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 Manual @2005
Valley Anesthesia Educational Programs, Inc'

EQUIPMENT
Self-StudY

The Anesthesia Machine

Basic Arrangement of Gas Connections on Back of Machine

Po'or Outlrt lor Ptp.lt!. IDLt lot Ptp.lt!. Ialrt for

V.BtlLtot Orrgr.! ntt'out Orld.
I
I
I
I

Gas Connections

o DISS (Diameter lndex Safety System)

o On back of gas machine
o Quick connectors (Push on)
o Each indexed for a specific gas and not interchangeable
Pipeline lnlet
oxygen FIow From the Wall Supply opens the Check Valve in the

tE 6rIf.d,
Ptw.n4[fad

Cra.dbt UlDat

Check Valves
oxide
o wall gas hose to machine has pressur e of. 40-so psig for oxygen and nitrous pressure'
to
o check valve in pipeline inlet aisembly is a floating valve and seats according
o What is the function of this valve?
anesthesia machine
Answer:prevents oxygen cylinder gas from escaping the

Gas Machine
 Valley Anesthesia Educational Programs, Inc.
Manual @2005

Power 0utlet to the Ventilator with Check Valves

o Power outlet valve for ventilator

Orrlctn o DISS fitting
L.tlr O Ball and spring type valve
O When connected properly, the fitting (DISS)
!€!d.r, Cbcf pushes against the ball bearing and opens
V.lt
valve for orygen flow
n dr apdDg

Vdr 3t@ of
Ftury Ch.cf V.fn

DI3S rtt.bs lq
Ot f[!

OrtgaPomrBa.
b VaEdldot

Power Outlet Valve

Hanger Yoke Showing the Oxygen FIow From the cyrinder lnto the Machine

CLcL V.!r. n bb.r thl!.r

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'tL.!i!g- Ch.cl
V.h tt! hd.r
Contlgmion

Hanger Yoke Valve

o Hanger yoke valve
o The yoke assembly has pins for E cylinders to fit on. The oxygen pin index is 2, s and nitreus oxide is
3,5
O Acts as "safety" valve
o opens with preszure and closes with pressure (i.e., free floating valve)
o Prevents a full cylinder from emptying into an empty .ytind"il*"tioxygen from entering
a cylinder

Gas Machine 2
Valley Anesthesia Educational Programs, Inc. Manual @2005

Position of Hanger Yoke Valves When One 0xygen Cylinder is Turned 0n in a Double-Yoke Assembly

Question: What is the name of the gauge that

shows oxygen tank pressure?
Answer: Bourdon

VdE s.rt Gsl.t YoL. Plug

Double-Yoke Assembly

An lnside look at the Regulator as Oxygen Pressure ls Reduted

Adlurla.ar Ssr

adlu.@D. SPrlag

Y.ln Tlst DIE

ll!'h Pr.rur. laLt
hlm
Cb.EDar

ldrt*wo$ld
-

Vrh Rn ld4
Sprtng
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Oxygen Regulator

Oxygen cylinder pressure regulator

O First stage regulator
ICylinder pressure decreased to 40-50 psig (intermediate pressure)
IServes both yokes
IThis is a diaphragm valve
O Second stage regulator

3 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005

r Reduces pressure of 40-50 psig to 16 psig (intermediate to low pressure)

r Receives wall pressure oxygen or oxygen from first stage regulator
r Diaphragm valve
The 0xygen tlush Valve in the 0pen Position o Oxygen flush valve(anesthetist's panic button)
O Oxygen delivered directly to patient at a rate of
35-75 L/minute
O Pressurized at 40-50 psig from wall or cylinder
O Dilutes anesthetic gas

1T
Oxygen Flush Valve-Open

The Oxygen Flush Valve in the CIosed Position

Lll V.lF k i!t4

3Fi{

L!

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Oxygen Flush Valve-Closed

Gas Machine 4
Valley Anesthesia Educational Programs, Inc' Manual @2005

Pressure Sensor Shut-offValve in the 0pen Position Pressure Sensor Shut-offValve in the Closed Position

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Pressure Sensor Shut-off Valve-Closed

Pressure Sensor Shut-off Valve-Open

o Pressure sensor shut-offvalve or oxygen failure pressure device

O Senses oxygen pressure at 50 Psig
o Shuts off nitrous oxide
o Oxygen pressure must maintain at least 25 psigto keep valve open
O Pin and spring type valve
o Senses preE$rg only not flow delivery
The 0xygen Flow Meter and the Flow Control Valve

;;;---

Oxygen Flow Meter and

Control Valve

o Oxygen flow meter and flow control valve

O Deliver gas to patient circuit
o Receives low pressure (16 psig)
o Needle valve
O The Thorpe tube is gas specific and tapered with largest diameter at the top

5 Gas Machine
 Valley Anesthesia Educational Programs, Inc. Manual @2005

The Check Valve located Between the Vaporizer 0utlet and the Machine 0utlet

olill.a
Ct6.d Paltlca

Check Valve Between Vaporizer Outlet and Machine Outlet

o Check valve between vaporizer outlet and machine outlet (not present on all machines)
o Prevents reversal offlow to vaporizer
O Free floating type valve (stiffer)
Gas Flow Through the lnhalation Check Valve During lnspiration

Rabd

tlr Aborlrr

Check Valve During Inspiration

Question: What happens if the inspirator), valve sticks open?

Answer: The expiratory volume will exhaust through the inspiratory limb. The ETco, waveform will
become elevated.

Question: What happens if the expiratory valve sticks open?

Answer: Due to the path of least resistance, the inspired volume will not enter the endotracheal tube but
instead will bypass and exhaust throught the expiratory limb.

Gas Machine 6
Valley Anesthesia Educational Programs, Inc. Manual @2005

o lnspiration and expiration check valve (flutter valves)

o Permits direction of gas flow to and from the patient (unidirectional)
o Opening is limited by a retainer
. APL valve (pop off)
o Adjusts the limit of pressure in the patient circuit and rebreathing bag
O Tightening the knob will increase the pressure
o Attached to the exhalation check valve
o Absorber gas flows
o On inspiration the gas flows through the inhalation check valve and soda lime
O Gas flours down thr"ough the soda llme, directly from the common gas outlet, and from the rebreathing
bug
o Flow of gases opens the inhalation valve
o On expiiation gas flows through the exhalation check valve to the APl/rebreathing bag

?ctuhd{

APL Valve Absorber Gas Flows

7 Gas Machine
Valley Anesthesia Educational Programs, Inc. Manual @2005

Gas Flow Through the Exhalation Check Valve During Expiration

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Gas Flow Through Check Valve

(ourse of Gas Flow Through the Absorber During the Exhalation Phase of Respiration

Gas Flow Through the Absober During Exhalation

Gas Machine 8
 Manual @2005
Valley Anesthesia Educational Programs, Inc'

System
The Flow ofWaste Gases Through the lnterface Manifold ofa Gas Scavenging

Flow of Waste Gases Through the Interface Manifold

Waste gas scavenging sYstem
o Receives gas from the machine (APL) and ventilator
room if pressure
O positive pressure relief valve will allow gas to escape from the system to the operating
builds up in the sYstem
present'
o Wall evacuation system requires the needle valve to be properly adjusted. lfexcess flow is
not the positive pressure relief
then the negative pressure ielieve valve will open and if flow is enough
valve opens and waste gas enters the operating room
needle
o Adjusting the needle valre alters the flow of waste gases into the vacuum source; adjusting the
valve does not regulate vacuum or suction.

9 Gas Machine
 Valley Anesthesia Educational Programs, Inc. Manual @2005

Vaporizer: Tipped and then leveled

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Vaporizer Flow

Question: what will happen when the vaporizer is tipped then leveled?
Answer: Liquid vapor will get into the vaporizer chamber and the carrier flow will carry more agent to the
patient.

Question: What does this mean?

Answer: More agent picked up means a higher concentration of agent delivered to the patient. It may be a
lethal dose.

Question: What do I do?

Answer: Do NOT use the vaporizer; send it back to the company for recalibration.

Gas Machine l0
Valley Anesthesia Educational Programs, lnc. Manual @2005

High, lntermediate, and Low Pressure Components

r (cylinder
The anesthesia machine consists of three pressure system components. The high pressure
pressure) side includes the cylind", pr"rru.. gauge (Bourdon), the check valves in the hanger yoke, and
the index pins on the hanger yoke. High pressure is cylinder pressure.

o The intermediate pressure portion of the machine includes the flush valve, second stage regulator, oxy-
gen pressure "failsafe" shut-off valve, pressure gauges from pipeline, and diameter index safety system
a.rd flo* control valve of manifold. This can be hospital piped-in gas (55 psi) or cylinder gas after the
first stage regulator.

o The low pressure portion of the machine includes the vaporizer(s), common gas outlet, manifold, and
check valves. Low pressure is 16 psi and is the pressure a,fter the second stage regulator.

HoeVitaltNall
?regsure
45-55 psi

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yr
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is
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re

Component Pressures

11 Gas Machine
 Valley Anesthesia Educational Programs, Inc. Manual @2005

5ummary
There are three primary valves in the gas machine, and each has its own special function. I(now these
valves and their special functions.

The first valve is the "free floating" valve. This valve moves in the direction it is being pushed by gas flow.
The valve can be found, for example, in the D.I.S.S. and dual hangar yolk systems. The primary function of
any free floating valve is to prevent gases from leaking out of the system. A pressurized system from the
cylinders will push these valves closed to prevent gases from escaping or leaking out of the system.

The second valve is a ball and soring valve. and its function is to permit gas flow after you have made a con-
nection such as plugging the gas lines into the wall. You supply the energy to make this valve function prop-
erly. If the connection is not complete, the gas flow will not occur. I like to call this the "all-or-none" valve
because it is either hooked up correctly with the gas flow or is not. There is no in between. The orygen
flush valve is an "al1-or-none" valve because you supply the energy to make it work. When you take you
thumb off, gas flow stops.

The third valve is a diaphragm valve. There are two of these valves in the machine, the first and second
stage regulators. Remember these valves reduce pressure, and that is all they do. The first stage regulator
takes cylinder Pressure and reduces it to 55 pounds per square inch gauge (prig), which is the same as the
hospital wall pressure. Remember there are only two valves that reduce pressure.

The special. valves you need to review and understand are:

. D.I.S.S.
a oxygen flush valve
o single hanger yoke
r dual hanger yoke
t oxygen pressure sensor valve
o pop off valve
Complications Related to 6as Machine Management
o Hypoxia (inadequate orygenation of arterial blood)
o Failure to deliver adequate oxygen to alveoli may be caused by poor alveolar ventilation or low FiO2
o Factors that may cause a failure to deliver adequate oxygen to the alveoli
r Empty oxygen cylinder
r Incorrect cylinder on oxygen yolk
r Closed oxygen cylinder valve
r Orygen flow meter off
I Oxygen leak within the machine or flow meter
I Incomplete or absent circuit unidirectional valves
r Breathing circuit leak
I Inadequate ventilation

Gas Machine 12
Valley Anesthesia Educational Programs, lnc' Manual @2005

o Hypercarbia
O Factors that may cause hypercarbia
r Patient factors
tr Central respiratory depression
tr Muscle relaxants
EI Motor blockade
tr Airway obstruction
D Severe intrapulmonary shunting
r Delivery system problems
tr Apnea (not ventilating)
tr lnadequate minute ventilation
E Increased dead space in apparatus
tr Missing unidirectional valves
EI Incorrectly assembled circuit system
tr Exhausted carbon dioxide absorbent
tr inadequate fresh gas flow

Primary and Selected References

1. Bowie and Huffman, Anesthesia Machine, 1985
2. Dorsch and Dorsch, Understanding Anesthesia Equipment, l99B
3. Sosis, Anesthesia Equipment, L997

MemoryMaster Content (2005 edition)

IIA1; IIA2; IIA3;IiA4; lE3.

13 Gas Machine
 Valley Anesthesia Educational Programs, Inc. Manual @2005

Quick Quiz: Gas Machine

1. The function of this valve is to change pressure:
a. Cylinder valve
b. First stage regulator
c. Fail safe valve
d. Flow meter
2. This valve regulates the flow of N2O via oxygen pressure:
a. Cylinder valve
b. First stage regulator
c. Fail safe valve
d. Flow meter
3. This is a"free floating" valve:
a. Cylinder valve
b. First stage regulator
c. Fail safe valve
d. Flow meter
4. This valve has a special "diaphragm" which identifies the function:
a. Cylinder valve
b. First stage regulator
c. Fail safe valve
d. Flow meter
5. The waste gas scavenging system has an adjustment knob and when you turn the knob you regulate:
a. Vacuum
b. Suction
c. Flow
d. Pressure
6. If this gas scavenging knob was not adjusted properly and there was not enough gas evacuating, what
would happen?
a. The negative pressure valve would open
b. The positive pressure valve would open
c. Low pressure alarm would sound
d. The reservoir bag would empty
7. Gas flowing through the oxygen flush valve is:
a. Used to deepen the anesthetic level
b. At a rate of 3 L/min
c. Intermediate pressure
d. Regulated by a free-floating valve
8. Your flow meter float is read at the and if broken it will
a. Bottom; fall
b. Top; go up
c. Bottom; go up
d. Top; fall
9. If a vaporizer accidentally gets knocked over and then used, would the concentration to the patient
read differently than dialed?
a. The patient only receives what is dialed
b. The patient concentration would be greater
c. The patient concentration would be less
d. None of the above

Quick Quiz: Gas Machine t4

Valley Anesthesia Educational Programs, lnc' Manual @2005

10. The low pressure alarm on your gas machine is sounding. What happened?
a. patient is biting the tube
b. Patient's respiratory rate is > 25lmin
c. Disconnection has occurred in the circle
d. Pressure has increased in the circle

ANSWERS:I, b;2,c;3,a;4,b;5,c;6,b;7, c;8, d;9, b; 10, c'

t5 Quick Quiz: Gas Machine

Valley Anesthesia Educational Programs, Inc. Manual @2OOS

COMPRESSED GAS CYLINDERS

Self-Stady

Compressed Gas
Defined by the Department of Transportation "as any material or mixture having in the container either an
absolute pressure exceeding 40 lb/inz at 130"F, or both; or any liquid flammable material having a vapor
pressure exceeding 40lb/in2 at 100'Fl'

Al[ compressed gas cylinders are constructed according to Interstate Commerce Commission specifica-
tions.

The medical and anesthetic gases have a specification number of ICC3S and this marking must be placed
on each cylinder.

o Cylinders are constructed entirely of steel that meets certain chemical and physical requirements.
o The cylinder walls are 3/8 of an inch thick.
o Some cylinders are constructed of chrome molybdenum alloy.
o The given pressure in a tank is called the service pressure.
o Cylinders are pressure tested to L.66 (5/3) their service pressure.
a Each cylinder must have some tensile strength but must not exceed 10%.
a Each cylinder must be subject to a test by interior hydrostatic pressure at least once every five years.
Standards
The Federal Food, Drug, and Cosmetic Act also regulates the medical gases contained in cylinders. Their
potency and purity are set by the standards of the United States Pharmacopeia.

The medical gas industry generally expressed the contents of full cylinders in terms of gallons measured at
70"F and normal atmospheric pressure, and liquefied gases in cylinders are expressed in terms of weight.

o Department of Transportation (nor) - established requirements for the design, construction, testing,
marking, labeling, filling, storage, handling, maintenance, and transportation of compressed gas cylin-
ders.

o Compressed Gas Association (cce) - sets standards of safe practice. Has no legal force but compliance is
basis for accreditation by IcaHo.

a National Fire Prevention Association (Nrle) - same as for CGA - contains recommendations for the loca-
tion, construction, and installation of bulk oxygen systems (Nrne so)

o American National Standards Institute (nNst) - sets basic performance and safety requirements for com-
ponents of anesthesia machines, endotracheal tubes and connections, pressure and vacuum, and gas
pressure regulators.

. National Institute of Occupational Safety and Health (NrosH) and Occupational Safety and Health Act of
1970 (oSHA) - standards to protect the health and safety of workers.

o Food and Drug Administration (roe) - promulgates standards for medical devices and gases. American
(esrlt) - assesses technology and revises standards.
Society for Testing Materials

o foint Commission on Accreditation of Hospitals (lceuo) - voluntary accrediting agency.

o Pharmacopeia of the United States - develops purity specifications for medical gases.

o National Formulary - develops purity specification for medical gases.

Gas Cylinders t6
Valley Anesthesia Educational Programs, Inc. Manual 02005

Labeling and Marking

All cylinderr.n.rrib. marked according to Interstate Commerce Commissions Regulations. The lettering
must be 1/4" high.

The following 7 cylinder markings are required:

1. Regulatory body (oor). Typ" and material of the cylinder
2. Serial number
3. Purchaser, user, and manufacturer
4. Manufacturer'smanual
5. Manufacturer's identifying symbol
6. Retest date, retester, I.D. symbol, 110% filling, ten year test interval
7. Neck ring owners identification

a nb'
I LEy .Y ./
Oo^,
(a) G,?
4o
@)

@l

Figure iii-1: Compressed Gas Cylinder Labeling and Markings

Oxygen is a gas in the cylinder because it has a critical temperature below room temperature. Nitrous
oxidi is different than oxygen in this regard; nitrous oxide at room temperature is a liquid because it has a
critical temperature above room temperature.

t7 Gas Cylinders
Valley Anesthesia Educational Programs, Inc. Manual @2005

Withdrawing (ylinder Contents

o The cylinder should be open slightly for a moment to clear the outlet of possible dust. This is called
cracking the cylinder.

o There must be a suitable regulator device attached to the outlet valve.

o The adiabatic heat of compression can generate heat and cause ignition. The compression of cylinder
content into a small space generates the heat that may cause combustion.
Each valve stem on the cylinder has a safety device which under hazardous conditions of excessive heat or
fire will cause the cylinder to become exhausted. This safety device is a simple plug of soft metal alloy
called Wood's metal; it is composed of bismuth,lead, tin, and cadmium. This plug will melt at 200oF.

Primary and Selected References

1. Bowie and Huffman, Anesthesia Machine,1985, pp140-154
2. Dorsch and Dorsch, Understanding Anesthesia Equipment, 4th ed, 1999, pp3-62,75-120,937-968.
3. Sosis, Anesthesia Equipment, 1997, pp41-50, 1-10.

MemoryMaster Content (2005 edition)

IlAl; IlA2; IIA3; IIA4; IE3.

Gas Cylinders 18