We have recently had an anesthesia machine malfunction and are trying to determine if there is a standard that requires a backup, functioning anesthesia machine to be available. When our machines were all replaced several years ago, we acquired an extra machine “just in case”; however, that machine has been scavenged for parts, having been idle for over 5 years.
Michelle H Barker, CRNA, DNAP
Asheville, North Carolina
The Committee on Technology is unfamiliar with any regulations or standards that require a “spare” anesthesia machine to be available to a suite of operating rooms. We recognize that this is both a safety issue and an economic issue. Imagine that such a regulation existed and was applied to an outpatient surgical center with 2 operating rooms. A spare machine may be cost prohibitive, not just to purchase, but to maintain. One approach might be to develop a protocol specifying how to manage a catastrophic failure of an anesthesia machine during a surgical procedure.
In a suite of operating rooms the protocol could involve “borrowing” an anesthesia machine from another room that is not in use (during the day or after hours). If the catastrophic failure occurs at a time when no spare machine is available a protocol might include
- Using the spare oxygen tank in the room.
- Supply oxygen to disposable face mask if the patient is breathing spontaneously.
- Switch to manual ventilation using a self-inflating breathing bag if the patient is not spontaneously breathing.
- Obtaining a transport monitor if patient monitoring is an integral part of the machine. Instituting Total Intravenous Anesthesia (TIVA)
- .Closing the room after the case is finished until a fully functional anesthesia machine is available.
- MAC cases could be considered for a room without an anesthesia machine; however, the ever present risk of complications and needing to convert to a general anesthetic may preclude this option.
The cost of a spare machine should be considered and weighed against lost revenue from closing an operating room for the day or longer that it may take for a biomedical equipment technician to obtain the parts, repair the machine, completely evaluate the machine operation, and place it back in service.
A spare machine in the operating room environment that is not functional is inappropriate if it has been scavenged for parts. This machine should not remain near the ORs where it could be mistaken for a functional machine. If the anesthesia machines are supported by an in-house clinical engineering department, they should maintain the spare machine in functional form if they are going to leave it within the operating room area. If they are going to remove a part to fix another machine, the machine should live in the clinical engineering department until it is in completely functional according to the manufacturer’s specifications.
While a standard that requires a spare anesthesia machine be available in the event of a catastrophic machine failure does not exist, an economic argument may be made that it is a cost savings to have and maintain a spare machine rather than lose the revenue from closing the room for a day or two until the machine may be fixed.
Alternatively, a protocol could be developed for managing the patient safely in the event of a catastrophic failure of an anesthesia machine during a procedure.
The APSF Committee on Technology
Numerous questions to the Committee on Technology are individually and quickly answered each quarter by knowledgeable committee members. Many of those responses would be of value to the general readership, but are not suitable for the Dear SIRS column. Therefore, we have created this simple column to address the needs of our readership.
The information provided is for safety-related educational purposes only, and does not constitute medical or legal advice. Individual or group responses are only commentary, provided for purposes of education or discussion, and are neither statements of advice nor the opinions of the APSF. It is not the intention of the APSF to provide specific medical or legal advice or to endorse any specific views or recommendations in response to the inquiries posted. In no event shall the APSF be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with the reliance on any such information.