VOLUME AND FLOW

MEASUREMENT
 GAS VOLUME MEASUREMENT
• Benedict Roth Spirometer:
• Consists of a light bell that traps a closed volume of air over
water.
• The subject breathes in and out of this trapped gas causing
the bell to rise and fall following the inspired and expired
volumes.
• A sensor or pen coupled to the bell, traces its movement
giving a spirometric trace from which gas flow rates and lung
volumes can be derived .
• This device is relatively large in size and not portable.
 Vitalograph
• Bellows are used to measure gas volume.
• The top plate of the bellows is pivoted and its motion
is transferred to scriber which records volume
changes on a chart.
• The chart is motor driven.
• This allows expired
volume-time graphs
to be plotted.
 Dry Gas Meter
• It is used to measure larger gas volumes.
• In this diagram, two compartments are shown, A and
B.
• Gases passes into
compartment
B compressing
the bellows which
empty compartment
A.
• As the bellow are compressed they move a
lever to provide a volume recording and also
move a rod CC to shift the valves to a new
position.
• In this position compartment A is now filled until it too moves
the rod and lever mechanism.

• There is also a set of gears to record the volume measured.

 Wright Respirometer
• It is more convenient for measuring tidal volumes.
• Like dry gas meter it has a set of gears but in this
case the volume measurement is achieved by
monitoring the continuous rotation of a vane as it is
moved by the flow of gas.
• The effect of the slits is to cause a circular motion of
the airflow which rotates the vane.
• The vane does not rotate when the flow is reversed.
• It is calibrated for use for tidal volume measurement
and for tidal ventilation.

• Its calibration is inaccurate if it is used to measure a

continuous flow.

• Disadvantage: it does not give an electric output for

analysis and recording.
 Electric Volume Monitor
• Like the Wright respirometer the monitor depends
upon the movement of a vane mounted on jewelled
bearings within the airflow.
• To create a spiral movement of the air in this case,
the air passes through two sets of six fixed and
angled blades at either side of the moving vane.
• The vane moves alternately clockwise and
anticlockwise as the patient breathes in and
out and the vane’s movement is monitored by
means of two infrared beams.

• As electronic processor analyses the signal to

indicate tidal volume and minute volume.
• This gives more accurate measurements than the
non electronic Wright respirometer because the
drag of the gears on the vane is eliminated, but it
requires a source of electrical power and is not
portable or cheap.
LIQUID VOLUME MEASUREMENT
 DILUTION TECHNIQUES
• For red cell volume measurement, red cells
which have been specially identified by
radioactive labelling are used.

• Suppose a known amount or dose of these

labelled red cells is injected into a patient.

• After they have mixed thoroughly with the

patient’s blood the concentration of the labelled
cells may be deduced from the radioactivity of a
blood sample from the patient.
• For measuring plasma volume the same dilution
technique is used with radioactive albumin
instead of radioactive labelled red cells.

• The blood volume can then be calculated by

adding together the plasma and red cell volumes.

• It is possible to estimate blood volume from

either of these determinations provided that the
ratio of red cell volume to blood volume is known
from a haematocrit reading.
• Clinically these dilution techniques have limitations,
because in shocked patients pooling and stasis of
blood may occur in ill perfused areas and even
mixing of the radioactive indicator may not be
obtained.

• For measuring extracellular volume radioactive

sodium has been used.
• This dilution concept is also used to measure
blood loss.
• A washing reservoir contains in this case 35 litres of
water.

• Blood stained swabs from a patient are added to this

reservoir and even mixing of hemoglobin is
promoted by bubbles of compressed air.

• A detector consisting of a lamp and photocell

measures the concentration of diluted haemoglobin
in the washing reservoir.
• If the patient’s hemoglobin concentration is 140g/l
and the diluted concentration of hemoglobin in the
reservoir is 1g/l, the patient’s blood loss can be
calculated as:
GAS FLOW MEASUREMENT
• Continuous indication of gas flows in the anaesthetic
machine is provided by a variable orifice flowmeter,
often referred as Rotameter.

• A bobbin is supported in the middle of a tapered

glass or plastic tube by the gas flow and, as the flow
increases, the bobbin rises in the tube and the
clearance round the bobbin increases.
• There is variable orifice round the bobbin which
depends on the gas flow.

• The pressure across the bobbin remains constant

because it gives rise to a force which balances the
force of gravity on the bobbin.

• The increase in the area of the annular orifice as the

bobbin rises reduces flow resistance at higher flows
and so the pressure across the bobbin stays constant,
despite the flow increase.
• Small slots are placed round the top of the bobbin,
causing it to rotate centrally in the gas flow.

• In this type of flowmeter, readings are made from

the upper surface of the bobbin.

• In a variable orifice flowmeter there is a mixture of

turbulent and laminar flow, and so for calibration
purposes both the density and viscosity of the fluid
are important.
• The flowmeter tube must be kept vertical to obtain a
correct reading and to prevent the bobbin touching
the sides of the tube and sticking.

• Sticking is more likely to occur when the bobbin is

rotating near the bottom of the tube.

• Electrostatic charges may also build up on the bobbin

if it rubs against the side of the tube, and these may
increase the tendency to stick.
• To prevent the build up of such charges, some tubes
have a conductive strip running down the inside at
the back, while in others a clear conductive coating is
provided inside to conduct away any electrostatic
charges.

• The problem of sticking is less if a simple ball

flowmeter is used but this may be less acccurate
because there is no well defined surface to read.

• The readings are taken from the middle of the ball.

• The flow meters have a bore specially
moulded with a varying taper so that both low
and high flows can be measured conveniently.

• So, same flowmeter can be used for low flows

to a closed circuit and also for high flow
system.

• Added accuracy can be achieved if two

flowmeter, one for low and one for high flows
are used in tandem.
• Below the flow meter, there is needle valve.

• In the needle valve there is a spindle, attached to a

control knob which screws into the seating of the
inlet to turn off the gas supply to the flowmeter
above.

• Leakage of gas around the spindle is prevented by a

gland with its gland nut.

• A gland is a washer of compressible material, and

glands and gland nuts are also used to prevent
leakage on gas cylinders.
• At the bottom of each flowmeter a dust filter of
sintered metal is also present.

• Principle: at a normal gas supply pressure the linear

velocity of the gas round the control spindle
approaches the speed of sound and achieves a
constant maximum value.

• The flow only depends upon the area of the channel

and is unaffected by small changes of upstream
pressure e.g. at the outlet of flowmeters.
• This is an advantage that the gas flows once set do
not alter when additional apparatus such as a
vaporizer or a Manley ventilator is attached at the
outlet of the flow meters, though the bobbin
position may alter slightly.

• The positions of individual gas flowmeters on the

anaesthetic machine may cause problems.
• If there is a leak in the centre flowmeter or in the
centre of the block, more oxygen leaks out through
this hole than nitrous oxide, resulting in a higher
percentage of nitrous oxide than intended being
delivered to the patient.
• One solution would be to reverse the oxygen and
nitrous oxide flowmeter positions .

• But this is not universally accepted.

• There is suitabe channelling present in order to pick
up the oxygen selectively.
• Also there is a chain linking of oxygen and nitrous
oxide flowmeters so that
oxygen always flows when the
nitrous oxide is turned on .
 Wright Peak Flowmeter
• It measures flow by the variable orifice principle.

• In this flow meter patient’s expired gases are

directed against a moveable vane causing it to rotate.

• As the vane rotates, it open up a circular slot around

the base of the instrument and so allows the gases to
escape.
• Rotation of the vane is opposed by the force from a
coiled spring and a pointer mounted on the axis of
the vane registers its movement on a calibrated dial.

• The spring force is relatively constant and its action

on the area of the vane gives a very small steady
pressure to balance the constant pressure driving the
flow of gas through the variable orifice.

• The size of this orifice increases to that required for

the gas flow and at peak flow the vane reaches a
maximum position from which it is prevented from
returning by a ratchet.
• After maximum reading is taken, the vane can be
released by depressing a button and the pointer
returns to zero.

• An alternative , peak flowmeter, has a cylindrical

shape and the air escapes from a straight slot in
place of the circular one.

• For an adult a peak flow of 400 to 500 l/min is

common but in a patient with emphysema this may
be below 100 l/min.
 Pneumotachograph
• The measuring head of this instrument contains a gauze
screen and has a sufficiently large diameter to ensure laminar
flow through the gauze.

• The gauze acts as a resistance to flow , and so respiratory

airflow from the patient causes a small pressure drop across
the gauze.

• This pressure change is measured by a transducer which

converts the pressure change into an electrical signal which in
turn can be displayed and recorded.
• The pneumotachograph can measure rapid changes
in the patient’s respiration, at the same time
avoiding any appreciable resistance to breathing.

• As laminar flow depends on fluid viscosity and

turbulent flow on density, changes in the character
of the gas passing through the pneumotachograph
alter its accuracy for e.g. changes of temperature or
the addition of anesthetic gases can affect the
calibration.
 Bubble Flowmeter
• In this flowmeter a soap solution is used to produce
a soap film at the base of a burette.
• The gas flow is directed up this burette and the rise
of the film between two fixed points indicates the
flow, the rate of rise being measured by a stop
watch.
• Advantage: the film is very light and does not
obstruct flow and the system is not dependent on
the composition of the gases flowing.
• But it is only suitable only for low flows.
LIQUID FLOW MEASUREMENT
• Measurement of intravenous fluid infusion rate.

• The drops passing through the drip chamber have a

nominal volume which permits a measure of the
infusion rate to be made.

• This is obtained by multiplying the drop volume by

the rate at which the drops pass through the
chamber.
• Surface tension is an important factor determining
the final diameter of a drop forming at the end of a
tube.

• As the drop forms , the surface tension on its surface

balances the force of gravity on the liquid in the drop
and prevents the drop detaching from the end of the
tube.

• As the size increases the weight of the drop

eventually becomes too large to be supported by the
surface tension and the drop detaches from the end
of the tube.
• Infusion controllers and pumps determine the
infusion rate by counting drops passing through a
drip chamber.

• A beam of light or infrared radiation, produced by a

lamp or light emitting diode, passes through the
chamber to strike a photodetector is reduced every
time a drop interrupts the beam.

• Thus, the controller is able to count the drip rate and

adjust the flow of liquid to some set value.
• Drip counters should be positioned carefully so that
the light beam is halfway between the drop forming
orifice and the liquid level.

• The liquid should occupy one third of the drip

chamber, which should be vertical so that the drops
interrupt the light beam correctly.
• A volumetric pump uses a disposable cassette which
has one or more pistons and valves and is loaded
into a motorized holder.

• In this the volume of liquid administered and its flow

can be accurately known and the problems
associated with drip counters are avoided.

• Ordinary syringes, preloaded with a required drug

can also be used in a suitable motorized holder to
infuse a small volume of fluid accurately.
• Infusion pumps: these are used to deliver much
faster infusion rates e.g. over 1000ml/h for propofol.

• Some have electromagnetically encoded cards which

fit on the front of the device over the setting dials
and communicate the drug type and concentration
to the pump.

• The infusion rate is calculated automatically once the

dose in mcg/kg/min and the patient’s weight have
been selected with dials on the infusion pump.
Target controlled infusion (TCI)
• It is microprocessor based infusion devices.

• It incorporates a three compartment

pharmacokinetic model which describes the
distribution and elimination of the drug.

• It allows the desired target blood concentraion of

propofol considered appropriate for any individual
patient and level of surgical stimulation to be
achieved and maintained at any time.
• To check the flow of liquid from some apparatus
then a measuring cylinder and stop watch is
required.

• Variable orifice flowmeters may be used to

measure flow through a kidney machine or a
heart lung machine.

• In the case of flow in the circulation , more

advanced technique are required.

• These include dye dilution, isotope dilution, and

thermal dilution , ultrasonic measurement and
the electromagnetic flowmeter.
THE FICK PRINCIPLE
• Blood flow to the organ = 250
200-150
= 5L
• The patient rebreathes oxygen into a
Benedict Roth spirometer through a soda lime
absorber, and the rate for uptake of oxygen is
250ml/min.
• From a catheter in the right atrium or pulmonary
artery a sample of mixed venous blood is
obtained and analysed to show an oxygen
contern of 150ml/litre blood.
• An arterial blood sample shows the arterial blood
oxygen concentration to be 200ml/l
• Each lite of blood therefore gains an extra
50ml oxygen in its passage through the lungs
• 250ml o2 is being taken up in the lungs each
minute, therefore 250/50 i.e. 5 litres blood,
must flow through the lungs to carry this
volume.
THANK YOU