The Anaesthetic Machine

August 2017
What does the anaesthetic machine
do?
 What does the anaesthetic machine
do?
• Controlled delivery of gases and drug
• Control of gas flow and pressure
• Monitoring of gas and drug delivery
• Multiple safety features to protect machine
and patient
Who is responsible for the machine?
 Who is responsible for the machine?
• Anaesthetist?
• ODP?
• Trust?
Why do a machine check?
 Why learn about the machine check?
• Safe delivery of anaesthesia
– Oxygen
– Anaesthetic gases
• Useful in exams
• Part of the basic competence certificate
Machine Check
Self-inflating bag
AMBU bag
Power Supply
 Power supply
• Find power supply
• Are the lights on?
Gas Supply and Suction
 Tug Test
• Wall: Schrader valves
– Colour/name coded wall outlet and hose
– Shaped index collar connection
– Anti-kink hose
• Machine: NIST
– Colour/name coded
Gas cylinders
 Gas cylinders
• Back up gas supply
• Colour coded
• Fill level?
• Turned on?off?
 Gas cylinders
• Back up gas supply
• Colour coded
• Fill level?
• Turned on?off?
 Pressure Gauges
• Cylinder
• Pipeline
 Flowmeters
• Controls O2:Air:N2O mix
• Working? Sticking?
Spinning?
• Hypoxic guard
• Colour, shape and
location coding
Electronic Controls
Emergency O2 Flush
• High Flow O2 (75L/min
at pipeline pressure)
• Risk:
– Volutrauma
– Barotrauma
– Awareness
 Suction
• Clean
• Working
• To hand
Breathing System
 Vapourisers
• Tec • Aladin Cassettes
– Select-a-tec – Correct agent
– Meniscus level – Meniscus level
– Seated securely
 Vapourisers
• Provision of volatile agent
• Check fill level
• Desflurane – power supply?
• Leak free?
• Keyed filling mechanism
• Colour coded
• Spill protection
 Breathing System
• Appropriate circuit • Check the correct
• One way valves system is available and
• APL valve fitted
– Bain
• Reservoir bag
– Circle
• Leak test – T-piece
• Correct gas outlet
selected
Common Gas Outlet
• ALWAYS check !
 Breathing System
• Appropriate circuit • Ensure correct direction
• One way valves of gas flow
• APL valve • Check valves flutter
• Reservoir bag
• Leak test
 Breathing System
• Appropriate circuit • Function:
• One way valves – Unidirectional exhaust
• APL valve – Adjustable PPV
– Safety blow off
• Reservoir bag
• Leak test
 Breathing System
• Appropriate circuit • Reservoir of gas and
• One way valves volatile
• APL valve • Various sizes
• Reservoir bag • Closed or open ended
• Leak test
 Breathing System
• Appropriate circuit • Occlusion
• One way valves • Bulb
• APL valve
• Reservoir bag
• Leak test
 Soda Lime
• Securely seated
• Exhausted?
Two Bag Test
Ventilator
Ventilator
Scavenging
 Scavenging
• Working
• Configured
Monitors
Monitors
Monitors
Airway equipment
Airway Equipment
• Range of equipment
• Spares
• Trained helper
• Check the light
 NEVER FORGET
• Self-inflating bag
• Common gas outlet
• Difficult airway equipment
• Resuscitation equipment
• TIVA/Pumps/infusions
• Help
 Before each case
• Check the breathing system – two bag test
• Ventilator – correct for patient
• Airway equipment – correct for patient
• Suction – clean and working

Weekly
• Oxygen failure alarm (Daily tug test)
 At the end of the check…
• Could you keep the patient oxygenated and
asleep…
– If the power was lost?
– If the pipeline gas supply failed?
– Where is your help?
 References
• AAGBI (2012) Safety Guideline: Checking Anaesthetic
Equipment 2012. AAGBI
• Hooper et al. (2015) Graphic Anaesthesia: Essential diagrams,
equations and tables for anaesthesia. Scion
• Aston et al. (2014) Equipment in Anaesthesia and Critical
Care: A complete guide for the FRCA. Scion.