Anesthesia Machine Safety Check for Aestiva (Based on 1993 FDA Recommendations
Emergency Backup
1. Verify emergency oxygen supply & ventilation equipment (Ambu bag)
a. Ensure extra oxygen E-cylinder is present & gas supply is appropriate (at least 1000 psi)
b. Check oxygen flow via auxiliary O2 flowmeter with anesthesia machine in standby mode
Monitors: Turn on cardiac and gas monitors
Put breathing bag on end of circle breathing circuit to minimize N20 waste gases during checkout (facemask can sit on
top of anesthesia machine)
HIGH PRESSURE SYSTEM (exposed to cylinder pressure)
INTERMEDIATE PRESSURE SYSTEM (exposed to pipeline supply)
2. Check oxygen low pressure alarm & O2 cylinder supply
a. Turn system switch ON (turn on machine- ventilator display will light up)
b. Disconnect oxygen pipeline supply (O2 cylinder should be closed)
c. Activate O2 flush valve briefly to eliminate O2 in machine
d. Verify No O2 PRESSURE ALARM (audible & visual on ventilator display)
e. Check oxygen cylinder pressure (turn counter-clockwise to open)
-Confirm a minimum of 1000 psi O2 on pressure gauge
-Check nitrous oxide (N20) & air cylinder pressures
f. Check Fail-Safe Valve
-Turn oxygen & N20 at 5 L/M on flowmeters
-Close oxygen cylinder & observe falling oxygen float on the flowmeter
[Nitrous oxide should fall to zero faster than oxygen before the
No O2 PRESSURE ALARM begins alarming]. O2 cylinder remains closed. Close N20 and air cylinders.
3. Check Central Pipeline Supply (oxygen, nitrous oxide, air)
a. Verify all gas pipeline hoses are connected (include vacuum hoses for scavenger and anesthesia suction)
b. Check that each pipeline pressures read ~50 psig (primary gas supply)
c. Turn off flowmeters (turn flow control valves clockwise to close)
LOW PRESSURE SYSTEM
4. Check Low Pressure System: Vaporizers turned off
a. Check each vaporizer fill level (fill if needed with liquid anesthetic) & tighten fill cap
5. Perform leak check of machine low pressure system
a. Turn system switch to STANDBY (off)
b. Test bulb suction (thumb seals open end, squeeze to ensure bulb stays deflated)
c. Open Auxiliary Common Gas Outlet (ACGO) by moving lever downward & attach bulb suction
d. Squeeze bulb suction several times & verify it stays deflated. Turn on one vaporizer and squeeze bulb suction
several times (should stay deflated for ~10 seconds)
e. Check INTERLOCK system by attempting to turn ON each vaporizer during the individual vaporizer low
pressure leak check (only one vaporizer should be able to be turned ON at any given time). Repeat check for
each vaporizer located on machine.
f. Close ACGO (move lever up) & remove bulb suction from ACGO (store in anesthesia machine drawer)
g. Turn system switch ON
6. Test Flowmeters
a. Adjust flows of all fresh gases through their full range (check for smooth float movement; inspect for flowtube
damage such as cracks). *Start by turning on nitrous oxide to 10L/M (oxygen will increase and turn on)
b. Attempt to generate a hypoxic mixture with N20 & O2 (Link-25). Observe changes in flow & alarms
7. Check absorbent and Test Scavenging System
a. Open canisters to inspect CO2 absorbent (replace absorbent if exhausted). Verify canisters are secured
b. Automatic scavenge system: Vacuum must be connected and functional. Visually inspect flow tube indicator;
ball should be in green range (not red).
8. Check Breathing System.
a. Calibrate O2 sensor to 21%
b. Open hatch door & remove oxygen sensor (cord will remain attached). Exposure sensor to room air.
c. Go to ventilator display menu (pages icon) and initiate calibration for 21% (several screens). Checking sensor
reading & verify low O2 alarm setting & function
d. Replace oxygen sensor & close hatch. Activate oxygen flush valve & verify that oxygen sensor reads > 90%
e. Verify that breathing circuit, HME, and bacterial/viral filter are securely attached to machine & undamaged.
Place in BAG mode.
f. Confirm ETCO2 is visible on cardiac monitor (ensure capnography waveform is present during preoxygenation,
prior to induction of general anesthesia)
9. Test Ventilator & Unidirectional Valves
a. Set appropriate ventilator settings for patient. Fresh gas flow OFF
b. Switch lever to VENT mode (picture of bellows)
c. Fully fill bellows with O2 flush valve
d. Verify that bellows are delivering appropriate tidal volumes during inspiration (exhalation: bellows are full)
e. Set fresh oxygen gas flow to 5 L/M. Check for proper action of inspiratory and expiratory UNIDIRECTIONAL
VALVES if not already observed.
10. Perform Leak Check of the Breathing System (repeat this section for each new circuit and anesthesia case)
a. Turn off flowmeters (fresh gas)
b. Close APL valve & occlude Y-piece of breathing circuit
c. Use O2 flush valve to pressurize system to ~30cm H20 (hold for minimum of 10 seconds)
d. Open APL valve & observe pressure decrease in reservoir bag
e. Place facemask on breathing circuit (add air to facemask with a syringe if needed to increase cuff volume)
11. Verify cardiac and gas monitors are fully functional (self-test completed) and set appropriate alarms
(Verify capnography, pulse oximeter, gas monitor/analyzer, EKG & temperature cables, and pressure lines, etc.)
a. Verify monitor is set for appropriate patient profile: adult, pediatric, neonate
12. Final Check of machine status
a. Vaporizers and flowmeters OFF
b. APL valve open (‘Min’ on dial for Aestiva)
c. Selector switch on BAG mode
e. Suction is functional and Yankauer at head of bed
f. Breathing system is ready
g. Place in APNEA ALARM STANDBY mode
h. Verify anesthesia set-up is ready (SALT: Suction, airway (oral), laryngoscope, tube (ETT), drugs, & other items)
I. Write date, time, & provider initials on small dry erase board on machine to verify pre-use checkout complete
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Use this guide to check the Aestiva Anesthesia Machine