Machine Care & Troubleshooting

Question 1

Describe the flow of oxygen thru the anesthetic machine (first 5 steps)

Answer 1

1. O2 enters the machine at lower back of flowmeter.
2. O2 exits flowmeter near the top
3. O2 enters the vaporizer, collects anesthetic agent.
4. O2 agent mixture exits vaporizer
5. Gas & agent enters breathing bag & inhalation tube and is inhaled by the patient.

Question 2

Describe the flow of oxygen thru the anesthetic machine (last 5 steps)

Answer 2

6. Patient exhales - waste gas enters machine thru exhalations valve
7. Waste gas enters CO2 absorber canister, CO2 is removed.
8. Gas with CO2 removed enters breathing bag, inhalation tube & patient (recycled)
9. Small amount of easter gas exits APL valve.

Question 3

Before every surgery, you should… (2)

Answer 3

1. Inspect machine connections & rubber parts for signs of looseness, damage, & wear.
2. Perform leak test!
   - This should be done whenever change any breathing circuit, breathing bag, or make any change to the anesthesia machine.

Question 4

How to do a leak test (6)

Answer 4

1. Close pop off valve
2. Place finger over the end of the patient circuit
3. Turn on flowmeter until 20cm/H2O pressure is reached on manometer.
4. Turn off flowmeter
5. If pressure drops: turn on flowmeter until the needle stabilizes at 20cm/H2O
   - Flow on flowmeter will indicate severity of the leak
6. When complete, open the pop off valve!! Then let go of the patient circuit end.

Question 5

Common places for leaks to occur:
Primary sources (4)
Secondary sources (2)

Answer 5

1. Primary:
   - Pop off valve
   - Rebreathing bags
   - Hoses
   - Y-piece
2. Secondary:
   - Metal & rubber rings on valves
   - CO2 absorber canister

Question 6

Oh no! You have a leak. What are some of the consequences of this? (3)

Answer 6

1. You will be breathing whatever is leaking. Big leak, bad for your health!
2. Patient may not stay on the table
3. Wasting money on oxygen

Question 7

If your machine is leaking, what parts of the machine should you listen to for leaking? (8)

Answer 7

1. Breathing bag
2. Breathing circuit
3. Vaporizer fittings
4. Upper & lower canister gaskets
5. Improperly seated canister
6. Negative pressure relief valve
7. Pop-off valve
8. O-rings (all four of them)

Question 8

You have a persistent leak; how can you use a bottle & soap to check?

Answer 8

Use bottle and a mild soap to spray onto the machine. It will bubble up where the leak is occurring.
REMEMBER: Do not spray the vaporizer!

Question 9

You’ve tried everything & still cannot locate the leak. What should you do? And why?

Answer 9

1. Do:
   - Ask for HELP. Keep asking until it’s resolved.
2. Why:
   - This is managed death & we want to make sure that’s managed in such a way as our patients wake up & are the same after surgery as they were before.

Question 10

How often should an anesthetic machine be cleaned?

Answer 10

Weekly!

Question 11

How to clean anesthesia machine (4)

Answer 11

1. Component should be soaked in chlorhex for 20-30 minutes.
   - Offers broad spectrum antimicrobial action, yet gentle on the parts.
2. After soaking, rinse components
3. Allow to air dry. Small parts can be wiped dry
4. Reassemble machine

Question 12

Name the parts of the machine that should be disassembled & soaked: (7)

Answer 12

1. Sodalime cannister
2. Reservoir bags
3. Breathing tubes
4. Y-pieces
5. Unidirectional valves
6. Removable rubber gaskets
7. Non-rebreathing system hoses & bags

Question 13

Daily maintenance cleaning machine & parts (3)
1. Anesthesia machine
2. Breathing bag
3. Breathing circuit
4. Inhale/exhale disks
5. Vaporizer

Answer 13

1. Clean anesthesia machine- should be done with a soft cloth & dilute chlorhex & water.
2. Remove breathing bag, wash with dilute chlorhex & water, rinse, hang to dry.
3. Remove breathing circuit, wash with dilute chlorhex & water, rinse, hang to dry.
4. Remove white disks from inhale/exhalation valves, wipe off with soft cloth, wipe out valves, reassmble.
5. Vaporizer: Wipe down as needed. Never spray directly with any solution.
   - This can cause the dial to corrode

Question 14

Weekly cleaning: Absorbent canister (5)

Answer 14

1. Replace absorbent material in canister approx every 8-12hrs of use.
2. IMPORTANT: May need to be done sooner depending on usage.
3. Follow manufacturers recommendations for proper use of CO2 absorbents.
4. Absorber canister should be disinfected with dilute chlorhex & water.
5. Take caution! Material is caustic & can cause damage to eyes and lungs!

Question 15

Weekly cleaning:
Care should be taken when flowing high amounts of ___ thru your anesthesia machine to not get dust from the ___ into your ___ circuits.

Answer 15

1. O2
2. Absorbent
3. Breathing

Question 16

T/F: Keep track of the last time you change the CO2 absorbent with tape (dated & signed)

Answer 16

True

Question 17

Yearly cleaning

Answer 17

Service & calibrate vaporizer
- This cannot be done in the clinic or a van in your parking lot! Servicing needs to be done in a temp controlled environment. When vaporizer is serviced, it also has parts replaced.

Question 18

Every one to two years, replace all your ___, ___, & ___ tubing.

Answer 18

1. Gaskets
2. O-Rings
3. Rubber tubing

Question 19

Don’ts of anesthesia machine care & use (7)

Answer 19

Don’t:
1. Over tighten needle valve on your flowmeter
2. Use flowmeter as a “handle”
3. Use flush valve while patient is hooked to breathing circuit
4. Use different anesthetic agent than the one your vaporizer is calibrated for
5. Spray water directly onto vaporizer
6. Use alcohol on your anesthesia machine or vaporizer.
7. NEVER tip the anesthesia machine & vaporizer over!
- This could cause severe damage. If this occurs, it’s advised to send in for service.

Question 20

Do’s of anesthesia machine use & care (2)

Answer 20

Do:
1. Always leave the pop-off valve in the OPEN position
2. If using F/Air canister, change after 12hrs of use or 50g of weight gain

Question 21

Minimizing Waste-Gas Exposure (7)
Name four

Answer 21

1. Fill vaporizer at end of work day (less ppl around)
2. Avoid spilling liquid anesthetic
3. Use low-flow tech whenever possible
4. Leave recovering Pt attached to machine as long as possible so exhaled gases can be scavenged
5. Turn on vaporizer only when Pt is attached
6. Place recovering Pt in well-ventilated area
7. Use mask or chamber induction only when necessary. Vent chamber out of doors.