During a recent repair to the piped-in O₂ supply lines, an anesthesia dept planned to use available tanks to supplement their needs. No Problem Right ??

But, the discovery was made that the perfusion pump didn't have it's own tank supply readily available during the shutdown, and an inquiry was made to "Tech Talk" as to how other institutions have bridged this problem ???

One resolution, with a little groundwork, is easy. But first you have to prove to yourself that your Anesthesia Dept cannot exist solely off the E-cylinders already stationed on the backs of the anesthesia machines (or perfusion pumps).

Have YOU ever "pulled" the piped in supply and fired up the ventilator, just to see how long it will take to deplete an E-cylinder of O₂ with your anesthesia machines ??

If Not – "THAT" is your first assignment. . . .
Find out the time that a tank will last before being exhausted by your anesthesia machine's ventilator.

At Catawba Valley Medical Center in Hickory NC, I have 20 Anesthetic Locations recently equipped with 16 new Datascope Anestars as well as 4 older Ohmeda's scheduled for replacement.

For my "Anestars", I discovered that it takes 800cc's of drive gas (from the E-cyl) to administer an 800cc Tidal Volume (also from the tank) to the patient.

Therefore, your E-cylinder stationed on the back of your anesthesia machine will only give you about 50% of what you think your estimate will be from a formula using a tank factor to estimate time left in a cylinder, such as "pounds per square inch, on the gauge times the tank factor, divided by your flow rate, denoted in liters per minute."

P.S.I.G. x T.F.
   L / M

[P.S.I.G. = Pounds per square inch on the gauge]
[T.F. = The "Tank Factor" is .28 for an E-cyl and 3.14 for an H-cyl]
[L / M = The "flow rate" denoted in "Liters per Minute"]
[*E-cyl's contain approx 659 liters of O₂ /*Dorsch & Dorsch.]

If you do the math, It will not take you long to realize that your dept may not keep the number of tanks on hand to exist very long off of E-cylinders; and if you did have the tanks available, you may not have the staff to be changing E-cylinders prn on each anesthesia machine with all your OR's running.

In the event of an O₂ "disaster" your OR probably already has a contingency delineating how YOU will wind down cases and close rooms; and your Respiratory Therapy Dept probably already has a "Back Fill" contingency for maintaining a ventilator care unit during an O₂ Shutdown that will be easy to adapt to your OR.

But now, will the last rooms you will be using all be in the same "zone" ??

The answer to this question lies with the way piped-in medical gas zones are set up within your institution.

In the time it takes to position and plug in an H-cylinder, equipped with a 2-stage regulator, and a "Chemtron" male-adapter on a 5'–10' length of "High Pressure Hose" into any wall outlet where you would plug in a flow meter or into dropper hoses for an anesthesia machine, you can "back fill" and supply an entire "zone" with O₂.

If you OR has 2 sets of "dropper hoses" for anesthesia machines on opposing sides of the OR then those hoses "near the door" will be your best buddy during a backfill situation. And remember Back Filling one room may in turn backfill a couple of rooms, all in the same zone, and possibly by using the rooms that have been closed down – those unused outlets where you anesthesia machine "was" plugged into may now become your inlets – it just depends on how your zones are configured.

*If you are attempting to "back fill" a zone with a high volume demands – (such as a busy O.R. or ventilator care unit) it may take strategically placing tanks equally around the zone to fully meet and maintain your 50 psi requirements.

The math you did for the E-cylinders on the anesthesia machine will be your factor for estimating your O₂ consumption on the H-cylinder. [*H-cylinders contain approx 6500 liters of O₂ - *Dorsch & Dorsch] Then establish that there is an adequate supply of H-cylinders to last until the "cavalry" can arrive with a new supply of tanks.

Hopefully you can take a different look at your OR and understand how to isolate your OR from the Piped-In O₂ Supply at the "Cut-Off / Zone Valves"; and then learn and understand what rooms are in each zone and how many zones you can "create" within your OR so you too can "Back Fill" each zone.

With this "Back Fill" approach for your OR – this contingency can account for the O₂, N₂O and Medical Air needs for your Anesthesia Dept, your OR and your perfusion pumps. Contact your Bio-Med group or RT Dept for help with this project.

What contingencies or approaches have you established in your OR ??

I'd like to share with you a label that we've used in my department for over 2 years. I call it the "USE ME FIRST" label.  Anytime I or my Anesthesia Technician counterpart "Mike" find an anesthesia drug or tray or supply item nearing "out of date" it gets tagged with a piece of fluorescent orange "USE ME FIRST" tape.  This label is well imbedded in our departmental process because now even some of the CRNA "old timer's" look for (and now ask for) "USE ME FIRST" items.

I've traditionally ordered this tape from Shamrock as a specialty roll compared to the rolls that have already made their way into the marketplace via the Shamrock Catalogue.  So I got to thinking about this label and "Tech Talk", and then pulled out my catalogue, found the phone number, called and asked the nice lady that answered the phone for the person with the biggest desk in the sales department; and was then transferred to and subsequently spoke with Dan Zale, National Sales Manager of Shamrock Scientific Specialty Systems Inc in Bellwood Illinois. 

I mentioned to Dan the "USE ME FIRST" label that I've been ordering, explained how it was used, and mentioned that I wanted to present this label in "Tech Talk", and asked if he could make this label available to Tech Talk's readers.  Dan e-mailed me the next day with the great news for you, the readers of "Tech Talk" . . .

Shamrock will make the "USE ME FIRST" label available as a "regular" tape roll,  (2 roll minimum order) and they can now be ordered thru Shamrock's customer service dept (800) 323-0249 as catalogue item # STSA-1.

This label has become a common sight in my department, which makes items needing to be used easier to find and use as well as easier to locate when pulling "out of date" items.  I hope you too will find it useful in your department, for marking items for use, that are soon to be going out of date.

Lynn Preston Cer.A.T.
Catawba Valley Medical Center
Hickory NC

Here's a situation that was discovered in a heart room by an anesthesia technician and now submitted to "Tech Talk":

After drawing a blood gas from the a-line of a quad-transducer set, a flush was performed to clear the a-line. All of a sudden there appeared a strange sight in the high pressure tubing going to the patient's radial arterial line. Instead of there being the usual reddish murky flow of "kool-aid" the tubing was suddenly filled with red-globs that gave an appearance similar to that of a "lava-lamp". Have you even seen this before?? Can you guess what happened??

What steps would you take to troubleshoot and resolve this strange occurrence?? (Incidentally, the "lava-lamp" effect was reported to have been totally resolved within 60 seconds of discovery thanks to aggressive troubleshooting and resourcefulness of the Anesthesia Technician on duty)

This situation is a classic example of a medication error. The “lava lamp effect” was due to a major difference in the surface tensions of the constituents (i.e., the salad dressing effect of oil and vinegar).

A “heart set” consisting of a single- and a triple-transducer configuration, a cardiac output set, and multiple IV lines was assembled by Anesthesia Technician “A.” At this point, while preparing the setup, a bag of premixed Lidocaine was accidentally used instead of the premixed Heparin flush. This bag was inserted in the pressure bag associated with the triple-transducer set; the triple-transducer set was then spiked by a different Anesthesia Technician who obviously didn’t check the label on the bag when it was spiked. Both techs made the same mistake: They didn’t read the label!

ASATT President Maretta Grandona, Cer.A.T.T., offers these troubleshooting tips:
     Troubleshooting Rule #1: Is the patient OK? Ask the anesthesia provider this question and check the patient’s vital signs.
     Troubleshooting Rule #2: What did you do immediately before the fault/problem occurred?

In this situation, as the a-line set up was flushed the “lava lamp effect” occurred. Rule #2 tells us to check the fluid used for the flush.
     • Stop flushing
     • Check vital signs
     • Check the label on the bag of fluid

Maretta also offers this helpful reminder: Always read the label ... carefully!
     • When you gather necessary supplies prior to set up
     • When you hang the bag
     • When you spike the bag

Don’t you become the next head-line on the evening news!

Thanks for reading “Tech-Talk”!

ASATT
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