Professional Documents
Culture Documents
Outline:
Oxygen concentrator
Ventilators:
Manley multivent
Glostavent
179
THE EPSTEIN MACKINTOSH OXFORD (EMO) VAPORISER
GENERAL DESCRIPTION
The EMO vaporiser is a calibrated, draw-over vaporiser which will
accurately deliver a pre-set concentration of ether in room air. Additional
oxygen can be added if required. The easiest way to describe the EMO
vaporiser is to consider it in three sections.
180
To summarise, the lower part of the vaporiser consists of the following:
• An ether vaporising chamber.
• A water jacket both inside and outside the ether vaporiser.
• At the entrance to the ether vaporiser an inlet closing device.
• At the exit from the ether vaporising chamber a thermo–compensating
valve.
The middle section of the EMO consists of a central chamber just above the
water compartment already described. This has two entry ports.
• One entry port (a) conducts the gases which have bypassed the ether
vaporising chamber.
• The second entry port (b) conducts gases which have passed through
the ether vaporiser and picked up ether vapour.
These gases then mix and leave the central chamber through the main outlet
of the EMO.
In the transit position the entry port (b) is completely closed and (a) is
completely open. As the concentration of ether is increased, then (b)
progressively opens and (a) progressively closes. Thus more and more of the
gas passing through the EMO machine is made to pass through the ether
vaporising chamber so with each movement of the indicator more ether
vapour is delivered to the patient.
181
FEATURES OF THE EMO
182
• Introduction of oxygen to the EMO circuit via a T-Piece
This is a non-rebreathing valve, which means that the patient inspires only
from the inhaler and expires into the atmosphere. This is brought about by
the to-and-fro movement of the bobbin.
These valves can stick. Always have a spare valve available. The valves are
sterilised by chemical means: 5% chlorhexidine (Hibitane) for 5 minutes.
It is important to ensure the valve is dry before use.
185
THE AMBU ANAESTHETIC VALVE
The Ambu E valve with 2 flaps is a non-rebreathing valve. This means that
the expired carbon dioxide is not rebreathed. It can be used for both
spontaneous and controlled ventilation. The Ambu valve is like the Ruben
valve except that the bobbin is replaced by 2 yellow silicone rubber flaps.
The valve can be dismantled easily for cleaning and sterilisation.
The Ambu E valve comes in 2 models: the anaesthetic model (2 flaps ) for
both spontaneous and controlled ventilation and the resuscitation model
used for IPPV. This has only 1 flap, is not a non-rebreathing valve and is not
suitable for anaesthetic use.
Apparatus here means the EMO, the OMV, the OIB and a non–rebreathing
valve.
It is possible to combine the vaporisers, bellows, valves and other
components in a variety of ways.
Principles
• If more than one vaporiser is to be incorporated in the circuit then the
more volatile agents must be placed further from the patient. If this is
not done, the less volatile agent will condense as the vapour passes
through the second vaporiser. The EMO must therefore always be
placed further from the patient than the OMV.
186
• Position the bellows (or the inflating bag) between the vaporiser and
the patient.
• Introduce the oxygen at the vaporiser inlet via a T piece and 1 metre
reservoir tube (i.e. further from the patient).
• When you are using a non-rebreathing (inflating) valve such as the
Ruben valve, always use the horseshoe magnet with the OIB. It must be
used to immobilise the valve closer to the patient.
• Before using the set-up, always check that the flow of air is in the right
direction i.e. towards the patient.
The difficulty of monitoring respiration in spontaneously breathing patients
can be overcome by a simple and inexpensive method. Attach a rubber glove
to the expiratory limb of the uni-directional (non-rebreathing) valve and cut
a small hole in one finger to allow the expired gases to escape. This can then
be attached to the scavenging system if desired. Respiratory excursion can
be monitored by observing the movements of a piece of cotton attached to
the end of the reservoir tube, observing movements of the uni-directional
valve and listening to the chest with a stethoscope.
187
Standard set up using the EMO, O1B and non–rebreathing valve.
188
THE OXFORD MINIATURE VAPORISER:
189
OMV vaporisers can be coupled together to use 2 volatile agents
simultaneously, e.g.. halothane upstream (for its anaesthetic properties) then
trilene (for its analgesic properties).
The OMV is suitable for draw-over paediatric use (under 15 kg), provided
three important steps are taken. Use paediatric bellows or self–inflating bag
instead of the adult size on the OIB, use the paedivalve instead of the adult
non-rebreathing valve and use tubing of a smaller diameter. Alternatively,
oxygen at 4–6L/min can convert the OMV vaporiser into a plenum device
for use with the Ayre’s T– piece.
190
THE OXYGEN CONCENTRATOR
This machine concentrates oxygen from atmospheric air. Atmospheric air
consists of approximately 80% nitrogen and 20% oxygen. An oxygen
concentrator separates these two components. Zeolite granules are used to
selectively adsorb nitrogen from compressed air.
191
Fig 13.16 An Oxygen Concentrator
192
VENTILATORS
Manley Multivent
This is a versatile ventilator designed mainly to meet the needs of
developing countries and is one of the less expensive makes. In practical
terms, it is a mechanised OIB with a control panel. There are 2 types
available, standard and ether compatible.
It has an on/off switch and 3 other controls, one each for tidal volume,
respiratory rate and inspiratory: expiratory ratio.
Standard settings for a normal adult are indicated by colour coding and there
is a low-pressure alarm system. The ventilator is powered by an oxygen
cylinder or compressed air at 20psi (1.5kg/cm2) from a modified oxygen
concentrator (a De Vilbiss model is currently produced). If the oxygen
cylinder runs out, or there is a power failure it can be used as a hand
ventilator.
If the drive gas is supplied by an oxygen cylinder, the gas can be recycled
into the breathing circuit to give approximately 34% inspiratory oxygen
concentration.
A rechargeable battery operates the electronic circuits and if it is kept fully
charged it will function for 150 hours. The weight on the arm compressing
the bellows ensures complete emptying with each compression. Tidal
volumes can be set to accommodate child as well as adult patients.
GLOSTAVENT
The Glostavent is the name describing the Manley Multivent mounted on a
trolley, which has on the lower shelf a modified oxygen concentrator,
incorporating an inbuilt oxygen analyser. This is capable of producing
compressed air at 20psi (1.5kg/cm2), to power the ventilator as well as
producing oxygen to entrain into a draw-over system.
193
Fig 13.17 The Glostavent
(Manley Multivent with O2 concentrator mounted on trolley)
194