Anesthesia Machine Basics

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Questions and Answers

According to Standard 6 for anesthesia workstations, when should the function of anesthesia equipment be verified?

  • Weekly, according to hospital policy
  • At the end of each surgical case
  • Prior to each anesthetic (correct)
  • Only when equipment malfunction is suspected

What is the primary purpose of the oxygen flush valve on an anesthesia machine?

  • To provide a high flow of oxygen directly to the patient, bypassing the ventilator
  • To rapidly refill or flush the circuit with oxygen, bypassing the vaporizers and flowmeters (correct)
  • To regulate the pressure of oxygen delivered to the patient
  • To administer a precise mixture of oxygen and anesthetic gases

In the context of anesthesia workstations, what does the term 'DISS' refer to?

  • Direct Injection Scavenging System
  • Differential Impedance Sensor System
  • Digital Information Support System
  • Diameter Index Safety System (correct)

What is the approximate pressure of the central gas supply that is delivered to the anesthesia workstation?

<p>50 psi (C)</p> Signup and view all the answers

What is the purpose of a one-way check valve in a central gas supply system?

<p>To prevent retrograde gas flow (D)</p> Signup and view all the answers

According to the standards, when should a daily anesthesia equipment check be performed?

<p>Before the first case of the day (A)</p> Signup and view all the answers

The oxygen flow valves in the anesthesia machine are designed to:

<p>Deliver a minimum oxygen flow when the anesthesia machine is turned on (A)</p> Signup and view all the answers

What is the purpose of the fail-safe valve or oxygen failure cut-off valve in an anesthesia machine?

<p>To prevent the delivery of hypoxic gas mixtures if the oxygen supply fails (C)</p> Signup and view all the answers

If pipeline oxygen pressure is lost and a cylinder is left open, what will be the first indication of this to the anesthesia provider?

<p>An alarm will sound when the cylinder is empty (B)</p> Signup and view all the answers

What is the purpose of pressure regulators in an anesthesia machine?

<p>To reduce pressure (B)</p> Signup and view all the answers

What pressure is maintained by the first-stage regulators that reduce cylinder pressure for both oxygen (O2) and nitrous oxide (N2O)?

<p>45 psig for both O2 and N2O (A)</p> Signup and view all the answers

How do second-stage regulators affect pipeline and cylinder pressure in an anesthesia machine?

<p>They drop the pressure further to a range of 14-26 psi. (D)</p> Signup and view all the answers

Which best describes the functionality of a free floating valve (check valve)?

<p>It prevents gases from leaking out of the system (A)</p> Signup and view all the answers

What is the main function of a diaphragm valve in the context of anesthesia machines?

<p>To allow pressure regulators to function (B)</p> Signup and view all the answers

A minimal oxygen flow of about 150 ml/min is usually delivered when the machine is on. What is the purpose of this?

<p>To prevent hypoxic gas mixtures (B)</p> Signup and view all the answers

Which of the following is true regarding the information displayed on Bourdon pressure gauges?

<p>They measure both pipeline and cylinder pressures (D)</p> Signup and view all the answers

What do the color-coded hoses attached to the wall outlets in an operating room do?

<p>Connect to wall outlets with gas-specific fittings to help prevent misconnections. (A)</p> Signup and view all the answers

What is the typical pressure of the central supply of gasses connected to the anesthesia machine?

<p>50 psi (B)</p> Signup and view all the answers

On an anesthesia workstation, where does the low-pressure circuit begin?

<p>At the flowmeters (B)</p> Signup and view all the answers

Most anesthesia machines are designed such that the oxygen flowmeter is positioned downstream relative to other flowmeters. Why?

<p>To reduce the risk of a hypoxic mixture being delivered (A)</p> Signup and view all the answers

What feature is found on the oxygen knob of flowmeters to ensure easy identification?

<p>It is fluted (D)</p> Signup and view all the answers

According to cylinder supply guidelines, which organization sets the potency and purity standards for medical gases?

<p>United States Pharmacopeia (US Pharmacopeia) (D)</p> Signup and view all the answers

What does the acronym 'PISS' stand for, in relation to anesthesia equipment?

<p>Pin Index Safety System (A)</p> Signup and view all the answers

What's one reason it's important to reboot anesthesia machines every 24 hours?

<p>For self-tests and machine checkout (C)</p> Signup and view all the answers

What pressure is typically associated with a full nitrous oxide cylinder where liquid is present?

<p>745 psig (A)</p> Signup and view all the answers

What type of flowmeter is characterized by constant pressure and a variable orifice?

<p>Thorpe tube (B)</p> Signup and view all the answers

What can occur to N2O cylinders with high flows?

<p>Frost accumulation (B)</p> Signup and view all the answers

Electrical outlets with circuit breakers are a feature of which part of the anesthesia workstation?

<p>Back Cover (B)</p> Signup and view all the answers

Which of the following components is responsible for removing carbon dioxide from the breathing system?

<p>Carbon dioxide absorber (A)</p> Signup and view all the answers

According to the information provided, what is often lacking among anesthesia practitioners, leading to use error?

<p>Knowledge about the delivery system (D)</p> Signup and view all the answers

Which parameter is used to determine proportionality between pressure and flow in a flowmeter?

<p>Tube shape and physical properties of gas (D)</p> Signup and view all the answers

What is the primary function of an anesthesia machine?

<p>To deliver gases at a safe level to the breathing circuit (B)</p> Signup and view all the answers

What is the purpose of the Flow Proportioning Device?

<p>Hypoxic guard (A)</p> Signup and view all the answers

Which piece of equipment is powered by both electric and pneumatic power?

<p>Anesthesia Machine (D)</p> Signup and view all the answers

What does Drager use to monitor the oxygen-nitrous oxide ratio?

<p>Pressure control piston (B)</p> Signup and view all the answers

What is the function of a high pressure relief valve?

<p>To open if excessive pressures exist (B)</p> Signup and view all the answers

What piece of equipment receives medical gasses from a gas supply?

<p>Anesthesia Machine (C)</p> Signup and view all the answers

What is the expected outcome of adjusting a pressure regulator on an anesthesia machine?

<p>To manage fluctuations and stabilize gas pressure from supply sources. (C)</p> Signup and view all the answers

What is the purpose of the manual bag port on an anesthesia machine?

<p>To allow for manual ventilation of the patient. (A)</p> Signup and view all the answers

Why is it recommended to reboot anesthesia machines approximately every 24 hours?

<p>To run self-tests and machine checkout procedures. (A)</p> Signup and view all the answers

What is the function of the 'balance regulator' in some GE Datex anesthesia machines?

<p>To serve as a fail-safe mechanism by controlling nitrous oxide flow based on oxygen pressure. (C)</p> Signup and view all the answers

What is the primary reason for performing a daily anesthesia equipment check?

<p>To adhere to manufacturer's operating instructions and safety precautions. (A)</p> Signup and view all the answers

What distinguishes a 'high-pressure' circuit from other pressure circuits in an anesthesia machine?

<p>It begins at the cylinder and ends at the cylinder regulators. (D)</p> Signup and view all the answers

If the pipeline oxygen supply fails and an oxygen cylinder is open, what action ensures continuous gas delivery?

<p>The anesthesia machine automatically draws from the cylinder, but this will not be known until the cylinder is empty. (C)</p> Signup and view all the answers

What is the implication of the oxygen supply pressure dropping below a threshold in the anesthesia machine's fail-safe system?

<p>Nitrous oxide flow is reduced or shut off to prevent a hypoxic mixture. (C)</p> Signup and view all the answers

What criteria determines the proportionality between pressure and flow within a flowmeter?

<p>The resistance and physical properties of the gas, determined by the shape of the tube. (C)</p> Signup and view all the answers

What is a key function of the rotameter in an anesthesia workstation?

<p>To precisely control and indicate the flow rate of individual gases. (C)</p> Signup and view all the answers

What is the function of the oxygen knob fluting found on anesthesia machines?

<p>To easily feel and identify the oxygen control, especially in low light conditions. (C)</p> Signup and view all the answers

Why is oxygen typically the last gas added in the flowmeter sequence of anesthesia machines?

<p>To minimize the risk of a hypoxic gas mixture being delivered, even with a leak. (C)</p> Signup and view all the answers

What does the term 'diameter index safety system' (DISS) refer to in the context of anesthesia equipment?

<p>The specific threading that prevents hoses from being connected to the incorrect gas source. (C)</p> Signup and view all the answers

Which factor makes anesthesia machines unsuitable for long-term ventilator use?

<p>Design is mainly for short term use. (B)</p> Signup and view all the answers

Why is a fully charged backup battery on an anesthesia machine designed to last only approximately 30-45 minutes?

<p>Because the machine relies on a connection to external power soon/after power failure. (B)</p> Signup and view all the answers

What action is recommended in response to finding the cylinder pressure lower than the pipeline pressure?

<p>Nothing the regulator is doing its job (B)</p> Signup and view all the answers

Which parameter will activate a high pressure relief valve?

<p>excessive pressure (95-110 psi) (C)</p> Signup and view all the answers

What gases do free floating valves prevent from leaking out of?

<p>Any gas (D)</p> Signup and view all the answers

Approximately what percentage of air is oxygen?

<p>21% (D)</p> Signup and view all the answers

About how much pressure does Central Supply deliver?

<p>50 psi. (D)</p> Signup and view all the answers

According to cylinder supply standards, which of the following does the US Pharmacopeia set?

<p>Potency and purity standards (D)</p> Signup and view all the answers

A cylinder requires 7 markings to be on it by ICC, which one of the following is NOT on the cylinder?

<p>Cost (D)</p> Signup and view all the answers

What is the pressure of a full nitrous oxide tank?

<p>750 psig (A)</p> Signup and view all the answers

How can you calculate the Minutes Left Before Tank Expires?

<p>Contents Remaining (L) / Flow Rate (L/min) (B)</p> Signup and view all the answers

Where would you find electrical outlets on the anesthesia machine?

<p>Back (D)</p> Signup and view all the answers

Which of these devices can be powered by electricity?

<p>Ventilator (C)</p> Signup and view all the answers

What is the purpose for pressure regulators?

<p>Adjust to high pressures (C)</p> Signup and view all the answers

What is the last thing that gasses go through, before reaching the patient?

<p>Common Gas Outlet (A)</p> Signup and view all the answers

Diaphragm valves are used in:?

<p>Pressure regulators (D)</p> Signup and view all the answers

The GE Aespire Proportioning device is?

<p>Mechanical (A)</p> Signup and view all the answers

According to the graphic, what piece of equipment has a check valve

<p>Cylinder (D)</p> Signup and view all the answers

Flowmeters are downstream of?

<p>Only some safety devices (B)</p> Signup and view all the answers

What is the color in the picture for air

<p>Yellow (B)</p> Signup and view all the answers

What is a critical consideration when using the oxygen flush valve in conjunction with mechanically delivered inspiration?

<p>Monitoring for potential barotrauma due to rapid pressure increase. (D)</p> Signup and view all the answers

What is the most crucial preventative measure to mitigate risks associated with the hypoxic mixture?

<p>Vigilant use of an oxygen analyzer (A)</p> Signup and view all the answers

What is the rationale behind performing a daily anesthesia equipment check, as stated in Standard 6?

<p>To adhere to manufacturer's operating instructions and safety precautions. (B)</p> Signup and view all the answers

In the event of both pipeline oxygen supply failure and an open oxygen cylinder, why is awareness of cylinder depletion important?

<p>The change in gas source will not be immediately obvious and the first indicator will be cylinder depletion. (C)</p> Signup and view all the answers

What is the functional difference between the newer 'balance regulator' and traditional fail-safe valves in anesthesia machines?

<p>The 'balance regulator' is a variable valve that adjusts based on oxygen pressure, unlike the traditional open/close fail-safe valve. (B)</p> Signup and view all the answers

What is the mechanism by which the 'balance regulator' in GE Datex-Ohmeda machines acts as a fail-safe?

<p>By reducing the pressure of nitrous oxide based on the presence of sufficient oxygen pressure. (A)</p> Signup and view all the answers

Which factor determines the proportionality between pressure and flow in a flowmeter?

<p>The shape and physical properties of the flowmeter tube and the gas. (C)</p> Signup and view all the answers

How does the design of the oxygen knob prioritize user safety?

<p>The oxygen knob is distinctively fluted, larger, and protrudes furthest to the right for easy identification. (B)</p> Signup and view all the answers

What operational difference should be considered regarding Bourdon pressure gauges on anesthesia machines?

<p>They can measure both pipeline and cylinder pressure. (B)</p> Signup and view all the answers

What is the primary objective of the Diameter Index Safety System (DISS) regarding the central gas supply?

<p>To employ noninterchangeable threaded connections, preventing misconnections. (B)</p> Signup and view all the answers

Why are anesthesia machines generally considered unsuitable for long-term ventilator use, despite their ability to provide mechanical ventilation?

<p>They are not designed to provide continuous ventilation for extended periods. (C)</p> Signup and view all the answers

In the context of anesthesia workstations, what specific function do diaphragm valves serve within pressure regulators?

<p>To reduce pressure only. (B)</p> Signup and view all the answers

What is the purpose of the one-way check valve in the central gas supply?

<p>To prevent retrograde flow within the gas supply system. (A)</p> Signup and view all the answers

What conditions could cause N2O cylinders to get cold and frost to accumulate?

<p>High flows because N20 Cylinders may get cold and accumulate frost with high flows. (D)</p> Signup and view all the answers

Why is oxygen positioned last in the flowmeter sequence?

<p>To ensure that any leaks downstream will not result in a hypoxic mixture. (B)</p> Signup and view all the answers

What are the implications of the American Society for Testing Materials (ASTM) mandating specific positioning for the zero reading on Bourdon pressure gauges?

<p>Facilitating a quick visual confirmation of gauge functionality and integrity. (D)</p> Signup and view all the answers

When the oxygen supply pressure falls below a specified threshold, what is the immediate consequence within the anesthesia machine?

<p>All other gases shut off, causing a pneumatic alarm. (D)</p> Signup and view all the answers

How does the physical property that the flowmeter is designed for affect flow at high flows?

<p>High flow is orificial and dependent on the gas's density. (C)</p> Signup and view all the answers

How do second-stage regulators affect pipeline and cylinder pressure?

<p>They drop pipeline and cylinder pressure further (14-26 psi). (D)</p> Signup and view all the answers

What inherent limitation exists regarding the ability of the fail-safe valve to prevent all causes of hypoxic accidents?

<p>The fail-safe valve does not protect against problems unrelated to O2 supply. (A)</p> Signup and view all the answers

Following a pipeline oxygen supply failure, why does the anesthesia machine continue to function normally when an oxygen cylinder is left open?

<p>A lower pressure is intentionally set on the cylinder regulator, so that flow proceeds from the higher-pressure pipeline source. (B)</p> Signup and view all the answers

How does the design of free-floating valves, also known as check valves, ensure unidirectional gas flow?

<p>They rely on a physical mechanism that is pushed open by gas flow in the permitted direction. (A)</p> Signup and view all the answers

What is the initial action if a cylinder connected to the anesthesia machine is found to have lower pressure than the pipeline supply?

<p>Close the cylinder and rely solely on the pipeline supply. (B)</p> Signup and view all the answers

In the context of anesthesia machine components, what is the role of the 'yoke' in the high-pressure system?

<p>To provide a tight seal and connection between the cylinder and the machine (C)</p> Signup and view all the answers

What specific condition triggers the activation of the high-pressure relief valve?

<p>Excessive pressure, such as from regulator failure. (A)</p> Signup and view all the answers

What is the typical oxygen percentage of air?

<p>21% (A)</p> Signup and view all the answers

Besides the DOT (Regulatory body), what else does the ICC require be on all cylinders?

<p>Manufacturer's Symbol. (A)</p> Signup and view all the answers

What could be a result of not seating the pipeline connection correctly?

<p>The gas will not flow. (D)</p> Signup and view all the answers

What part of the central gas supply filters debris from the wall supply?

<p>A filter (B)</p> Signup and view all the answers

According to the content, how do you calculate the minutes left before the gas tank expires?

<p>Divide the contents remaining in liters by the flow rate in liters per minute. (A)</p> Signup and view all the answers

What determines the proportionality between pressure and flow?

<p>Proportionality between pressure and flow is determined by shape of the tube (resistance) and physical properties (density and viscosity) of the gas (are not interchangeable). (A)</p> Signup and view all the answers

What does the flow control valve turn?

<p>counterclockwise (D)</p> Signup and view all the answers

What is the typical minimal oxygen flow when the anesthesia machine is left on?

<p>150 ml/min (B)</p> Signup and view all the answers

What is one of the limitations of the Drager oxygen ratio controller system?

<p>When the oxygen flow is less than 200 ml/min, the slave control valve closes completely, preventing any flow of nitrous oxide. (B)</p> Signup and view all the answers

What typically happens to the flowmeters following a leak?

<p>Oxygen leak will cause hypoxic mixture, especially if it is positioned downstream (B)</p> Signup and view all the answers

What is the most critical consideration when using the oxygen flush valve?

<p>Ensuring the patient is disconnected from the ventilator to prevent barotrauma. (B)</p> Signup and view all the answers

What is the initial indicator of pipeline oxygen loss when a cylinder is inadvertently left open during anesthesia, as designed in modern anesthesia machines?

<p>Depletion of the oxygen cylinder, indicated by a pressure drop on the cylinder gauge. (A)</p> Signup and view all the answers

In the GE Datex-Ohmeda Aestiva/5, what best describes the role of the 'balance regulator' in the event of decreasing oxygen pressure?

<p>It acts as a variable valve, reducing the flow of nitrous oxide proportionally to the decrease in oxygen pressure. (B)</p> Signup and view all the answers

How does the design of the Diameter Index Safety System (DISS) mitigate the risk of misconnection of gas pipelines?

<p>By employing noninterchangeable threaded connections specific to each gas. (B)</p> Signup and view all the answers

When a cylinder connected to the anesthesia machine is found to have a lower pressure than the pipeline supply, what immediate action should be taken?

<p>Investigate for potential leaks in the cylinder connection and ensure it is tightly sealed. (B)</p> Signup and view all the answers

In the context of vaporizers on the anesthesia machine, what best describes the purpose of the interlock system?

<p>The interlock system serves to prevent the simultaneous activation of multiple vaporizers, thus reducing the risk of delivering excessively high concentrations of anesthetic agents. (B)</p> Signup and view all the answers

Within the high-pressure system of an anesthesia machine, what function does the yoke serve besides securing the cylinder?

<p>It incorporates check valves to ensure unidirectional gas flow. (D)</p> Signup and view all the answers

Why is it important to be vigilant of oxygen levels when a fail-safe valve has already been put in place?

<p>Because it is possible that other types of pressure will lead to hypoxic accidents despite the fail-safe valve being in place. (A)</p> Signup and view all the answers

Considering the limitations of the oxygen ratio controller in the Dräger anesthesia machine, why does its safety mechanism not provide fail-safe protection against hypoxic mixtures?

<p>It does not affect the flow of a third gas mixed into the stream. (A)</p> Signup and view all the answers

Given that anesthesia machines are not intended for long-term ventilator use, what describes the key differences that make ICU ventilators more suitable for extended respiratory support?

<p>ICU ventilators are designed for long-term use, offer tailored respiratory support, advanced monitoring, and have alarms that are better suited for the ICU setting. The anesthesia machine lacks some of these features because they are only made for short term use. (C)</p> Signup and view all the answers

What accounts for the variation in flow behavior within a flowmeter between low and high flow rates?

<p>The shift from laminar to turbulent gas flow affects the relationship between pressure and flow, altering the sensitivity of the flowmeter. (A)</p> Signup and view all the answers

How does the American Society for Testing and Materials (ASTM) ensures standardization and reliability regarding pressure readings on anesthesia machines?

<p>ASTM mandates a specific range for the resting position of the needle on Bourdon gauges. (A)</p> Signup and view all the answers

Under what circumstance would the high pressure relief valve open?

<p>Exceeding the set pressure limit. (B)</p> Signup and view all the answers

Why does the anesthesia machine continue to function normally with an oxygen cylinder still open, even after the pipeline oxygen supply fails?

<p>The cylinder regulator is intentionally set at a lower pressure than the pipeline, ensuring flow from pipeline unless it is lost. (A)</p> Signup and view all the answers

If a leak were to occur, what would you expect of the flowmeters?

<p>Oxygen leak downstream could deliver hypoxic mixture to patient. (B)</p> Signup and view all the answers

Which statement accurately reflects a risk associated with the physical characteristics of nitrous oxide cylinders?

<p>N2O Cylinders may get cold and accumulate frost with high flows. (C)</p> Signup and view all the answers

When does the O2 supply failure alarm alert you to dropping pressure?

<p>20-30 psig (B)</p> Signup and view all the answers

How are cylinders constructed?

<p>According to Interstate Commerce Commission (ICC) specifications. (D)</p> Signup and view all the answers

Why are electrical outlets incorporated into the anesthesia workstation design an important safety feature?

<p>They allow for independent circuit breaking and system protection, minimizing total system failure upon a single device fault. (A)</p> Signup and view all the answers

Regarding the potential for delivering a hypoxic mixture, what is the significance of positioning the oxygen flowmeter downstream relative to other flowmeters?

<p>It helps ensure delivery of set oxygen concentrations even if there's a leak in a prior flowmeter. (D)</p> Signup and view all the answers

What aspect of Bourdon pressure gauges creates a challenge in interpreting gas cylinder pressure?

<p>They are an indirect measurement for gases stored as liquids (e.g., nitrous oxide) and provides no indication of the remaining volume until almost empty. (A)</p> Signup and view all the answers

What can result from incorrectly seating the pipeline connection within the anesthesia workstation?

<p>Leakage of gases from the connection point. (B)</p> Signup and view all the answers

When calculating tank life, which value do you multiply by when using an oxygen tank?

<p>0.35 (A)</p> Signup and view all the answers

How should free-floating valves, also know as check valves, be?

<p>Unidirectional. (B)</p> Signup and view all the answers

What best describes the operation of flowmeters within the anesthesia machine?

<p>Constant pressure, variable flow. (B)</p> Signup and view all the answers

What action should be taken when the backup battery of the anesthesia machine is malfunctioning?

<p>The machine should immediately be taken out of service. (C)</p> Signup and view all the answers

What is the key factor determining proportionality between pressure and flow?

<p>The gas density and viscosity. (C)</p> Signup and view all the answers

Which of the following parameters typically activates the oxygen supply failure alarm in an anesthesia machine?

<p>Oxygen Pressure. (B)</p> Signup and view all the answers

How are the flow control valve turned?

<p>Counterclockwise. (D)</p> Signup and view all the answers

What is one of the reasons that most anesthesia practitioners make errors?

<p>Anesthesia practitioners' knowledge about the delivery system is often lacking. (B)</p> Signup and view all the answers

In anesthesia machines, what role do diaphragm valves primarily serve?

<p>Pressure regulators rely on diaphragm valves to reduce pressure. (B)</p> Signup and view all the answers

In an anesthesia machine, what is the function of a one-way check valve?

<p>To allow for central gas flow in one direction. (D)</p> Signup and view all the answers

Aside from securing the cylinder, what else does the machine use the hanger yoke in the high pressure system for?

<p>To prevent other gasses from flowing. (D)</p> Signup and view all the answers

How is indexing achieved through the DISS

<p>A series of increasing and decreasing diameters in the components of the connections. (C)</p> Signup and view all the answers

Given the intricate pneumatic and electronic integration within modern anesthesia workstations, what are the potential ramifications of failing to regularly reboot the system, particularly concerning the calibration of gas sensors and the performance of automated self-tests?

<p>All of the above (D)</p> Signup and view all the answers

In the event of a total pipeline oxygen supply failure, coupled with the inadvertent depletion of the oxygen cylinder reserve, what immediate and preemptive measure can an astute anesthesia provider employ to maintain patient oxygenation, circumventing reliance on the machine's fail-safe mechanism?

<p>Initiate manual ventilation with room air, accepting the transient FiO2 reduction, while concurrently sourcing an alternative oxygen source, such as an ambu bag connected to an oxygen cylinder. (C)</p> Signup and view all the answers

Within the architecture of contemporary anesthesia workstations featuring electronic gas mixing, how does the 'balance regulator' in GE Datex-Ohmeda machines interface with and modulate the delivery of nitrous oxide in response to fluctuations in oxygen supply pressure?

<p>The balance regulator modulates a diaphragm-controlled valve, which decreases nitrous oxide flow proportionate to any reduction in oxygen supply pressure, ensuring a minimum oxygen concentration. (B)</p> Signup and view all the answers

In the context of the Diameter Index Safety System (DISS), what engineering principle ensures the prevention of gas-pipeline misconnections, even when a provider attempts to forcefully attach a non-compatible gas hose to a wall outlet?

<p>The DISS employs a series of progressively increasing and decreasing internal and external diameters on both the hose connectors and wall outlets, creating a lock-and-key system of exclusively compatible fittings. (B)</p> Signup and view all the answers

Considering the intricate design of the oxygen knob on anesthesia machines, how might its specific textural features and spatial positioning relative to other control knobs serve to mitigate the potential for errors in low-visibility or high-cognitive-load scenarios?

<p>The oxygen knob's knurled texture, larger size, and furthest right positioning offer highly discernible tactile and spatial distinctions, even when visual cues are compromised. (D)</p> Signup and view all the answers

What are the functional distinctions between first-stage and second-stage pressure regulators within the anesthesia machine, with respect to their specific roles in modulating gas pressure and ensuring stable gas delivery to downstream components?

<p>First-stage regulators reduce high-pressure cylinder gas to a standardized intermediate pressure, while second-stage regulators further lower this pressure to the level appropriate for flowmeters and vaporizers. (A)</p> Signup and view all the answers

Given the potential for substantial errors stemming from inadequate knowledge of anesthesia delivery systems, what specific area of knowledge should be emphasized to enhance anesthesia practitioners’ ability to effectively troubleshoot and resolve system-related complications?

<p>Emphasizing the comprehensive understanding of gas pathways, pressure regulation mechanisms, and fail-safe systems within the anesthesia machine is crucial for pinpointing and rectifying malfunctions. (B)</p> Signup and view all the answers

In the context of Bourdon pressure gauges on anesthesia machines, what inherent limitation should an anesthesia provider consider when interpreting pressure readings, especially in situations where ambient temperature fluctuates significantly?

<p>Bourdon gauges exhibit significant hysteresis, causing readings to lag behind actual pressure changes, particularly when transitioning from high to low pressure states. (C)</p> Signup and view all the answers

What implications arise from the fact that anesthesia machines are not designed for long-term ventilator use, particularly concerning the synchronization algorithms, humidification capabilities, and responsive modes of ventilation support?

<p>All of the above (D)</p> Signup and view all the answers

Free-floating valves open with pressure, and close with pressure. Considering the design and function of free-floating valves, also known as check valves, how do these valves ensure unidirectional gas flow, preventing retrograde flow even under fluctuating pressure conditions?

<p>A pressure gradient across the valve forces a ball or disc against a seat, creating a seal that prevents reverse flow, while forward flow easily lifts the ball or disc off the seat. (B)</p> Signup and view all the answers

In the event that the pressure of a cylinder connected to the anesthesia machine is found to be lower than the pipeline supply pressure, what intricate sequence of diagnostic and corrective actions should be undertaken to avert potential complications related to inadequate gas delivery?

<p>Isolate the cylinder by closing its valve, verify the pipeline supply pressure, and if pipeline pressure is adequate, document the cylinder pressure discrepancy for subsequent biomedical engineering evaluation. (C)</p> Signup and view all the answers

Given the limitations of the oxygen ratio controller in the Dräger anesthesia machine, particularly when a third gas aside from oxygen and nitrous oxide is introduced into the system, how might an astute anesthesia provider circumvent this safety mechanism to avert the delivery of a potentially hypoxic mixture?

<p>Rely on independent oxygen monitoring with an in-line oxygen analyzer and adjust the individual gas flows accordingly, overriding the machine's inherent proportioning limitations. (B)</p> Signup and view all the answers

Which factor most critically determines the proportionality between pressure and flow within a flowmeter, significantly influencing the precision of gas delivery across a wide range of flow rates encountered during diverse anesthetic procedures?

<p>The geometric configuration of the flowmeter tube and physical properties of the gas, dictating the resistance encountered by the gas stream at varying flow velocities. (A)</p> Signup and view all the answers

How do the operational characteristics of flowmeters change as the gas transitions from low to high flow rates, specifically concerning the dominant physical properties governing gas behavior within the flowmeter?

<p>Gas flow transitions from laminar to turbulent, density becomes the dominant factor. (A)</p> Signup and view all the answers

How does the American Society for Testing and Materials (ASTM) ensure standardization and reliability regarding pressure readings on anesthesia machines, considering potential variations in manufacturing tolerances and component aging?

<p>By specifying the permissible range within which the zero reading of Bourdon gauges must fall, ensuring consistent baseline accuracy across different machines and manufacturers. (D)</p> Signup and view all the answers

Given the crucial role of the oxygen flush valve in emergency situations, what specific risk does its activation pose, and what strategies can mitigate such harm?

<p>Risk of barotrauma; mitigate by disconnecting the patient from the ventilator circuit during activation. (D)</p> Signup and view all the answers

In which pressure circuit does the yoke reside?

<p>High-pressure (B)</p> Signup and view all the answers

What percentage of air is oxygen?

<p>21% (D)</p> Signup and view all the answers

Besides safety, what purpose do electrical outlets serve within the anesthesia workstation design?

<p>Power source for monitoring and other equipment (B)</p> Signup and view all the answers

What is the formula to calculate the 'Minutes Left Before Tank Expires'?

<p>(Current Tank Pressure (psi) / Full Tank Pressure (psi)) * Tank Capacity (L) / Flow Rate (L/min) (A)</p> Signup and view all the answers

What is the function of diaphragm valves in anesthesia machines?

<p>Reduce pressure (D)</p> Signup and view all the answers

What criteria do flowmeters utilize to measure the proportionality between pressure and gas flow?

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What purpose does the manual bag port serve?

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According to central gas supply guidelines, what pressure is expected from central supply?

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According to cylinder supply guidelines, what is constructed according to Interstate Commerce Commission (ICC) specifications?

<p>All cylinders (D)</p> Signup and view all the answers

How can one-way check valves be described?

<p>non-retrograde (A)</p> Signup and view all the answers

A cylinder requires 7 markings to be on it by ICC, which one of the following is NOT one of them?

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What typically happens to the flowmeters if a leak were to occur?

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According to the oxygen failure safety guidelines, what happens at < 30 psi of pressure?

<p>All other gasses shut off (B)</p> Signup and view all the answers

Why is oxygen the last gas added in the flowmeter sequence of anesthesia machines?

<p>If there is a leak in another flowmeter before the oxygen, oxygen should still flow downstream avoiding a hypoxic mixture (A)</p> Signup and view all the answers

What is the danger to using the O2 flush valve during what part of the breath cycle?

<p>Inspiration (C)</p> Signup and view all the answers

According to slide #5, what bypasses CO2?

<p>EZchange canister module (A)</p> Signup and view all the answers

Which statement accurately refutes the misconception that the fail-safe valve provides absolute protection against hypoxic gas mixtures?

<p>The valve is not designed to protect against leaks downstream from the flow control valves. (C)</p> Signup and view all the answers

What is the primary goal behind performing a daily anesthesia equipment check?

<p>To minimize risk of equipment malfunction (A)</p> Signup and view all the answers

What part of the central gas supply works traps debris from the wall supply?

<p>Filters (C)</p> Signup and view all the answers

In cases of increased pressure, which valve is responsible for pressure release?

<p>High pressure relief valve (B)</p> Signup and view all the answers

What powers Drager's oxygen ratio monitor?

<p>Pressure control (C)</p> Signup and view all the answers

Color-coded E-cylinders attach to machine by hanger yoke assembly. What's important to note about this assembly?

<p>Gas-tight seal using a Bodok seal washer (C)</p> Signup and view all the answers

In an Ohmeda flowmeter, the nitrous oxide flowmeter is set at 26 psig, and a 14-Teeth drive this flowmeter. Which of the following is true of the oxygen flowmeter, if the chain is connected and the flowmeter is also set at 26 psig?

<p>It runs at 28 teeth (D)</p> Signup and view all the answers

Flashcards

Anesthesia Delivery System Knowledge

Anesthesia practitioners' knowledge of the delivery system is often lacking, leading to critical incidents primarily due to use error.

Equipment check

Adhere to manufacturer's operating instructions and safety precautions during the equipment check.

Operating Equipment Standard

Minimizes the risk of fire, explosion, electrical shock, and equipment malfunction.

Secondary Gas Supply Gauges

Switch for secondary gas supply, usually cylinder gauges.

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Auxiliary Common Gas Outlet (ACGO)

The outlet switch for using an auxiliary gas source.

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O2 Pressure Failure Alarm

Alarm for low oxygen pressure

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O2 Failure Device (failsafe)

Automatically stops other gases if O2 supply fails

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Anesthesia Machine Function

Receives medical gasses from a gas supply.

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Anesthesia Machine Control

Controls the flow and reduces the pressure of desired gases to a safe level.

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Anesthesia Vaporization

Converts liquid anesthetics into a vapor for use.

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Anesthesia Machine Delivery

Delivers gases for circuit connected to the patient's airway.

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Anesthesia Machine Design

Machines are not intended for long-term ventilation.

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Anesthesia Machine Maintenance

Machines should be rebooted every 24 hours

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Anesthesia Machine Function

Oxygen and inhaled anesthetics delivery and CO2 removal

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Pressure Regulation Component

Regulates pressure and mixes component gases

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Physiologic Monitoring systems

Includes ECG, BP, temperature, and oxygen saturation.

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Flow Proportioning Device

Prevents hypoxic mixtures with a hypoxic guard.

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Automated Record Keeping

Records data automatically and connects to hospital systems.

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High-pressure circuit

Starts at the cylinder and ends at the cylinder regulators. (at 45 psig)

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Intermediate-pressure circuit

Starts at the pipeline and ends at the flowmeter valve (50-55 psig).

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Low-pressure system

Starts at flowmeters and ends at common gas outlet.

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Cylinder Regulator Intent

Ensures flow from the higher-pressure pipeline, if open.

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Low Pipeline O2 Alarm

Alarmed only after the cylinder is empty.

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First-stage regulators Role

Reduce cylinder pressure to ~45 psig.

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Second-stage regulators Role

drop pipeline and cylinder pressure further (14-26 psi).

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Free Floating Valve (Check Valve)

Moves with gas flow to prevent leaks.

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Ball and Spring Valve

A valve that permits gas flow after connecting.

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Diaphragm Valve

Allow pressure regulation; reduces pressure.

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Fail-safe Valve

Maintains minimal oxygen flow (>12-14 psig).

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Fail-safe Benefit

Prevents hypoxic gas mixtures.

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Fail-Safe Reaction

stops nitrous oxide if O2 fails.

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Old School Pneumatic Alarm

All other gases shut proportional to O2

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Fail-safe Limitations

Doesn't protect against every hypoxic accidents.

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Fail-safe Alternative

GE Datex Aestiva/5 machine variable valve in a balance regulator.

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Bourdon Gauges Mechanism

A linkage connects the coil to a rotating arm.

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Bourdon Applications

Gauges measure both pipeline and cylinder pressure.

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Central Gas Supply

Pipelines enter surgery with color-coded wall outlets.

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Central Supply Pressure

The pressure from the central supply = about 50 psi.

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Cylinder Connection

E-cylinders attach with a hanger yoke assembly.

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Bodok Seal

Provides sealed gas around tank and its hanger yoke.

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ICC Cylinder

Determined 7 specific markings to be present.

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Pin Index Safety System (PISS)

The PIN number indicates gases.

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N2O Cylinders

These cylinders turn old fast.

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Oxygen, Air Cylinder

Pressure is directly proportional

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Nitrous oxide Cylinder

Liquid, gas until 750psi

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Oxygen Flush

35-75 l/min

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Equipment verification

Verify function of anesthesia equipment.

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System switch

Switch for the anesthesia machine system.

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EZchange canister module

Module for bypassing the CO2 absorber canister.

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Anesthesia machine

A device intended for short-term ventilation.

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Anesthesia Machine

Delivery depends on oxygen and inhalation.

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Datex-Ohmeda & Dräger

Two major manufacturers of the Anesthesia machine

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Cylinders

The cylinder which acts as a central supply Back-Up

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Interstate Commerce Commission (ICC)

Interstate standards for cylinder creation

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Federal Food, Drug, & Cosmetic Act

Regulates medical gases

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US Pharmacopeia

Purity standards are set

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Cylinders

The supply for oxygen and nitrous should it fail

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High pressure relief valve

Valve will open if there is a pressure issue.

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Temperatures

A cylinder has a limited heat temperature

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Fusible plug

Device melts when heated to extreme temperature.

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Wood's metal

Melts with heat

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Gaseous state

Volume is measured

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Pressure system

Used to measure

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Nitrous

14.1 lb when empty

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NonInterchangeable

Calibrates the gases

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Glass flow tubes

A fragile oxygen-providing system

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Oxygen Flow

Protects safety devices and oxygen supplies.

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Oxygen limiting safety system

Ohmeda proportion limiting control safety system

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Safety relief valve

A valve that opens at elevated pressures.

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Alternate 02

Always ensure this before using

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Rapidly refill or flush

Used in high-pressure situations

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Daily Equipment Check

Performed daily to ensure proper functionality according to the manufacturer's guidelines.

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Flowmeter

A device using a bobbin or ball within a tapered tube to indicate gas flow rate.

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Datex-Ohmeda

One of the major brands of anesthesia machines.

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Dräger Medical

The other major brand of anesthesia machines.

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Suction regulator

A device that suctions fluids during procedures.

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Ventilator Component

This is the area of the machine that is used for ventilation.

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Scavenging system

Removes waste anesthetic gases.

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Gas supply

Begins at the central pipeline or cylinder yokes.

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Pressure Gauges

Used to measure both pressure and flow.

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Safety Devices

Ensure correct gas is delivered and prevent hypoxic mixtures.

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Flow Control Valve

Located after pressure reducers; control gas entry into flowmeters.

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Oxygen flow control Knob

Designed with fluted knobs, are larger and are farthest to the right.

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Vaporizer

A device that adds anesthetic vapor to gas flow.

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Common gas outlet

Where the final gas mixture exits the anesthesia machine.

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One-way check valve

Check that valve prevents retrograde flow into a cylinder.

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Pressure regulator

Reduces cylinder pressure 2200psi to around 45psi.

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Gas Inlet

This component receives medical gases from a gas supply

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Study Notes

  • Anesthesia practitioners' knowledge about the delivery system is often lacking.
  • Critical incidents related to use of anesthesia delivery systems most commonly stem from use error.

Standard 6: Equipment

  • Complete a daily anesthesia equipment check, adhering to manufacturer's instructions and safety precautions.
  • Verify the function of anesthesia equipment prior to each anesthetic.
  • Operate equipment to minimize risks like fire, explosion, electrical shock, and equipment malfunction.

Anesthesia Machine Basics

  • The anesthesia machine receives medical gases from a supply.
  • The machine controls the flow and reduces the pressure of the gases to a safe level.
  • This machine vaporizes volatile anesthetics into the final gas mixture.
  • Gases are delivered at a common gas outlet, connected to the breathing circuit and patient.
  • Oxygen flow valves are designed to deliver a minimum flow when the machine is on.
  • These machines is not intended for long-term ventilator use.
  • Reboot every 24 hours for self-tests and machine checkout.
  • Never turn off machine alarms; pause to assess the patient.
  • They are not intended or designed for patient transport.
  • The fully charged backup battery only last 30-45 minutes.

Components of Anesthesia Workstations

  • Anesthesia machine function elements:
    • Oxygen and inhaled anesthetic delivery
    • Carbon dioxide removal
    • Pressure regulation
    • Gas mixing
  • The machine is powered by electric and pneumatic power.
  • Major manufacturers include Datex-Ohmeda (GE Healthcare) and Dräger Medical.
  • Some are designed for mobility, compactness, and MRI compatibility.
  • Additional components:
    • Vaporizers
    • Anesthetic breathing circuit
    • Ventilator
    • Scavenging system
    • Suction regulator
  • Respiratory and physiologic monitoring systems:
    • ECG
    • BP
    • Temperature
    • Oxygen saturation
    • Inhaled and exhaled concentrations of oxygen
    • Carbon dioxide
    • Anesthetic gases
  • Flow Proportioning Device (hypoxic guard)
  • Protection and alarm systems
  • Automatic recordkeeping and networking with hospital systems

Gas Pressure Circuits

  • Consist of high-pressure, intermediate-pressure, and low-pressure circuits.
  • High-Pressure Circuit: Begins at the cylinder and concludes at cylinder regulators (45 psig).
  • Intermediate-Pressure Circuit: Begins at the pipeline and ends at the flowmeter valve (50-55 psig).
  • Low-Pressure Circuit: Begins at flowmeters and ends at the common gas outlet (16 psig).
  • Cylinder regulators intentionally set at a lower pressure.
    • This ensures flow from the higher-pressure pipeline is used first.
    • If pipeline oxygen is lost and a cylinder is left open, delivery begins from cylinder without warning.
      • The first sign is that the cylinder is empty.

Pressure Regulators

  • Adjust for high and variable pressures.
  • Diaphragm valves reduce pressure.
  • Enhance safety and cylinder use.
  • First-stage regulators reduce cylinder pressure to 45 psig, from:
    • 2200 for O2
    • 745 for N2O
  • Cylinder pressure slightly lower than pipeline pressure.
  • A high-pressure relief valve opens if pressure becomes excessive (95-110 psi).
  • Second-stage regulators drop pipeline and cylinder pressure further (14-26 psi).

Valves

  • Free Floating (Check Valve)
    • Moves in the direction of gas flow.
    • Prevents gas leaks.
  • Ball and Spring Valve
    • Permits gas flow after a connection like accessing pipeline gas.
    • Requires applied energy.
    • Examples: flush valves
    • Requires correctly seated pipeline connection.
  • Diaphragm Valve
    • Allow pressure regulators to function to reduce pressure.

Fail-Safe Valve

  • Minimal oxygen flow of 150 ml/min is supplied when the machine is on (if > 12-14 psig).
  • It prevents hypoxic gas mixtures if oxygen supply fails.
  • Nitrous oxide flow stops if oxygen supply PRESSURE fails.
  • If oxygen pressure falls below 30 psig, other gases shut off, or proportionately decrease (Pneumatic alarm).
  • Oxygen supply low-pressure alarm sounds when pressure drops below threshold (20-30 psi).
  • These don't protect against all causes of hypoxic accidents; an oxygen analyzer and vigilance are vital.
  • In GE Datex Aestiva/5 the ""fail-safe"" valve is a variable valve in the balance regulator.
    • A second-stage pressure regulator for oxygen reduces pressure to about 30 psig (intermediate pressure).
    • Oxygen pressure pilots the balance regulator, then oxygen pressure pushes on the diaphragm and opens the nitrous oxide path.
    • Acts as a fail-safe valve.

Bourdon Pressure Gauges

  • Coiled tube expands as pressure is applied.
  • Linkage connects coil to a rotating arm to record pressure.
  • The American Society for Testing Materials (ASTM) requires a zero reading is between 6 and 9 o’clock.
  • Bourdon gauges measure both pipeline and cylinder pressures.

Central Gas Supply

  • Pipelines connect to color-coded wall outlets for:
    • Yellow - Air
    • Blue - Nitrous oxide
    • Green - Oxygen
  • Color-coded hoses with gas-specific fittings prevent misconnections.
  • Diameter Index Safety System (DISS): Noninterchangeable threaded connections.
  • Indexing is achieved by diameters of the connections.
  • Oxygen or air may power a ventilator (pneumatic) or an auxiliary oxygen flow meter.
  • Filters trap debris from the wall supply.
  • Pressure from central supply is about 50 psi.
  • Adequate pressure is necessary for flow meters.
  • Color-coded Bourdon pressure gauges.
  • One-way check valve prevents retrograde flow.
    • Free-floating valves open/close with pressure.

Cylinder Supply Overview

  • Constructed according to Interstate Commerce Commission (ICC) specifications.
  • The Federal, Food, Drug, and Cosmetic Act regulates medical gases.
  • Potency and purity standards set by the US Pharmacopeia.
  • ICC requires 7 markings:
    • DOT (Regulatory body)
    • Serial Number
    • Purchaser, user, manufacturer
    • Manufacturer’s manual and symbol
    • Retest date, retester, ID symbol, 110% filling, ten-year test interval
    • Neck ring owner's identification
  • Color-coded E-cylinders attach to machine by hanger yoke assembly.
  • Assembly provides gas-tight seal (Bodok seal between tank and hanger yoke).
  • Cylinders are backup supply.
  • Cylinder pressure is about 45 psi.
  • Pin Index Safety System (PISS):
    • Two metal pins correspond to holes.
      • Oxygen: 2, 5
      • Nitrous: 3, 5
  • Features a one-way check valve preventing retrograde flow.
    • Free-floating valves open/close with pressure.
  • N2O cylinders get cold and frost with high flows.
  • Vaporization/expansion absorbs heat from the metal cylinder.
  • Oxygen and nitrous oxide act as oxidizers.
  • Temperatures over 130°F (57°C) increase fire risk.
  • Safety relief devices:
    • Fusible plug – Melts at elevated temperatures.
    • Valve - Opens at elevated pressures.
    • Frangible disks – Ruptures under pressure.
  • Oxygen and Air Cylinders
    • They are in a gaseous state.
    • Pressure is proportional to volume.
    • The duration of the tank is calculable based on flow rate.
    • Air contains 21% oxygen.
  • Nitrous Oxide Cylinders
    • They contain liquid (90-95% capacity) and gas.
    • Pressure is 750 psig as long as liquid remains.
    • Pressure decreases when all liquid is vaporized.
    • Expect pressures to fall (~400 liters) after 75-85% of contents are used.

Oxygen Cylinder Duration Calculation

  • Tank Capacity (L) / Full Tank Pressure (psi) = Contents Remaining (L) / Gauge Pressure (psi)
  • Contents Remaining (L) / Flow Rate (L/min) = Minutes Left Before Tank Expires
  • Use 660 L/1900 psig to calculate contents

Flowmeters

  • Color-coded and calibrated to specific gases.
  • Thorpe tube flowmeters are used.
  • Newer machines use electronic flowmeters.
  • Flow Control Valve turns counterclockwise to the desired flow.
  • Gas enters the bottom of a vertical, tapered (Thorpe) tube.
  • A bobbin or ball float indicates flow.
  • Floats are designed to rotate, keeping them centered.
    • Shape of the tube (resistance)
    • Gas' physical properties (density and viscosity)
  • Oxygen enters the circuit, even if the operator forgets to turn on the flow.
  • Minimum oxygen flow (usually around 150 ml/min) is supplied.
  • Auxiliary flow meters may be present.
  • Some contain two glass tubes for different flow rates.
  • Malfunctions involving:
    • Dirt in flow tube
    • Vertical tube misalignment
    • Sticking of a float
    • Broken/fallen float
  • Oxygen knob is fluted, larger, and protrudes furthest to the right.
  • Oxygen/nitrous ratio controllers include:
    • Dräger oxygen ratio controller system (pressure control piston)
    • Datex-Ohmeda proportion limiting control system (chain connects knobs)
  • Mechanically/pneumatically/electronically linking oxygen and nitrous oxide
  • These ensure a minimum oxygen of 21-25%.
  • This does not affect the flow of a third gas (e.g., air, helium, or carbon dioxide).
  • Oxygen Flowmeter positioned downstream, relative to other flowmeters.
    • It is the most fragile component.
    • Potential leaks introducing hypoxic mixture.
  • Flowmeters are downstream from safety devices except for the oxygen analyzer.

Drager Oxygen Ratio Monitor Controller/Sensitive Oxygen Ratio Controller

  • When oxygen flow is less than 200ml/min, the slave control valve closes completely, preventing nitrous oxide flow.

Alternate Oxygen Control

  • If the anesthesia display is not working, this control is activated.
  • The Alternate O2 control delivers through an independent pneumatic path to the vaporizer and patient circuit.
  • Depending on the machine, anesthesia gas may be delivered with this control during electronic/power failure.

Oxygen Flush Valve

  • Delivers 35-75 L/min
  • It bypasses flowmeters, manifold, and vaporizers.
  • Direct link between intermediate and low-pressure circuit.
  • Delivers a large volume of oxygen for emergency use.
  • Used to rapidly refill or flush the circuit, but should be used with caution.
  • Possible risks:
    • Barotrauma during mechanically delivered inspiration.
    • Dilution of anesthesia gases.
  • It is controversial for jet ventilation.
  • The protective rim around the flush button limits accidental activation.
  • It should not be used if the bag is empty.
  • Instead one should increase the flow of gas.

Common Gas Outlet

  • The oxygen/medical gas/anesthetic agent mixture exits the machine through this outlet.
  • Some machines have an auxiliary common gas outlet, which can be used in certain circumstances.
    • Bain circuit
    • T-piece pediatric circuit

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