Humphrey ADE Circuit - How to prime without gasing yourself?

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

James Colver Cert. Ed, RVN — Mon, 29 Jan 2018 10:19:13 GMT

lol yes he does like a chat..

We were struggling to get patients down without priming first - although yes, we could have topped up induction agent.

Will tentatively go back to trying without priming but also keen to hear other people's experience. Also a stickler for following manufacturers' instructions.

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

Susanna Taylor — Mon, 29 Jan 2018 03:30:01 GMT

[quote user="James Colver Cert. Ed, RVN"]

Maybe give Dr. Humphrey a call! I'm sure he can explain it better than we can, he invented it after all! 01743 891140

[/quote]

Ha! only if you have half a day spare! And dont ask him why its actually called an ADE still when its not actually used as a D and/or E!

Anyhow... Its been interesting hearing peoples different opinions and experinces on this one. I 'grew up' using ADEs all the time as my training practice had 3 (goodness knows why), and generally I do like them - they encourage the use of mini lacks in small patients (the A part) and has the advantage of having some PEEP over other systems.

Effectively, with the canister on, it works just the same as any other circle. All circles need a high flow to fill them up quickly at the start. I would not recommend pre filling due to the exposure risk, and as previously mentioned its not necessary, just use a high flow rate for 10min, dump the bag a few times if needed, and if urgent, give a little induction drug top up (hardly ever needed if induced/intubated without problems)

I expect the 'thing' about pre-filling the ADE came from the reps wanting to give people something 'to do' when they said they were having problems when making the switch to a circle for possibly the first time. Like a lot of things it gets passed on. I used ADEs for years, never prefilled and never had problems,

hope helps, interested in any one elses other thoughts!

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

James Colver Cert. Ed, RVN — Sun, 28 Jan 2018 12:47:27 GMT

Maybe give Dr. Humphrey a call! I'm sure he can explain it better than we can, he invented it after all! 01743 891140

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

Courtney Scales — Sun, 28 Jan 2018 09:25:42 GMT

To me - just set the FGF higher to fill the circuit with the patient attached. It would only take 1-2 minutes to saturate the system.

How do you perform a cuff leak test when the system is full of anaesthesia gas. Seems like a potential for exposure there.

I just cannot fathom this whole concept; after 10 years and in referral nursing.. see why there is a need for it. I would rather use a tiny 0.5-1mg/kg propofol bolus if the patient started to lighten. Very rarely have I had one go to jump off the table.

Me no comprendo

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

James Colver Cert. Ed, RVN — Sat, 20 Jan 2018 14:58:11 GMT

(and I prime the circles as well)

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

James Colver Cert. Ed, RVN — Sat, 20 Jan 2018 14:55:16 GMT

Here it is -

"Notes: The main clue to a successful and quick anaesthetic is to pre-fill the system with oxygen and the vapour at a percent about 1.5 to 2 times the anticipated maintenance level eg 2.5 – 3% for isoflurane and 4-5% for sevoflurane. Once the level of anaesthesia has been reached, lower the FGFs to those recommended."

link - https://www.anaequip.com/equipment_setup/

Also see the PDF for veterinary use from the same website.

Priming the ADE is absolutely necessary, especially if using the extremely low flow rates.

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

Courtney Scales — Fri, 19 Jan 2018 17:25:52 GMT

I would also love to read the text that suggests priming it. Thanks!

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

Courtney Scales — Fri, 19 Jan 2018 17:24:28 GMT

Prime a circuit? Why does the normal 'circle' concept not work here.. EG a higher FGF for the first 10 minutes, to denitrogenise and make the system at equilibrium. The propofol shouldn't really wear off that quickly to cause a problem. Seems like a waste of time, inhalant agent and oxygen.

RE: Humphrey ADE Circuit - How to prime without gasing yourself?

Becky Jones — Wed, 17 Jan 2018 13:31:20 GMT

Yes , you get a lovely red cap to keep over the end . Ours regularly goes walk about so I suggest a designated pot is put next to the machine to keep it in ! Priming wise 2 minutes minimum and up to 5 generally .