PART 3 Breathing Circuit The system that brings

PART 3: Breathing Circuit The system that brings the fresh gas from the vaporizer to the patient and takes the expired gases from the patient to the scavenger. May contain unidirectional valves, reservoir bag, pop off valve, CO 2 canister, negative pressure relief valve, pressure manometer. Non-rebreathing System Rebreathing System

Rebreathing System Set up as a circle system exhaled gases are recirculated and rebreathed by the patient New Used Can fresh gas is also added in for patients weighing >7 kg be used as a closed or semi-closed system Begins with the fresh gas inlet Vaporizer outlet port connects to the fresh gas inlet, which connects to the inspiratory unidirectional valve

Rebreathing System: Closed Pop-off valve is completely closed! Only provides enough oxygen to meet metabolic demands of the patient Flow rates (L/min) must be kept very low!! The volume of gas added to the circuit = the volume of gas used by the patient This is very tricky to achieve and is therefore not commonly used

Rebreathing System: Semi-Closed Also known as partial rebreathing system Pop-off This valve is open or partially closed system requires a scavenging system because more oxygen than the patient needs is being provided

Unidirectional Valves One-way valves that allow the flow of fresh gas to enter the inhalation valve and exit the exhalation valve. Valve is either a rigid disk or a flap that flutters as gas flows past it Inspiratory/Inhalation valve opens as patient inhales Fresh gas enters the inspiratory breathing hose, then the ET tube and then the patient’s lungs Gas exchange occurs now = sleepy patient 02 CO 2 and anesthetic gases are then exhaled and travel up the expiratory breathing hose. Flows through the unidirectional exhalation valve This valve prevents the expired gases from traveling back to the patient before the CO 2 is removed.

Breathing Tubes for Rebreathing System 1. Y Tubes Come in large animal, small animal, and pediatric Large animal tubes can only be used on large animal machines 2. Universal F-circuit Come in adult (green-blue) and pediatric (red) Pediatric = patients 15 -35 lbs Adult = patients weight > 35 lbs The inspiratory tube is located within the expiratory tube Each connects to the machine separately at their respective flutter valves CO 2 absorber

CO 2 Absorber Exhaled gases flow out of the expiratory breathing tube and into the CO 2 canisters usually contain calcium hydroxide granules that selectively absorb CO 2 from other gases breathed out. Example: soda lime granules “Exhausted” soda lime granules no longer absorb CO 2. patient breathes in CO 2

CO 2 Absorber HOW DO I KNOW WHEN THE GRANULES ARE EXHAUSTED? Color change to violet, off-white or pink depending on the brand. CO 2 saturated granules are hard and brittle, new ones can be chipped and crumbled Once color becomes abnormal, it is possible that it changes back to normal within hours! next, gas flows into the rebreathing bag AND through the pop-off simultaneously

Reservoir Bag- aka rebreathing bag Expandable bag that fills as gases enter the circuit or as patient exhales Deflates as patient inhales Range in size from 0. 5 L to 30 L; 1 L increments Volume of bag should be minimally 60 m. L/kg *This is equal to 6 times their minimum tidal volume

Reservoir Bag Calculation If your patient weighs 15 lbs, how many m. Ls of air should the bag hold? How many liters is this? *Always round up to next highest bag *If that size doesn’t work for your patient, switch it out!

Reservoir Bag Functions 1) Helps in determining correct ET tube placement movement of bag with breaths = tube in trachea (yay!) 2) Allows assessment of respiratory rate and depth Good for when you can’t see your patient Why can’t you see your patient? ! Allows manual ventilation of the patient 3) Also known as “giving a breath” or “bagging”

Indications for Manual Ventilation 1. Reverse atelectasis if present; prevent if not Done by closing pop-off and gently squeezing bag Performed once q 10 minutes = “sighing” patient Removal of CO 2 and anesthetic that builds up when respirations have decreased in volume Anesthetics decrease tidal volume up to 50% Forcing fresh gas in stimulates gas exchange in the alveoli 3. Assist or control ventilation – especially if in respiratory arrest or “deciding not to breathe” IPPV 2.

Is Your Reservoir Bag the Right Size? Bags should consistently be ~ ¾ full upon exhalation If bag is going from over-inflated to flat = Bag is too small and doesn’t hold enough oxygen patient won’t be able to fully inflate lungs on inhalation AND Bag will overinflate on exhalation increases pressure in the circuit If bag is flat during respirations (under-inflated) = Bag is too big will not see movements with each breath and wasted space in circuit

Pressure Manometer Measures pressure of gas within the breathing circuit this includes the patient’s lungs Unit is in cm H 20 Should read between 0 -2 cm H 2 O during normal respirations Pressure How increases as system is closed do we close the circle and why? Gauge animals! Watch should never exceed 20 CM H 20 in small manometer while “bagging” patient

Pop-off Valve - aka pressure relief valve, exhaust valve Always kept open for semi-closed system Allows exhaled gas to leave the breathing circuit and be scavenged Prevents the build-up of excess gas or pressure within the circuit. If the pressure were allowed to build up (forgot to open pop-off valve), the alveoli in the lungs could rupture!

Pop-off Valve The degree that the pop off valve is opened changes the flow rate and how full the reservoir bag is. (semi-closed system) If you see your reservoir bag unintentionally expanding very quickly- check pop-off! Only close the pop-off valve when you are currently providing breaths for the patient Must be opened between breaths

Negative Pressure Release Valve aka Air Intake Valve Special feature activated in emergencies Indicated by a completely empty reservoir bag 1. When an active scavenging system is utilized, if negative pressure is detected in the circuit, this valve opens and allows room air in. Instances when there is excessive suction 2. O 2 flow rate is too low or the tank runs out of oxygen ALWAYS keep an eye on your oxygen pressure gauge *Better for the patient to breathe room air than no air