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

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:

This table summarises the different set ups:

2.6 Passive Humidification, ETCO2 connections, inline suction, expiratory valve filters, and Adaptations for Patients with suspected Highly Infectious Respiratory Disease

• A Y-piece Heat-Moisture Exchanger Filter (HMEF) should be ALWAYS be used to provide passive inspired gas HUMIDIFICATION and to protect the ventilator from BACTERIAL CONTAMINATION by aerosolised respiratory secretions.
• An additional High Efficiency “yellow” filter MUST ALSO be used at the EXPIRATORY VALVE in any patient suspected to have a highly infectious respiratory disease. This is to prevent VIRAL AEROSOLISATION from the ventilator exhaust.
• In-line suction should be used where possible (ETT ≥ 4.0) for any patient suspected to have a highly infectious respiratory disease – for example where enhanced PPE is required
• Please also read section 9.1 if further information is required for highly infectious disease transfers
• All necessary consumable equipment is stored in the cupboard under the Hamilton-T1 in the PICU Clean Utility Room at Staff Base 2
• The HMEF and Expiratory Valve filter connections are shown in the illustrations below:

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 patient’s 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 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
  

Ayres T-piece set-up

• As routine please also ensure the T-piece has the High Efficiency 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 and between patients if a new T-piece is not used.

• 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
  

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

• Once all the checks have been completed, you will be in the standby screen from where you can set your initial settings.
• IF YOU ARE UNDERTAKING AN INTERNAL TRANSFER, CHECK THE BATTERY ICONS STATUS BEFORE COMMENCING VENTILATION. IF BELOW 70%, DO NOT USE, OBTAIN A LOAN MACHINE FROM ED RESUS.
• Select the appropriate patient group (neonatal or adult/paed) by touching the appropriate patient group button.
• You can set your initial ventilator settings using either quick setup (see fig 4.1 below) or set them manually.
• For the Neonatal patient group, you can enter the weight directly but for the adult/paed patient group use the Gender and height to arrive at the IBW
• Input your patient's height/length by using the pat.height button and the ventilator calculates and displays the Ideal body weight (IBW). If you do not have a height, use the height button to arrive at an IBW that is closer to your patient’s weight.
• Each of the quick setup buttons have preconfigured ventilatory mode, ventilatory settings and alarm limits.
• You can change the mode, settings and alarm limits if needed as detailed in figures 4.2, 4.3 and 4.4.
• You can also set all your initial ventilatory mode, settings and alarm limits manually without using the quick setup buttons as per the following figures.

Auto-set alarms can be made only adult mode

Table 2

Table 3: Summary of features

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 delivery device
7.7 Attach adaptor between inspiratory limb (blue) and swivel vent connector	7.8 Attach NoxBox sampling line to adaptor