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The August 2017 What does the anaesthetic machine do?

What does the anaesthetic machine do? • Controlled delivery of and drug • Control of flow and of gas and • Multiple safety features to protect machine and patient Who is responsible for the machine?

Who is responsible for the machine?

• Anaesthetist? • ODP? • Trust? Why do a machine check?

Why learn about the machine check?

• Safe delivery of anaesthesia – – Anaesthetic gases • Useful in exams • Part of the basic competence certificate

Machine Check

Self-inflating bag AMBU bag Power Supply Power supply

• Find power supply • Are the lights on? Gas Supply and Suction

Tug Test

• Wall: Schrader valves – Colour/name coded wall outlet and hose – Shaped index collar connection – Anti-kink hose • Machine: NIST – Colour/name coded Gas cylinders Gas cylinders

• Back up gas supply • Colour coded • Fill level? • Turned on?off?

Gas cylinders

• Back up gas supply • Colour coded • Fill level? • Turned on?off?

Pressure Gauges

• Cylinder • Pipeline

Flowmeters

• Controls O2:Air:N2O mix • Working? Sticking? Spinning? • Hypoxic guard • Colour, shape and location coding Electronic Controls

Emergency O2 Flush

• High Flow O2 (75L/min at pipeline pressure) • Risk: – Volutrauma – Barotrauma – Awareness Suction

• Clean • Working • To hand Breathing System

Vapourisers

• Tec • Aladin Cassettes – Select-a-tec – Correct agent – Meniscus level – Meniscus level – Seated securely

Vapourisers

• Provision of volatile agent • Check fill level • – power supply? • Leak free? • Keyed filling mechanism • Colour coded • Spill protection Breathing System

• Appropriate circuit • Check the correct • One way valves system is available and • APL valve fitted – Bain • Reservoir bag – Circle • Leak test – T-piece • Correct gas outlet selected Common Gas Outlet

• ALWAYS check ! Breathing System

• Appropriate circuit • Ensure correct direction • One way valves of gas flow • APL valve • Check valves flutter • Reservoir bag • Leak test Breathing System

• Appropriate circuit • Function: • One way valves – Unidirectional exhaust • APL valve – Adjustable PPV – Safety blow off • Reservoir bag • Leak test Breathing System

• Appropriate circuit • Reservoir of gas and • One way valves volatile • APL valve • Various sizes • Reservoir bag • Closed or open ended • Leak test Breathing System

• Appropriate circuit • Occlusion • One way valves • Bulb • APL valve • Reservoir bag • Leak test

Soda Lime

• Securely seated • Exhausted? Two Bag Test Ventilator Ventilator Scavenging Scavenging

• Working • Configured Monitors Monitors Monitors Airway equipment Airway Equipment

• Range of equipment • Spares • Trained helper • Check the light

NEVER FORGET

• Self-inflating bag • Common gas outlet • Difficult airway equipment • Resuscitation equipment • TIVA/Pumps/infusions • Help Before each case

• Check the breathing system – two bag test • Ventilator – correct for patient • Airway equipment – correct for patient • Suction – clean and working Weekly • Oxygen failure alarm (Daily tug test) At the end of the check…

• Could you keep the patient oxygenated and asleep… – If the power was lost? – If the pipeline gas supply failed? – Where is your help?

References

• AAGBI (2012) Safety Guideline: Checking Anaesthetic Equipment 2012. AAGBI • Hooper et al. (2015) Graphic Anaesthesia: Essential diagrams, equations and tables for anaesthesia. Scion • Aston et al. (2014) Equipment in Anaesthesia and Critical Care: A complete guide for the FRCA. Scion.