513: Anesthesia Machine Checkout

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513: ANESTHESIA MACHINE CHECKOUT

Back 1

513: ANESTHESIA MACHINE CHECKOUT

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Step 1: verify backup ventilation (ambu bag)

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Just in case machine fails.

AMBU bag is the only way of continuing positive pressure ventilation.

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Step 2: check O2 cylinder supply (at least half full)

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For backup if pipeline supply fails.

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Step 3: check central pipeline supplies (50 PSI).

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Ensure you have adequate gas supply.

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Step 4: check initial status of low pressure system (everything OFF).

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Getting machine ready for next steps.

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Step 5: perform leak check of low pressure system.

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1. create vacuum to see if there are cracks in flowmeter tubes or vaporizers.

2. need to have machine OFF so you don't a false positive result.

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Step 6: turn machine ON

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Flowmeters don't work with machine OFF.

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Step 7: test flowmeters

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1. make sure floats don't get stuck.
2. make sure hypoxic guard mechanism prevents FIO2 setting less than 25%.

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Step 8: adjust and check scavenging system

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1. loose vacuum will release waste gases into OR.
2. broken negative pressure valve will allow excessive vacuum & create subatm. pressure.
3. broken positive pressure valve will cause buildup of waste gases.

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Step 9: calibrate O2 monitor

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1. don't want hypoxic gas mixture

2. want to know if there is hypoxic mixture being delivered, hence the alarm.

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Step 10: check initial status of breathing system

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1. improperly attached circuit can cause ventilation problems.
2. exhausted CO2 absorbent causes rebreathing.
3. absorbent change may cause circuit leak.

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Step 11: perform breathing system leak check.

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1. use low flow b/c high flow will hide a leak.
2. closing APL valve allows pressure to build up in the circuit while using O2 flush creates high pressure.
3. gas will escape through leak under high pressure.

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Step 12: test ventilation systems & unidirectional valves.

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1. ensure ventilator works properly.
2. high gas flows will hide a leak.
3. stuck inspiratory valve will increase pressure in machine.
4. stuck expiratory valve will increase pressure in the pt's lungs.

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Step 13: check, calibrate, &/or set alarm limits of all monitors.

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1. ensure monitors work properly.
2. ensure alarms will alert you when appropriate.

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Step 14: check final status of machine

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Ensure you are ready to start case once the pt is in the room.

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How do you troubleshoot leaks?

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1. start from pt end & work backward.
2. check connection
3. adjust CO2 absorber

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How do you troubleshoot absence of or distorted CO2 waveform?

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1. make sure sample line is tight & functioning by breathing into it.
2. make sure line is not occluded or bent.

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How do you troubleshoot when suctioning isn't working?

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1. check wall suction
2. make sure canister top is not loose.
3. make sure all ports are closed
4. tighten suction tubing

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So, at what point do you turn the machine ON during machine checkout process?

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When you start checking for the functioning of the flowmeters.

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If you were checking ventilator system and unidirectional valve on the Excel, at what point do you turn the ventilator ON?

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After you have:
1. switched from BAG mode to VENT mode and set appropriate setting.
2. connected the circuit to the "lungs."
3. filled the lungs and bellows with O2 flush.