Anastasia machine

For the Anastasia machine must do the following things:

Safety Precautions:

* Remove contents of shelves before moving machine.* When moving the anesthesia machine, always use the handles provided and pull the machine whilewalking backwards.* Always disconnect pressure hoses and electric cords, securing them before moving the anesthesiamachine.* Always turn the E cylinders off and bleed all gas pressure from the anesthesia machine before moving.* Always turn all flow valves, vaporizers, external monitors, and the system power switch to OFF whenthe anesthesia machine is not in use.* Always activate the oxygen flush button for several seconds after the anesthesia machine has been shutdown.* Always remove the oxygen sensor from the inspiratory valve dome, and install the plug in the inspiratoryvalve dome when the oxygen monitor is not in use.* Always clean your hands thoroughly before servicing anesthesia equipment.* Always use barrier precautions when handling or servicing an anesthesia machine that may be contaminated.* Use only lubricants specified by NAD on your Narkomed anesthesia system.* Service the anesthesia equipment only in a well ventilated area; avoid inhaling gases or vapors.* Do not repair high pressure cylinder regulators. When malfunctioning, replace with a new regulator.* Do not attempt to disassemble, repair, or recalibrate vaporizers. Any vaporizer requiring serviceshould be drained of residual fluid, dried, and returned to NAD.* Do not operate the anesthesia machine unless the electrical power cord is plugged into an appropriate, live AC receptacle.

Testing Procedures: 1. All components of the anesthesia delivery system need to be visually inspected daily.a. Check all fittings and connections for proper fit.b. Check unidirectional valves; ensure that the discs are present and properly placed.c. Check all hoses, tubing, and rebreathing for any deterioration.d. Check vaporizer level.

2. Gas Source

a. Open valve on tank(s) to verify that the tank has 500 psi or more in it. If less then500 then tank(s) needs to be changed to ensure proper line pressure is maintainedin the system.b. Check for any high-pressure leaks and correct if any are present.

3. Anesthesia machine and Circle Breathing System

a. Turn flowmeter(s) to verify that float does not stick in any position in the tube,and then turn off.b. Connect tubes to the inhalation and exhalation valves.c. Attach breathing bag.d. Close Pop-off valve.e. Occlude the end of the circuit with your thumb.f. Pressurize system to 30 cm H2O by depressing the flush valve.g. Observe that the manometer holds pressure for 10 seconds.

It should not drop more than 5 increments in 10 seconds (If a leak is present, turn on the flowmeter to compensate for the leak, a leak of greater than 200ml must be corrected before use. However, All leaks should be corrected before use. Use soapy water to locateleak(s), then correct.

Relieve pressure by opening the pop-off, the pressure on the manometer should

go to 0-2 cm H20 (This will insure that the pop-off is functioning correctly) If pressure is maintained then disconnect scavenging hose from the pop-off valve. If pressure is relieved then inspect scavenging system.

4. Non-Rebreathing systema. Ensure connection of fresh gas from the anesthesia machine to non-rebreathingcircuit.b. Occlude the patient port.c. Close the relief valve.d. Fill the reservoir bag until it is distended. Should remain full and the pressureshould not decrease.e. The inner tube can be tested, by occluding it at the patient end with the O2 flowingat 1-2 L/min. The float in the flowmeter should fall.

5. Scavenging System

a. Ensure that the scavenging system is connected to pop-off valve.b. If a canister is being used, ensure that the canister output is not occluded. Thiswill cause a build up of pressure in the system.c. If an active system is being used make sure that it is working appropriately and no occlusions are present.

An anesthesia delivery system that has been appropriately tested will allow for the correct flow of the anesthetic gas mixtures through the system.

Thus allowing the removal of CO2 from the exhaled gases before the patient inhales. Also the proper removal of waste gaseswill ensure a safe work environment for the hospital staff.

Checking the Anaesthetic Machine

Always have an alternative resuscitation device (e.g. self-inflating bag).

Check that cylinders are full and attached to the anaesthetic machine. There must always be a reserve supply of oxygen. Never use a machine if there is no reserve supply of oxygen.

Turn off all cylinders. Turn on all flow meters. There should be no flow. Check the flow meters

for cracks. Turn on the oxygen cylinder. There should only be flow in the oxygen

flow meter. The bobbin should spin. Repeat with each oxygen cylinder. Set the

oxygen flow to 4 litres/min. Turn on the nitrous oxide cylinder. Check that there is flow in the nitrous oxide flow meter (the bobbin

should spin) and that the oxygen flow meter is still at 4 litres/min. Turn off the oxygen supply and push the oxygen flush button. The oxygen failure alarm should sound. Turn on the oxygen cylinder again. The oxygen failure alarm should go

off. Check that all vaporisers are full and correctly fitted. The controls should operate thoughout their full range without sticking. Turn off the vaporisers. If the anaesthetic machine is fitted with a pressure relief valve it should be

tested by occluding the common gas outlet whilst gas is flowing. (Never do this test if a pressure relief valve is not fitted).

Attach the breathing system. Check that it has been correctly assembled. Close the APL valve, occlude

the end and fill with gas. Squeeze the reservoir bag to ensure there are no leaks.

Open the valve and ensure the breathing system empties. Check all airway equipment, suction equipment and drugs.

This checklist is an abbreviated version of the publication by the Association of Anaesthetists of Great Britain and Ireland 'Checking Anaesthesia Equipment 2012'.

Calibration

a. Checking the Flow Tubes. The function test chart (figure 2-1) shows the tests you use to calibrate/verify the anesthesia apparatus. You must check both the N2O and the O2 flow tubes at 1 lpm (liter per minute), at 4 lpm, and at 7 lpm. You check the vaporizer flow tubes at 0.2 lpm, at 0.5 lpm, and at 1 lpm. For example, to calibrate/verify the N2O flow tube, you supply N2O to the apparatus. Then conduct function test 33 at 1 lpm and at 4 lpm; then conduct function test 37 at 7 lpm. When the flow shown on the flow tube reaches the level in lpm as indicated on the chart, record the readings on the RT200. You then determine if the difference between the readings on the RT200 and the flow tube is within the limits of the manufacturer's literature. If the readings are within the limits, you should proceed to calibrate the O2 and vaporizer flow tubes. If the readings are not within the limits, the flow tube must be repaired or replaced. To calibrate the O2 flow tube and the vaporizer flow tubes, repeat the procedure above with O2 supplied to the anesthesia apparatus (with no N2O supplied). Each flow tube must successfully complete calibration/verification before you return the anesthesia apparatus to service.

Figure(2.1)

(1) You test each tube at three different pressures using different function tests. In order to get accurate readings, you must use the correct gas when performing a particular test.

(2) To test the N2O flow tube:

(a) Turn on the O2 gas to a minimum of 30 psi. (b) Turn on the N2O gas. (c) Input test 33 on the RT200. (d) Record readings on the RT200 when the N2O flow meter gauge reads 1 lpm and 4 lpm. (e) Input test 37 on the RT200. (f) Record the reading on the RT200 when the N2O flow meter gauge reads 7 lpm.

(3) To test the O2 flow tube:

(a) Turn off the N2O gas and turn on the O2 gas. (b) Input test 31 on the RT200. (c) Record the readings on the RT200 when the O2 flow meter gauge is at 1 lpm and at 4 lpm. MD0353 2-4 (d) Input test 33 on the RT200. (e) Record the readings on the RT200 when the O2 flow meter gauge is at 1 lpm and at 4 lpm. (f) Input test 35 on the RT200. (g) Record the reading on the RT200 when the O2 flow meter gauge reads 7 lpm. (h) Input test 37 on the RT200. (i) Record the reading on the RT200 when the O2 flow meter reads 7 lpm.

(4) To test the O2 for vaporizer flow tubes:

(a) Turn on the O2 gas, only. (b) Input test 31 on the RT200. (c) Record all readings on the RT200 when the O2 for vaporizer flow meter gauges (high and low flow) reads 0.2 lpm, 0.5 lpm, and 1 lpm. (d) Input test 33 on the RT200. (e) Record all readings on the RT200 when the O2 for vaporizer flow meter gauges (high and low flow) reads 0.2 lpm, 0.5 lpm, and 1 lpm.

(5) Compare all readings to manufacturer's specifications for the specific flow tube.

b. Checking the Pressure Gauge. You also calibrate/verify the breathing circuit pressure gauge with three separate tests. Because these are all low range pressures, you use test 11 to verify the gauge reading at 10 cm H2O. You use test 12 to verify the reading at 30 cm H2O and 60 cm H2O. (The O2 flow may need to be turned on slightly to establish a consistent pressure.) You record the analyzer readings at each level and compare the readings to the manufacturer's specification.

Maintenance

WARNING - DO NOT MODIFY, TAMPER WITH OR DISASSEMBLE THE VAPORIZER BECAUSE OF THE DANGERS OF DAMAGING THE UNIT AND ALTERING THE ACCURACY OF GRADUATION. Observation of the instructions given earlier, regular servicing and normal professional vigilance is normallyall that is required to maintain the vaporizer in a safe working condition.Schedule

Every Two Weeks:The vaporizer should be drained into an appropriately marked container when the agent level is low and theagent discarded. Less frequent intervals may be used when the anesthetic agent does not contain additivesor stabilizing agents.

Annually:The vaporizer should be serviced at an authorized service center. This service should include:1) Complete disassembly of components.2) Inspection of all parts for damage and wear.3) Thorough cleaning of all metal parts.4) Replacement of wicks, seals and damaged, worn or outdated items.5) Lubrication where necessary.6) Re-assembly of vaporizer and testing for and correction of any leaks.

7) Verification of the delivered vapor concentrations under closely defined conditions at different temperatures in order to test the temperature compensating mechanism. Any re-graduation or adjustment where necessary.8) Maintaining continuous service record.

WARNING - DO NOT PUT WATER OR ANY OTHER SOLVENT IN A VAPORIZER. A VAPORIZERSHOULD BE FILLED WITH THE SPECIFIED ANESTHETIC AGENT ONLY.

Clean the exterior of the vaporizer with a damp cloth. Never allow cleaning agents to accumulate in the filler, gas inlet and outlet

ports, or around the control dial. Contamination

If a contaminant is put into the vaporizer (e.g. inappropriate anesthetic agent, alcohol, water, etc.), contactan authorized service center immediately.

RepairsRepairs should only be carried out by an authorized service center.Note: It is not possible to change the graduation range or anesthetic agent.