Volume 7, No. 4 • Winter 1992

Text of 1992 Proposed FDA Anesthesia Checklist

Emergency Ventilation Equipment

* 1. Verify Backup Ventilation Equipment is Available & Functioning

High Pressure System

* 2. Check Oxygen Cylinder Supply

a. Open 02 cylinder and verify at least half full (about 1000 psi).

b. Close cylinder.

* 3. Check Central Pipeline Supplies

a. Check that hoses are connected and pipeline gauges read 45-55 psi.

Low Pressure System

* 4. Check Initial Status of Low Pressure System

a. Close flow control valves and turn vaporizers off.

b. Check fill level and tighten vaporizers’ filler caps.

c. Remove 02 monitor sensor from circuit.

*5. Perform Leak Check of Machine Low Pressure System

a. Verify that the machine master switch and flow control valves are OFF.

b. Attach ‘Suction Bulb’ to common (fresh) gas outlet.

c. Squeeze bulb repeatedly until fully collapsed.

d. Verify bulb stays fully collapsed for at least 10 seconds.

e. Open one vaporizer at a time and repeat ‘c’ and ‘d’ as above.

f. Remove suction bulb, and reconnect fresh gas hose.

* 6. Turn On Machine Master Switch

and all other necessary electrical equipment.

* 7. Test Flowmeters

a. Adjust flow of all gases through their full range, checking for smooth operation of floats and undamaged flow-tubes.

b. Attempt to create a hypoxic 02/N20 mixture and verify correct changes in flow and/or alarm.

Breathing System

* 8. Calibrate 02 Monitor

a. Calibrate to read 21 % in room air.

b. Reinstall sensor in circuit and flush breathing system with 02.

c. Verify that monitor now reads greater than 90%.

9. Check Initial Status of Breathing System a. Set selector switch is in “Bag’ mode.

b. Check that breathing circuit is complete, undamaged and unobstructed.

c. Verify that C02 absorbent is adequate.

d. Install breathing circuit accessory equipment to be used during the case.

If an anesthetist uses the same machine in successive cases, these steps need not be repeated or may be abbreviated after the initial checkout.

10. Perform Leak Check of the Breathing System

a. Set all gas flows to zero (or minimum).

b. Close APL valve and occlude Y-piece.

c. Pressurize breathing system to 30 cm H20 with 02 flush.

d. Ensure that pressure remains at 30 cm H20 for at least 10 seconds. Scavenging System

11. Check APL Valve and Scavenging System

a. Pressurize breathing system to 50 cm H20 and ensure its integrety.

b. Open APL valve and ensure that pressure decreases.

c. Ensure proper scavenging connections and waste gas vacuum.

d. Fully open APL valve and occlude Y-piece.

e. Ensure absorber pressure gauge reads zero when: -minimum 02 is flowing, and 02 flush is activated.

Manual and Automatic Ventilation Systems

12. Test Ventilation Systems and Unidirectional Valves

a. Place a second breathing bag on Y-piece.

b. Set appropriate ventilator parameters for next patient.

c. Set 02 flow to 250 ml/min, other gas flows to zero.

d. Switch to automatic ventilation (Ventilator) mode.

e. Turn ventilator ON and fill bellows and breathing bag with 02 flush.

f. Verify that during inspiration bellows delivers correct tidal volume and that during expiration bellows fills completely.

g. Check that volume monitor is consistent with ventilator parameters.

h. Check for proper action of unidirectional valves.

i. Exercise breathing circuit accessories to ensure proper function.

j. Turn ventilator OFF and switch to manual ventilation (Bag/APL) mode.

k. Ventilate manually and assure inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance.

l. Remove second breathing bag from Y-piece.


13. Check, Calibrate and/or Set Alarm Limits of all Monitors

** Capnometer Pulse Oximeter

** Oxygen Analyzer Respiratory Volume Monitor (Spirometer)

** Pressure Monitor with High and Low Airway Pressure Alarms

Final Position

14. Check Final Status of Machine

a. Vaporizers off.

b. APL valve open.

c. Selector switch to “Bag”.

d. All flowmeters to zero (or minimum).

e. Patient suction level adequate.

f. Breathing system ready to use.