paediatric reservoir bags: just how easily do they burst? jocelyn erskine st5 graham bell consultant...
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Paediatric reservoir bags: just how easily do they burst?
Jocelyn Erskine ST5Graham Bell Consultant Anaesthetist
Kevin Jerome ODPRHSC, Glasgow
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Background Patients inadvertently connected to circle breathing system with APL fully closed
Risk of developing high pressure within breathing system and possibility of transmission to patient
Decision to conduct a quality control study to investigate how much pressure a reservoir bag can withstand
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MethodsPre-used closed Intersurgical® reservoir bags
0.5, 1 and 2 litre sizes from cohort of batch numbers
Digital pressure monitor
Penlon Prima SP® anaesthetic machine
Outwith standard operating hours
1 pair of ear defenders!
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Druck® Digital Pressure Indicator
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MethodsPressure monitor connected to expiratory limb of circle via standard oxygen tubing
Patient end of the circle occluded
APL fully closed, bags inflated with an oxygen/air mix
Maximal pressure prior to each bag bursting recorded in cmH2O
iPhone App (Multi Measures, SkyPaw Co. Ltd) measured max decibels at bursting
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Testing apparatus
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Results91 bags: 45 x 0.5L
39 x 1L
7 x 2L
Bag size (Litres) Pburst (cmH2O) Max dB
0.5 48.3 (6.2 [31.0-60.5])
99.5 (2.3 [94-105])
1 48.7 (6.3 [35.9-61.5])
101 (1.5 [95-101])
2 32.1 (5.6 [24.5-39.5])
100 (0.7 [99-101])
Results are mean (SD[range])
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Pattern of bursting
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DiscussionOne of the main functions of the reservoir bag is to limit the pressure within the circuit
Law of Laplace: P= 2(tension)/R
Intersurgical® bags: made of vulcanised rubber, subjected to ISO standard quality assurance checks
No measurement of pressure required to burst bag
Bags burst at pressures <60cmH2O
Inconceivable it wouldn’t be noticed!
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AcknowledgementsThanks to:
Graham Bell & Kevin Jerome
Medical Physics, RHSC
MRI Dept, RHSC
Adrian Cox at Intersurgical