Proximal flow measurement

2021-02-02
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 Table of Contents

Table of Contents
1. Introduction 4

2. Flow sensor 5

3. Position of the flow sensor 6

4. Hamilton Medical flow sensors 7

5. Conclusions 8

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 1. Introduction

1 Introduction
Introduction

An external flow sensor is required by all Hamilton Medical ventilators but not by many other
ventilators. People may come up with questions such as:
¡ What is a flow sensor?
¡ What does it do?
¡ How does it work?
¡ Why do Hamilton Medical ventilators require a flow sensor?
¡ What are the advantages of using an external flow sensor?
¡ What do I need to know about it for everyday work?

This module will answer these basic questions and will take you about 10 minutes to complete.

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 2. Flow sensor

2 Flow sensor
Flow sensor

A ventilator is complex pneumatic equipment, and is a critical part of a ventilator system for
mechanical ventilation. Ventilator functionality or performance is heavily dependent on accurate
monitoring of pressure, flow, and volume at specific locations of the gas passageway.

A flow sensor is a device used to measure the flow rate and direction of passing gas. There are
many types of flow sensor depending on the applied working principles. The flow sensor types
used commonly in mechanical ventilators include:
¡ hot wire anemometer,
¡ differential pressure flow sensor,
¡ ultrasonic flow sensor,
¡ and pneumotachograph.

Hamilton Medical ventilators use a differential pressure flow sensor.

A differential pressure flow sensor is based on Bernoulli’s equation: The sensor introduces a
restrictor into the gas channel, which creates a pressure drop across the restrictor. The higher the
gas flow, the greater the pressure drop. Thus, we can know the current flow rate by comparing the
pressures measured simultaneously at both sides of the restrictor.

Differential pressure flow sensors have two subtypes: a.) the restrictor is a fixed orifice, or b.) the
restrictor is a variable orifice.

The Hamilton Medical flow sensor has a variable orifice that is an elastic plate with cut in a special
profile. This specially formed flap acts as a swing door. The gas flow determines the direction and
extent of the door opening. This type of variable orifice imposes a low resistance at a high flow,
and assures measurement accuracy at a low flow.

The pressure signals from the flow sensor are transmitted over a pair of tubes and measured by
pressure sensors inside the ventilator. The tube connection is color-coded because the ventilator
must be able to identify the pressure before and after the restrictor.

Each flow sensor with a variable orifice may differ slightly in its pneumatic characteristics.
Therefore, every new flow sensor must be calibrated before clinical use. Its unique calibration table
is then stored in the ventilator’s internal memory. Use of a new flow sensor without calibration is a
misuse of the equipment. In this case, the ventilator uses the stored calibration table for the
previous flow sensor. Thus, monitoring may be less accurate.

Differential pressure flow sensors with a variable orifice have the following advantages:
¡ Good dynamic response
¡ Relatively low flow resistance
¡ No electrically powered parts
¡ Simultaneous monitoring of pressure, flow, and volume, which is the integral of flow over time
¡ Maintained accuracy with humid air

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 3. Position of the flow sensor

3 Position of the flow sensor

Typically, a ventilator uses two flow sensors. One is always positioned at the ventilator’s inspiratory
port. The second can be in one of two locations: a.) at the expiratory port or b.) at the airway
opening.

The flow sensor at the airway opening is often referred to as a "proximal flow sensor" because it is
close to the patient. The expiratory flow sensor is often referred to as a "distal flow sensor"
because it is far from the patient.

Does the position of the flow sensor matter?

The major difference between a proximal and a distal flow sensor is the presence of a breathing
circuit. A proximal flow sensor sits between the patient and the circuit, sensing the source signals
directly. A distal flow sensor is positioned after the circuit, sensing the transmitted source signals
that are somewhat distorted by the circuit.

First, the elastic tube weakens and smoothes the source signals so that, in theory, ventilators with
distal flow sensor are less sensitive, possibly causing ineffective triggering efforts, especially when
the original signal is rather weak.

Second, the intermittent positive pressure results in gas compression and tube expansion.
Consequently, a part of the gas volume delivered by the ventilator is trapped inside the circuit.

For instance, if a ventilator originally delivers 500 ml into the circuit, the patient may receive only
450 ml because the circuit retains 50 ml. This physical phenomenon is known as "circuit
compliance". A distal flow sensor cannot show the actual tidal volume delivered to the patient. To
ensure patient to receive 500 ml, the ventilator must deliver more, perhaps 550 ml. This mechanism
is known as "circuit compliance compensation".

Third, the elastic tube can introduce a variety of artifacts, including from gas leak, accumulated
condensed water, circuit oscillation, and the like. These artifacts can strongly interfere with flow
sensor performance and can induce auto-triggering.

These drawbacks are inevitable with distal flow sensors because they are associated with the use of
a breathing circuit. With proximal flow sensors, the monitoring is more sensitive, is not affected by
circuit compliance, and is less affected by artifacts from circuit.

For these reasons, proximal flow sensors are widely used for neonatal mechanical ventilation and in
research work on mechanical ventilation. After carefully balancing its potential benefits and
drawbacks, Hamilton Medical decided to use proximal flow sensors.

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 4. Hamilton Medical flow sensors

4 Hamilton Medical flow sensors

The proximal flow sensor is the centerpiece of Hamilton Medical ventilators. Sensitive and accurate
pneumatic monitoring is the foundation of intended ventilator functions. It is particularly important
for some advanced functions, such as the ASV and INTELLiVENT-ASV modes, IntelliSync+, P/V Tool,
volumetric capnography, and so on.

Hamilton Medical offers three types of flow sensor, and are all differential pressure flow sensors
with variable orifice.
¡ Adult/pediatric flow sensor for single patient use
¡ Adult/pediatric flow sensor for multiple use, autoclavable
¡ Neonatal flow sensor for single patient use
Here are some practical tips for the use of the flow sensors:

The flow sensors are patient population specific. Adult/pediatric flow sensors cannot be used for
neonatal patients, and vice versa.

Do not reuse flow sensors that are intended for single patient use.

The blue hose must be connected to the blue connector and the colorless hose must be connected
to the white connector on the ventilator.

Calibrate every new flow sensor before first use. The calibration procedure is explained in the
modules for the respective ventilators.

During mechanical ventilation, calibrate the flow sensor again:

a.) if the ventilator alarm "Flow sensor calibration needed" appears,

b.) if monitoring accuracy is in doubt, and

c.) before use of Heliox therapy.

Visually inspect the flow sensor daily during mechanical ventilation for any damage or optical
change. Specially check that the flap is intact and free from thick secretions and blood clots.

Remove a flow sensor that is damaged, or fails the calibration two times. Handle a used flow
sensor as a contaminated medical device.

When using the neonatal flow sensor, position it at about ≥ 45° relative to the floor to prevent
water accumulation inside the flow sensor.

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 5. Conclusions

5 Conclusions
Conclusions

The proximal flow sensor is the centerpiece of Hamilton Medical ventilators. This module
introduced proximal flow measurement. We have learned about:
¡ Differential pressure flow sensors with variable orifice
¡ Position of the flow sensor
¡ Hamilton Medical flow sensors and practical tips of its use
This e-learning module has a test included. If you pass the test, your certificate will be delivered to
your mailbox automatically. By using the Feedback function, you can send us your comments,
questions, or suggestions.

Thank you for choosing Hamilton Medical College, Hamilton Medical’s free and open e-learning
service!

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