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Anesthesia Gas MachineCheckout Procedure

InitialSteps

High-PressureSystem

Low-PressureSystem

BreathingSystem

VentilatorSystem

Final StatusCheck

AGM Check: Initial Steps

1.1 Quick visual check

1.2 Back-up ventilation equipment

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

AGM Check: Initial Steps 2

1.2 Back-up ventilation equipment Self-inflating resus bag

& O2 source

Check for incorrect assembly / damaged parts

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AGM Check: High Pressure System

2.1 Check central pipeline supplies

2.2 Check O2 reserve cylinder supply

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

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

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


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

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


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

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


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”


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


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


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


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


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

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


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


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


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


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)

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


AGM Check: Ventilation Systems

5.1 Test automatic ventilation system

5.2 Test manual ventilation system

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

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

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


AGM Check: Final Status Checks

6.1 Gas machine and breathing system

6.2 Monitors

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

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”)


To Menu. Anesthesia Gas Machine Checkout Procedure Initial Steps High-Pressure System Low-Pressure...

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