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Anaesthesia Workstation checklist and safety features
This document provides a 14-step pre-anesthesia checklist to ensure the safe functioning of all components of the anesthesia workstation. It involves checking oxygen supplies, the low and high pressure systems, scavenging and breathing systems, ventilation equipment, and monitors. A leak test of the breathing circuit is performed by pressurizing it to 30 cm H2O for 10 seconds without loss of pressure. All monitors are calibrated and have alarm limits set before final confirmation that the workstation is ready for use.
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Anaesthesia Workstation checklist and safety features
- 1.
- 2. INTRODUCTION Anaesthesia machine isdesigned to deliver: O2 along with other anesthetic gases including volatile anaesthetic vapours in specified concentrations to patients with the help of breathing circuits.
- 3. From a simplepneumatic device of the early 20th century, the anesthesia machine has evolved to incorporate various mechanical, electrical and electronic components to be more appropriately called ANAESTHESIA WORKSTATION .
- 4. CHECK PROTOCOL •Checking eachcomponent of anesthesia machine for appropriate functioning prior to use is essential to ensure patient safety. •However , a single checklist cannot satisfactorily test the integrity and safety of all existing anesthesia machines due to their complex nature as well as variations in design among manufacturers.
- 5. • An in-depth& elaborate check should be done following service of the workstation. Further, machine check should be done daily prior to first use. •This should be user friendly & less time consuming while also ensuring satisfactory check of all components of machine.
- 6. PAC 2008 (Pre-Anesthesia Checklist) •Theanesthesia machine must be equipped with an ascending bellows ventilator & certain monitors (capnograph, pulse oximeter, oxygen analyzer, spirometer, breathing system pressure monitor with high & low pressure alarms). •If not so equipped, the checklist must be modified according to the difference in equipment design and variations.
- 7. Emergency Ventilation Equipment 1.Verify backup ventilation equipment is available and functioning •Contaminated O2 supply, loss of oxygen supply pressure, and obstruction of the breathing system, cause the machine to be inoperable. •So check for the gas supply in Boyle’s or at least an AMBU should be ready.
- 8. High Pressure System 2.CheckO2 cylinder supply •A) Open O2 cylinder & verify at least half full •B) Close cylinder •It is not necessary to check any other cylinder besides O2. 3.Check central pipeline supplies. Check that hoses are connected & pipeline gauges read about 50 psi. Check for proper connection at wall.
- 9. Low Pressure System 4.Checkinitial status of low pressure system. •Remove O2 analyzer sensor & begin calibration. •Close flow control valves & turn vaporizers off. •Check fill level and tighten vaporizers’ filler caps. •Check vaporizers interlock.
- 10. 5. Perform leakcheck of low pressure system. a)Verify that the machine master switch and flow controls valves are off. b)Attach suction bulb to common(fresh) gas outlet. c)Squeeze bulb repeatedly until fully collapsed. d)Verify bulb stays fully collapsed for at least 10 seconds.
- 11. e)Open one vaporizerat a time and repeat steps c & d. f)Remove suction bulb, and reconnect fresh gas hose. This is called NEGATIVE PRESSURE LEAK TEST. Leaks as low as 100 ml/min may lead to critical decrease in the concentration of volatile anesthetic.
- 12. 6. Turn onmaster switch and all other necessary electrical equipments. 7. Test Flow-meters. •A)Adjust flow of all gases through their full range, checking for smooth operation of floats and undamaged flow tubes. •B)Attempt to create a hypoxic O2/N2O mixture and verify correct changes in flow and/or alarm.
- 13. Scavenging System 8. Adjustand check scavenging system. •A) Ensure proper connections between the scavenging system and both APL(pop off) valve and ventilator relief valve. •B) Adjust waste-gas vacuum(if possible). •C)Fully open APL valve and occlude Y-piece.
- 14. •D) With minimumO2 flow, allow scavenger reservoir bag to collapse completely and verify that absorber pressure gauge reads about zero. •E) With the O2 flush activated, allow scavenger reservoir bag to distend fully, and then verify that absorber pressure gauge reads <10 cm H2O.
- 15. Breathing System 9. CalibrateO2 monitor •Final line of defense against hypoxic mixtures. •A)Ensure monitor reads 21% in room air. •B)Verify low O2 alarm is enabled and functioning. •C)Reinstall sensor in circuit and flush breathing system with O2. •D)Verify that monitor now reads greater than 90%.
- 16. 10.Check initial statusbreathing system •A)Set selector switch to Bag mode •B)Check that breathing circuit is complete, undamaged, and unobstructed. •C)Verify that CO2 absorbent is adequate. •D)Install breathing circuit accessory equipment (eg. Humidifier, PEEP valve) to be used during the case.
- 17. 11. Perform leakcheck of the breathing system •The usual high pressure check. •A)Set all gases to zero or minimum. •B)Close APL valve valve and occlude Y-piece. •C)Pressurize breathing system to about 30 cm H2O with O2 flush. •D)Ensure that pressure remains fixed for at least 10 seconds. •E)Open APL valve and ensure that pressure decreases.
- 18. Manual and AutomaticVentilation Systems 12.Test ventilation systems and unidirectional valves •A)Place a second breathing bag on Y-piece. •B)Set appropriate ventilator parameters for next patient. •C) Switch to automatic-ventilation (ventilator) mode. •D)Turn ventilator on and fill bellows and breathing bag with O2 flush.
- 19. •E)Set O2 flowto minimum, other gas flows to zero. •F)Verify that during inspiration bellows deliver appropriate tidal volume and that during expiration bellows fill completely. •G)Set fresh gas flow to about 5L/min. •H)Verify that the ventilator bellows and simulated lungs fill and empty appropriately without sustained pressure at end expiration.
- 20. •I)Check for properaction of unidirectional valves. •J)Exercise breathing circuit accessories to ensure proper function. •K)Turn ventilator off and switch to manual ventilation(Bag/APL) mode. •L)Ventilate manually and ensure inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance. •M)Remove second breathing bag from Y-piece.
- 21. Monitors 13. Check, calibrateand/or set alarm limits of all monitors: •Capnograph, •pulse oximeter, •O2 analyzer, •respiratory-volume monitor(spirometer), •pressure monitor with high and low airway-pressure alarms.
- 22. Final Position 14.Check finalstatus of machine •A)Vaporizers off •B)APL valve open •c)Selector switch to Bag mode •D)All flowmeters to zero(or minimum) •E)Patient suction level adequate •F)Breathing system ready to use.
- 23. Anesthesia Time Outimmediately before induction All monitors attached, functional? - capnogram, SpO2 waveforms? Flowmeter , ventilator settings proper? Manual/ventilator switch to manual and APL open? Vaporizers filled? Repeat check before each patient.
- 24.