PS55 2012: Minimum safe facilities for anaesthesia

 

List:

·        Staff

·        Facilities

·        Systems

·        Equipment

·        Drugs

·        Special location

 

Staff:

·        Operating room

o   Anaesthesia assistant

o   At least three people for positioning each patient

·        Department

o   Anaesthetist in charge of purchasing and management of equipment

o   Technician in charge of maintenance of equipment

 

Facilities:

·        Operating room

·        Recovery area (see PS04)

·        Uninterruptable power source

·        Emergency lighting

·        Intercom to communicate emergency calls

·        Refrigeration for fluid, blood, biological products

·        Climate control 18-28°C

 

Systems for:

·        Replacement of drug stock

·        Decontamination of equipment

·        Checking of equipment

·        Routine servicing of equipment

·        Evacuation of theatre complex

 

Clinical equipment:

Anaesthetic machine

·      Selective gas delivery

·      Controlled and calibrated gas flow rate

·      Controlled and calibrated vapourisers

·      Circle circuit +/- T piece circuit

·      Mechanical ventilator

·      HME filters for sterility

·      Scavenging

·      Alarms for high/low pressure, hypoxia

·      (TIVA infusion pumps)

Airway

·      Range of sizes where appropriate

·      Manual bag & mask resuscitator

·      Suction + Yankeur + catheters for anaesthesia use only

·      Face masks / OPA / NPA / LMA

·      ETT / stylets / bougies /connectors

·      Two laryngoscopes / blades

·      Cuff inflating syringe

·      Tapes and scissors

·      Sterile lubricant jelly

·      Magill's forceps and throat packs

·      Adhesive tapes

Vascular access

·      Range of sizes where appropriate

·      Cannulae / bungs / dressings / alcohol wipes / tourniquets

·      IV giving sets including pump sets

·      Crystalloid

Emergency

·      Defibrillator / cardioverter

·      Chest drain

·      Difficult airway equipment (if intubation common)

·      ABP and CVP (if sick patients or major surgery)

Monitoring

·      SpO2

·      NIBP

(see PS18)

 

Protective equipment:

Patient protection

·      Temperature control: blankets, forced air warmer

·      Positioning: arm boards

·      Transfer: slideboard, slidesheet

·      Pressure care: head rings, gel or foam pads

Personal protection

·      Gowns

·      Gloves

·      Masks

·      Goggles

Waste disposal

·      Ordinary

·      Biological fluid

·      Sharps

 

Drugs for adverse events:

Cardiorespiratory

·      Adrenal dysfunction

·      Anaphylaxis

·      Bronchospasm

·      Cardiac arrest

·      Cardiac arrhythmias

·      Hypotension

·      Hypertension

·      Respiratory depression

Drug-related

·      Local anaesthetic systemic toxicity

·      Malignant hyperthermia

o  24-36 x 20mg ampoules

o  Depends upon size and location of hospital

Other

·      Hypoglycaemia

·      Hyperglycaemia

·      Uterine atony

·      Raised ICP

 

Special locations:

Labour ward

·      Midwife present during and available after epidural insertion

·      If Entonox then O2 ≥30%

·      Neonatal resus equipment

o  Dedicated O2 and suction

o  Bag + mask / guedel / ETT / laryngoscope

o  IV cannula kit / IV fluid / drugs

o  Temp control e.g. radiator

ECT

·      Spont and mech breathing system

·      Oxygen source

·      Emergency backup for each of the above

·      O2 failure warning device

·      Backup breathing system

Dental

·      Chair must turn into a bed

 

 

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