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FDA Anesthesia Apparatus Checkout
Recommendations, 1993

This checkout, or a reasonable
equivalent, should be conducted before administration of anesthesia. 
These recommendations are only valid for an anesthesia system that conforms
to current and relevant standards and includes an ascending bellows
ventilator and at least the following monitors: capnograph, pulse oximeter,
oxygen analyzer, respiratory volume monitor (spirometer) and breathing
system pressure monitor with high and low pressure alarms.  This
is a guideline that users are encouraged to modify to accommodate differences
in equipment design and variations in local clinical practice. Such
local modifications should have appropriate peer review.  Users
should refer to the operator manual for specific procedures and precautions.

Emergency
Ventilation Equipment

*1. Verify Backup Ventilation
Equipment is Available & Functioning.

High Pressure
System

*2. Check O<sub>2 Cylinder
Supply

a. Open O<sub>2 cylinder and verify at least
half full (about 1000 psi).

b. Close cylinder.

*3. Check Central Pipeline Supplies

Check that hoses are connected and pipeline gauges
read about 50psi.

Low Pressure System

*4. Check Initial Status of
Low Pressure System

a. Close flow control valves and turn vaporizers off.

b. Check fill level and tighten vaporizers' filler
caps.

*5. Perform Leak Check of Machine
Low Pressure System

a. Verify that the machine master switch and flow control
valves are OFF.

b. Attach "Suction Bulb" to common (fresh)
gas outlet.

c. Squeeze bulb repeatedly until fully collapsed.

d. Verify bulb stays fully collapsed for at
least 10 seconds

e. Open one vaporizer at a time and repeat "c"
and "d" as above.

f. Remove suction bulb, and reconnect fresh gas hose.

*6. Turn On Machine Master Switch

and all other necessary electrical equipment.

*7. Test Flowmeters

a. Adjust flow of all gases through their full range,
checking for smooth operation of floats and undamaged flowtubes.

Attempt to create a hypoxic O</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;"><sub>2/N</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;">₂</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;">O mixture and verify correct changes in flow and/or alarm.

Scavenging System

*8. Adjust and Check Scavenging
System

a. Ensure proper connections between the scavenging
system and both  APL (pop-off) valve and ventilator relief valve.

b. Adjust waste gas vacuum (if possible).

Ful</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;">ly open APL valve and occlude Y-piece.
With minimum O</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;"><sub>2 flow, allow scavenger reservoir bag to collapse completely
and verify that absorber pressure gauge reads about zero.
With the O</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;"><sub>2 flush activated, allow the scavenger reservoir bag
to distend fully, and then verify that absorber pressure gauge reads < 10 cm H</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;">₂</span><span class="Normal--Char" style=" font-family: 'Times New Roman', 'Arial';
font-size: 9pt;">O.

Breathing System

*9. Calibrate O<sub>2
Monitor

a. Ensure monitor reads 21% in room air.

b. Verify low O<sub>2 alarm is enabled and functioning.

c. Reinstall sensor in circuit and flush breathing
system with O<sub>2.

d. Verify that monitor now reads greater than 90%.

10. Check Initial Status of Breathing
System

a. Set selector switch to "Bag" mode.

b. Check that breathing circuit is complete, undamaged
and unobstructed.

c. Verify that CO<sub>2 absorbent is adequate.

d. Install breathing circuit accessory equipment (eg,
humidifier, PEEP valve) to be used during the case. 

11. Perform Leak Check of the Breathing
System

a. Set all gas flows to zero (or minimum).

b. Close APL (pop-off) valve and occlude Y-piece.

c. Pressurize breathing system to about 30cmH₂O
with