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Clinical Conference:

Technology Rounds
Biomedical Engineering

Evelyn Fan, M.H.Sc., Clinical Engineer


Biomedical Engineering
November 2, 2005
Plan for today
Introduction
Biomedical Engineering OR Team
Fabius GS: “Low Fresh Gas” alarm
Fresh gas decoupling
You’re on call…
What’s wrong with this picture?
Summary
Conclusion
Who are we?
BWH Biomedical Engineering Department
 27 people
 3 teams (OR, ICU, Ambulatory) support the medical equipment used
in the entire hospital and outside clinics
 Responsible for managing and supporting 15,735 medical devices

OR team specifically manages all operating room


equipment, including CPD, and Anesthesia for outside
areas such as Endoscopy, MRT/ MRI, Angio/ Cath lab, etc.
 3114 medical devices managed by the OR team
 2088 of which have a risk class of ‘Life-Support/ High-Risk/ Normal’,
meaning they require scheduled maintenance at least 1x/ yr.
 63 anesthesia machines, which require scheduled maintenance 2x/ year.
•Ernst Daniel,

OR Biomed Team Clinical Engineer


•Evelyn Fan,
Clinical Engineer
•Dr. Jim Philip,
Medical Liaison
•Eddie Holmes,
Facilities Technician
•Claire Cabral, Sr. BMET
•Garth Meikle, Sr. BMET
•Ross Jacques, BMET
What does biomed do?
Vision: It is our goal that no patient is harmed by the application
of a medical device within our sphere of influence.
Goal: To be a ‘Solutions Department’, providing technology
solutions to advance the care and safety of patients and staff.

Repairs & Scheduled Maintenance (SM) of clinically used


equipment, projects/ installations, on-call/ night-call coverage,
incident investigations, capital equipment purchases, etc.
Work with many departments including: OR/CSS, anesthesia
techs, CPD, Anesthesia, Nursing, Infection control, Perfusion,
Environmental Affairs, Risk Management, etc.
More details to come in future article for the Anesthesia
Record…
‘Fresh Gas Low’ alarm
Bellows vs. Piston
What is Fresh Gas Decoupling?

Water Trap
Inhalation
O2 sensor Inhalation
Pressure
sensor

Inspiratory valve
I

Expiratory valve

Water trap
O2 sensor Exhalation
Pressure
sensor

Inspiratory valve
E

Expiratory valve

Water trap
What does the water trap have to do
with the ‘Fresh Gas Low’ alarm?
What does the water trap have to do with
the ‘Fresh Gas Low’ alarm?

During expiration, piston


moves down to actively fill
with fresh gas  negative
Inspiration
pressure created
Water in ventilator hose
creates ‘occlusion’  higher
Expiration negative pressure detected
by pressure transducer
Interpreted electronically by
machine as ‘Low Fresh Gas’
alarm.
You’re on call..
OR 18, Fabius GS, Anesthesiologist calls you
Reports a “Low Fresh Gas” alarm
Let’s take a closer look..

•Gas monitor exhaust line is


unhooked from circuit
•SAM module is pulling
200mL/min = leak!
And the solution is…

•Gas monitor exhaust line should


be attached to expiratory gas
sampling port connector
•Or should be attached to
scavenging
What is wrong with this
picture?
What alarm would you see?

No alarm message even though


reservoir bag is off and machine
is pulling in room air
Fresh gas
decoupling
Room air
E entrainment
Piston is
electronically
driven by the
motor
No ADS
alarms

With no bag present, piston


draws in room air
Summary
Fresh gas decoupling: What to do when you see a
 Good: Motor-driven piston ‘Low Fresh Gas’ alarm
results in minimal tidal volume
changes with FGF changes  Check the water trap
 Bad: If bag is empty (ie. low  Check for a deflated reservoir
flow) ADS may alarm; if bag is bag (which may indicated the
missing can lead to room air presence of a leak!)
entrainment  dilution of  Check the breathing circuit
[agent]
 Call biomed 
Since the reservoir bag is a (pager # 11055)
part of your circuit, make
sure your reservoir bag is
attached to the bag arm at
all times!
Conclusion
‘Ask Biomed’
 Email: Evelyn Fan (efan1@partners.org)
 Cc: Dr. Jim Philip (jphilip@zeus.bwh.harvard.edu)
Look out for upcoming article in Anesthesia Record
about biomedical engineering…
Questions?
Acknowledgements
Special thanks to:
 Dr. J. Philip, Medical Liaison
 Garth Meikle, Sr BMET & Ross Jacques, BMET
 OR Biomedical Engineering team
 Drager Medical Technical Support
Additional Slides
What happens to O2% when reservoir bag is
removed from circuit?
What happens to O2% when reservoir bag is
removed from circuit?
What happens to O2% when reservoir bag is
removed from circuit?

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