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U.S. Department of Health and Human Services
Indian Health Manual

Part 3, Chapter 22: Manual Appendix 3-22-A

Anesthesia Equipment Checkout Requirements
  1. Machine Checkout Overview.

    * = Footnote

    1. *  Verify that backup ventilation equipment is available and functioning.
    2. *  Check oxygen cylinder supply.
    3. *  Check central pipeline supplies.
    4. *  Check initial status of low pressure system.
    5. *  Perform leak check of machine low pressure system.
    6. *  Turn on machine master switch and all other necessary electrical equipment.
    7. *  Test flowmeters.
    8. *  Adjust and check scavenging system.
    9. *  Calibrate O2 monitor.
    10. Check initial status of breathing system.
    11. Perform leak check of breathing system.
    12. Test ventilation systems and unidirectional valves.
    13. Check, calibrate and/or set alarm limits of all monitors.
    14. Check final status of machine.
  2. Procedure.
    1. *  Emergency ventilation equipment:  Verify backup ventilation equipment is available and functioning.
    2. *  High pressure system
      1. *  Check oxygen cylinder supply.
        1. Open O2 cylinder and verify at least half full (about 1000 psi).
        2. Close cylinder.
      2. *  Check central pipeline supplies.

        Check that hoses are connected and pipeline gauges read about 50 psi.

    3. *Low Pressure System.
      1. *  Check initial status of low pressure system.
        1. Close flow control valves and turn off vaporizers.
        2. Check fill level and tighten vaporizers' fill caps.
      2. *  Perform leak check of machine low pressure system.
        1. Verify that the machine master switch and flow control valves are off.
        2. Attach "suction bulb" to common (fresh) gas outlet.
        3. Squeeze bulb repeatedly until fully collapsed.
        4. Verify that bulb stays fully collapsed for at least 10 seconds.
        5. Open one vaporizer at a time and repeat 'c' and 'd' above.
        6. Remove suction bulb and reconnect fresh gas hose.
      3. *  Turn on machine master switch and all other necessary electrical equipment.
      4. *  Test flowmeters.
        1. Adjust flow of all gases through their full range, checking for smooth operation of floats and undamaged flow tubes.
        2. Attempt to create hypoxic O2 /N2O mixture and verify that correct changes in flow and/or alarm.
    4. *  Scavenging System.  Adjust and check scavenging system.
      1. Ensure proper connections between the scavenging system and both APL (pop-off) valve and ventilator relief valve.
      2. Adjust gas vacuum, if possible.
      3. Fully open APL valve and occlude Y-piece.
      4. With minimum O2 flow, allow scavenger reservoir bag to collapse completely and verify that absorber pressure gauge reads about zero.
      5. With the O2 flush activated, allow the scavenger reservoir bag to distend fully and then verify that absorber pressure gauge reads < 10 cm H2O.
    5. Breathing System.
      1. *  Calibrate O2 monitor.
        1. Ensure monitor reads 21% in room air.
        2. Verify low O2 alarm is enabled and functioning.
        3. Reinstall sensor in circuit and flush breathing system with O2.
        4. Verify that monitor now reads greater than 90%.
      2. Check initial status of breathing system.
        1. Set selector switch to "Bag" mode.
        2. Check that breathing circuit is complete, undamaged and unobstructed.
        3. Verify that CO2 absorbent is adequate.
        4. Install breathing circuit accessory equipment (e.g. humidifier, PEEP valve) to be used during case.
      3. Perform leak check of breathing system.
        1. Set all gas flows to zero (or minimum).
        2. Close APL (pop-off) valve and occlude Y-piece.
        3. Pressurize breathing system to about 30 cm H2O with O2 flush.
        4. Ensure that pressure remains fixed for at least 10 seconds.
        5. Open APL (pop-off) and ensure that pressure decreases.
    6. Test manual and automatic ventilation systems and unidirectional valves.
      1. Place a second breathing bag on Y-piece.
      2. Set appropriate ventilator parameters for next patient.
      3. Switch to automatic ventilation (ventilator) mode.
      4. Turn ventilator ON and fill bellows and breathing bag with O2 flush.
      5. Set O2 flow to minimum, other gas flows to zero.
      6. Verify that during inspiration bellows delivers appropriate tidal volume and that during expiration bellows fills completely.
      7. Set fresh gas flow to 5 L/min.
      8. Verify that the ventilator bellows and simulated lungs fill and empty appropriately without sustained pressure at end expiration.
      9. Check for proper action of unidirectional valves.
      10. Exercise breathing circuit accessories to ensure proper function.
      11. Turn ventilator OFF and switch to manual ventilation (Bag/APL) mode.
      12. Ventilate manually and assure inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance.
      13. Remove second breathing bag from Y-piece.
    7. Monitors.  Check, calibrate and/or set alarm limits of all monitors.
      1. Capnometer
      2. Oxygen analyzer
      3. Pressure monitor with high and low airway pressure alarms
      4. Pulse oximeter
      5. Respiratory volume monitor (spirometer)
    8. Check final status of machine.
      1. Vaporizers off
      2. APL valve open
      3. Selector switch to "Bag"
      4. All flowmeters to zero (or minimum)
      5. Patient suction level adequate
      6. Breathing system ready to use
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* If an anesthesia provider uses the same machine in successive cases during a day, these steps nee not be repeated or may be abbreviated after initial checkout (U.S. Food and Drug Administration, 1993).