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Hamilton T1 transport ventilator set-up guide & pre-use checks

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  • The Hamilton T1 ventilator is to be used for internal hospital transfers of PICU ventilated patients.
  • The same ventilator is used for all Paediatric ScotSTAR transfers.
  • It can ventilate all patient sizes and can give from 21 – 100% oxygen.
  • It can deliver Non-Invasive Ventilation (NIV), HiFlo as well as invasive ventilation modes. We will not be using it for mobile HiFlo.
  • It is not MRI compatible.
  • Patient monitoring during transfer will be delivered by our standard PICU Philips monitors (there is an ability to monitor SpO2 & etCO2 that we are not using on the Hamilton T1).
  • The Hamilton T1 is stored in the far right of the equipment store & should always be plugged into mains power when not in use
1. Hamilton ventilator basic views

  1. USB connector
  2. High-pressure oxygen DISS or NIST inlet fitting
  3. Low-pressure oxygen connector
  4. AC power receptacle
  5. Cooling air intake and dust filter. Do not obstruct.
  6. AC power cord with retaining clip
  7. Serial number label
  8. DC power receptacle

 

2. Setting up the ventilator

 

2.5   Circuit set-up

There are 2 potential set-ups for the transport ventilator and each requires a slightly different arrangement for checking of the flow sensor & adaptor - these are weight banded:

<15kg: For this document we will term this group NeoPaeds,
This set-up includes:

Pink expiratory flow valve (comes separately from other items below)

Blue/White vent tubing

Blue/White flow probe

Dumbbell shaped adaptor

≥15Kg: This group uses standard set up for adults
This set-up all comes in the same bag & includes:   

Blue/grey expiratory flow valve

White dual lumen vent tubing

Blue/White flow probe

Funnel shaped adaptor

 

This table summarises the different set ups:

 

Valve (type/colour)

Flowsensor

Circuit

Adaptor for pre-use check

NeoPaeds

Neonatal (pink)

Neonatal/paeds

Paediatric

Dumbbell

Adult

Adult (Blue or grey - white/plastic)

Adult

Adult

Funnel

 

 

 

 

2a. Setting up the ventilator - COVID/Flu adaptations

In-line suction should be used at all times where possible (ETT ≥ 4.0)

Please also read section 9.1 if further is required for highly infectious disease transfers

All necessary equipment is stored by the Hamilton-T1 in the PICU Store Room

In order to maintain staff safety we should adjust the circuit set-up with the following filters

Dual limb circuit (<15kg)

Attach filter to expiratory port (Intersurgical Clear Guard Midi - ref 1644000)

<4.0 ETT patient-end of circuit should be set-up as detailed below

ETT ≥4.0 should be set up as follows, with appropriate sized ventilator tubing & flow sensor & in-line suction as per the patients weight

Co-axial (Paed/Adult) ventilator tubing (≥15kg)

A - Attach connector to inspiratory port (Intersurgical Connector 22M-22F- ref 1961000S)

B - Attach filter to expiratory port (Intersurgical Clear Guard Midi - ref 1644000)

In-line suction should be used at all times where possible (ETT ≥ 4.0)

ETCO2 should be placed “above” the pink Pharma HME-F filter (this allows VT up to 900ml) as detailed below

Ayers T-piece set-up

As routine we should also ensure the T-piece has the bacterial/viral filters (Intersurgical HME-F 14410000) attached as shown and gas supply to the T-piece should be switched off when not in use

These filters should be changed every 24 hours

T-Piece < 4.0 ETT

T-Piece 4.0 ETT and above

Use small ETCO2 if ETT is 4.5 or less and large ETCO2 if ETT 5.0 or above

3. Tests and calibrations

NeoPaeds Flow Sensor Check
Adult Flow Sensor Check

NB     Remember to remove the “pre-use check” adaptor prior to use on a patient

O2 test check if needed – we don’t do this routinely

 

4. Ventilating a patient

 

NBThe Pinsp is actually a DP (ie Pressure above PEEP)
Set Ti for ventilation last (as will reset if you adjust weight/height settings)

 

 

Auto-set alarms can be made only adult mode

5. Monitoring patient data

6. Ensuring an adequate oxygen supply for patient transport

 

 

6.2 Quick reference guide

7. Attaching iNO to Hamilton T1

NoxBox can be attached to the Hamilton T1 using the neo/paeds tubing only:

7.1 Access NoxBox pack 7.2 Open contents 7.3 Select components
7.4 Attach funnel to iNO. Attach sampling line to delivery device 7.5 Attach to inspiratory port (blue) of Hamilton T1 7.6 Remove adaptor from nCPAP pressure pack (in vent tubing pack)
7.7 Attach adaptor between inspiratory limb (blue) and swivel vent connector 7.8 Attach NoxBox sampling line to adaptor  
 
8. Attaching to mobile monitor bed stack

Secure for patient transfer as noted below:

 


Attach onto monitor stand as noted and secure using leather strap

Connect ventilator tubing to oxygen splitter to enable blended FiO2/Air to be delivered if needed as well

9. Glossary of control parameters
Parameter
Definition
Apnea Backup A function that provides ventilation after the adjustable apnea time passes without breath attempts. If "Automatic" is enabled, control parameters are calculated based on the patient's IBW.
ETS Expiratory trigger sensitivity. The percentage of peak inspiratory flow at which the ventilator cycles from inspiration to exhalation.
Flow trigger The patient's inspiratory flow that triggers the ventilator to deliver a breath.
Gender Sex of patient. Used to compute ideal body weight (IBW) for adults and pediatrics.
I:E Ratio of inspiratory time to expiratory time. Applies to mandatory breaths.
%MinVol Percentage of minute volume to be delivered in ASV mode. The ventilator uses the %MinVol, Pat. height, and Gender settings to calculate the target minute ventilation.
Oxygen Oxygen concentration to be delivered. 
Pasvlimit The maximum pressure to apply in ASV mode. Changing Pasvlimit or the Pressure alarm limit automatically changes the other: The Pressure alarm limit is always 10 cmH2O greater than Pasvlimit.
Pat. height Patient height. It determines the ideal body weight (IBW), which is used in calculations for ASV and startup settings for adults and pediatric patients.
Pcontrol The pressure aditional to PEEP/CPAP.
PEEP/CPAP Positive end expiratory pressure.
P high The high pressure setting in APRV and DuoPAP modes. Absolute pressure, including PEEP.
Pinsp Pressure (additional to PEEP/CPAP) to apply during the inspiratory phase. Applies in PSIMV+ IntelliSync and NIV-ST.
P low The low pressure setting in APRV.
P-ramp Pressure ramp. Time required for inspiratory pressure to rise to the set (target) pressure.
Psupport Pressure support for spontaneous breaths in SPONT, NIV, and SIMV+ modes.
Rate Respiratory frequency or number of breaths per minute.
Sigh Breaths delivered at a regular interval (every 50 breaths) at a pressure up to 10 cmH2O higher than non-sigh breaths, as allowed by the Pressure alarm limit.
Thigh Length of time at the higher pressure level, P high, in DuoPAP and APRV modes.
TI Inspiratory time, the time to deliver the required gas (time to reach the operator-set Vt or Pcontrol value).
TI max Maximum inspiratory time for flow-cycled breaths in NIV, NIV-ST, and SPONT in neonatal modes.
TI low Length of time at the lower pressure level, P low, in APRV mode.
Vt Tidal volume delivered during inspiration in (S)CMV+ and SIMV+ modes.
Vt/kg Tidal volume per weight.

 

Editorial Information

Last reviewed: 15 April 2019

Next review: 01 April 2022

Author(s): M Davidson, T Geary, K Martin

Version: 1.3

Approved By: PICU Guidelines Group