Clinical Conference: Technology Rounds Biomedical Engineering

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Clinical ConferenceTechnology RoundsBiomedical
Engineering

• Evelyn Fan, M.H.Sc., Clinical Engineer
• Biomedical Engineering
• November 2, 2005

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Plan for today

• Introduction
• Biomedical Engineering OR Team
• Fabius GS Low Fresh Gas alarm
• Fresh gas decoupling
• Youre on call
• Whats wrong with this picture?
• Summary
• Conclusion

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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.

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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

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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

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Fresh Gas Low alarm
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Bellows vs. Piston
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What is Fresh Gas Decoupling?
Water Trap
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Inhalation
Inhalation
O2 sensor
Pressure sensor
Inspiratory valve
Expiratory valve
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Exhalation
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What does the water trap have to do with the
Fresh Gas Low alarm?
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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 created
• Water in ventilator hose creates occlusion ?
  higher negative pressure detected by pressure
  transducer
• Interpreted electronically by machine as Low
  Fresh Gas alarm.

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Youre on call..

• OR 18, Fabius GS, Anesthesiologist calls you
• Reports a Low Fresh Gas alarm

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Lets take a closer look..

• Gas monitor exhaust line is unhooked from circuit
• SAM module is pulling 200mL/min leak!

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And the solution is

• Gas monitor exhaust line should be attached to
  expiratory gas sampling port connector
• Or should be attached to scavenging

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What is wrong with this picture?
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What alarm would you see?
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• Fresh gas decoupling
• Room air entrainment
• Piston is electronically driven by the motor
• No ADS alarms

With no bag present, piston draws in room air
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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)

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Conclusion

• Ask Biomed
• Email Evelyn Fan (efan1_at_partners.org)
• Cc Dr. Jim Philip (jphilip_at_zeus.bwh.harvard.edu)
• Look out for upcoming article in Anesthesia
  Record about biomedical engineering
• Questions?

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Acknowledgements

• Special thanks to
• Dr. J. Philip, Medical Liaison
• Garth Meikle, Sr BMET Ross Jacques, BMET
• OR Biomedical Engineering team
• Drager Medical Technical Support

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Additional Slides
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What happens to O2 when reservoir bag is removed
from circuit?
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What happens to O2 when reservoir bag is removed
from circuit?
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What happens to O2 when reservoir bag is removed
from circuit?