non return valves 18 1-11
TRANSCRIPT
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NON RETURN VALVES (UNIDIRECTIONAL VALVES)
Dr.P.N.REDDYDEPT.OF ANESTHESIOLOGY
NARAYANA MEDICAL COLLEGENELLORE
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Introduction
Useful in resuscitation equipment.Remote areas where CO2 absorption not
available.Non rebreathing valve:- It directs the FGF to the patient & releases
expired air to atmos. Or to a scavenging system.
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VALVE TERMINOLOGYVALVE BODY ASSEMBLY:- It is a housing with associated internal parts
including one or more movable parts which opens,shuts or partially obstructs one or more parts.
VALVE SEAT:- It is a surface usually annular,with an opening
which maybe partially or completely obstructed by a movable part to direct or obstruct the flow.
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PATIENT PORT:- It is the part attached to the mask or ET
tube.It has female 15mm with a concentric 22mm connector.
EXHALATION PORT:A channel through which exhaled gas escape to
atm. Or scavenging system after passing through the valve.
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POSITIONAL VALVE:- It is one which must remain horizontal as it
requires gravity to close it completely.NON POSITIONAL VALVES:- It is closed by elastic tension or rubber or
spring & may be used in any position.
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FLAP VALVE:It is one in which movable part is made of
flexible material & it is secured at its centre or by its edge.
FISH MOUTH VALVE:- Its a valve in which two flaps approximate at
midpoint.
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The flow of gases in one direction causes the flaps open like a fish mouth.Reversal of flow prevents retrograde flow.
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DISC VALVE:- Consists of flat disc made of plastic or
metal.It is held in position by gravity or by a spring.
MUSHROOM VALVE:- It is a hollow balloon like device which when
inflated occludes the opening.
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CLASSIFICATION OF VALVES BASED ON MECHANICAL
CHARACTERISTICS:- Like presence or absence of springs,rubber
flaps & knife edge etc.BASED ON FUNCTIONAL CLASSIFICATION - Like spontaneous ,controlled or both.- In spontaneous respiration pressure inside
the valve is negative whereas in controlled ventilation it is positive.
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VALVES DESIGNED FOR SPONTANEOUS VENTILATIONDuring inspiration ,negative pressure closes
the expiratory valve .During expiration,positive pressure opens the
exh. Valve.If this used for controlled ventilation,exp.port
must be closed during inspiration.
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VALVES DESIGNED FOR CONTROLLED VENTILATIONDuriung insp. Positive pressure opens the
inlet valve & closes the exh. Port.During exp. Gases escape through the
exp.port.If spontaneous ventilation is allowed pt.
breathes atm. Air .These valves are used for resuscitation
purpose.
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VALVES DESIGNED FOR BOTH SP/CONTROLLED VENTILATIONAlso called Automatic non rebreathing valves.In these valves exh.port is closed & insp.port
is opened whether it is spont. Or controlled.During exh. Air escapes through unblocked
exh.port & insp.port is blocked to prevent rebreathing.
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SPECIFIC VALVESAMBU:- Classification : controlled resp.- Construction: Body is clear plastic or metal.- Contains 2 seats .- The movable part consists of yellow plastic
disc which is held on to the seat by a spring.- Locating pin centres the disc.
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AMBU contd..FUNCTION:1. When bag is squeezed, the force of gas
pushes the disc against seat B closing the exh. port & allowing gas to flow to pt.
2. During exh. The pressure on the bag side falls & the spring pushes the disc onto seat A.
3. Gases escape through exh.port.4. If pt.breathes spont. Air enters through
exh.part.
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AMBU contd..CARE & CLEANING: - it can be opened & cleaned.- Guiding pin must be inserted properly.
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AMBU E VALVECLASS:- sp/controlled.- Construction: transparent plastic with inlet
coloured blue .- Contains two moulded shutters – for inh. &
exh.
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FUNCTION:- -VE pressure during insp. Closes the exh.
shutter& gas is drawn through inlet shutter.- During contro. Venti. Positive pressure opens
insp. Shutter & occludes exh.shutter.- During exp. Insp. Shutter collapses & exp.
Shutter opens.
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If there is overflow both shutters open & vent the gases out.
EVALUATION:- Resistance : 0.6 – 0.25.- Dead space: 10ml.- Back flow: 9% of TV.
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AMBU E2 VALVECLASSIFICATION: SPONT/CONTROLLED.Construction: clear plastic body with 1
shutters.No exhalation shutter.FUNCTION:- -ve pressure during inh. Opens inh. Shutter &
also air is drawn from exh. Channel .
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It is mixture of FGF & air.During controlled venti.,during insp.
Insp.shutter occludes the exp. Channel & gases go to the pt.
During exh.insp. Shutter closes & gases go out.
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EVALUATION:- RESISTANCE: not available.- DEAD SPACE: 10ml.- BACK FLOW: 9%.CARE & CLEANING:- It can be disassembled ,cleaned with
soapwater or sterilizing solution.parts can be boiled or autoclaved.
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AMBU HESSEIt is similar to ambu E2 valve but bigger in
size.EVALUATION:- resistance :0.2 -0.9 cmH2O.- Back flow :7.3% of TV.
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FINK VALVECLASSIFICATION: SPONT/CONTROLLED.CONSTRUCTION:body made of metal.- A flexible diaphragm is positioned above the
exh.port.- A pressure tube leads from the inlet side of
the insp.flap valve to the space above the diaphragm.
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This space can communicate to the atm.through a vent.
At the top of the valve an adjustable knob which is connected to rotating disc.
Knob turned max. counterclock wise,pressure tube communicates with the space above the diaphragm& vent to atm. Is closed.
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If the knob is turned clockwise disc closes the pressure tube & vent.
At an intermediate position vent & pressure tube are partially closed .
FUNCTION:- spont: knob is turned clockwise ,insp.-ve
pressure opens the insp.flap valve & closes the exp.flap valve.
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- During exh.insp.valve is closed by exhaled
gas & it escapes through exh.port.
- Cotn.ventilation:knob turned fully counter
clockwise bag squeezes the pr in the inlet inc.
& it is transmitted to the space above the
diaphragm & it is pushed on to the exp.flap.
Gases go to the pt.
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During exh.pr in the inlet dec. ,inh.flap closes ,diaphragm goes up,exh.flap opens.
EVALUATION:- DEAD SPACE:11.5CC- BACK FLOW: NO- RESISTANCE:0.5-8cmH2O.
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CARE & CLEANING:- Can be disassembled ,washed with water &
can be autoclaved.
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FRUMIN VALVECLASSI:spont/contr.CONSTRUCTION:- Consists of a clear plastic body containing
rubber or silicon insp. flap & an inflating rubber valve which covers the exh.port.
- A pr channel connects the mushroom valve with inlet.
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FUNCTION:sp.venti.
- During insp.the insp.valve is opened & fresh air
drawn towards the pt.
- Normal resting position of the M valve seals off
the exp.port.
- During inadequate gas flow the –ve pr during
insp. Collapses the M valve & exp.port is also
opened & atm.air is drawn in.
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During contr.venti. The pr in the inlet & M
valve is same but as the area of M valve is
more it seals off the exp.valve(prmultiplied by
area).
During exh. The pr at inlet drops soalso in
the M valve & insp.valve is closed & gases go
out.
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EVALUATION:- RESISTANCE:1.5CMH2O.- No back leak.CARE:- It can be disassembled,cleaned & can be gas
sterilised.
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LAERDAL VALVECLASSI:spont/contr.CONSTRUCTION:- It is a clesr plastic body & yellow rubber
insp.fish mouth valve with a circular flange .- A circular exh.flap valve occludes the
exh.port.FUNCTION: SP.- During insp. Fish mouth valve allows air to go
to the pt.
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- exh. Flap prevents inh.of room air.- During exh.fish mouth valve closes ,gas
escapes through exh.port.- contr. Same as above.EVALUATION:- RESISTANCE:0.3-2.8CMH2O.
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CARE & CLEANING:- Can be disassembled,cleaned with
water,chemicals ,can be autoclaved.
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LEWIS – LEIGH VALVECLASSI: sp/contr.CONSTRUCTION:- Consists of a clear plastic body with a
chimney which can be rotated by 90degrees.- This changes the position of exh.valve seat at
the bottom of the chimney.- A disc type valve is located at the top of the
exh.chimney.
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FUNCTION:- Spont. vent: if flap valve is rotated counter
clockwise ,insp.gas goes to the pt. Disc valve prevents fresh air entry to th pt .During exp.flap valve seat & gas goes to the chimney.
- Contr.venti: chimney is rotated clockwise 90degrees,the flap valve can seat on either the ridge or the body or lower edge of chimney.
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- During insp. Flap valve blocks exh.valve, gas goes to the pt.
- During exp.the flap valve seats on the ridge of the body allowing the gas to the chimney & gas goes out through disc valve.
- During overflow – both valves are opened.
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RUBEN VALVECLASSI: sp/contr.CONSTRUCTION:- Clear plastic body with metal fittings .- Blue- inlet .- Red -patient- Gold -outlet.- Inside the body ,a spool shaped piston held on
to a seat A by a spring.
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- A disc type valve is near the exh.port.FUNCTION:- CONTR.VENTI – during insp. The piston is
pushed to right against seat B .- Gas enters the pt.- Exp.valve prevents the rush of atm.air.- During exp. ,as the pr drops the spring
pushes the piston against the seat A & exp.valve opens.
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Spont.vent: - exp. Valve will not be there .- Pt. takes atm air.EVALUATION:- RESISTANCE: 0.8-1CMH2O.- Back leak :5%.- Dead space : 9ml.
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DISADVANTAGES:
- Clicking noise.
- Sticking of valve in insp. Position.
- Sticking of bobbin & exh.valve.
CARE & CLEANING:
- Cleaned by flushing with soap water,chemical solutins.
Deteriorates when exposed to heat .
- Can be gas sterilised .
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STEPHEN – SLATER VALVECLASSI: spont.CONSTRUCTION:- Valve body made of metal.- Has 2 rubber flaps each secured by a shaft at
centre .FUNCTION:- insp. –ve pr opens the inh. Flap valve allowing
the gas to the pt.
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- -ve pr keeps the exh.flap closed.- Exp. -- posi pr opens the exp. Valve & closes
the insp flap.EVALUATION:- RESISTANCE – 1.75CMH2O.- DEADSPACE – 10CC.- BACKLEAK – 30CC WITH 500ML TV.
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DISADVANTAGES:- With prolonged & repeated use,exp.leaf may
curl & allow air dilution.CARE & CLEANING:- Can be washed ,gas sterilised .- Rubber valves should not be autoclaved or
boiled.
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HEIDBRINK VALVEAPL valve, exp valve or pop off valve.
It allows expired air and surplus gases to go out
without permitting entry of outside air even during
–ve phase.
The pr required to open valve must be low.
It should not allow spont collapsing of R bag.
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CLASSI: spont/contr.CONSTRUCTION: - Metal structure with a disc & spring .- Disc rests on a “knife edge” seating.- It has a stem to ensure proper position.- Clockwise closure ,anticlockwise open.- Screw down fully closes the valve.- Small grub screws & a groove prevents
falling of the valve.
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Hazards of unidirectional valves
1.External occlusion
2.Internal occlusion
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Advantages of unidirectional valves1. CO2 Absorption system avoided
2. Light weight 3. Compact4. Mobile5. Inexpensive6. Simple7. Minute volume can be estimated8. Less dead space, less resistance, less
rebreathing9. Composition of delivered and inspired gas is
same10.Better feel of lungs
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Disadvantages of unidirectional valves1. Large volumes of inspired mixture leading
to O.T. pollution2. Higher cost , Explosion 3. Noisy and sticky valves4. Some times two hands may be needed to
ventilate5. Cleaning and sterilisation is some what
difficult6. Valves must be located near the patient
possible disconnection of E.T.tube7. Increased resistance with higher flows8. Some rebreathing can occur9. Some difficulty to use with scavenging
systems
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Disadvantages of unidirectional valves
10.No standardisation among the valves11.More dead space in some valves in pediatric
patients12.Fresh gas flow must be matched to minute
volume.
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Thank u.