Anesthesia Machine Check

Question 1

Step 1

(Prior to each case) Verify that back-up ventilation equipment (self-inflating Ambu bag and oxygen tank) is available and funcitoning

Answer 1

Question 2

Step 2

Check the oxygen E-cylinder supply and make sure that it works and has at least 1000psi

Answer 2

1. Disconnect the wall supply hoses
2. Close the tank on the back with clockwise rotation
3. Press the oxygen flush button and drain the system of all oxygen
4. Open the E cylinder with a counterclockwise rotation and verify that the E-cylinder goes back up to at least 1000psi

Question 3

Step 3

Check the fail safe valve to ensure you can’t deliver nitrous oxide without simultaneous delivery of oxygen

Answer 3

1. Turn oxygen and nitrous up to 5L/min
2. Turn off the oxygen E-cylinder on the back of the machine (and make sure the oxygen wall supply is still disconnected)
3. As pressure and flow of O2 begin to fall, the flow of NO2 will fall as well (if fail safe is functioning properly)

Question 4

Step 4

Reattach the wall supply hoses and check the wall supply pressure to verify it is 50psi

Answer 4

Question 5

Step 5

Check the low pressure system with the “test suction bulb”

-The machine should be turned off during this step

Answer 5

1. Verify that the bulb is properly functioning by occluding the connecter end with your thumb and making sure the bulb stays deflated after squeezing it
2. Open the common auxillary gas outlet
3. Connect the test suction bulb to the common gas outlet
4. Once connected, squeeze the bulb several times until it stays deflated, and verify that it stays deflated for 10 seconds
5. Open the vaporizers one at a time and verify that the bulb stays deflated for at least 10 seconds while each vap is on
6. Also make sure that only one vaporizer can be opened at a time
7. Once low pressure test is completed, CLOSE THE COMMON AUXILIARY GAS OUTLET (ACGO) SWITCH and disconnect the test suction bulb from the common gas outlet.

Question 6

Step 6

Drain excess water from the machine by opening the hatch and pressing the drain button while simultaneously pressing the oxygen flush button

Answer 6

Question 7

Step 7

Turn the machine back on, remove the oxygen flow sensor and calibrate it

Answer 7

Reconnect the oxygen flow sensor back when calibration is complete

Question 8

Step 8

Turn on all the flowmeters and make sure they work and confirm that the mechanical proportioning system works by verifying that the maximum amount of NO2 that can be delivered is 75%

Answer 8

Question 9

Step 9

Verify that the scavenging sstem is properly functioning by making sure that the indicator flow tube is in the green range

Answer 9

Question 10

Step 10

Inspect the CO2 absorbent to ensure that it is not expired

Answer 10

Question 11

Step 11

Make sure the ventilator works properly

Answer 11

Attach the breathing bag to the circuit, flipping the switch to ventilator mode, and ensuring that the breathing bag and ventilator both appropriately fill

-Ensure no leak, and ensure that the scavenging system works by verifying the absence of a sustained increase in circuit pressure when the flowmeters are turned up

Question 12

Step 12

While the vent is on, inspect the unidirectional valves to ensure that they are working properly during inspiration and expiration

Answer 12

Question 13

Steps at Beginning of Each Case

Set the tidal volume for the next patient, and make sure it is in the 5-10mL/kg range

Answer 13

1. High pressure leak test by flipping the switch to bag mode, close the APL valve, occlude the Y-piece, and hit the flush button to ensure that you can build up pressure in circuit while in bag mode
2. Hit the O2 flush button until the circuit pressure reaches 30cmH20 and stays there for at least 10sec. After 10 sec, open APL valve and ensure the pressure decreases (this is verification of scavenging)

Question 14

Suction available?

Answer 14

Verify that suction is available in the room and working adequately enough to clear the patients airway