The Anesthesia Machine Check

Jose Anesthesia Tech

Jose Anesthesia Tech

Geetings to all readers that have been waiting for a new post from the Nurse Anesthetist.  Today, the focus on anesthesia equipment is increasing both in board review preparation and in the practicing anesthestist.  I will highlight this by a short vignette from this week.

This is another day in the OR with simple cases and a time crunch to get the room set up before the CRNA meeting set for 6:30.  This is the usual state of affairs.  Doing the machine check is a habit that we all have and usually goes off without a hitch but not today.  The first thing I usually do is to check to see if the anesthesia techs have done a machine check for the day.  Arriving at 6:00 in the OR I checked and NO machine check done yet.  That’s unusual.  OK, I can do it no problem and I always have to check the ventilator and tanks anyway so this is just another step.
The first run through results in a high leak failure.  Lets trouble shoot this.  Fist, change the circuit and recheck – plus I changed the CO2 canister which is sometimes the source of a leak in the system if there is a crack in the plascic.  I did a another recheck and this resulted in a failure with high leak.   OK, now its 6:15 and I have to get this done and all the meds drawn up so I call my buddy Jose the anesthesia tech.  Jose to the rescue I am thinking.
Jose goes through a couple of maneuvers and scratches his head quickly and then decides to change out the anesthesia machine BLOCK.  For those that have not seen this done its pretty cool.  Its like a lobotomy of sorts.  The Block in the ADU houses the one way valves for inspiration and expiration.
anesthesia block parts
Even after Jose changed the Circuit, the CO2 absorber and the Block the damn thing still failed because of a high leak.  I have never seen this go this far and still fail.  I am out of clear territory now and ask Jose what to do next.  He said, “well once and awhile we have to check the bellows.”   Really, the bellows can fail as well?  DAMN it, if there was one thing that I thought was sacred it was the bellows.  The sky is falling and its now 6:25.
Jose changed out the bellows housing and wiped down the O’rings on the bottom of the frame between the bellows housing and the rest of the anesthesia machine.  So now we have changed out the CO2 canister, the circuit, the Block housing the fresh gas flow and now the bellows.  Is there anything left I asked Jose.  Of course, I thought that maybe there is a crack in the internal flow meters which could cause a catastrophic failure as I’m seeing here.  It could happen.
Here is the naked fresh gas flow without the bellows in the ADU.

anesthesia machine naked

In the end Jose got the machine working within 15 minutes and thanks to his help I got to the meeting on time. There are several points here I want to make sure all of you understand and take to heart.  There is only one person responsible for an anesthesia machine full check out.  It’s not Jose.
Jose helped me but it is my responsibility to my patients and my profession to make sure that every day without fail not matter what, I DO A COMPLETE AND FULL anesthesia machine check out.  I do not leave this to the techs and bless them they are willing to help.

The other day I had to switch rooms with another anesthesia provider at 07:15.  Did I assume that he had checked out his machine???  Did I rush off to see my patient because we were running late due to the room switch???  NO, I went to the room and did a complete anesthesia machine check out myself.  What I found was an empty O2 cylinder.  No problem, I called the techs and had it changed.  Later that day I talked to some one in charge telling him what I had found hoping that he would make it a point to emphasize the importance to all Anesthesia providers the necessity to check their machines.  I was disappointed to hear him say, “well the techs have to do a better job.”  What about the person doing the case I asked.  “Sometimes we are all too busy” or some such nonsense.  I respect the people I work with greatly but was very disappointed in this response.

The point here is that YOU, the provider, is the only one that is responsible for a complete and thourgh machine check out.  No one else will take the Stand for you in the court room.
If there is an issue with the anesthesia machine and there is morbidity or mortality due to a machine issue the wonderful anesthesia tech that you have relied on will not be named in the law suit.  It’s you and me or any other anesthesia provider that starts a case with a malfunctioning machine that will pay the price of NEGLIGENCE.  The biggest price that will be payed will be in patient insult.  Let me say that again, it is the patient that pays the biggest price.  I do not want any injury to my patient’s on my conscience or imputed to my profession as a Nurse Anesthetist.  I am hoping that all this rant will at least open your mind to the things we all know to be basic.
1)  Never start a case without a complete machine check.
2)  If you have trouble ask for help from some one that knows more than you.
3) Do not ignore any equipment malfunction in the OR.  GET IT FIXED.  DO not jerry rig anything.
4) If all else fails change the bellows.  Kari, knows this one.
OK, thanks for reading and taking this simple cautionary tale to heart.  NEVER start your day without a complete anesthesia machine checkout.
Categories : General


  1. This article is relevant for medical professional especially those who handle anesthesia.Good tip of advice. Thank you!


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