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Anesthesia Machine Self-Study Topics
Anesthesia Machine Self-Study Topics
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A Fl*wnteiers
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Manual @2005
Valley Anesthesia Educational Programs, Inc'
EQUIPMENT
Self-StudY
Gas Connections
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Check Valves
oxide
o wall gas hose to machine has pressur e of. 40-so psig for oxygen and nitrous pressure'
to
o check valve in pipeline inlet aisembly is a floating valve and seats according
o What is the function of this valve?
anesthesia machine
Answer:prevents oxygen cylinder gas from escaping the
Gas Machine
Valley Anesthesia Educational Programs, Inc.
Manual @2005
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Hanger Yoke Showing the Oxygen FIow From the cyrinder lnto the Machine
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Contlgmion
Gas Machine 2
Valley Anesthesia Educational Programs, Inc. Manual @2005
Position of Hanger Yoke Valves When One 0xygen Cylinder is Turned 0n in a Double-Yoke Assembly
Double-Yoke Assembly
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Oxygen Regulator
3 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005
1T
Oxygen Flush Valve-Open
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Gas Machine 4
Valley Anesthesia Educational Programs, Inc' Manual @2005
Pressure Sensor Shut-offValve in the 0pen Position Pressure Sensor Shut-offValve in the Closed Position
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5 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005
The Check Valve located Between the Vaporizer 0utlet and the Machine 0utlet
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Ct6.d Paltlca
o Check valve between vaporizer outlet and machine outlet (not present on all machines)
o Prevents reversal offlow to vaporizer
O Free floating type valve (stiffer)
Gas Flow Through the lnhalation Check Valve During lnspiration
Rabd
tlr Aborlrr
Answer: The expiratory volume will exhaust through the inspiratory limb. The ETco, waveform will
become elevated.
Answer: Due to the path of least resistance, the inspired volume will not enter the endotracheal tube but
instead will bypass and exhaust throught the expiratory limb.
Gas Machine 6
Valley Anesthesia Educational Programs, Inc. Manual @2005
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7 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005
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Gas Machine 8
Manual @2005
Valley Anesthesia Educational Programs, Inc'
System
The Flow ofWaste Gases Through the lnterface Manifold ofa Gas Scavenging
9 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005
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Vaporizer Flow
Question: what will happen when the vaporizer is tipped then leveled?
Answer: Liquid vapor will get into the vaporizer chamber and the carrier flow will carry more agent to the
patient.
Gas Machine l0
Valley Anesthesia Educational Programs, lnc. Manual @2005
r (cylinder
The anesthesia machine consists of three pressure system components. The high pressure
pressure) side includes the cylind", pr"rru.. gauge (Bourdon), the check valves in the hanger yoke, and
the index pins on the hanger yoke. High pressure is cylinder pressure.
o The intermediate pressure portion of the machine includes the flush valve, second stage regulator, oxy-
gen pressure "failsafe" shut-off valve, pressure gauges from pipeline, and diameter index safety system
a.rd flo* control valve of manifold. This can be hospital piped-in gas (55 psi) or cylinder gas after the
first stage regulator.
o The low pressure portion of the machine includes the vaporizer(s), common gas outlet, manifold, and
check valves. Low pressure is 16 psi and is the pressure a,fter the second stage regulator.
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11 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005
5ummary
There are three primary valves in the gas machine, and each has its own special function. I(now these
valves and their special functions.
The first valve is the "free floating" valve. This valve moves in the direction it is being pushed by gas flow.
The valve can be found, for example, in the D.I.S.S. and dual hangar yolk systems. The primary function of
any free floating valve is to prevent gases from leaking out of the system. A pressurized system from the
cylinders will push these valves closed to prevent gases from escaping or leaking out of the system.
The second valve is a ball and soring valve. and its function is to permit gas flow after you have made a con-
nection such as plugging the gas lines into the wall. You supply the energy to make this valve function prop-
erly. If the connection is not complete, the gas flow will not occur. I like to call this the "all-or-none" valve
because it is either hooked up correctly with the gas flow or is not. There is no in between. The orygen
flush valve is an "al1-or-none" valve because you supply the energy to make it work. When you take you
thumb off, gas flow stops.
The third valve is a diaphragm valve. There are two of these valves in the machine, the first and second
stage regulators. Remember these valves reduce pressure, and that is all they do. The first stage regulator
takes cylinder Pressure and reduces it to 55 pounds per square inch gauge (prig), which is the same as the
hospital wall pressure. Remember there are only two valves that reduce pressure.
. D.I.S.S.
a oxygen flush valve
o single hanger yoke
r dual hanger yoke
t oxygen pressure sensor valve
o pop off valve
Complications Related to 6as Machine Management
o Hypoxia (inadequate orygenation of arterial blood)
o Failure to deliver adequate oxygen to alveoli may be caused by poor alveolar ventilation or low FiO2
o Factors that may cause a failure to deliver adequate oxygen to the alveoli
r Empty oxygen cylinder
r Incorrect cylinder on oxygen yolk
r Closed oxygen cylinder valve
r Orygen flow meter off
I Oxygen leak within the machine or flow meter
I Incomplete or absent circuit unidirectional valves
r Breathing circuit leak
I Inadequate ventilation
Gas Machine 12
Valley Anesthesia Educational Programs, lnc' Manual @2005
o Hypercarbia
O Factors that may cause hypercarbia
r Patient factors
tr Central respiratory depression
tr Muscle relaxants
EI Motor blockade
tr Airway obstruction
D Severe intrapulmonary shunting
r Delivery system problems
tr Apnea (not ventilating)
tr lnadequate minute ventilation
E Increased dead space in apparatus
tr Missing unidirectional valves
EI Incorrectly assembled circuit system
tr Exhausted carbon dioxide absorbent
tr inadequate fresh gas flow
13 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005
10. The low pressure alarm on your gas machine is sounding. What happened?
a. patient is biting the tube
b. Patient's respiratory rate is > 25lmin
c. Disconnection has occurred in the circle
d. Pressure has increased in the circle
Compressed Gas
Defined by the Department of Transportation "as any material or mixture having in the container either an
absolute pressure exceeding 40 lb/inz at 130"F, or both; or any liquid flammable material having a vapor
pressure exceeding 40lb/in2 at 100'Fl'
Al[ compressed gas cylinders are constructed according to Interstate Commerce Commission specifica-
tions.
The medical and anesthetic gases have a specification number of ICC3S and this marking must be placed
on each cylinder.
o Cylinders are constructed entirely of steel that meets certain chemical and physical requirements.
o The cylinder walls are 3/8 of an inch thick.
o Some cylinders are constructed of chrome molybdenum alloy.
o The given pressure in a tank is called the service pressure.
o Cylinders are pressure tested to L.66 (5/3) their service pressure.
a Each cylinder must have some tensile strength but must not exceed 10%.
a Each cylinder must be subject to a test by interior hydrostatic pressure at least once every five years.
Standards
The Federal Food, Drug, and Cosmetic Act also regulates the medical gases contained in cylinders. Their
potency and purity are set by the standards of the United States Pharmacopeia.
The medical gas industry generally expressed the contents of full cylinders in terms of gallons measured at
70"F and normal atmospheric pressure, and liquefied gases in cylinders are expressed in terms of weight.
o Department of Transportation (nor) - established requirements for the design, construction, testing,
marking, labeling, filling, storage, handling, maintenance, and transportation of compressed gas cylin-
ders.
o Compressed Gas Association (cce) - sets standards of safe practice. Has no legal force but compliance is
basis for accreditation by IcaHo.
a National Fire Prevention Association (Nrle) - same as for CGA - contains recommendations for the loca-
tion, construction, and installation of bulk oxygen systems (Nrne so)
o American National Standards Institute (nNst) - sets basic performance and safety requirements for com-
ponents of anesthesia machines, endotracheal tubes and connections, pressure and vacuum, and gas
pressure regulators.
. National Institute of Occupational Safety and Health (NrosH) and Occupational Safety and Health Act of
1970 (oSHA) - standards to protect the health and safety of workers.
o Food and Drug Administration (roe) - promulgates standards for medical devices and gases. American
(esrlt) - assesses technology and revises standards.
Society for Testing Materials
o Pharmacopeia of the United States - develops purity specifications for medical gases.
Gas Cylinders t6
Valley Anesthesia Educational Programs, Inc. Manual 02005
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Oxygen is a gas in the cylinder because it has a critical temperature below room temperature. Nitrous
oxidi is different than oxygen in this regard; nitrous oxide at room temperature is a liquid because it has a
critical temperature above room temperature.
t7 Gas Cylinders
Valley Anesthesia Educational Programs, Inc. Manual @2005
o The cylinder should be open slightly for a moment to clear the outlet of possible dust. This is called
cracking the cylinder.
o The adiabatic heat of compression can generate heat and cause ignition. The compression of cylinder
content into a small space generates the heat that may cause combustion.
Each valve stem on the cylinder has a safety device which under hazardous conditions of excessive heat or
fire will cause the cylinder to become exhausted. This safety device is a simple plug of soft metal alloy
called Wood's metal; it is composed of bismuth,lead, tin, and cadmium. This plug will melt at 200oF.
Gas Cylinders 18