Anesthesia Machine Checkout

functioning breathing system and safety devices

what is the goal of the machine check?

human vigilance

what remains essential as guarantor of machine safety and proper function?

Verify Auxiliary Oxygen Cylinder and Manual Ventilation Device (Ambu Bag) are Available & Functioning.

Item #1

Verify patient suction is adequate to clear the airway.

Item #2

Turn on anesthesia delivery system and confirm that AC power is available.

Item #3

Verify availability of required monitors, including alarms.

Item #4

Verify that pressure is adequate on the spare oxygen cylinder mounted on the anesthesia machine.

Item #5

Verify that the piped gas pressures are ≥ 50 psig.

Item #6

Verify that vaporizers are adequately filled and, if applicable, that the filler ports are tightly closed.

Item #7

Verify that there are no leaks in the gas supply lines between the flowmeters and the common gas outlet

Item #8

Test scavenging system function.

Item #9

Calibrate, or verify calibration of, the oxygen monitor and check the low oxygen alarm.

item #10

Verify carbon dioxide absorbent is fresh and not exhausted.

Item #11

Perform breathing system pressure and leak testing.

Item #12

Verify that gas flows properly through the breathing circuit during both inspiration and exhalation.

Item #13

Document completion of checkout procedures

Item #14

Confirm ventilator settings and evaluate readiness to deliver anesthesia care.

(ANESTHESIA TIME OUT)

Item #15

clockwise

what direction do you turn the cylinder to CLOSE it?

1000psig

what is the adequate pressure (psig) that the O2 cylinder should be?

negative pressure

what do we need to make sure the scavenging system doesn't draw?

1️⃣ Push the Menu key.

2️⃣ Turn the knob → select Setup/Calibration (highlight).

3️⃣ Push knob → show next screen → select O₂ Sensor Cal.

4️⃣ Turn and push knob → confirm O₂ Sensor Cal.

5️⃣ Select 21%, then push knob.

6️⃣ Follow screen instructions:

Remove O₂ sensor from circuit.

Expose sensor to room air.

Do not twist or stress the cable.

Ensure cable is connected.

7️⃣ Select "Start Cal." → push knob to begin calibration.

Result: Screen shows "Calibrating..." → then either Complete or Failure.

If calibration fails:

Repeat calibration.

If still fails → perform 100% O₂ calibration, then repeat 21%.

Once successful, reinstall O₂ sensor and complete pre-operative tests.

calibrating O2 sensor steps

1: Occlude Y-piece

2: Set APL valve to instructed levels (above 30cmH2O)

3: Hold O2 flush until pressure in circuit builds above 15cmH2O

4: Ensure that all parameters pass

Performing the leak test (Drager Fabius) steps

14

Checking APL valve and scavenger:

With APL valve open and Y-connector occluded, press O2 flush valve and confirm pressure is less than ______cmH2O

1: check final status of machine

2: vaporizers off

3: APL valve open

4: ventilator in Standby or Man/Spont.

5: All fresh gas flow controls to zero

6: Patient suction level adequate

7: breathing system ready to use

final machine position check steps

checking monitors and alarms

what is considered a "BIG STEP" in the anesthesia machine check?

D-Drugs

A-Airway

M-Machine

M-Monitors

I-IV

T-Tush (chair), table, tape, temp

S-Suction

A good final mnemonic to use to make sure you're ready for patient to come in

If cylinder is OPEN and pipeline is disconnected, dial 5 L/min of N2O and O2, close the O2 tank à N2O should turn off before oxygen

How to test the O2 fail safe

Make sure the bulb does not have any leaks

What must you check before checking for leaks?

Flip the auxiliary common gas outlet switch and then attach the bulb to the outlet. If there is not auxiliary common gas outlet, attach the bulb to the common gas outlet behind the breathing circuit and the flow sensor modules

Where do you attach the squeeze bulb and what do you do before attaching it? Where else could you attach it if needed?

turned off. The machine has a minimal oxygen flow of 50-200 mL/min when turned on.

Machine must be ___ for the negative pressure leak test and why

Less than 21% oxygen

What is a hypoxic gas mixture?

25%

The link 25 allows a minimum of how much oxygen

shuts off nitrous oxide when oxygen pressure is less than 10psi

What does the oxygen ratio monitor controller do

protection of the pt against both positive and negative barotrauma.

The active open scavenging system has holes/slits in the scavenging apparatus itself to allow what?

within the factory-set lines by adjusting the strength of the suction.

In an active open scavenging system, you want to keep the scavenger bobber within the ____ by adjusting the ________

has a knob to control the amount of suction, positive and negative pressure relief valves, and a reservoir bag

What are the components of an externally attached active (ie. active closed) scavenging system

1.5: causes the reservoir bag to oscillate with the ventilator

How many turns for the black needle valve on the scavenging system? what does this cause?

6-8 mL/kg

What is the general appropriate tidal volume for the ventilator

Item #2: Verify patient suction is adequate to clear the airway.

Item #4: Verify availability of required monitors, including alarms.

Item #7: Verify that vaporizers are adequately filled and, if applicable, that the filler ports are tightly closed.

Item #11: Verify carbon dioxide absorbent is not exhausted.

Item #12: Perform breathing system pressure and leak testing.

Item #13: Verify that gas flows properly through the breathing circuit during both inspiration and exhalation.

Item #14: Document completion of checkout procedures.

Item #15: Confirm ventilator settings and evaluate readiness to deliver anesthesia care (Anesthesia Time-Out).

What are the recommended essential steps in a Pre-Anesthesia Checkout Procedure to be completed prior to each procedure?