NSCI 5711 Anaesthetic Monitoring Equipment Procedure Part 2 PDF

NSCI 5711 – Anaesthetic Monitoring Equipment Readings for this lecture Ko, J., & Krimins, R. (2012). Anesthetic monitoring devices to use & what the results mean. Today’s Veterinary Practice (Estados Unidos), 2(2), 23-31. https://todaysveterinarypractice.com/anesthetic-monitoring-devices-to-u...

NSCI 5711 – Anaesthetic Monitoring Equipment Readings for this lecture Ko, J., & Krimins, R. (2012). Anesthetic monitoring devices to use & what the results mean. Today’s Veterinary Practice (Estados Unidos), 2(2), 23-31. https://todaysveterinarypractice.com/anesthetic-monitoring-devices-to-use-what- the-results-mean/ Taylor, S. (2016). How to use and maintain anaesthesia monitors. The Veterinary Nurse, 7(4), 232-237. https://www.theveterinarynurse.com/review/article/how-to- use-and-maintain-anaesthesia-monitors Flaherty, D., & Musk, G. (2005). Anaesthetic monitoring equipment for small animals. In Practice, 27(10), 512- 521.https://inpractice.bmj.com/content/inpract/27/10/512.full.pdf?casa_token=gv 1lPfERCScAAAAA:sJkSxvuikDpZG408jYNkf311rLLz0WRq5SPIO0qIDsRsUAjrWhkuvyw vYeKGr8pHokbugBC2shmx Commonly available monitoring machines…. Stethoscope Oesophageal stethoscope Thermometer – rectal or oesophageal Ap Alert Pulse Oximeter Ultrasonic Doppler blood pressure monitor Oscillometric blood pressure monitor Capnograph Electrocardiogram (ECG) Focus on these this year! Stethoscope Oesophageal stethoscope Thermometer – rectal or oesophageal Ap Alert Pulse Oximeter Ultrasonic Doppler blood pressure monitor Oscillometric blood pressure monitor Capnograph Electrocardiogram (ECG) What you need to know this year? What is the machine called? (full names) What does it tell us? Which body systems does it monitor/give us information about? How does the machine work? How do you correctly use the machine? How do you care for, clean and store the machine to prevent damage?  In your table groups, work together to answer the questions ACTIVITY about your given monitoring machine You have 20 minutes to answer all of the questions We will go through your answers at the end  Stethoscope Most common piece of equipment Monitors heart rate & rhythm, respiration rate and effort/character Gives us information on the cardiovascular system and the respiratory system The process of using a stethoscope to listen to body sounds is called auscultation.  Stethoscope How does it work? Basic, low-tech piece of equipment Amplifies the sound that you hear through the tubes to the earpieces More info here: https://science.howstuffworks.com/innovati on/everyday- innovations/stethoscopes.htm#pt1 Stethoscope How to use it? If double sided, ensure you’re using the correct side. o Bell side (with hole) = low pitch sounds like heart murmur, vessels. o Diaphragm side - flat disc like = higher pitch sounds like normal heart beats and lung/breath sounds – used most often Ensure earpieces are facing toward your nose, & place into ears Hold patients left foreleg, bend at elbow, place stethoscope on the thorax, (left side) in line with the point of the bent elbow. Left hemithorax at about the fifth to sixth intercostal space. Count beats per minute – can count over 15 secs & multiply by 4. How NOT to use a stethoscope……  Stethoscope How do I care for it? Wipe over entire stethoscope regularly with a disinfecting agent such as 70% isopropyl alcohol Clean & Wipe ear pieces regularly with Trigene/Safe for Pets or Isopropyl alcohol. Disinfect the head after each patient For more information, visit https://www.littmann.com/3M/en_US/littmann- stethoscopes/my-stethoscope/using-your- stethoscope/care/ Oesophageal Stethoscope Oesophageal Stethoscope Adapted Stethoscope which is placed in the oesophagus once the ET tube is placed (in trachea) & the cuff is inflated Works in the same way but used differently Prior to placement – measure the distance from the 5th – 6th rib to the incisors. Mark on the tubing the appropriate distance with tape or a marker Should slide into the oesophagus easily with no resistance – make sure the ET tube is already placed in the trachea and cuff inflated. Use ear pieces the same way as with the acoustic stethoscope Oesophageal Stethoscope How do I care for it? As for normal stethoscope for tubing & ear pieces Tube with rubber diaphragm should be wiped over using an Aqueous solution (mild antibacterial soap/solution) They MUST NOT BE immersed in water – once water inside will not come out They can be sent for Ethylene Oxide gas once or twice a year along with your ET tubes. Apnoea Alert Monitor (apAlert) Monitors the respiratory system – but not well(!) Produces an audible tone when warm air passes past a sensor attached between the ET tube and the breathing circuit. Gives respiratory rate but NOT respiratory effort or character Can be very unreliable - moving your patient or circuit can register a breath, even when the patient isn’t breathing Apnoea Alert Monitor (apAlert) How do I care for it? Wipe over line, base unit & attachment with Trigene dampened cloth Do not immerse line or probe in water Send for service regularly N.B.: NEVER RELY ON MACHINES, ESP. THIS ONE Pulse Oximeter Measures the average pulse rate & the oxygen saturation of haemoglobin within the blood stream. Information on the cardiovascular and the respiratory systems Most will display pulse rate (# of pulse waves per/min) & emit an audible beep for each pulse wave Pitch of beep will change with alterations in SpO2 Machine can be set to alarm when Pulse or SpO2 low Pulse Oximeter How does it work? Probe is placed over tissue such as tongue, ears, lip, toes, vulva, perineum etc – anywhere with a superficial vascular bed. Sensor detects how much oxygen is in the blood by comparing how much red light and infrared light is absorbed as it passes through. More detail if you are interested: https://www.howequipmentworks.com/pulse_oximeter/ Pulse Oximeter - probes Clamp vs. reflectance probe Pulse Oximeter How do I use it?  Pulse Oximeter How do I use it? Place probe on tongue or superficial tissue bed – ensure blood flow is not obstructed in any way as this will affect the reading If using rectal probe – ensure it is lubricated before use & you can tape it to the tail to keep in place Use on the toes normally only works on light coloured fur in the webbing of the toes Set the alarms on your pulse oximeter before use. SpO2 MUST be 95% or higher Movement and compression of tissue will affect the reading Pulse Oximeter How do I care for it? Keep safety cover & handle in place when using if possible Service when required Clean probes after each use Warm water swab with aqueous can be used to clean away debris Sensors to be wiped with Isopropyl alcohol after each use Ensure to take probe apart from holder & spray holder with disinfectant to clean, ensure you dry it well Never wrap probe cord around unit tightly – this will cause damage. Blood pressure monitors Non-invasive blood pressure (NIBP) monitoring is easy to do, and we can use machines to do this. Invasive blood pressure (IBP) monitoring is another story – more on this at level 6 and 7. TWO main types of NIBP monitor: Ultrasonic Doppler Oscillometric BP Monitor (Pet Trust, PetMap etc.)  Blood Pressure (BP) Most reliable & non-invasive way to monitor your patient’s circulatory system Systolic arterial pressure (SAP) Ventricular contraction  highest blood pressure Diastolic arterial pressure (DAP) Ventricular relaxation  lowest blood pressure Mean arterial pressure (MAP)  takes into account systolic and diastolic function MAP = DAP + 1/3 (SAP–DAP) Blood Pressure (BP) BP is the ultimate measure of circulation and the cardiovascular system. BP provides good info about GA depth. As GA deepens -> BP drops. Maintenance of normal BP is very important, it delivers the heart/brain with essential blood flow = oxygen, nutrients etc. Ultrasonic Doppler Measures systolic blood pressure only & provides an audible pulse wave. Gives us information on the cardiovascular system How does it work? Ultrasonic waves emitted by transmitter reflected back to a receiving crystal at a different frequency due to movement of red blood cells flowing within the artery & pulsations of the vessel wall. Sound produced as whooshing sound. Then flow of blood is occluded & a manometer measures the pressure at which blood flow returns = systolic blood pressure  Ultrasonic Doppler How do I use it Choose the correct sized cuff and place on forelimb of patient above the carpus - width of cuff should be 40% of limb circumference. Clip fur from palmar surface over metacarpal artery Wet area with alcohol to increase contact area Apply water soluble gel on concave side of probe Probe is placed where pulse rate can be heard through sound box – can tape in place if needed Cuff is inflated until audible pulse is gone, and then slowly deflated until you can hear it again – this value is the systolic blood pressure More information with images: http://www.vasg.org/doppler_use.htm Ultrasonic Doppler How do I care for it? Service when required You can never over charge it, a fading battery makes use harder. DO NOT remove leads – this adds to wear & tear DO NOT wrap electric line around base unit Wipe the line and base unit with a disinfectant dampened cloth Use water swab only on the probe end, do not soak Check cuffs regularly for wear & tear Have new stocks of cuffs ready in case Clean cuffs with a mild soap solution, rinse well & dry, care with lines. Oscillometric Blood Pressure Monitor Same principles as the doppler, but electronic, no need for probe placement Gives THREE values – SYSTOLIC, DIASTOLIC and MEAN arterial pressure Oscillometric Blood Pressure Monitor How do I use it Choose the correct sized cuff and place on forelimb of patient above the carpus - width of cuff should be 40% of limb circumference. Press the ‘START’ button and wait Can also be set to auto cycle NOTE – may be unreliable on patients under 5kg Oscillometric Blood Pressure Monitor How do I care for it? Service when required Keep it charged Wipe the line and base unit with a disinfectant dampened cloth or isopropyl alchohol Check cuffs regularly for wear & tear Have new stocks of cuffs ready in case Clean cuffs with a mild soap solution, rinse well & dry, care with lines.