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    Clinical Conference: Technology Rounds: Biomedical Engineering

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    haseeb Jutt
    1) The Biomedical Engineering department at BWH manages over 15,000 medical devices used in the hospital and clinics, including over 3,000 devices in the operating rooms. 2) The presentation discusses a "Low Fresh Gas" alarm that occurred on a Fabius GS anesthesia machine, explaining that this alarm can be caused by water accumulating in the ventilator hose and creating higher negative pressure during expiration. 3) It reviews the concept of "fresh gas decoupling" where the piston is electronically driven independently of fresh gas flow, preventing tidal volume changes with fresh gas flow changes. However, if the reservoir bag is empty or missing, the anesthesia machine may entrain room air and dilute the

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    Clinical Conference: Technology Rounds: Biomedical Engineering

    Uploaded by

    haseeb Jutt
    44 views25 pages
    1) The Biomedical Engineering department at BWH manages over 15,000 medical devices used in the hospital and clinics, including over 3,000 devices in the operating rooms. 2) The presentation discusses a "Low Fresh Gas" alarm that occurred on a Fabius GS anesthesia machine, explaining that this alarm can be caused by water accumulating in the ventilator hose and creating higher negative pressure during expiration. 3) It reviews the concept of "fresh gas decoupling" where the piston is electronically driven independently of fresh gas flow, preventing tidal volume changes with fresh gas flow changes. However, if the reservoir bag is empty or missing, the anesthesia machine may entrain room air and dilute the

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    Fabius Low FGF Alarm 05

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    Fabius Low FGF Alarm 05

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    1) The Biomedical Engineering department at BWH manages over 15,000 medical devices used in the hospital and clinics, including over 3,000 devices in the operating rooms. 2) The presentation discusses a "Low Fresh Gas" alarm that occurred on a Fabius GS anesthesia machine, explaining that this alarm can be caused by water accumulating in the ventilator hose and creating higher negative pressure during expiration. 3) It reviews the concept of "fresh gas decoupling" where the piston is electronically driven independently of fresh gas flow, preventing tidal volume changes with fresh gas flow changes. However, if the reservoir bag is empty or missing, the anesthesia machine may entrain room air and dilute the

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    44 views25 pages

    Clinical Conference: Technology Rounds: Biomedical Engineering

    Uploaded by

    haseeb Jutt
    1) The Biomedical Engineering department at BWH manages over 15,000 medical devices used in the hospital and clinics, including over 3,000 devices in the operating rooms. 2) The presentation discusses a "Low Fresh Gas" alarm that occurred on a Fabius GS anesthesia machine, explaining that this alarm can be caused by water accumulating in the ventilator hose and creating higher negative pressure during expiration. 3) It reviews the concept of "fresh gas decoupling" where the piston is electronically driven independently of fresh gas flow, preventing tidal volume changes with fresh gas flow changes. However, if the reservoir bag is empty or missing, the anesthesia machine may entrain room air and dilute the

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    Clinical Conference:

    Technology Rounds
    Biomedical Engineering

    Evelyn Fan, M.H.Sc., Clinical Engineer


    Biomedical Engineering
    November 2, 2005
    Plan for today
    Introduction
    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.
    •Ernst Daniel,

    OR Biomed Team 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
    O2 sensor Inhalation
    Pressure
    sensor

    Inspiratory valve
    I

    Expiratory valve

    Water trap
    O2 sensor Exhalation
    Pressure
    sensor

    Inspiratory valve
    E

    Expiratory valve

    Water trap
    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
    Inspiration
    pressure created
    Water in ventilator hose
    creates ‘occlusion’  higher
    Expiration negative pressure detected
    by pressure transducer
    Interpreted electronically by
    machine as ‘Low Fresh Gas’
    alarm.
    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
    E entrainment
    Piston is
    electronically
    driven by the
    motor
    No ADS
    alarms

    With no bag present, piston


    draws in room air
    Summary
    Fresh gas decoupling: What to do when you see a
     Good: Motor-driven piston ‘Low Fresh Gas’ alarm
    results in minimal tidal volume
    changes with FGF changes  Check the water trap
     Bad: If bag is empty (ie. low  Check for a deflated reservoir
    flow) ADS may alarm; if bag is bag (which may indicated the
    missing can lead to room air presence of a leak!)
    entrainment  dilution of  Check the breathing circuit
    [agent]
     Call biomed 
    Since the reservoir bag is a (pager # 11055)
    part of your circuit, make
    sure your reservoir bag is
    attached to the bag arm at
    all times!
    Conclusion
    ‘Ask Biomed’
     Email: Evelyn Fan (efan1@partners.org)
     Cc: Dr. Jim Philip (jphilip@zeus.bwh.harvard.edu)
    Look out for upcoming article in Anesthesia Record
    about biomedical engineering…
    Questions?
    Acknowledgements
    Special 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?

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