• Gas flow rate
  • bobbin = top
  • ball = middle of ball
• Level 3 check is the checks that are performed before each patient
  • the priority is that pre-patient checks are performed, rather than the exact list of checks
• can check if piped gas is as-advertised
  • cf N2O disasters
  • FiO2 0.25 + N2O 60% = what you intend
  • observe the MEASURED FiO2 / FiN2O = actual

• Common gas outlet = where all the gases leave the machine

• 1 = New system / after servicing or repair
• 2 = Before each list
• 3 = Before each patient

• 1:Service label
• 2:High pressure system
  • Reserve O2 cylinder
    • Pressure = appropriate
    • On/Off = works
    • Content = adequate
    • Cylinder/yoke = no leak
  • Gas supply lines
    • Pressures = appropriate
    • turn reserve cylinders OFF after check
• 3:Low pressure system
  • Flow controls
    • Turn on
    • Flow indicators = work
    • O2 supply failure warning = works
  • Vapourisers (IA delivery device)
    • Content = adequate
    • Circuit leaks = both on/off states
  • Machine leaks upstream from common gas outlet
  • Breathing systems
    • CO2 absorbent condition
    • Test for leak
      • follow protocol
      • guide = P > 30 cm H2O and FGF 300 mL/min
    • Test integrity of circle breathing system
      • inflation / deflation of breathing bag
      • movement of unidirectional valves
      • normal resistance and compliance to feel
• 4:Automatic ventilation system
  • follow manufacturer's recommendations
  • turn on, ensure alarms work
    • disconnection
    • high pressure
• 5:Scavenging system
• 6:Emergency ventilation system
  • presence and function of alternative method of providing O2 and PPV
  • ie. Ambu-bag
• 7:IV and LA delivery devices
• 8:Other
  • Airway equipment
  • Suction apparatus
  • Breathing gas analysis
  • Monitoring equipement
  • IV infusion devices
  • Breathing circuit humidifiers
  • Breathing circuit humidifiers
• 9:Final check
  • Turn vapourisers off
  • Purge system with air / O2
• 10: Document

• 1:Vapouriser
• 2:Breathing system
• 3:IV / LA devices
• 4:Other

• Self-inflating bag and mask
  • if anaesthetic machine fails, can still oxygenate and ventilate patient
  • check that PEEP valve works (opens and closes when squeezing bag)
• Bougie
• AGSS (Anaesthetic Gas Scavenging System)
  • ball in the middle (green zone)

• adequate suction = sticks to thumb

• I = IVC
• M = Monitoring
• A = Airway
• D = Drugs
• E = Extras, eg. suction

• Adequate pressure (for ventilating patient)
  • APL 70
  • Make sure that pressure is maintained in circuit

• disconnect face mask
• leave blue filter on
• put machine onto bag
• put pressure up to 50 cmH2O and turn FGF down
• look for leak / pressure decline
• do this before each case
• during a crisis mid-case, this allows you to focus more on the patient, because you have already checked the machine

ANZCA PS31