SPAG Delivery through the Ventilator David R. Gibson 2016

Gather Parts: Non-disposables Complete SPAG-2 set-up. 50 PSI O2 hose Blender/hoses set-up

Gather Parts: disposables 3 filters 4-22mm ID (large) adaptors 2 – Briggs “T” adaptors One-way valve Corrugated tubing PEEP valve & adapter Scissors

SPAG Set-up Drying Flow OFF 1. Set up the SPAG as normal The input should come from a blender, and Blender set same as the ventilators FIO2%. Drying Flow OFF 1. Set up the SPAG as normal See: PowerPoint on RTConnection.org explaining how, Wall outlets connections with the exception that the drying flow should be left OFF.

PEEP Relief Valve Set-up 2. Set-up PEEP valve and adapter: Set PEEP on valve to same level of PEEP on the ventilator Bacteria filter between briggs “T” and PEEP valve

Vent Circuit Set-up Patient wye 3. “T” into inspiratory limb about a tidal volume length away (two 50cc sections for each 100cc tidal volume) 4. Use a one-way valve to avoid loss of tidal volume during inspiration. Tidal Volume Length away One-way Valve goes this direction To SPAG

Other Considerations Assess for obstruction frequently! Suction PRN Watch for sudden high pressure limits May need to changes expiratory filters Discard HME during SPAG delivery, and replace afterward.

Expiratory limb Set-up Q2 ! Place two filters on the expiratory limb. Change Q2 hours…with each vent check

Summary view