c








 
1. Verify backup ventilation equipment is available and
functioning (e.g. Ambu bag).



2. Check oxygen cylinder supply:

a. Verify that at least one backup cylinder is available and

check to see that it is at least half full (about 1000 psi) by
opening the cylinder valve and verifying that the cylinder
pressure gauge goes up. No other cylinders need to be
checked. b. Close the oxygen cylinder valve after
checking.

3. Check central pipeline supplies:

Check that hoses are connected and that the pipeline

pressure gauges read about 50 psi.


 
4. Check initial status of low pressure system.

a. Close the flow control valves and turn the vaporizers

off. b. Check the vaporizer fill levels and tighten the
vaporizer filler caps, test interlock system.

5. Perform leak check of low pressure system.

a. Verify that the machine master switch and flow control

valves are off. b. Attach a suction bulb to the common
gas outlet. c. Squeeze the bulb repeatedly until it is fully
collapsed. d. Verify that it stays collapsed for at least 10
seconds (a vacuum cannot be created if there is a
significant leak). e. Open one vaporizer at a time and
repeat step c & d (the bulb will initially re-inflate due to the
gas that was in the vaporizing chamber). f. Remove the
suction bulb and reconnect the fresh gas flow hose to the
common gas outlet.

6. Turn on the machine master switch and all other

necessary equipment. The low pressure alarm should be
heard because of the sudden increase of gas pressure in
the oxygen pipeline.

7. Test flowmeters.

a. Adjust flow of all gases through their full range,

checking for smooth operation of floats and undamaged
flowtubes. The minimum flowrate of oxygen should be 200
ml/min in Ohmeda Modulus I and II machines. b. Attempt
to create a hypoxic O2/N2O mixture by adjusting
flowmeters and make sure the hypoxic safeguard
mechanism prevents this from happening.

! 

8. Adjust and check scavenging system.

a. Ensure proper connections between the scavenging

system and both the APL valve and ventilator relief
valve. b. Adjust waste gas vacuum. c. Fully open APL
valve and occlude the Y-piece. d. With minimum O2 flow,
allow the scavenger reservoir bag to collapse completely
and verify that the absorber pressure reads about zero
(this tests the negative pressure relief valve - room air is
drawn into the scavenging system). e. With the O2 flush
activated allow the scavenger reservoir bag to distend
fully, and then verify that the absorber pressure gauge
reads < 10 cm H2O (this tests the positive pressure relief
valve - the high flow of the O2 flush will overcome the
scavenging system and excess gas will vent through the
valve).

Š

9. Calibrate the oxygen monitor.

Two different oxygen analyzers are actually used in our

operating room. One type is an electrochemical (slow)
sensor that measures FiO2 in the inspiratory limb of the
circuit. The FiO2 will be displayed in the same display as
the ventilator settings. The other type is a paramagnetic
sensor (fast) that is inside the gas-analyzing unit that also
does infrared absorption spectrometry of the anesthetic
gases and shows the capnogram.

a. Ensure the oxygen monitor reads 21% in room air. b.

Verify that the low O2 alarm is enabled and
functioning. c. Reinstall the sensor in the circuit and flush
breathing system with O2. d. Verify that the monitor now
reads greater than 90%.

10. Check initial status breathing system.

a. Set the selector switch to Bag mode. b. Check that the

breathing circuit is complete, undamaged and
unobstructed. c. Verify that CO2 absorbent is adequate
and not exhausted. d. Install breathing circuit accessory
equipment (e.g. PEEP valve) that is to be used during the
case.
11. Perform (positive pressure) leak check of the
breathing system.

a. Set all gas flows to minimum. b. Close APL valve and

occlude the Y-piece. c. Pressurize the breathing system
to about 30 cm H2O with O2 flush (check the inspiratory
pressure gauge). d. Ensure that the pressure does not
decrease for at least 10 seconds. e. Open the APL valve
and ensure that the pressure decreases.

 

12. Test ventilation systems and unidirectional valves.

a. Place a second breathing bag on the Y-piece. b. Set

appropriate ventilator parameters for next patient. c. Set
the selector switch to Ventilator mode. d. Turn the
ventilator on and fill bellows and breathing bag with O2
flush. e. Set O2 flow to minimum and other gas flows to
zero. f. Verify that during inspiration bellows delivers
appropriate tidal volume and that during expiration bellows
fills completely. g. Set fresh gas flow to about 5 L/min. h.
Verify that the ventilator bellows and simulated lungs fill
and empty appropriately without sustained pressure at
end expiration. i. Check for proper action of the
unidirectional valves. j. Exercise breathing circuit
accessories to ensure proper function. k. If everything
works satisfactorily, turn the ventilator off and switch the
selector switch to Bag mode. l. Ventilate manually and
feel if there is an appropriate amount of system resistance
and compliance during inflation and deflation of the
"artificial lungs". m. Remove the second breathing bag
from the Y-piece.

s

13. Check, calibrate and/or set alarm limits of all monitors.

"

14. Check final status of machine.

a. Vaporizers off b. APL valve open c. Selector switch to

Bag mode d. All flowmeters to zero or minimum
(oxygen) e. Patient suction level adequate f. Breathing
system ready to use ?