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What is the difference between sterilizing and disinfecting?
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sterilization destroys all viruses, bacteria etc., disinfecting only partially does so.
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These are used to grasp tissue, but they do NOT help control bleeding
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Tissue Forceps
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T/F: Some tissue forceps grasp firmly and cause some tissue trauma; they are used for skin, muscle or fascia, or tissue to be removed Other forceps grasp gently and cause minimal tissue trauma; these are used to grasp intestines, bladder and other delicate tissues
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true
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how many Allis tissue Forceps are there in the surgical pack?
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2
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Which Forceps have broad, flared jaws, less traumatic to tissues
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Babcock Forceps
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Which forceps May be straight or curved, May have smooth or serrated jaws, A fairly atraumatic type of forceps
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Sponge Forceps
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how many Backhaus Towel Clamps are there in a surgical pack?
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4, 2 on each set of huck towls.
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What is Used to secure drape to patient
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Backhaus Towel Clamps
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Identify this instrument.
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Jones towel Clamp
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forceps cannot be locked into place with the ratchet; they are held in position by your thumb and index finger
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Thumb Forceps
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These are sturdy forceps for grasping skin or fascia The interdigitating teeth provide a firm grip
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rat tooth thumb forceps
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which thumb forceps have very small interdigitating teeth at the tip. used for grasping delicate tissues
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Adson Thumb Forceps
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have a short row of small teeth running lengthwise on the tip of the forceps. used for grasping delicate tissues
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Brown Adson Thumb Forceps
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These are not in the pack, but may be hanging with bandage scissors and suture scissors. have a similar shape to rat tooth forceps, but the jaws are smooth, or have transverse grooves rather than teeth. They are used for handling gauze and bandages, not tissues
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Dressing Forceps
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What are the hand held retractors?
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Snook ovariohysterectomy hook (spay hook) Senn retractors
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Most common handheld retractor, used for pulling the uterus up through the abdominal incision
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Snook ovariohysterectomy hook (spay hook)
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double ended hand held retractor, different type retractor on each end
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Senn retractors
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use ratchet to stay in position; look on the instrument board for these retractors
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Self retaining retractors
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used to retract abdominal walls during surgery
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Balfour retractors
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used to retract muscle & fascia
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Gelpi retractors
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used to retract muscle & fascia
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Weitlaner retractors
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Bard Parker scalpel handle
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Bard Parker scalpel handle
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Bard Parker scalpel Small animal- #3 handle fits
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scalpel blades #10, #11, #12 and #15
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Bard Parker scalpel Large animal- #4 handle fits
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scalpel blades #20, #21 and #22
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most used suture needle
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Half circle suture needle
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suitable for most internal sutures
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Taper point suture needle
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What suture needle is preferred for skin, and sometimes for fascia
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Cutting or reverse cutting suture needles
