InternationalNepalFellowshipCamps Anaesthesia equipment list and setup guide

Anaesthetic box contents listITEM SIZE QUANTITY

Ambu bellows & non rebreathing valve adult 1

paed 1

neonate 1

Ampoule file

Blood giving sets 2

Catheter mounts

Chest drain

Elbows & connectors for pipes various

ET cuff forceps

ETT cleaning brushes

ETT introducers

ETT portex adaptors

ETT sets various

Face masks (Rendel Baker) 1

Face masks (various sizes) all

Laryngeal mask airways

Laryngeal spray (Forrester)

Laryngoscope set - Magill curved blades large 1

medium 1

small 1

Laryngoscope set - Magill straight blades medium 1

small 1

Magill’s forceps 1

Mini tracheotomy set - adult 1

Mini tracheotomy set - paed 1

Nasogastric tubes (10; 12; 14; 16) 1 of each

NG tube

OMV (halothane & trilene)

OMV bellows

Pharyngeal airways (various sizes)

Plastic bags for oxygen

Scissors

Space blanket 3

Sphygmomanometer + adult & child cuffs 1

Spirit swab container & swabs

Stethoscope 1

Suction catheter (to pass via ETT) 10 2

12 2

14 2

16 2

Tape

Towels for trollies 10

Tourniquet

Tray for drugs 2

Waste gas exhaust pipe (4 metres) 2

Yankaur sucker (plastic & metal) 2

Emergency boxITEM SIZE

SIB (Ambu) bag

Masks small, medium, large

Airways 40mm, 50mm, 1, 2, 3

Laryngoscopes Child, Adult

Magill’s forceps Child, Adult

Introducer Child, Adult

Gum Elastic Bougie [NB Long medium sized bougie taped to box lid]

Child, Adult

RAE ETT’s 3, 4, 5, 6, 7 cuffed, 6.5 Armoured cuffed, Cuff syringe 20 ml

No 3 LMA

Catheter mount

Mini Tracheotomy kit

Learning guides and photosIf you are unfamiliar with this equipment we suggest:

A. You set up the circuit as shown in the photos and described in the learning guide.

Adult circuit is labelled 1 to 12 from Upstream to Mask [Photo 1 to 4]

PHOTO 1 - FULL ADULT CIRCUIT

PHOTO 3 - OXFORD INFLATING BELLOWS (OIB) NOS. 7 TO 10. NB. MAGNET

PHOTO 2 - UPSTREAM NOS. 1 TO 6

PHOTO 4 - DOWNSTREAM 11, 12, MASK, EXHAUST

Paediatric circuit is the same from 1 to 7. Then add ABC [Photo 5, 6]. NB. The Oxygen inlet bung is needed if this AMBU bag is used in this anaesthetic circuit. It should be removed for direct oxygen, if needed for resuscitation.

B. You set up the tray of Emergency Airway equipment as shown in the photo and list. (Photo 7).

PHOTO 7 - EMERGENCY AIRWAY EQUIPMENT

PHOTO 5 - FULL PAEDIATRIC CIRCUIT NOS. 1 TO 7 SAME AS ADULT PHOTO 6 - PAEDIATRIC CIRCUIT DOWNSTREAM ABC

Note bung over oxygen inlet on the bag because, in the circuit, oxygen is delivered upstream of the vapourisers. This bung should be removed to give direct oxygen with this ambu bag for resuscitation.

- SIB (Ambu) bag- Masks: small, medium, large- Airways: 40mm, 50mm, 1, 2, 3.- Laryngoscopes: Child, Adult.- Magill’s forceps: Child, Adult- Introducer: Child, Adult- Gum Elastic Bougie: Child, Adult. NB Long

medium sized bougie taped to box lid.- RAE ETT’s: 3, 4, 5, 6, 7 cuffed, 6.5 Armoured cuffed., Cuff syringe 20 ml.- No 3 LMA- Catheter mount- Mini Tracheotomy kit.

EMERGENCY AIRWAY EQUIPMENT INCLUDES:

C. Please remember to draw up your Emergency drugs; Atropine, Suxamethonium and Adrenaline.

D. Remember to check the Oxygen cylinder, the oxygen concentrator, suction, monitors and table tilting.

Then… Relax, be safe and ENJOY!

NOTE: Please do not add any extra equipment without first consulting the INF anaesthetist responsible for Camps.

Setting up theatreKEY OMV = Oxford Minature Vapouriser OIB = Oxford Inflating Bellows SIB = Self inflating bag (Ambu type)

1 CONSTRUCT THE CIRCUITa. Collect all components of the drawover apparatus (anti-static tubing with connector pieces, face masks (size: 3 and 4), x 2 OMV vaporisers, valve, tubing from oxygen supply, oxygen inlet connector and OIB plus magnet.

PHOTO 1 - FULL ADULT CIRCUIT

PHOTO 3 - OXFORD INFLATING BELLOWS (OIB) NOS. 7 TO 10. NB. MAGNET

PHOTO 2 - UPSTREAM NOS. 1 TO 6

PHOTO 4 - DOWNSTREAM 11, 12, MASK, EXHAUST

PHOTO 5 - FULL PAEDIATRIC CIRCUIT NOS. 1 TO 7 SAME AS ADULT PHOTO 6 - PAEDIATRIC CIRCUIT DOWNSTREAM ABC

b. Inspect the equipment to ensure that it is clean and dry

c. Check the tubing connectors are well fitting

d. Inspect the valve to see that both leaflets are in place

e. Fix the magnet over the patient-end valve of the OIB [PHOTO 3], provided you are using the Ambu E valve at the facemask in step 1.

f. Ensure that the OMV levers move freelygIdentify the flow direction of the 2 OMVs and connect together so direction is same for both, halothane upstream [PHOTO 2]

h. Attach the oxygen inlet connector directly upstream to the halothane OMV [PHOTO 2]

i. Attach the oxygen reservoir tubing and oxygen supply tubing to the oxygen inlet connector

j. Attach tubing between trilene vaporiser (upstream) and OIB (downstream)

k. Connect I m anti-static hose to patient-end of OIBlAttach inlet part of patient valve to this tubing, above [PHOTO 4]

m. Attach oxygen supply tubing to oxygen supply

n. Check and tighten all connections

o. Check the vapourisers contain anaesthetic agents

p. Assemble paediatric ambu bag and connector

2 CHECK CIRCUIT FUNCTIONS CORRCTLYa. Inflate and deflate OIB – action should be easy – feel air expelled via the patient port of the valve

b. Occlude the patient port of the valve – depression of the OIB should be impossible

c. Occlude the oxygen reservoir tubing and attempt to inflate the OIB – bellows should only rise with difficulty

d. Connect the face mask to the expiratory port of patient valve

PHOTO 6 - PAEDIATRIC CIRCUIT DOWNSTREAM ABC

3 PREPARING THE OXYGEN SUPPLYa. Connect oxygen tubing to the outlet of the oxygen concentrator, if available

b. Plug in and turn on the oxygen concentrator

c. Ensure output from oxygen concentrator at 2 and 6 I/min AND

d. Connect oxygen tubing to the outlet of the oxygen cylinder

e. Make sure the oxygen rotameter is turned off

f. Open the oxygen cylinder and check pressure gauge

g. Open the rotameter to ensure oxygen can be supplied, then close again

4 PREPARE SUCTION APPARATUSa. Collect suction apparatus, tubing and suction/Yankauer suckers

b. Connect tubing and catheter/Yankauer

c. Ensure it reaches the patient’s headdPlug in and turn oneCheck for good suction

5 CHECK OPERATING TABLE FOR HEAD DOWN AND LEFT LATERAL TILTIf lateral tilt not functioning, make a sandbag. If head down not functioning, improvise with e.g. stool on side under foot end.

6 PREPARE FOR BAG & MASK VENTILATIONa Collect the correct sized equipment ( SIB, mask, airways )

PHOTO 7 - EMERGENCY AIRWAY EQUIPMENT

7 PREPARE FOR INTUBATIONa. Collect appropriate size ETTs, x2 laryngoscopes, Magill’s forceps, tape, air syringe 10 ml, intubation tray, stylet and a tray for used equipment, Stethoscope

b. Collect and check the SIB

c. Check the ETT cuffs and deflate fully

d. Check the laryngoscopes function correctly

e. Insert the stylet into an ETT and fix so that the end of the stylet remains in the ETT near its end

f. Put the ETT with stylet, syringe and l laryngoscope in to the intubation tray

g. Add mini tracheotomy kit [PHOTO 7]

8 PREPARE IV FLUIDSa. Collect necessary equipment (cannula, alcohol swab, infusion set, IV fluid, drip stand, tourniquet and tape)

b. Choose appropriate sized cannulacSelect the appropriate infusion fluid

9 PREPARE ANAESTHETIC DRUGSa. Draw up atropine 0.6 mg and suxamethonium 100 mg into labelled syringes and have available adrenaline 10 mls of l:l0,000

b. Have ready other anaesthetic drugs as required - thiopentone, ketamine, ephedrine or mephentamine, diazepam, analgesic

c. Collect an adequate supply of needles and syringes

d. Collect bins for rubbish and for “sharps”

e. Collect spinal anaesthesia set

10 PREPARE MONITORS