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What happens when ceramic switch on the Bird 7 is on the right?
Used during patient care activites likely to make splashed/sprays of blood, body fluids, secretions or excretions
Mask and goggles or faceshield
What happens when ceramic switch on the Bird 7 in on the left?
Complete destruction of all forms of microbial life
Similiar to ASSS. Used for equipment that is attracted to gas sources less than 200 psig.
Diameter Index Safety System (DISS)
FiO2 range of simple O2 mask
What catergory and processing for devices touching only intact skin or don't contact patient like, face mask, BP cuffs, ventilators
Category: Non Critical
Processing: Detergent washing, Low/Intermediate - level disinfection
What 2 lights does pulse ox use
What isolation precatuion for Particulate respirator and negative pressure isolation room?
Airborne Infection Isolation
What are advantages and disadvantages of Dry Heat?
Advantages: inexpesive, simple; non-toxic
Disadvatages: Damages heat sensitive equipment
What are advatages and disadvantages of incineration?
Advantages: Surest method; simple
Disadvantages: Limited use; may result in air pollution
What are advantages and disadvatages of autoclave (pressurized steam)?
Advantages: inexpensive, fast; non-toxic, prewrapping of items
Disadvantages: Damage heat or moisture sensitive equipment
What are advantages and disadvantages of Ethylene Oxide?
Advantages: effective; prewrapping of items
Disadvantages: Time consuming; expensive; toxic residues most be removed by
Low Flow humidifier liter flow
Liter Flow simple O2 Mask
Inactivation of most pathogenic organisms except spores
Disinfection (general term)
What are applicable equipment for autoclave (pressurized steam)?
Metal instruments; linens
Inactivation of all vegitative bacteria, most viruses, most fungi and mycobacterium tuberculosis, without destruction of bacterial spores
Inactivation of all micro organisms except bacterial spores (with enough exposure times, spores can be destroyed too!)
Measures Hemoglobin Saturation
Inactivation of most bacteria some viruses and fungi without destruction of resistant micro organisms (ex. Mycobacterium tuberculosis or bacterial spores)
What are applicable equipment for Dry heat?
laboratory glassware; metal instruments
What are applicable equipment for ionizing radiation?
foods; some medical supplies
Removal of all foreign material (soil) from objects
What are advantages and disadvantages of ionizing radiation?
Advantages: Fast, effective; prewrapping of items
Disadvantages: Expensive; toxic byproducts may be produced
Uses light to dtect tiny changes occuring in tissue during pulsated blood flow
Common elements of pulse ox (4 things)
1. All have LEDs
2. one silicone photodiode
3. Transmit light through capillary bed
4. Receives light on other side of capillary bed
Type 3AA cylinders are made of what?
Heat-Treated High Strength steel
What isolation precaution for: surgical mask within 3' of patient?
What are applicable equipment for incineration?
Disposables; grossly contaminated articles
Used during procedures and patient care activites when contact of clothing/exposed skin with blood/body fluids, secretions or excretions is anticipated
What are applicable equipment for boiling?
Metals; Heat-resistant plastic
Used when touching blood, body fluids, secretions, excretions, contaminated items; touching mucus membranes and nonintact skin
Therapeutic breathing maneuver which patients are coached to inspire from resting inspiratory capacity (IC) with end inspiratory pause
Sustained Maximal Inspiration (SMI)
What are advantages and disadvantages of boiling?
Advantages: Inexpensive, Simple
Disadvantages: Time consuming; altitude dependent; may damage equipment
Liter Flow for Nasal Canula
Large cylinders use size and thread indexed connection system. Shape of nipple, diameter and thread count are specified per gas.
ASSS (American Standard Safety System)
What are applicable Equipment for Ethylene Oxide?
Heat Sensitive items
What Safety system is used in Cylinders "A-E"?
PISS (Pin Index Safety System)
What category and how do you process devices that are introduced into bloodstream or other parts of the body?
Example: surgical Devices, Intravascular catheters, implants, heart-lung bypass components, dialysis components, bronchoscope forceps/brushes
What isolation precautions for: Gown and gloves for contact with patient or environment of care (medical equipment)
What catergory and processing of devices that directly or indirectly contact mucus membranes like endoscopes/bronchoscopes, oral nasal and tracheal airways, ventilator circuits/humidifiers, PFT mouth pieces and tubing, nebulizers and resevoirs
Processing: High-level Disinfection
3A, 3AA, 3AL are to be tested every ___ years.
If cylinder has stamped "*" what does it mean?
Cylinders with "+" stamped into them mean what?
Capable of holding 10% more than the max filling pressure
Type 3A cylinder is made of what?
High carbon-steel (non-heat treated)
FiO2 Range of Non-Rebreather Mask
Minute Ventilation Formula
Inspiratory flow rate Formula
Tidal Vol (Vt) X Resp Rate (CXR) = Min Vol.
Min Vol. X 4 = Inspiratory Flow Rate
Liter Flow for Partial Rebreather Mask
FiO2 Range of Partial Rebreather Mask
Liter Flow for Non-rebreather Mask
Cylinder Duration Formula
- Tank Factor X PSI
Tank Factor: E Cylinder = 0.28, H Cylinder = 3.14
Large volume nebulizer flow rate
Small volume nebulizer flow rate
Used as primary source of O2 and other gas in small hospitals without bulk liquid systems and reserve tanks with hospitals with liquid systems. What kind of cylinders?
"G" and "H"
Frequently used as source of O2 in emergency situations and transporting patients needing O2 therapy. Used in anesthesia and for portable diagnostic equipment. What kind of cylinder?
Type 3AL cylinders are made of what?
IBW formula Male/Female
- Male: 106 + [6 X (height in inches - 60)]
- Females: 105 + [5 X (height in inches - 60)]
- Then divide by 2.2 = Kg
FiO2 Range of Nasal Canula
IPPB goals for: Min/Med/Hyperinflate
- Kg X 10-15 (Min and Meds)
- Kg X 50 X .75 (Hyperinflate)
Pressure Range IPV
Frequency Range IPV
- 100-300 bpm
- 100 is harder, and 300 is easier
Equipment most likely to spread pathogens
- 1.Large reservoir jet nebulizer
- 2.Ventilator circuits
- 3.Bag-valve-mask devices (manual resuscitators)
- 4.Oxygen therapy apparatus
- 5.Pulmonary function devices
- 6.Suction equipment
Within 24 hours an organism can colonize enough to cause an infection in the patient.
A Pulse oximeter combines the principles of spectrophotometry with photoplethysmography
- �Uses spectrophotometry to measure hemoglobin saturation
- �Plethysmography uses light to detect the tiny changes that occur in living tissue during pulsatile blood flow
- �Uses two wavelengths of light, one red and one infrared, measuring only the functional hemoglobin
- �Uses two light emitting diodes (LED) to transmit light through a capillary bed to a silicone photodiode detector
- Reference picture in PowerPoint handout
Basic Components of IPPB
- Ambient chamber
- Pressure Chamber
- Center body
- Venturi / Venturi gate assembly
- Ceramic switch / Clutch plate assembly
- Permanent magnet
Centerbody components of IPPB
- �Contains many of the controls:
- �Venturi / venturi gate assembly
- �Ceramic switch / clutch plate
- �Timing cartridge
- �Hand timing rod and clutch plate magnet relationship
Various controls on an IPPB
- Expiratory timer
- Flow rate control
- Sensitivity control
- Pressure control
- Air mix control- know flow and Fio2s when on and off and position for on and off
- Exhalation valve
Bird mark 7A contains what controls?
- on/off switch
- inspiratory flow rate
- air mix control difference (always in employment on 7A)
- pressure/time trigger control
- apneustic flowtime
To obtain minimal accepted IPPB tidal volume: (for medication delivery)
10-15 mL/Kg of ideal body weight
- Ex. 5�3�� woman
- IBW in Kg = 54.5 or 55
- 55 X 10 = 550
- 55 X 15 = 825
- 30% of predicted Inspiratory Capacity
- *Multiplying the IBW in Kg by 50 will give the predicted Inspiratory Capacity, you are looking for 30% of that volume.
55 X 50 X .30 = 825
To obtain the Target Volume or Goal: (for hyperinflation)
75% of the predicted Inspiratory Capacity
- Ex. 5�3�� woman
- IBW in Kg = 54.5 or 55
*Multiplying the IBW in Kg by 50 will give the predicted Inspiratory Capacity, you are looking for 75% of that volume.
55 X 50 X .75 = 2063
What characteristics are contained in a Flow-oriented Incentive Spirometry (IS or SMI) device?
- -The patient�s inspiratory flow rate causes a float to rise in a canister
- -The patient should maintain an inspiratory flow that slowly elevates the ball
- -Rapid inspiration will cause the float to rise too quickly but will not maintain it in a suspended position
- -Slow inspirations do not generate sufficient flow to raise the float
What characteristics are contained in a Volume-oriented Incentive Spirometry (IS or SMI) device?
- -The patient inspires until a preset volume of gas is inhaled
- -Indicators are used to motivate patients and indicate when desired volume is achieved
- -Most systems are designed to require a sustained inspiration before the achieved volume indicator is activated.
- What kind of cylinder
- What filling PSI
- What is Cylinder Size
- Who is owner
- What is original safety test date?
- What is elastic expansion "EE"?
- 1/80 (month and year)
Calculate initial Goal for IS
- Calculate IBW/2.2 to get IBW in Kg
- Multiply by 12-15 ml/kg
What are the Factors to consider when processing reuseable equipment?
Equipment processing definitions (all tables can be found in Chapter 4 of Egan)
Comparison of sterilization methods
A patient is HIV positive and test positive for acid-fast bacillus from a sputum sample. What type of transmission based precautions are indicated for this patient?
airborne precaution in addition to standard