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1
Q

Name 10 pieces of equipment from PS 56 (difficult airway)

A 
Oropharyngeal
Mac 3+4
Intubation LMA with ET and stabilising rod
LMA 
Selection of specialised ET
Stylet 
Bougee (tip at 35 degree) 
Long airway exchange catheter 
Means to detect CO2
Cricothyroodotomy set
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2
Q

What are the rules of bronchoscopes in PS 56?

A

Need a light and ancillary equipment

Available within 5 minutes

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3
Q

How should difficult airway equipment be stores as per PS 56?

A 
Dedicated trolley 
Labelled
Should be portable 
Essential available within 1 min
Contents easy to ID 
Contents listed on external label
Checked daily and documented
Location tracking (whiteboard)
Orientate staff with location
Designated staff member responsible
Seek expert advice on any changes
Scope stored clean and straight 
Paediatric equip separate
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4
Q

PS 51, what should be considered when purchasing?

A 
Reduce errors
Designated pharmacist liaise with dedicated drug officer
Avoid similar packaging 
Package allows easy drug ID
Change of packet communicated
Stock only one conc of same drug
Avoid drugs requiring dilution
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5
Q

PS 51, what should be considered with storage?

A

Clean and tidy
Standardised aposition of drug throughout
Dangerous/infrequent drugs kept separate
Similar sound/look kept apart
Stored in a way to facilitate ID

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6
Q

PS 51, what are the considerations for drug drawing and checking?

A

Check drug and dose
Department should have system for expiry checks
Draw only one drug at a time
No interruption - discard
Ideally double check with second person prior to admin - must for IT
One ampoule per patient

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7
Q

PS 51, what considerations are there for storage during anaesthetic?

A

Interval between drawing and admin minimum
Syringes placed in logical order in tray
Different routes not in same tray
Emergency drugs kept in separate receptacle

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8
Q

PS 51, what considerations are given to infusions?

A

Ideally syringe driver/pump
One way valves
Label pt end of line
Different infusion device or colour for different routes of admin

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9
Q

PS 55, what are the minimum staff requirements?

A

Anaesthetist
Anaesthetic assistant
Minimum of 3 staff to position patient
Relevant procedural staff

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10
Q

List 15 pieces of equipment according to PS 55, that must be present.

A 
Range of face mask
Magills + throat pack
Oro/naso pharyngeal and LMA 
2 laryngoscope with blade range 
Range of ET and connector 
Suction with handles/catheters - exclusive 
Syringe for ET cuff 
Stylet and bougee 
Stethoscope 
IV infusion, cannulation and fluid 
Range of tapes 
PPE 
Monitoring (Ps18) 
Safe disposal of wastes 
Scavenging 
Means to inflate lungs - appropriate size and separate oxygen source 
(Scissor, lube)
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11
Q

PS 55, what must be present if inhalational anaesthetic used?

A

System capable of accurate oxygen delivery
Calibrated vaporiser
Infusion device for IV agents
Range of breathing systems with methods of sterility of gases
Breathing system suitable to paeds

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12
Q

PS 55, list 10 items which must be available?

A 
DI
Arterial line/CVL
Rapid infuser
Defibrillator with sync capability 
Intra pleural drain
Equipment to Warm/humid gases 
Cooling
Warming
Block equipment 
Positioning equipment 
Automatic ventilator
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13
Q

PS 55, what are 5 other requirements for safe anaesthesia?

A 
Good lighting
Emergency call system
Fridge
Emergency power
Temp management of room between 18-28
Transfer aides
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14
Q

PS 55, drug requirements?

A

Common drugs
Available for the management of all emergencies
Initial dantrolene supply (x24)

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15
Q

PS 55, problems with obstetrics areas?

A 
Midwife competent on epidural management
Any inhalational delivery system must deliver >30% 
Exclusive suction to mother + baby
Exclusive oxygen to mother + baby
Appropriate drugs
Neonate resus
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16
Q

PS 55, equipment on the neonate resus unit?

A 
Oxygen delivery
Clearing airway
Intubation
Ventilation
IV and drug admin
Temp care
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17
Q

PS 55, problems with ECT?

A

Anaesthetic delivery system not essential
Need breathing system capable of 100% O2 for SV/IPPV plus alternate system
Filter/new equipment per patient
Adequate oxygen available plus back up

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18
Q

PS 55, problems with dental?

A

Chair must be able to go rapidly head down

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19
Q

PS 56, 5 pieces on ancillary bronchoscope equipment?

A 
Ain tree
Light source
Intubating airway (berman)
Endoscopy mask
Swivel connector
Anti fog
Bite block 
Nadal vasoconstriction
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20
Q

PS 54, 15 safety requirements?

A

Pin index cylinder connections
Reserve oxygen incase fail that is easy to activate
NIST connections
Gas supply pressure display visible from front
If high P system, O2 supply failure alarm
If gas flow meter bank, Oxygen last gas to enter, most left knob
If mechanical, 1 control knob per gas
Anti hypoxic mechanism
If >2 mountable, interlock vaporisers
Anti-clockwise vaporiser dial turn on
FGO 22mm and 15mm connection
High P relief mechanism in ABS
Scavenging different connect size
Automatically activated alarms
High airway P alarm
Low airway P alarm (<10 for >1sec)
O2 flush protect from accident push
On/off protect from accident push
Backup power for 30 mins - alarm and state of reserve power displayed

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21
Q

PS 54, what are the maintenance requirements?

A

Ongoing for life
Appropriate staff carry this out
Log for each equipment
Replace if affecting clinical use

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22
Q

PS 31, what are the levels of checks?

A

1: detailed check prior to use or after service or repair
2: start of each list
3: before each anaesthetic case

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23
Q

PS 31, what personnel can complete each check?

A

1: trained person attended manufacturers course or program developed with a biomed engineer

2 + 3: trained and accredited in these checks

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24
Q

PS 31, who is responsible for this check?

A

Anaesthetist but can be delegated to suitably trained person

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25
PS 28, define asepsis, disinfection and sterile?
Asepsis: prevention of microbial contamination of tissue or sterile material Disinfect: inactivation of non-sporting microbes using thermal/chemical Sterile: complete destruction of all microbes and spores
26
PS 28, differentiate between critical, semi-critical and non-critical equipment?
Critical: penetrates skin, vascular, membrane etc so must be sterilised Semi-critical: contact with membranes or non-intact skin so need high level disinfect or sterile Non-critical: contact with intact skin or so need disinfecting or cleaning
27
PS28, describe the points of hand hygiene
``` Soap/water if dirty Also alcohol solution hand rub Ideally 60-95% alcohol Ideally coupled with antiseptic 5 moments of hand hygiene ```
28
PS28, what are the points around mask use?
``` For sterile procedures Local policy for wearing in the OT Must cover nose and mouth and be tied Change between patient/procedure Hand hygiene once removed Don't wear around neck ```
29
PS28, what are the hat and attire points?
Hat must completely cover hair Fresh scrubs daily - change if soiled Dedicated footwear or overshoes Hand hygiene after removal
30
PS28, what are the rules around sharps?
``` Do not resheath Do not bend or manipulate Dispose immediately Needle-free system encouraged Local needle stick protocol ```
31
PS 28, what are other measures of reducing infection?
Timely AB prophylaxis Normothermia Restrictive transfusions Vaccinating staff
32
PS 28, how should laryngoscopes be cleaned?
Blade is critical so needs sterilisation Handle should be cleaned with soapy water between cases. If contaminated with blood should be disinfected after washing.
33
PS 28, how is the breathing system cleaned?
Multiple uses if an HME is used Internally/externally soiled or high-risk infection then change Breathing bags cleaned with soapy water between cases
34
PS 28, how is the gas sampling line cleaned?
Sampled gas not returned to the system unless passed through a 0.2 micron filter
35
PS 28, how is the anaesthetic machine cleaned?
If HME used internal components don't need cleaning Bellows, Uni-directional valves and absorbers should be cleaned regularly Surfaces and screens cleaned with soapy water between cases
36
PS 28, how is a non-critical ultrasound cleaned?
Remove gel and debri with towel Wipe with wet detergent cloth Wipe with disinfectant - including cable and machine surfaces Any gel used should be sterile or single use-packaged
37
PS28, how is a semi-critical ultrasound cleaned?
(Eg block, IV) Probe and cable should be protected by sterile cover, sterile gel Remove cover without contaminating probe and clean as per non-critical If blood contaminated- clean as per critical probe
38
PS28, how is a critical ultrasound probe cleaned?
(Eg TOE) Disinfection and sterilisation of tip and shaft Decontamination and disinfection of handle, cable, external parts - soapy water and then disinfectant
39
PS 28, how should IV cannulation be handled?
Hand hygiene Gloves Skin disinfection such as 70% alcohol with chlorhexidine
40
PS 28, how should CVL insertion be handled?
``` Aseptic technique Full body drape Full PPE - sterile Skin disinfect of alcohol and antiseptic Sterility checklist recommended ```
41
PS 28, how should vascular access ports be handled?
Aseptic technique | Wiping surface with 70% alcohol and allow to dry
42
PS 28, how should RA be handled?
Single shot, non-CNA: Aseptic with skin prep, hand hygiene and sterile gloves, no-touch technique, sterile U/S and gel CNA, catheter: Full aseptic technique and maximal barrier as per CVL, 0.5% chlorhexidine in alcohol,
43
PS 28, what precautions should be taken for drug use?
One ampoule per patient Care with glass 0.2 micron filter needle recommended when drawing from non-sterile Wipe surface of rubber stoppers and dry prior to drawing from
44
PS 18, what are the principles of this document?
Clinical observation and measurement Duration by clinical judgement Alarms must be ON (except bypass) Regular recordings
45
PS 18, what regular assessment and recording should be included?
Circulation by detection of pulse and supplemented by device - <10mins Ventilation continually monitored Oxygenation - adequate lighting needed
46
PS 18, what monitors must be in use?
``` O2 analyser must for patient on ABS Pulse ox must for GA/Sed Disconnect/fail alarm for any automatic ventilator CO2 monitor must for GA; avail for Sed Inhalational agent monitor must for GA where inhalational is present ECG - available, should for GA/RA NIBP - available AL, EEG, temp, NMT - available ALL ALARMS ON AND AUDIBLE ```
47
PS 03, what can increase the risk of incorrect blocks?
``` Time delay from checkin Time pressure Distracting environment Covering the mark Turning the patient ```
48
PS 52 important points.
Minimal delay Minimum nurse, orderly and practitioner Sufficient equipment for journey
49
PS 04, what are the rules about the area?
``` Designated area Close to anaesthetising site Part of operating suite Easily accessed by staff Provisions for evacuation Ventilation like OT Space for each bed (1.5x OT) Uninterrupted view of patients Storage space Scrub facility Wall clock displaying seconds visible Emergency call Emergency power ```
50
PS 04, what must be present in each bay?
``` Adequate space at head Pulse ox, BP, steth, temp O2 outlet and delivery, flow meter Suction (handles, catheters) 2x power outlet Light and colour for observation Emergency lighting Room for equipment and charting ```
51
PS 04, what equipment must be in the area?
``` Means to manually ventilate with oxygen with 1 available per 2 beds Drugs and equip to intubate Emergency drugs Pain drugs Iv equipment and fluid Syringe and needle Warming EtCO2 device ```
52
PS 04, what must a bed have?
``` Firm base Moveable Sit up Iv pole Tilt ends 15 degrees Brakes Rails Somewhere to mount equipment ```
53
PS 04, what is the staffing requirements?
Always present RN in charge 1:1 ratio until protective reflexes have returned and then 1:3 Anaesthetist must be contactable
54
PS 43, what are some points?
``` Reduces vigilance and performance Equivalent to intoxication Need 8 hours sleep Care when changing from day to night shift Sleep debt is accumulative Consider proper meals, naps, breaks and sleeping ASAP after shift Stimulants not recommended Take regular A/L and leisure/rest time Consider alternative cover ```
55
PS 60, what are the recommendations?
``` Any query allergy patients treat as this Avoid Remove products from room Put up signs Label patient bed Consider medic-alert Clearly handover Facility should have a product register ```
56
PS 26, what are the ideas?
Voluntary without coercion Withdraw is an option Young, reduced mental capacity, unconscious, sedated not ok Legal guardian, EPA If not: Must be in pt best interest, steps taken to obtain pt view Emergency: discussion with pt or family ASAP Informed information of risks/benefit Document discussion Discussion with anaesthetist performing is essential
57
PS 03, what are the principles of this document?
``` Experienced practitioner Informed consent prior Requires assistant (PS8) Environment (PS55) lipid available Infection control (PS28) COAG check patient IV obtained prior Monitoring Block timeout ```
58
PS 03, what monitoring should be included?
``` NIBP RR Conscious state ECG and pulse ox available O2 if sedated ``` Continue for 30min or until stable
59
PS 03, what is the block timeout?
Verify site/side with other ID pt, check surgical consent, ID surgical mark, discuss with pt, place a block mark close to site and keep visible Pause prior to needle insert to confirm block mark, site and side verbally Pause before needle insertion for each new site of position changes or separate blocks done
60
PS 03, what are the requirements of the proceduralists presence?
Remain immediately available until block achieved, pt stable and immediate complications diminished. Can handover/delegate to appropriate trained personnel thereafter If for anaes also then must remain
61
PS 03, what methods help reduce risks in the ward?
Labeled and unique coloured tubing Dedicated pumps labeled Maximums set on pumps No injection ports Regular assessment - monitoring, pt pain feedback, catheter check Review by proceduralist/delegate daily Protocol for catheter removal including coag restart and analgesic cover
62
PS 03, what is different with the OBS RA guidelines?
From moment block in, pt must be in care of OBS practitioner who can assess baby and deliver Ensure consented prior Skilled staff and monitor required Continue monitor post delivery until block affects subside
63
PS 08, what are the main points of this document?
Present for preparation, induction and emergence. Remain until instructed ok to leave. Immediately available during maintenance. Under direct supervision Assistant available for every case Supervision level 1-3 Exclusively responsible to one anaesthetist Minimum 12 month clinical experience Participate in CPD
64
What checks do biomed do?
``` Leak check Connections Valve function Accuracy of flow Electrical safety Failure alarm and cut off Alarms Scavenging and suction ```

Anaesthesia (8 decks)

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