What is the protocol for checking an anaesthesia (anesthesia) machine before use?

Anaesthesia Machine Check Protocol

The anaesthetist must perform a comprehensive pre-use check of anaesthetic equipment at the start of every operating session using a standardized checklist, with additional abbreviated checks before each individual patient, as failure to check equipment is a major contributory factor in anaesthetic misadventures resulting in hypoxic brain damage or death. 1

Two-Tiered Checking System

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) 2012 guideline establishes a two-part checking protocol that has been endorsed by the Chief Medical Officers of England, Scotland, Wales and Northern Ireland 1:

1. Full Session Check (Start of Operating Day)

• Perform a complete equipment check at the beginning of each operating theatre session covering all aspects from gas supply pipelines through the machine, breathing systems, filters, connectors, airway devices, ventilators, suction, monitoring and ancillary equipment 1
• This comprehensive check should take only a few minutes but represents an essential component of safe patient care 1

2. Brief Pre-Patient Check

• Conduct specific abbreviated checks before each new patient during a session or when there is any alteration or addition to the breathing system, monitoring or ancillary equipment 1

Core Checking Components

Power and Gas Supply

• Verify the anaesthetic workstation is connected directly to mains electrical supply (no multisocket extension leads) and switched on 1
• Confirm back-up batteries are charged and understand what backup power systems are available in your facility 1
• Perform a "tug test" on all gas pipeline connections to confirm correct insertion into appropriate sockets during regular pre-session checks 1
• Check the oxygen failure alarm weekly by disconnecting the oxygen hose while the oxygen flowmeter is turned on, maintaining a written record 1

Critical Safety Equipment

• Ensure a self-inflating bag is immediately available in any location where anaesthesia may be given, as this alternative means of ventilation may be life-saving 1
• Verify an alternative source of oxygen is readily available 1

Breathing System Verification

• Perform a two-bag test after the breathing system, vaporizers and ventilator have been checked individually 1
• This integrated approach ensures the entire system functions as a unit 1

Essential Documentation Requirements

• Keep a record with the anaesthetic machine that checks have been completed 1
• The "first user" check after servicing is especially important and must be recorded 1
• This documentation is critical as errors can occur when reassembling machines after service 1

Training and Competency Requirements

• Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so 1
• Full training and formal induction for any machines is essential - a quick "run-through" before the start of an operating session is not acceptable 1
• Hospitals must ensure all personnel are trained to use and check relevant equipment, with records of training maintained 1
• Knowledge of these safety checks may be tested as part of the FRCA examination 1

Modern Anaesthetic Workstations

• Understand which checks are performed automatically during machine start-up and ensure the automated check has been completed 1
• Many modern workstations enter a self-testing cycle when switched on; functions tested by the machine need not be retested by the user 1
• Use the AAGBI checklist in conjunction with manufacturer-specific checklists, not as a replacement 1

Critical Incident Response

• Perform an immediate brief check of equipment if a critical incident occurs, even if the equipment was checked before the start of the case 1
• Equipment faults may develop during anaesthesia due to pipeline failure, electrical failure, circuit disconnection or incorrect configuration 1

Common Pitfalls to Avoid

• Human factors contribute to greater complications than machine faults 2
• Failure to check the anaesthetic machine and/or breathing system features as a major contributory factor in many anaesthetic misadventures, including those resulting in hypoxic brain damage or death 1
• When changing anaesthetists during an operating session, the status of anaesthetic equipment must be confirmed, including that a formal check has been performed 1
• Take careful note of any information or labeling on the machine that might refer to its current status 1

Practical Implementation

The AAGBI checklist should be laminated and attached to each anaesthetic machine to assist in routine checking 1. The anaesthetist has primary responsibility to ensure these checks have been performed and must be satisfied they have been carried out correctly 1. This systematic approach, integrated into routine practice with proper documentation, forms the foundation of safe anaesthetic delivery and is recognized worldwide, including incorporation into the WHO Surgical Safety Checklist 1.