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Clinical Conference:Technology RoundsBiomedical Engineering
Evelyn Fan, M.H.Sc., Clinical Engineer
Biomedical Engineering
November 2, 2005
Plan for todayIntroduction
Biomedical Engineering OR Team
Fabius GS: “Low Fresh Gas” alarm
Fresh gas decoupling
You’re on call…
What’s wrong with this picture?
Summary
Conclusion
Who are we?BWH Biomedical Engineering Department 27 people 3 teams (OR, ICU, Ambulatory) support the medical equipment used
in the entire hospital and outside clinics Responsible for managing and supporting 15,735 medical devices
OR team specifically manages all operating room equipment, including CPD, and Anesthesia for outside areas such as Endoscopy, MRT/ MRI, Angio/ Cath lab, etc. 3114 medical devices managed by the OR team 2088 of which have a risk class of ‘Life-Support/ High-Risk/ Normal’,
meaning they require scheduled maintenance at least 1x/ yr. 63 anesthesia machines, which require scheduled maintenance 2x/ year.
OR Biomed Team•Ernst Daniel, Clinical Engineer
•Evelyn Fan, Clinical Engineer
•Dr. Jim Philip, Medical Liaison
•Eddie Holmes, Facilities Technician
•Claire Cabral, Sr. BMET
•Garth Meikle, Sr. BMET
•Ross Jacques, BMET
What does biomed do?Vision: It is our goal that no patient is harmed by the application of a medical device within our sphere of influence.
Goal: To be a ‘Solutions Department’, providing technology solutions to advance the care and safety of patients and staff.
Repairs & Scheduled Maintenance (SM) of clinically used equipment, projects/ installations, on-call/ night-call coverage, incident investigations, capital equipment purchases, etc.
Work with many departments including: OR/CSS, anesthesia techs, CPD, Anesthesia, Nursing, Infection control, Perfusion, Environmental Affairs, Risk Management, etc.
More details to come in future article for the Anesthesia Record…
‘Fresh Gas Low’ alarm
Bellows vs. Piston
What is Fresh Gas Decoupling?
Water Trap
Inhalation
I
Water trap
Inhalation
Inspiratory valve
Expiratory valve
Pressure sensor
O2 sensor
E
Water trap
Inspiratory valve
Expiratory valve
Pressure sensor
O2 sensor Exhalation
What does the water trap have to do with the ‘Fresh Gas Low’ alarm?
What does the water trap have to do with the ‘Fresh Gas Low’ alarm?
During expiration, piston moves down to actively fill with fresh gas negative pressure createdWater in ventilator hose creates ‘occlusion’ higher negative pressure detected by pressure transducerInterpreted electronically by machine as ‘Low Fresh Gas’ alarm.
Inspiration
Expiration
You’re on call..OR 18, Fabius GS, Anesthesiologist calls you
Reports a “Low Fresh Gas” alarm
Let’s take a closer look..
•Gas monitor exhaust line is unhooked from circuit
•SAM module is pulling 200mL/min = leak!
And the solution is…
•Gas monitor exhaust line should be attached to expiratory gas sampling port connector
•Or should be attached to scavenging
What is wrong with this picture?
What alarm would you see?
No alarm message even though reservoir bag is off and machine is pulling in room air
Fresh gas decoupling
Room air entrainment
Piston is electronically driven by the motor
No ADS alarms
E
With no bag present, piston draws in room air
Summary
Fresh gas decoupling: Good: Motor-driven piston
results in minimal tidal volume changes with FGF changes
Bad: If bag is empty (ie. low flow) ADS may alarm; if bag is missing can lead to room air entrainment dilution of [agent]
Since the reservoir bag is a part of your circuit, make sure your reservoir bag is attached to the bag arm at all times!
What to do when you see a ‘Low Fresh Gas’ alarm Check the water trap Check for a deflated reservoir
bag (which may indicated the presence of a leak!)
Check the breathing circuit Call biomed
(pager # 11055)
Conclusion
‘Ask Biomed’ Email: Evelyn Fan ([email protected]) Cc: Dr. Jim Philip ([email protected])
Look out for upcoming article in Anesthesia Record about biomedical engineering…
Questions?
AcknowledgementsSpecial thanks to: Dr. J. Philip, Medical Liaison Garth Meikle, Sr BMET & Ross Jacques, BMET OR Biomedical Engineering team Drager Medical Technical Support
Additional Slides
What happens to O2% when reservoir bag is removed from circuit?
What happens to O2% when reservoir bag is removed from circuit?
What happens to O2% when reservoir bag is removed from circuit?