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The College of Medicine of South Africa

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Machine-check guidelines for the DA(SA)

Disclaimer This document is provided for the sole purpose of guiding candidates for the DA(SA) examination in passing the compulsory Anaesthesia machine-check OSCE station at the examinations. It is not a comprehensive checklist, nor a recommendation for the checking of anaesthesia machines/workstations in clinical practice. This document is not peer reviewed and has not been sanctioned by the South African Society of Anaesthesiologists. Basic anaesthesia machine-check
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ON if an electrical machine, turn off all flows and connect breathing system Check O2 monitor in room air - calibrate to 21% if necessary & place at the common gas outlet (if possible) Verify correct assembly of breathing system (Hoses, reservoir bag, Y-piece etc) - do not occlude If present - check air rotameter and flow @ 6 lpm and close (O2 monitor should read 21-25%) Check O2 rotameter and flow @ 2 lpm (O2 monitor should rise) Check N2O rotameter and flow @ 8 lpm (O2 monitor drops, but remains >25% - ie Hypoxic guard OK)

Disconnect wall O2 (or close 1 O2 cylinder) and :Check that N2O flow ceases (ie O2 failure cut-off switch functional) Wait for O2 failure alarm Check O2 cylinder (2 O2 cylinder) pressure (P >50 000 kPa) Check O2 flush (Manometer should not rise - ie valve/s not sticking & O2 monitor should rise) Close O2 cylinder and reconnect wall O2 (or open 1 O2 cylinder) and :Perform "tug test" on O2, suction and other wall probes Check all pipeline (or cylinder) gauge pressures Replace O2 monitor in normal position Occlude breathing system and perform :Positive pressure leak test of CIRCLE and machine - Vaporiser/s ON Check vaporiser interlocks Check function of valves of circle system Check Soda-lime

Positive pressure leak test of ADE and machine - Lever UP & Vaporiser/s ON Check vaporiser interlocks Check lever function of ADE Positive pressure leak test - Lever DOWN (Ventilator hose in situ and blocked) Check APL valve pressure release (Manometer 60 hPa or cm "H2O") Ventilator /

-2Ventilator Check function (describe procedure if unfamiliar with ventilator) Check presence and function of resuscitator (eg AMBU, Laerdal etc) Suction Check function (>50 kPa negative P in 2 sec and <-300 kPa) Check for presence of suction nozzle (eg Yankauer) & catheters Vaporisers Check if properly attached Filled Ancillary equipment Check laryngoscopes (x 2) Check for presence of Magill forceps Masks Endotracheal tubes Check monitors Sphygmomanometer Pulse oximeter

Introducer Airways Alternative - / Supra- glottic airway (eg LMA) ECG / Defibrillator Capnograph

Notes - When performing the machine-check during the OSCE, please state clearly what you are checking - If any deficiencies are detected, report them - Practice on various types of machines if possible. The machine used during the exam may be the most basic to the more sophisticated. You have 10 min for the check - You may ask the invigilator specific questions about the machine e.g. where the ON / OFF switch is (if any) - If unfamiliar with the ventilator describe the technique you would use on your own machine

Johannesburg March 2008