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What is another name for controlling waste gas levels?
- WAGs disposal
- Scavenging systems
What is the NIOSH recommendation to OSHA about occupational exposure?
- Workers should not be exposed to an 8-hour time-weighted average of
- >2ppm halogenated agents
- >25ppm nitrous oxide
What is the purpose of scavenging?
Controlling occupational exposure to WAGs
What is the strongest relationship that can harm workers exposed to occupational waste gases?
Nitrous and reproductive difficulties
Is it normal to smell anesthetic gas during a case?
What is typical WAG level in unscavenged OR?
- 10-70ppm halogenated agent
- 400-3000ppm nitrous
What are WAG levels with minimal scavenging?
- 1ppm halogenated agent
- 60ppm nitrous
What can WAG levels get down to with meticulous scaventing?
- <0.005ppm halogenated agent
- 1ppm nitrous
What are the 2 most important factors in reduction of WAGs?
- 1) scavenger
- 2) OR ventilation efficiency
What is active scavenging?
Suction applied to WAGs
What is passive scavenging?
WAGs proceed passively down corrugated tubing through the room ventilation exhaust grill of the OR
What type of scavenging interface is safer for the patient? Why?
- Open interface
- No hazard of positive or negative pressure due to scavenger failure
What type of scavenger interface has NO audible indication of waste gas leaks?
What type of scavenger interface places providers at greater risk for occupational exposure?
With what type of scavenger interface will a hissing sound be heard during mechanical expiration or when manual bag is squeezed?
- Closed interface
- Occurs due to positive pressure relief valve opening
What happens in closed scavenger interface in the presence of negative pressure?
- 1) negative pressure >0.25cmH2O valve opens
- 2) room air enters scavenging system to break the vacuum
- 3) scavenging bag will collapse flat
What is the function of the scavenging bag?
Provides reservoir or buffer that handles surges of gas with peak inflow rates greater than continuous suction
What problem in scavenging can cause barotrauma?
Obstruction distal to interface or excess negative pressure from too much suction
What must you do in the presence of obstruction to scavenger interface or excessive negative pressure from suction?
- 1) disconnect gas collection tube from APL - very hard to do with our integrated machines
- 2) Turn off suction at scavenger interface
What are things to do to reduce WAG exposure?
- 1) good mask fit
- 2) avoid insufflation technique
- 3) prevent flow from breathing system into room air
- 4) wash out anesthetics into the breathing circuit with APL open at the end of a case
- 5) don't spill liquid agent
- 6) use low flow
- 7) used cuffed ETT
- 8) check machine regularly for leaks
- 9) disconnect nitrous pipeline connection at wall at the end of the day
- 10) TIVA
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