5. Ventilation Systems - Automatic and Manual

5.1 Perform leak test - Ventilator circuit

  • Selector switch set to Ventilator - all flows set to minimum, occlude Y-piece
  • Fill bellows with O2 flush - pressure does not exceed 15 cm H2O - release flush
  • Set selector switch to Bag/APL and remove occlusion at Y-piece - ventilator bellows does not drift downward
  • defective ventilator pop-off valve - should release when > 2.5 cm H2O
  • leak - see next section

5.2 Test automatic ventilation system

  • Place a second breathing bag on the Y-piece
  • Set O2 flow to 250 ml/min and other gas flows to zero - set appropriate ventilator parameters for next patient
  • Set selector switch to Ventilator, turn ventilator ON and fill bellows with O2 flush
    • Inspiration - bellows delivers correct tidal volume; expiration - bellows fills completely
    • Volume monitor is consistent with ventilator
    • Proper action of unidirectional valves
  • pop-off valve does not close to allow bellows to fill completely
  • bellows housing not fastened tightly
  • drive gas hose not firmly attached
  • connection from absorber to bellows is leaking
  • volume sensor cartridge faulty
  • valves stick or do not seat properly
  • Remove breathing bag from Y-piece while ventilator is still working
    • Low pressure alarm sounds until breathing bag is replaced
  • Turn ventilator OFF
  • alarm faulty OR ventilator senses pressure 4 - 9 cm H2O with breathing bag off - obstruction somewhere?

5.3 Test manual ventilation system

  • Switch to Bag/APL mode
  • Ventilate manually and assure inflation and deflation of artificial lungs and appropriate feel of system resistance and compliance
  • Remove second breathing bag from Y-piece
  • faulty APL valve - incorrect pressure adjustment

6 Final Status Checks

6.1 Gas machine and breathing system

  • Vaporizers OFF
  • Selector switch to Bag/APL-APL valve open
  • Set O2 flow to 3 L/min - other gases to zero
  • Attach face mask to Y-piece and through a surgical mask, breath in and out through the circuit as final test
  • Set O2 flow to minimum
  • Patient suction adequate

6.2 Monitors

  • Check that capnometer registers the CO2 from your breath - and apnea alarm sounds after appropriate interval; check alarm settings
  • Check oximeter on your own finger for function; check alarm settings
  • Make sure manual BP cuff is available

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