1. To Menu

2. Anesthesia Gas Machine Checkout Procedure
Initial Steps
High-Pressure System
Low-Pressure System
Breathing System
Ventilator System
Final Status Check

3. AGM Check: Initial Steps
1.1 Quick visual check
1.2 Back-up ventilation equipment

4. 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

5. AGM Check: Initial Steps 2
1.2 Back-up ventilation equipment
Self-inflating resus bag & O2 source
Check for incorrect assembly / damaged parts
Back to Menu

6. AGM Check: High Pressure System
2.1 Check central pipeline supplies
2.2 Check O2 reserve cylinder supply

7. AGM Check: High Pressure System 1
2.1 Check central pipeline supplies
Hoses are connected correctly (colours, DISS)
Pipeline gauges read psig
Disconnect O2 pipeline
Misconnections
Line pressure fluctuations
Failure of central O2 supply

8. 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 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

9. AGM Check: High Pressure System 2 (cont’d)
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
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
Back to Menu

10. 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

11. 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

12. AGM Check: Low Pressure System 2
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

13. 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

14. AGM Check: Low Pressure System 3
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”

15. AGM Check: Low Pressure System 3 (cont’d)
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

16. AGM Check: Low Pressure System 4
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

17. AGM Check: Low Pressure System 4 (cont’d)
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

18. AGM Check: Low Pressure System 4 (cont’d)
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 drops while Air continues
Close all 3 gas flow controls and reconnect O2 pipeline - verify pipeline pressure
No low O2 supply alarm when O2 supply 30 psig
Shutoff valve for N2O fails to close when 20 psig
Back to Menu

19. 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

20. AGM Check: Breathing System 1
4.1 Calibrate O2 monitor
Ensure monitor reads 21% with sensor in room air
Verify low O2 alarm enabled by breathing 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

21. AGM Check: Breathing System 2
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

22. AGM Check: Breathing System 3
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

23. AGM Check: Breathing System 4
Numerous leak sites possible
Auxiliary 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 cracked
Flow 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
4.4 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

24. AGM Check: Breathing System 5
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)

25. 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
Back to Menu

26. AGM Check: Ventilation Systems
5.1 Test automatic ventilation system
5.2 Test manual ventilation system

27. 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

28. 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 cm H2O with breathing bag off - obstruction somewhere?
Leak somewhere – see previous slide

29. 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
Back to Menu

30. AGM Check: Final Status Checks
6.1 Gas machine and breathing system
6.2 Monitors

31. 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

32. 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”)
Back to Menu