The Anaesthetic Machine August 2017 What does the anaesthetic machine do? What does the anaesthetic machine do? • Controlled delivery of gases and drug • Control of gas flow and pressure • Monitoring of gas and drug delivery • 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 – Oxygen – 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 • Desflurane – 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. .