mobiquity®Wallet checkout - Quick, seamless and secure checkout
To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure...
-
Upload
linda-marianna-elliott -
Category
Documents
-
view
216 -
download
4
Transcript of To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure...
![Page 1: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/1.jpg)
To MenuTo Menu
![Page 2: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/2.jpg)
Anesthesia Gas MachineCheckout Procedure
InitialSteps
High-PressureSystem
Low-PressureSystem
BreathingSystem
VentilatorSystem
Final StatusCheck
![Page 3: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/3.jpg)
AGM Check: Initial Steps
1.1 Quick visual check
1.2 Back-up ventilation equipment
![Page 4: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/4.jpg)
AGM Check: Initial Steps 1
1.1 Quick visual check for: Obvious damage /
Missing components BioMed notice of
Return-to-Service Electrical power cord
plugged into receptacle with generator backup
System master switch OFF
Red receptacle
![Page 5: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/5.jpg)
AGM Check: Initial Steps 2
1.2 Back-up ventilation equipment Self-inflating resus bag
& O2 source
Check for incorrect assembly / damaged parts
Back to MenuBack to Menu
![Page 6: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/6.jpg)
AGM Check: High Pressure System
2.1 Check central pipeline supplies
2.2 Check O2 reserve cylinder supply
![Page 7: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/7.jpg)
AGM Check: High Pressure System 1
2.1 Check central pipeline supplies Hoses are connected
correctly (colours, DISS) Pipeline gauges read
50-55 psig Disconnect O2 pipeline
Misconnections
Line pressure fluctuations Failure of central O2 supply
![Page 8: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/8.jpg)
AGM Check: High Pressure System 2
2.2 Check O2 reserve cylinder supply Bleed O2 cylinder pressure
to zero with O2 flush(O2 pipeline disconnected)
Open O2 cylinder and verify at least half full (approx. 1000 psig)
Avoid reading “old”
cylinder pressure
Check for wrong cylinder - double gasket defeats pin index system or pins are broken
Dust protection cap still in place
![Page 9: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/9.jpg)
AGM Check: High Pressure System 2 (cont’d)
2.2 Check O2 reserve cylinder supply (cont’d) Listen
- no audible leak
Open and close O2 flowmeter - no flow seen
Close cylinder - pressure gauge drops less than 100 psig in five min
Missing gasket; cylinder not seated in yoke properly
Cylinder valve stem loose Unused yoke vacant with no
yoke plug
Machine master switch allows leak
Cylinder control valve leaks Leaking pipeline check valve
Back to MenuBack to Menu
![Page 10: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/10.jpg)
AGM Check: Low-Pressure System
3.1 Check vaporizer installation
3.2 Perform low-pressure leak test
3.3 Turn ON gas machine master switch
3.4 Test flowmeters
![Page 11: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/11.jpg)
AGM Check: Low Pressure System 1
3.1 Check vaporizer installation Tops of vaporizers are
parallel to manifold - cannot be lifted off manifold
Vaporizers are full and fill ports closed
Verify all vaporizers OFF
Vaporizer not locked on to manifold properly
Overfilling of vaporizer
![Page 12: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/12.jpg)
AGM Check: Low Pressure System 2
3.2 Perform low-pressure leak test Do leak test with "suction
bulb" device on auxiliary (fresh) gas outlet • Verify bulb stays
collapsed for > 10 secs Repeat leak test for each
flowmeter
Defective suction bulb
Leak somewhere between flow control valves and common gas outlet
• Cracked, loose, misaligned flow tubes
• Loose connections – internal piping, components
![Page 13: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/13.jpg)
AGM Check: Low Pressure System 2 (cont’d)
3.2 Perform low-pressure leak test Repeat leak test for each
vaporizer, one at a time - setting dial to 1% conc.
Verify with each vaporizer that the other vaporizer(s) cannot be turned ON
Verify all vaporizers OFF, aux. gas outlet closed, and flush system with O2
Partially open filler/drain port Missing vaporizer port O-ring
on manifold
Faulty interlock mechanism - can turn on two vaporizers simultaneously
Vaporizer will not turn ON - interlock obstructed by ECG lead, etc
![Page 14: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/14.jpg)
AGM Check: Low Pressure System 3
3.3 Verify Electrical Power and Oxygen Supply Failure Alarm
Unplug machine power from electrical receptacle
Turn ON master switch Verify “Battery Power OK”
message, plug in power cord and message disappears
Turn ON vital signs monitor
Battery discharged because machine previously left ON and unplugged from AC outlet
Allows gas analyzer to “warm up”
![Page 15: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/15.jpg)
AGM Check: Low Pressure System 3 (cont’d)
3.3 Verify Electrical Power and Oxygen Supply Failure Alarm(cont’d)
Verify O2 supply failure alarm
Drain O2 – press O2 Flush Distinctive auditory pattern Visual message on Vent
Turn ON O2 cylinder to silence alarm
Remove O2 sensor from circuit
Alarm mechanism malfunction
Exposes O2 sensor to room Air for later calibration
![Page 16: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/16.jpg)
AGM Check: Low Pressure System 4
3.4 Test flowmeters Minimum flows are 25
ml/min for O2 and zero ml/min for other gases
Flowtubes are undamaged; floats move smoothly throughout their full range
No flow - broken tip of needle valve
Floats sticking - dirt, grease, static
Float stuck at top of flow tube
Stop broken off from top of flow tube and resting on float
![Page 17: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/17.jpg)
AGM Check: Low Pressure System 4 (cont’d)
3.4 Test flowmeters (cont’d) O2 and N2O flow controls
cannot supply hypoxic flowrates
Turning vaporizer ON does
not lower gas flow(Then verify vaporizer OFF)
N2O/O2 3:1 proportioner - linkage broken or gear stop misaligned
Obstruction in vaporizer or manifold
![Page 18: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/18.jpg)
AGM Check: Low Pressure System 4 (cont’d)
3.4 Test flowmeters (cont’d) Low O2 pressure stops N2O
gas flow but NOT Air• Set all 3 floats to mid-
range - close O2 cylinder - push O2 flush
• O2 supply failure alarm sounds and N2O float dropswhile Air continues
Close all 3 gas flow controls and reconnect O2 pipeline- verify pipeline pressure
No low O2 supply alarm when O2 supply pressure@ 30 psig
Shutoff valve for N2O fails to close when O2 @ 20 psig
Back to MenuBack to Menu
![Page 19: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/19.jpg)
AGM Check: Breathing System
4.1 Calibrate O2 monitor
4.2 Check initial status of breathing system
4.3 Check function of unidirectional valves
4.4 Perform leak test - Bag / APL valve circuit
4.5 Check APL valve and scavenging system
![Page 20: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/20.jpg)
AGM Check: Breathing System 1
4.1 Calibrate O2 monitor Ensure monitor reads 21%
with sensor in room air Verify low O2 alarm enabled
bybreathing on to sensor through your surgical mask
Reinstall sensor in circuit - flush breathing system with O2
- monitor should read > 95%
cannot calibrate - faulty fuel cell
crossover between O2 supply and other gas - hospital piping, hoses or in gas machine
wrong gas in central supply / cylinder
![Page 21: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/21.jpg)
AGM Check: Breathing System 2
4.2 Check initial status of breathing system Set selector switch to “Bag/APL”
Circuit complete, undamaged, unobstructed
Verify CO2 absorbent is adequate (colour, quantity)
Attach gas sampling line to circuit
Set all flows to zero (or minimum)
manufacturing defects causing leaks or obstruction
foreign object obstructing e.g. sampling port cap inside elbow
![Page 22: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/22.jpg)
AGM Check: Breathing System 3
4.3 Check function of unidirectional valves Attach a spare breathing bag to
the inspiratory outlet of the absorber and close APL valve completely
Fill both test bag and reservoir bag with O2 flush until pressure gauge reads 35 cm H2O – pressure should hold
Open APL valve – pressure holds but only reservoir bag deflates
If needed, repeat test on expiratory inlet with inspiratory outlet occluded
Missing, incompetent valves or incorrectly seated
If pressure holds - both valves are competent
If reservoir bag deflates before opening APL valve - expiratory valve is leaking
![Page 23: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/23.jpg)
AGM Check: Breathing System 4
4.4 Perform leak test - Bag / APL valve circuit Set selector switch to
Bag/APL - close APL valve and attach spare breathing bag to Y-piece
Inflate bag with O2 flush to just < 40 cm H2O
Circuit pressure holds steady for > 10 secs • Sustained pressure alarm
sounds Ventilator bellows does not
move
Numerous leak sites possibleAuxiliary FGF outlet left open (alarm sounds) CO2 canisters not locked into position Faulty canister seals or granules are preventing a good seal CO2 drain plug partially open Unidirectional valve housing loose O2 sensor not firmly seated in port or sensor housing is crackedFlow sensor housing cracked Pressure sensing tubing from gauge is not tightly connected (internal)Leak in breathing bag, circuit hoses Unused sampling ports not capped Faulty selector switch - allows cross-over of gas into ventilator circuit
![Page 24: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/24.jpg)
AGM Check: Breathing System 5
4.5 Check APL valve and scavenging
system With APL valve still closed and
circuit occluded, squeeze inflated bag until pressure reaches approx. 70 cm H2O • High pressure alarm sounds when
limit exceeded (e.g. 40 cm H2O)
• APL valve partially releases and reservoir bag on scavenger fills
Open APL valve slowly until pressure drops below 20 cm H2O, then stop • Pressure should stabilize and hold • Sustained pressure alarm stops
Improperly adjusted APL valve - set to release either too high or too low
No alarm - upper limit set too high
Cannot adjust pressure - valve sticking
(Sustained pressure limit is the high pressure limit or a max of 30 cm H2O)
![Page 25: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/25.jpg)
AGM Check: Breathing System 5 (cont’d)
4.5 Check APL valve and scavenging system
(cont’d) Open APL valve fully, flush
occluded circuit with O2 • Circuit pressure stays
< 10 cm H2O
• Scavenging reservoir bag fills and then positive pressure relief valve releases
APL valve fully open, flows set at minimum and circuit still occluded • Circuit breathing bag
does not deflate • Scavenging reservoir bag
does deflate
opening pressure of APL too high
hose from circuit to scavenger blocked
faulty positive pressure relief valve on scavenger
opening pressure of APL too low
too much vacuum and faulty negative pressure relief valve
no vacuum; needle valve closed
Back to MenuBack to Menu
![Page 26: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/26.jpg)
AGM Check: Ventilation Systems
5.1 Test automatic ventilation system
5.2 Test manual ventilation system
![Page 27: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/27.jpg)
AGM Check: Ventilation System 1
5.1 Test automatic ventilation system Selector switch set to Ventilator - all
flows set to minimum, breathing bag on Y-piece
Fill bellows with O2 flush between ventilator breaths - pressure does not exceed 15cm H2O - release flush
Set appropriate ventilator parameters for next patient- Inspiration - bellows delivers correct
tidal volume
- Expiration - bellows fills completely- Volume monitor is consistent with ventilator - Proper action of unidirectional valves
Defective ventilator relief valve - should release when > 2.5 cm H2O
Relief valve does not close to allow bellows to fill completely
Bellows housing not fastened tightly
Drive gas hose not firmly attached Connection from absorber to
bellows is leaking
Volume sensor faulty Valves stick or do not seat
properly
![Page 28: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/28.jpg)
AGM Check: Ventilation System 1 (cont’d)
5.1 Test automatic ventilation system(cont’d) Remove breathing bag from
Y-piece while ventilator is still working
Low pressure alarm sounds (“Cannot drive bellows”) until breathing bag is replaced
Set selector switch back to Bag/APL (turns ventilator OFF)when bellows fully inflated
Ventilator bellows does not drift downward
Alarm faulty OR ventilator senses pressure 4 - 9 cm H2O with breathing bag off - obstruction somewhere?
Leak somewhere – see previous slide
![Page 29: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/29.jpg)
AGM Check: Ventilation System 2
5.2 Test manual ventilation system Switch in Bag/APL mode Ventilate manually and assure
inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance
Remove second breathing bag from Y-piece
Faulty APL valve - incorrect pressure adjustment
Back to MenuBack to Menu
![Page 30: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/30.jpg)
AGM Check: Final Status Checks
6.1 Gas machine and breathing system
6.2 Monitors
![Page 31: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/31.jpg)
AGM Check: Final Status Checks 1
6.1 Gas machine and breathing system Vaporizers OFF Selector switch to Bag/APL
and adjust APL valve to MIN Set O2 flow to 3 L/min - other
gases to zero Attach face mask to Y-piece
and through a surgical mask, breathe in and out through the circuit as final test
Set O2 flow to minimum
![Page 32: To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure System Breathing System Ventilator System Final Status.](https://reader030.fdocuments.in/reader030/viewer/2022032601/56649dd15503460f94ac6a38/html5/thumbnails/32.jpg)
AGM Check: Final Status Checks 2
6.2 Monitors Check that capnometer
registers the CO2 from your breath - and apnea alarm sounds after appropriate interval; check alarm settings
Check oximeter on your own finger for function; check alarm settings
Make sure manual BP cuff is available
Patient suction adequate(“thumb test”)
Back to MenuBack to Menu