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Veterinary technicians must be familiar with the human safety considerations involved in veterinary anesthesia. Chapter 13. Workplace Safety. Hazards of Waste Anesthetic Gas. Sources of waste inhalant anesthetic gas

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Workplace Safety

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Workplace safety

Veterinary technicians must be familiar with the human safety considerations involved in veterinary anesthesia

Chapter 13

Workplace Safety


Hazards of waste anesthetic gas

Hazards of Waste Anesthetic Gas

Sources of waste inhalant anesthetic gas

Exhaled by patient or escaped from anesthetic machine during anesthetic period

Inhaled when emptying or filling anesthetic vaporizers

Inhaled after an accidental anesthetic liquid spill

Measurement of waste anesthetic gas in parts per million (ppm)


Hazards of waste anesthetic gas cont d

Hazards of Waste Anesthetic Gas (Cont’d)

Short-term effects of exposure to high levels of waste anesthetic gas

Direct effect of anesthetic agent on brain neurons

Resolve spontaneously when area is left

Frequent occurrence indicates excessive waste gas levels


Workplace safety

Long-term effects of exposure to high levels of waste anesthetic gas

Serious health problems

ReproductiveOncogenic

HepaticRenal

HematologicNeurologic

May be the result of toxic metabolites produced by the liver

Anesthetics eliminated through the lungs are less likely to produce long-term effects

Hazards of Waste Anesthetic Gas (Cont’d)


Long term effects of high level exposure to waste anesthetic gas

Long-Term Effects of High Level Exposure to Waste Anesthetic Gas

Reproductive effects

Risk of spontaneous abortion

Infertility

Congenital anomalies in children

Oncogenic effects

None of the commonly used agents are associated with an increased risk of developing cancer

Hepatic effects

Hepatotoxicity

Rare, most common with halothane exposure


Long term effects of high level exposure to waste anesthetic gas cont d

Long-Term Effects of High Level Exposure to Waste Anesthetic Gas (Cont’d)

Renal effects

Possible renal toxicity with methoxyflurane exposure

Neurologic effects

Possible loss of motor skills and short-term memory

Possible increased incidence of neurological disease

Hematologic effects

Possible bone marrow abnormalities


Measuring waste gas levels

Measuring Waste Gas Levels

Highest levels are in surgery suites, surgical prep rooms, and anesthesia recovery rooms

Highest levels during the anesthetic period are nearest the anesthetic machine

Factors that determine levels

Duration of anesthesia

Flow rate of carrier gas

Anesthetic machine maintenance

Effective scavenging system

Anesthetic techniques used

Room ventilation (15-20 air changes per hour is ideal)

Anesthetic spills


Reducing exposure to waste anesthetic gas

Reducing Exposure to Waste Anesthetic Gas

Use a scavenging system

Collects waste gas from the anesthetic machine and conducts it to a disposal site outside the building

Installation and consistent use are most important factors

Include exhaust from anesthetic machine, nonrebreathing systems, ventilators, anesthetic chambers, and capnometers

Active (high vacuum, low vacuum) or passive

Active system with dedicated vacuum pump is most efficient

Passive system is least expensive and is best used in rooms with exterior walls


Active and passive scavenging systems

Active and Passive Scavenging Systems


Potential difficulties with a scavenging system

Potential Difficulties with a Scavenging System

Prevent the negative (vacuum) pressure on the breathing circuit

Reservoir bag will collapse

Negative pressure relief valve will open

Obstructions may block waste gas from entering the scavenging system

Anesthetic gas will accumulate in the anesthetic circuit

Excess pressure develops in circuit and patient’s lungs

Positive-pressure relief valve will open


Alternative to scavenging system

Alternative to Scavenging System

Activated charcoal cartridges

Used in rooms not set up for scavenging

Charcoal absorbs anesthetic vapors

Replace cartridge every 12 hours or when weight increases 50 g

Don’t absorb nitrous oxide vapors

Inefficient at flow rates >2 L/min

Masks with charcoal filters

Worn by personnel at special risk

Not effective for nitrous oxide

Don’t use masks designed for particulate matter


Reducing exposure to waste anesthetic gas1

Reducing Exposure to Waste Anesthetic Gas

Check equipment for leaks

Common sites for leaking equipment

Nitrous oxide connections not tightly secured

Rings, washers, other seals joining tanks to machine hanger yokes are missing, worn, or out of position

Covering of unidirectional valve is not tightly closed

Carbon dioxide absorber canister is not securely sealed

Pop-off valve/scavenger connection is not airtight

Holes in or loose connections for breathing hoses, reservoir bag, or ET tubes

Vaporizer cap missing


Types of leak tests for anesthetic equipment

Types of Leak Tests for Anesthetic Equipment

High-pressure tests

Check for leaks between the gas tanks and the flow meter

Gas pressure ≥50 psi

Only oxygen or nitrous oxide (the carrier gasses) is released through any leaks


Types of leak tests for anesthetic equipment cont d

Types of Leak Tests for Anesthetic Equipment (Cont’d)

Low-pressure tests

Check for leaks in the anesthetic machine and breathing circuit

Gas pressure ≤15 psi

Oxygen, nitrous oxide, and anesthetic gas released through any leaks


Reducing exposure to waste anesthetic gas2

Reducing Exposure to Waste Anesthetic Gas

What type of leak test to perform

High-pressure and low-pressure: both nitrous oxide and oxygen carrier gasses

Low-pressure test alone: oxygen carrier gas alone

Low-pressure test: prior to machine use each day

High-pressure test: nitrousoxide tank weekly or when tank is changed

Leaks may be found by locating a hiss of escaping air or by using a detergent solution

Don’t use machine with a leak until the source of the leak has been identified and repaired


Monitoring waste gas levels

Monitoring Waste Gas Levels

Important considerations

Hospital employee becomes pregnant

Odor of anesthetic gas is frequently detected

Special concerns about waste gas levels

Professional monitoring

Accredited industrial hygiene laboratory

In-house monitoring

Detector tubes or badge dosimeters


Safely handling compressed gases

Safely Handling Compressed Gases

Fire safety

Oxygen and nitrous oxide support combustion

Static electricity can cause fire when oxygen and combustibles are present

Eliminate all sources of ignition or flames from any room where cylinders are stored or used


Safely handling compressed gases cont d

Safely Handling Compressed Gases (Cont’d)

Use and storage

Cylinders are storehouses of large amounts of energy

Wear impact-resistant goggles when connecting cylinders to anesthetic machine

Turn valve slowly and with proper wrench when turning on the cylinder

Chain or belt cylinders to wall

Store in an upright position to prevent damage

Store cylinders away from high traffic areas

Don’t drag or roll a cylinder

Keep full and empty cylinders separate

Label with tear-off labels

Use cylinders in the order they are received


Labeling compressed air cylinders

Labeling Compressed Air Cylinders


Accidental exposure to injectable agents

Accidental Exposure to Injectable Agents

Opioids used for restraint and capture of wild animals

Etorphine (Immobilon, M99) and carfentanil (Wildnil)

More potent than morphine

Absorbed through mucous membranes or broken skin

Accidental exposure through accidental injection, eye splash, or oral ingestion


Accidental exposure to injectable agents cont d

Accidental Exposure to Injectable Agents (Cont’d)

Precautions

Become educated on potent opioids before using them

Don’t work alone and wear gloves when using potent opioids

Have reversal agents drawn up and ready for use

Have a treatment plan in place

Dispose of needles and syringes in a closed container immediately


Accidental exposure to injectable agents cont d1

Accidental Exposure to Injectable Agents (Cont’d)

Cyclohexamines (ketamine, tiletamine)

Accidental eye splash may cause disorientation, excitement, dizziness, or unconsciousness

Alpha2-agonists

Xylazine, detomidine, medetomidine, dexmedetomidine

Accidental injection or skin contact may cause sedation, hypotension, bradycardia, respiratory depression, coma


Accidental exposure to injectable agents cont d2

Accidental Exposure to Injectable Agents (Cont’d)

Precautions

Personal protective equipment

Carefully load syringes

Properly dispose of needles and syringes

First aid, including eye wash, readily available


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