TRAINING REPORT – 6TH - 7TH SEMESTER(15 DAYS)

MADE BY:-SARTHAK JAIN

(11307042)UNDER SUPERVISION OF:-

MR.VIJAY JAIN(EXECUTIVE DIRECTOR-AIHPL)

AIRSEP(VISION AIRE):AS098-2The technique uses Swing

Adsorption principal and involves an air compressor, a set of Molecular Sieves (semi-permeable to Oxygen), an electronic system to control &monitor the system, a Flow meter to deliver Oxygen. It compresses the room air to generate a bulk of available Air at High Pressure. Since Air contains 21% Oxygen. We normally need 5 times Air to get near pure Oxygen. Taking care of the bleed, re-generating Sieve wash volume and other inefficiencies we need about 10-12 times air

Electronics Controls

ELECTRONIC CONTROLSStart up of the compressor with a re-settable circuit breaker.Cooling fan and air after cooler for proper air temperature for

holding low moisture Automatic swing between two sets of Molecular sieve bedsThe Oxygen purity analysis and displayOver- pressure, Over- temp alarm etc.

ADVANTAGES93% pure Oxygen at his controlNo complications associated with Cylinder handlingLow cost with nearly no risk of stock-outUn-interrupted supply of Life saving Oxygen approved by Drug

Controller Govt. of India

PHILIPS REMSTAR-1017453

-Application of constant positive pressure throughout the spontaneous ventilatory cycle.

-No mechanical inspiratory assistance is provided. Requires active spontaneous respiratory drive.

- Increases functional residual capacity (FRC) and improves oxygenation.

- May decrease WOB.- Tidal volume and rate determined

by the patient

It is used for patients with OSA (obstructive sleep apnea).

•OSA is a potentially life altering and life threatening breathing disorder which occurs during sleep.•Upper airway repeatedly collapse causing cessation of airflow•Apnea and Hypopnea•Short-term complications•Long-term complicationsA sleep study called Polysomnography is conducted for such patients before prescription of a CPAP.

Polysomnography - a painless study done in lab setting to monitor patient’s sleep patterns. It includes:

EEG, EOG, EMG, ECG, airflow, thoracic and abdominal respiratory movements, oxygen saturation, activity of the tibialis muscles, snoring activity, body position.

LAB SET UP

• Noninvasively provides a continuous stream of air pressure through nose using a mask

• Air pressure prevents airway collapse, allowing you to breathe freely during sleep

• Can alleviate OSA symptoms when used as prescribed

PHILIPS HARMONY-1014249

Is a spontaneous breathing mode in which two levels of pressure IPAP and EPAP are set to synchronize with patient breathing.

At either pressure level the patient can breathe spontaneouslyspontaneous breaths may be supported by PS if PS is set higher than PEEPH, PS supports spontaneous breath at upper pressure.

Is a Bi-level form of ventilation with sudden short releases in pressure to rapidly reduce FRC and allow for ventilationCan work in spontaneous or apneic patients. Bipap delivers CPAP but also senses when inspiratory effort is being made and delivers a higher pressure during inspiration. Auto track is preset and compensates for small leaks after recognizing it.

Harmony consist of a special comfort feature called Bi-Flex.It provide the Bi-Flex feature in S mode. The Bi-Flex attribute

adjusts therapy by inserting a small amount of pressure relief during the latter stages of inspiration and during active exhalation (the beginning part of exhalation).

NOTE: for the Harmony Bi-Flex is only available up to 20cmH2O in S mode.

The following table summarizes the initiation of triggers and cycles for each bi-level mode

Mode Trigger Limit Cycle

S Patient Pressure Patient/Device

S/T Patient/Device Pressure Patient/Device

PC* Patient/Device Pressure Device

T* Machine Pressure Device

AVAPS (average volume assured pressure support)

Adjusts Pressure support to maintain the target volume Adapts to changes in patient condition and disease progression Reduces needs for ventilator adjustment by eliminating IPAP

adjustments Combines advantage of pressure control and volume ventilation

Flow Reversal- A leak causes the flow to increase, if cycling to EPAP, the unit will automatically reverse the flow so that cycling can continue

IPAP Time- If inspiratory time exceeds three seconds, unit will cycle to EPAP

Volume- IPAP is triggered when 6cc of volume above baseline leak

Leak Tolerance- Digital Auto-Trak Sensitivity identifies leaks by comparing original flow baseline to the new baseline flow

DAMECA SIESTA iTSThe anesthetic machine also known as boyle’s machine

dispenses the gases that are necessary to induce sleep and prevent pain to humans during surgical procedures or other potentially painful manipulations.

The basic anesthetic delivery system consists of a source of oxygen (O2), an O2 flow meter, a precision vaporizer, which produces a vapor from a volatile liquid anesthetic, a patient breathing circuit (tubing, connectors and valves), and a scavenging device that removes any excess anesthetic gases. This is critical, since room pollution with anesthetic gases may lead to health problems in animals as well as in humans.

It has an integrated breathing system and the whole machine is micro-processor controlled. It is one of a kind with features like electronic mixer, multi gas analyzer and a sophisticated ventilator etc. I:E ratio= 3:1 to 19:9.

Scavenging system

APL valve

Soda lime

Corrugated tube

bellow

Flow meter

ventilator

vaporizer

Cardiac: Blood Pressure, Heart Rate, ECG

ECG: Rate, ST Segment (ischemia), Rhythm

Respiratory: Airway Pressure, Capnogram, Pulse Oximeter, Spirometry, Visual Cues

Temperature [pharyngeal, axillary, esophageal, etc.]

Urine output (if Foley catheter has been placed)

Nerve stimulator [face, forearm] (if relaxants used)

ETT cuff pressure (keep < 20 cm H2O)

Auscultation (esophageal or precordial stethoscope)

Visual surveillance of the anesthesia workspace and some exposed portion of the patient

PIN INDEXED SYSTEM- It is a gas specific system which prevents accidental rearrangement of cylinders.

GAS INDEX PINS oxygen 2,5 nitrous oxide 3,5 cyclopropane 3,6 o2 co2(co2<7.5%) 2,6 o2 co2(co2>7.5%) 1,6 o2 He (He>80.5%) 4,6 o2 He (He<80.5%) 2,4 air 1,5 nitrogen 1,4 N2o O2(N2o47.5%-52.5%) 7

Proportionating systems-Mechanical integration of the N2O and O2 flow-control valves-Automatically intercedes to maintain a minimum 25% concentration of oxygen with a maximum N2O:O2 ratio of 3:1.

vaporizer-A vaporizer is an instrument designed to change a liquid anesthetic agent into its vapor and add a controlled amount of this vapor to the fresh gas flow.

Adjustable pressure limiting valveUser adjustable valve that releases gases to the scavenging system and is intended to provide control of the pressure in the breathing system.

SODA LIMEAllows rebreathing of anesthetic gases. Composed of 94% calcium hydroxide, 5% sodium hydroxide, 1% potassium hydroxide, silica to harden granules, ethyl violet as an indicator.

Scavenging system

Protects the breathing circuit or ventilator from excessive positive or negative pressure.

TYPES OF CURCUITSBasic circle system- Arrangement is variable, but to prevent re-breathing of

CO2, the following rules must be followed:Unidirectional valves between the patient and the reservoir bag.Fresh-gas-flow cannot enter the circuit between the expiratory valve and

the patient.Adjustable pressure-limiting valve (APL) cannot be located between the

patient and the inspiratory valve.E.g.- Open, semi-open, semi-closed, closed.

Mapleson Classification- Mapleson A, B, C, D, E, F and bain breathing

circuits.

SPIROMETERYSpirometry is a method of assessing lung function by measuring the volume air that the patient is able to expel from the lungs after maximum inspiration. It is reliable method of differentiating between obstructive airways disorder (COPD, Asthma) and restrictive diseases (Where the size of the lungs is reduced).Spirometry plays a key role in the diagnosis and assessment of chronic obstructive disease COPD. COPD means airways obstructions which does not change markedly over several month.TYPES OF SPIROMETRY DONE:-1.Ergo Spirometer2.Diffusion system3.spiroscout(based on ultrasound)4.Ros box5.Software lf8

Ergo Spirometery System

Also called CPX or Cardio Pulmonary exercise System

Comprises of a Ergo Cycle/ tread mil and a Spirometery measurement system which measures the Spiro parameters of a patient under stress while the patient does exercise using the ergo cycle + ECG 12 lead

Important parameters measured are VO2, VCO2, Respiratory Exchange Ratio, VA, Breathing Reserve, Metabolic Equivalent, Anaerobic Threshold etc.

Body Box Diffusion system

Flow Sensing Spirometers : Flow sensing Spirometer directly measure flow. Volume is calculated by multiplying flow by time.V = Flow x Time. This require a computer or Microprocessor.Flow sensing Spirometers are :

1. Pneumotachograph ( Pressure differential device )

2. Thermistor or hot wire anemometer

3. Turbine based 4.vortexPneumotachograph : This device consists of a tube with fix

resistance. The fix resistance is very small and not sensed by the patient and can be bundle of capillary tube( Fleish type ) or a fine mesh screen. As air flow through the tube in either direction it meets fixed resistance. As the pressure on the air flow side of the element become greater than the pressure on the other side. The greater the flow greater the pressure difference. The Pressure difference is measured with a pressure transducer, and signal is sent electronically to amplifier and then to a computer or microprocessor.

Flow = Pressure/Resistance

Thermistor : The Thermistor consist of fine pieces of wire in the center of the tube. As air moves through the tube, it cools the heated wire. Electrical energy reheats the wire and maintain it at a specific temperature. The current which rises the airflow, is measured electronically and read as flow through the device.

Turbine : The speed of turbine (rotating wheel) increases as airflow increases. An electronic circuit counts the revolutions and calculate the flow.

Important parametersFVC – the volume of air that the patient can forcibly exhale in

one breath. FEV 1 - the volume of air that the patient exhale in the first

second of expiration.FEV1/FVC - the ratio of FEV1 to FVC

COPD can be diagnosed only if FEV1 less than 80% predicted and FEV1/FVC less than 70%

Measurement Principals for Flow Measurement and Sensors

Indirect flow measurementDifferential pressure measurement

Variable orificeCapillariesScreenPitot

Hot wire flow transducer (mass flow sensor)Vane (turbines)

Direct flow measurementUltrasonic flow transducer

Fleisch pneumotach

Turbines / Vanes

Lilly screen type

Variable orifice

Flow sensors overviesERS2008, buyer‘s guide, only ergospirometry