Essentials of Equipment in Anaesthesia, Critical Care and Perioperative Medicine, 5th Edition

Essentials of Equipment in Anaesthesia, Critical Care and Peri-Operative Medicine is a highly practical textbook for trainees in anaesthesia and an invaluable guide for all those who work with anaesthetic equipment, including anaesthetic and intensive care nurses and operating department practitioners. The superbly organized and easy-to read format of the book has been retained from previous editions. The text has been comprehensively updated and more focused on the FRCA with the addition of exam tips and new questions. A new chapter addresses the topical and ever expanding field of ‘Point of Care Testing’ in anaesthesia and intensive care. Clear colour photographs and illustrations as well as over 100 interactive self-assessment OSCE questions complete this concise account of anaesthetic equipment and its use in clinical settings. Front Cover Inside Front Cover Essentials of Equipment in Anaesthesia, Critical Care, and Peri-Operative Medicine Copyright Contents Preface Acknowledgements Chapter 1: Medical gas supply Gas supply Cylinders Components Problems in practice and safety features Cylinder valves Components Mechanism of action Problems in practice and safety features Piped gas supply Components Problems in practice and safety features Sources of gas supply Cylinder manifold Components Mechanism of action Problems in practice and safety features Liquid oxygen Components Mechanism of action Problems in practice and safety features Oxygen concentrators Components Mechanism of action (Fig. 1.25) Problems in practice and safety features Entonox Problems in practice and safety features Compressed air Centralized vacuum or suction system (Fig. 1.28) Components Mechanism of action Problems in practice and safety features Self-assessment questions MCQs Suggested further reading Chapter 2: The anaesthetic machine Pressure gauge Components Mechanism of action Problems in practice and safety features Pressure regulator (reducing valve) Components Mechanism of action Problems in practice and safety features Second-stage regulators and flow restrictors One-way valve or backflow check valves Flow control (needle) valves Components Flowmeters Components Mechanism of action Problems in practice and safety features Vaporizers Plenum vaporizer (Fig. 2.17) Components Mechanism of action Problems in practice and safety features Vaporizer filling devices Non-return pressure relief safety valve Emergency oxygen flush Problems in practice and safety features Compressed oxygen outlet(s) Oxygen supply failure alarm Common gas outlet (Fig. 2.29) Other modifications and designs Anaesthesia in remote areas Components Mechanism of action Problems in practice and safety features Suggested further reading Chapter 3: Pollution in theatre and scavenging Scavenging Passive system Components Mechanism of action Problems in practice and safety features Active system Components Mechanism of action Problems in practice and safety features Charcoal canisters (Cardiff Aldasorber) Components Mechanism of action Problems in practice and safety features Suggested further reading Chapter 4: Breathing systems Properties of the ideal breathing system Components of the breathing systems Adjustable pressure limiting (APL) valve Components Mechanism of action Problems in practice and safety features Reservoir bag Components Mechanism of action Problems in practice and safety features Tubings Mapleson classification Magill system (Mapleson A) Components Mechanism of action Problems in practice and safety features Lack system (Mapleson A) Components Mechanism of action Mapleson B and C systems (Figs 4.1 and 4.8) Components Mechanism of action Bain system (Mapleson D) Components Mechanism of action Problems in practice and safety features T-piece system (Mapleson E and F) Components Mechanism of action Problems in practice and safety features The Humphrey ADE breathing system Components Mechanism of action The circle breathing system and soda lime Components Mechanism of action Use of vaporizers in the circle breathing system Problems in practice and safety features Waters canister (‘to-and-fro’) bidirectional flow breathing system Suggested further reading Chapter 5: Tracheal tubes, tracheostomy tubes and airways Tracheal tubes Features of tracheal tubes (Fig. 5.1) Size The bevel The cuff High-pressure/low-volume cuffs Low-pressure/high-volume cuffs Route of insertion Connectors Problems in practice and safety features Specially designed tracheal tubes Oxford tracheal tube Armoured/reinforced tracheal tube Polar and Ring, Adair and Elwyn (RAE) tracheal tubes Laser-resistant tracheal tubes Evoked potentials tracheal tubes (Fig. 5.16) Microlaryngeal tube Tracheostomy tracheal tubes Components Problems in practice and safety features The fenestrated tracheostomy tube (Fig. 5.21) Laryngectomy (Montandon) tube Tracheostomy speaking valve (Fig. 5.23) Tracheostomy button (Fig. 5.24) Percutaneous tracheostomy tubes Minitracheostomy tube Components Mechanism of action Problems in practice and safety features Cricothyrotomy tube (Fig. 5.28) Components Mechanism of action Problems in practice and safety features Double lumen endobronchial tubes Components Mechanism of action Tube positioning Endobronchial blocker Components Mechanism of action Oropharyngeal airways Components Mechanism of action Problems in practice and safety features Nasopharyngeal airway Components Mechanism of action Problems in practice and safety features Supraglottic airway devices Laryngeal mask airway Components Mechanism of action The intubating laryngeal mask airway (ILMA) Problems in practice and safety features i-gel airway Components Mechanism of action Problems in practice and safety features AuraGain airway COBRA perilaryngeal airway (PLA) Suggested further reading Chapter 6: Masks and oxygen delivery devices Face masks and angle pieces Components Mechanism of action Problems in practice and safety features Nasal masks (inhalers) Catheter mount Components Mechanism of action Problems in practice and safety features Oxygen delivery devices Variable performance masks (medium concentration; MC) Components Mechanism of action Problems in practice and safety features Nasal cannulae Components Mechanism of action Problems in practice and safety features Nasal catheters Open oxygen delivery systems Fixed performance devices Venturi mask Components Mechanism of action Problems in practice and safety features Humidified high-flow nasal oxygenation (Fig. 6.16) Components Mechanism of action Problems in practice and safety features Suggested further reading Chapter 7: Laryngoscopes and tracheal intubation equipment Laryngoscopes Components Mechanism of action Problems in practice and safety features Fibreoptic intubating laryngoscope Components Mechanism of action Problems in practice and safety features Videolaryngoscopes (rigid indirect laryngoscopes) Magill forceps Introducer, bougie, bite guard, local anaesthetic spray, Endotrol tube and Nosworthy airway Retrograde intubation set (Fig. 7.17) Components Mechanism of action Problems in practice and safety features Suggested further reading Chapter 8: Ventilators Classification of ventilators Characteristics of the ideal ventilator Manley MP3 ventilator Components Mechanism of action Problems in practice and safety features Penlon Anaesthesia Nuffield Ventilator Series 200 Components Mechanism of action Problems in practice and safety features Bag in bottle ventilator Components Mechanism of action Problems in practice and safety features Servo-U ventilator Components (Fig. 8.6) Mechanism of action Problems in practice and safety features High-frequency jet ventilator Components Mechanism of action Problems in practice and safety features VentiPAC Components Mechanism of action Problems in practice and safety features Pneupac VR1 Emergency Ventilator (Fig. 8.11) Components Mechanism of action Problems in practice and safety features Venturi injector device Components Mechanism of action Problems in practice and safety features Self-inflating bag and mask Components Mechanism of action PEEP valve SUggested further reading Chapter 9: Humidification and filtration Heat and moisture exchanger (HME) humidifiers Components Mechanism of action Problems in practice and safety features Hot water bath humidifier Components Mechanism of action Problems in practice and safety features Nebulizers (Fig. 9.6) Gas-driven (jet) nebulizer Components Mechanism of action Spinning disc nebulizer Ultrasonic nebulizer Bacterial and viral filters Components Mechanism of action Electrostatic filters (Fig. 9.8) Pleated hydrophobic filters (Fig. 9.9) Vapor-Clean filters Suggested further reading Chapter 10: Non-invasive monitoring Integrated monitoring Electrocardiogram (ECG) Components Mechanism of action Problems in practice and safety features Arterial blood pressure Components Mechanism of action Problems in practice and safety features The Von Recklinghausen oscillotonometer Components Mechanism of action Problems in practice and safety features Pulse oximetry Components Mechanism of action Problems in practice and safety features End-tidal carbon dioxide analysers (capnographs) Components Mechanism of action Side-stream analysers Main-stream analyser Uses (Table 10.5) Problems in practice and safety features Oxygen concentration analysers Paramagnetic (Pauling) oxygen analysers Components Mechanism of action (Fig. 10.24) The galvanic oxygen analyser (Hersch fuel cell) Polarographic (Clark electrode) oxygen analysers Problems in practice and safety features Nitrous oxide and inhalational agent concentration analysers Components Mechanism of action Piezoelectric quartz crystal oscillation Problems in practice and safety features Mass spectrometer Wright respirometer Components Mechanism of action Problems in practice and safety features Pneumotachograph Components Mechanism of action Problems in practice and safety features Combined pneumotachograph and Pitot tube The Pitot tube Components Mechanism of action Problems in practice and safety features Ventilator alarms Pressure monitoring alarm Components Mechanism of action Problems in practice and safety features Volume monitoring alarm Peripheral nerve stimulators and neuromuscular blockade monitoring Components Mechanism of action Neuromuscular transmission monitoring Problems in practice and safety features Bispectral index (BIS) analysis Components Mechanism of action Problems and safety features Entropy of the EEG Suggested further reading Chapter 11: Invasive monitoring Invasive arterial pressure monitoring Components Mechanism of action The arterial pressure waveform (Fig. 11.7) The natural frequency Problems in practice and safety features Central venous catheterization and pressure Pressure transducer Fluid manometer (Fig. 11.13) Catheters Multilumen catheter Long central catheters/peripherally inserted central catheters (PICC) Hickman catheters Dialysis catheters Problems in practice and safety features Invasive electrocardiogram (ECG) Cardiac output Balloon-tipped flow-guided PA catheter Components Mechanism of action Information gained from PA catheter Problems in practice and safety features Oesophageal Doppler haemodynamic measurement Components Mechanism of action Problems in practice and safety features LiDCOrapid Components Mechanism of action Problems in practice and safety features Masimo Temperature probes Thermistor Components Mechanism of action Problems in practice and safety features Infrared tympanic thermometer Components Mechanism of action Problems in practice and safety features Thermocouples Components Mechanism of action Suggested Further Reading Chapter 12: Pumps, pain management and regional anaesthesia Patient-controlled analgesia (PCA) Components Mechanism of action Problems in practice and safety features Syringe pumps Volumetric pumps Target-controlled infusion pumps Elastomeric pumps Components Mechanism of action Problems in practice and safety features Epidural needles Components Mechanism of action Problems in practice and safety features Epidural catheter, filter and loss of resistance device (Fig. 12.9) The catheter Components Mechanism of action Problems in practice and safety features The filter (see Fig. 12.10) Loss of resistance device or syringe Spinal needles Components Mechanism of action Problems in practice and safety features Dural headache Spinal microcatheters Nerve block needles Components Mechanism of action Insulated needles Non-insulated needles Percutaneous localization of nerves Nerve stimulator for nerve blocks Components Mechanism of action Problems in practice and safety features Ultrasound guidance in regional anaesthesia Suggested Further Reading Chapter 13: Additional equipment used in anaesthesia and intensive care Continuous positive airway pressure (CPAP) Components Mechanism of action Problems in practice and safety features Haemofiltration Components Mechanism of action Problems in practice and safety features Arterial blood gas analyser (Fig. 13.5) Polarographic (Clark) oxygen electrode Components Mechanism of action Problems in practice and safety features pH electrode Components Mechanism of action Problems in practice and safety features Carbon dioxide electrode (Severinghaus electrode) Components Mechanism of action Problems in practice and safety features Intra-aortic balloon pump (IABP) Components Mechanism of action Problems in practice and safety features Intravenous giving sets Components Intravenous cannulae Blood warmers Forced-air warmers (Fig. 13.18) Defibrillator Components Mechanism of action Problems in practice and safety features Chest drain Components Mechanism of action Problems in practice and safety features The ultrasound machine (Fig. 13.27) Components Mechanism of action Problems in practice and safety features Suggested Further Reading Chapter 14: Point-of-care testing Introduction HemoCue Components Mechanism of action Problems in practice and safety features Hemochron Junior Components Mechanism of action Problems in practice and safety features Original TEG/ROTEM Background How it works TEG 6s Components Mechanism of action Problems in practice and safety features Suggested further reading Chapter 15: Electrical safety Principles of electricity (Fig. 15.1) Electric current (I) Potential difference or voltage (V) Electrical resistance (R) Impedance (Z) Ohm’s law Capacitance Inductance Identification of medical electrical equipment Class I equipment Class II equipment Class III equipment Type B equipment Type BF equipment Type CF equipment Attention! Protective earth Functional earth Additional protective earth Equipotentiality Drip proof, splash proof, water tight Anaesthetic-proof equipment Anaesthetic-proof equipment category G CE Isolated or floating circuit Current-operated earth leakage circuit breakers (COELCB) Maintenance of equipment Hazards of electrical shock The effects of electrocution Resistive coupling Diathermy Components Mechanism of action Problems in practice and safety features Static electricity Lasers Problems in practice and safety features Airway laser surgery Suggested Further Reading Appendices Appendix A Safety and standards Checking anaesthetic equipment Recommendations for standards of monitoring during anaesthesia and recovery Appendix B Appendix C Decontamination of medical equipment Clean, disinfect or sterilize instruments? Cleaning Manual cleaning Disinfection Sterilization Sterilization monitoring Single-use items Suggested further reading Appendix D Directory of manufacturers Ambu Anaequip UK B Braun Medical Ltd BD Blease Medical Equipment Ltd Blue Box Medical Ltd BOC Healthcare Chart Biomedical Ltd Cook Medical Covidien plc Dräger Medical UK Ltd Dynasthetics Gambro Lundia AB GE Healthcare Gradian Health Systems Halyard Intersurgical MANA-TECH LTD Maquet Ltd Olympus Keymed (Medical & Industrial Equipment) Ltd Penlon Ltd Philips HealthCare Proact Medical LTD Radiometer Ltd Rimer Alco Ltd Siemens Healthcare Smiths Medical Teleflex Verathon Medical United Kingdom Ltd Vygon (UK) Ltd Zoll Medical UK Glossary Gas laws Index Inside Back Cover "Essentials of Equipment in Anaesthesia, Critical Care and Peri-Operative Medicine is a highly practical textbook for trainees in anaesthesia and an invaluable guide for all those who work with anaesthetic equipment, including anaesthetic and intensive care nurses and operating department practitioners. The superbly organized and easy-to read format of the book has been retained from previous editions. The text has been comprehensively updated and more focused on the FRCA with the addition of exam tips and new questions. A new chapter addresses the topical and ever expanding field of 'Point of Care Testing' in anaesthesia and intensive care. Clear colour photographs and illustrations as well as over 100 interactive self-assessment OSCE questions complete this concise account of anaesthetic equipment and its use in clinical settings"--Publisher's description