The Anesthesia

Delivery System
Troubleshooting
and Overview

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Learning Objectives -
 Explore the major components, internal
and external, of the anesthesia system.

 Analyze the components part in failure

scenarios.

 Explain the steps of isolating,

troubleshooting and solving the failures.

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Learning Objectives -
 Illustrate the importance of good habits
during pre-operative testing of the
equipment.

 List the functions of an anesthesia

system as defined by the ASTM.

 Increase patient safety by sharing

knowledge and best practices. We are
all part of the care giving team!

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Disclaimer -
 The materials contained in this
document are intended for
educational purposes only. The
material does not establish any
specifications, operating
procedures, or maintenance
methods for any of the products
referenced. Always refer to the
manufacturer’s official
documentation.

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The Anesthesia
System: defined
by ASTM
( Work-station )
( Care-station )
• Supplies blended
anesthesia gases
and anesthetic
vapors to the
patient.
• Provides
manual and
mechanical
ventilation
capabilities.
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The Anesthesia
System:
• Monitors O2
concentrations
• Offers protection
devices and alarms
designed to keep
users and patients
safe.
• Interfaces with
the facilities waste
gas scavenging
system to remove
excess gas.
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7
Dr. Lewis is working in OR6 at St. Michaels
Hospital today and Bev, CRNA, is working with
him. The anesthesia system in OR6 is an older
Datex-Ohmeda Excel/7800 system. Just as the
patient is intubated, the ventilator alarms “Low
O2 Supply.” The flow meters drop to zero. Dr.
Lewis panics and calls the workroom for help!

Scenario:

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 GAS SUPPLY Troubleshooting
Question:
As Dr. Lewis and Bev stabilize the patient, Paula
enters the room and turns on the oxygen cylinder.
The alarm silences and Paula begins to troubleshoot;
she note’s that the oxygen supply hose is connected
to the wall. Where might Paula look to determine if
the oxygen supply pressure at the wall connector is
adequate?
Answer:
The machines onboard supply
gauges

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 GAS SUPPLY Troubleshooting

Question:
Paula determines that the wall supply pressure was zero. Turns out, a
workman had inadvertently turned off the rooms zone valve. Luckily,
Bev had checked the oxygen cylinder during her pre-op check and
determined 1500 psi was present. Even luckier, she remembered to
turn the tank off after testing. What if Bev did not turn the tank off after
testing; how would this scenario be different?

Question:
Under normal circumstances, if both the wall supply and cylinder
supply are both connected to a machine and both are of adequate
pressure and the cylinder is on. Which supply supplies the oxygen
to the machine?

Answer:
The Wall Supply supplies the machine under normal
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circumstances.
The Gas Supply
Module includes:

• A cylinder branch

• A pipeline branch

• Pressure gauges

• Safety systems

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The Gas Manifold has TWO inputs and ONE output !!
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Joe Hill, CRNA is checking the pressure of his
N2O tank in OR2 and as soon as he opens the
valve, the sound of a large rushing of air is heard
inside the machine. He closes the valve and the
sound dissipates. He calls Mike from Biomed for
help.

Scenario:

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 GAS SUPPLY Troubleshooting

Question:
Mike determines that a failure has occurred with
the N2O cylinder regulator on the gas supply
module and the “rushing of air” sound was
completely expected. What is Mike talking
about?

Answer:
The gas supply module has a built in safety
relief valve that opens to atmosphere at 75
psi. 14
The Gas Supply
Module:

• Check valves
prevent leakage

• A relief valve will

open if pressure
increases above ~
75 psi

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 GAS SUPPLY Troubleshooting

We have been talking about the cylinders a lot.

Lets EXPLORE them a little.

Question:
How much volume is left in a N2O “E” cylinder
that reads 750 psi?

Answer:
Somewhere between 1600 and 300 liters. The
pressure will remain constant as long as
liquid N2O is present in the cylinder. 16
Cylinder Supplies:
• Cylinders are
intended to be the
secondary or
emergency gas
supply to the
anesthesia system.
• Cylinders are high
pressure devices and
should be handled
and stored carefully!

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Pin Indexing
Safety System –
PISS:
• Unique pin set
for each available
gas cylinder.
• “E” Cylinders
are also color
coded for safety.
• Pins should
always be intact
and secure!

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Installation:
• Use a new
cylinder gasket
with each new
cylinder.
• Make sure that
two gaskets are
not being used!
• Using your
foot to stabilize
the cylinder may
help.

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Diameter
Indexing Safety
System – DISS:
• Unique diameter
(inside and
outside) for each
available gas
supply.
• Fittings and
hoses are also
color coded for
safety.

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Pipeline Supply:
• Many styles of
wall outlet fittings
exist.
• Normal wall
supply pressure is
45 – 55 psi.

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Summary of Pipeline and Cylinder Criteria:

• Anesthesia work-station provides both

pipeline and cylinder inputs.
• Pressure gauges for each input
• DISS and PISS safety systems
• Input filters and check-valves
• Cylinder systems have pressure reducing
regulators.

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What is the first device
that will inform you of a
crossover (non-oxygen
gas in the oxygen
pipeline)?

Is it the fail-safe?
Is it the hypoxic guard?

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Shut-off (Fail-
Safe) Valves:
• Prevents the flow
of other gases like
nitrous-oxide when
oxygen pressure is
less than 20 psi.
• Newer anesthesia
machine designs do
not have a shut-off
valve on the Air
supply.

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Flow Control
Assembly:
• Nitrous-oxide and
oxygen are linked
together to prevent a
hypoxic mixture.
• Gas flow is
controlled by a needle
valve design
• O2 flow control
knobs feel differently.
• Minimum O2 flow is
machine specific.

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27
Oxygen flow knob is uniquely
designed – Fluted vs. Knurled

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Float Types:
• Ball type – read the
center of ball.
• Float type – read
the top of float.
• Some floats are
fluted and spin to
give visual
confirmation of gas
flow.
• Flow tubes are
tapered glass with
etched markings.

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Common Gas
Manifold:
• Oxygen is always
downstream to all the
other gases. Oxygen
is always on the
right.
• Dual flow tubes are
connected in series.
• Some current
anesthesia machine
designs use graphical
images of flow-tubes
on a display screen.
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What is the first device
that will inform you of a
crossover (non-oxygen
gas in the oxygen
pipeline)?

The Oxygen Analyzer !

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 Susan Jones, CRNA, is working
in OR 3 at Frick Hospital. She
sets a 50/50 mix of O2 and N2O;
1 lpm each. The O2 monitor is
reading 75%, not 50% as
expected. You did the O2
calibration this morning but
skipped the low pressure leak
test. You call the anesthesia tech
into the room.

Scenario:

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 GAS SUPPLY Troubleshooting

The anesthesia tech brings in another O2 sensor but the

scenario does not change….the O2 analyzer is reading
accurately at 100% but reads high when O2 is mixed. The
machine is pulled from service after your short case and
sent to the Biomed shop.

Question:
Biomed determined that a part failed on the machine.
Can you think of the device on the machine that failed?

Answer:
The O2 flush button developed a 2 lpm leak. This flow
was diluting the mixture at the common gas outlet.
Could this failure of been detected prior to the case
starting? 35
 Common Gas
Manifold / O2 Flush
Valve:
• Fresh blended gas
is delivered to the
CO2 absorber via the
common gas outlet.
• The flush valve can
deliver 30 – 75 lpm
of O2.
CGO:
22 mm O.D • Connection point of
15 mm I.D
low pressure leak test
device on some
model machines.
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 Vicky is a CRNA working
in OR4 today and begins
her morning set up. The
room is equipped with a
Datex-Ohmeda Tec 7
Isoflurane vaporizer.
Vicki notices an
Scenario:
occasional drip from a
port in the front of the
vaporizer. What can she
do?

Tighten the drain screw

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38
Vaporizers:
• Flow over design
type splits the
incoming gas flow.
• Isoflurane,
Halothane, and
Sevoflurane are flow
over vaporizers.
• Desflurane is a
pressurized injection
type vaporizer.
• Do not tip
vaporizers!

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Sam Smith, CRNA calls the workroom and states,
my vaporizer is set to 2% and my analyzer says
the inspired agent concentration is 1.2%; please
help! Debbie from the workroom replaces the
vaporizer and the gas monitor but the scenario
does not change. Debbie calls Biomed for help!

Scenario:

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 VAPORIZER Troubleshooting
Casey from Biomed asks what is the Fresh Gas Flow
(FGF) of the anesthesia system. Once he hears the
clinician is using low flow anesthesia, he suspects the
Dilution Effect of Rebreathing is going on. He explains:
Minute Volume is composed of FGF and the recirculated
gases of the exhaled breath.

If FGF is high, it constitutes a larger share of the MV.

Fresh gas contains full agent concentration. The gas
analyzer reads accurately and matches the vap setting.

As FGF is reduced, more recirculated gas comprises the

MV. Recirculated gas contains diluted agent
concentrations and dilutes the overall inhaled
concentration. The gas analyzer reads accurately but
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lower than expected.
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CO2 Absorber:
• Absorbent granules
remove the CO2 from
the patients exhaled
gas.
• Facilitates either
Manual (bag) or
Automatic (vent)
ventilation.
• Provides a port for
patient O2 monitoring.
• Controls airway
pressure in Manual
mode.
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• 22 mm circuit fittings
Unidirectional Valves:
• Prevents rebreathing
of CO2
• Seat / Disc design
ensures one-way flow.
• Clear domes allow
visual inspection of
discs.
• Excess water
contamination on disc
could cause reverse
flow.

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Scenario: Dr. Law and Michael Boulton,
CRNA, are working in OR1at
Uniontwon. After intubation, the
patient and the machine were
moved and positioned for the
procedure; now the ventilator
bellows is struggling to refill
during expiration. FGF is 4 lpm.
What can they do?

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Check for leaks in the
breathing system:
• ET Tube position.
• Breathing circuit connections.
• Absorber fittings and
connections:
O2 sensor
Airway pressure lines
• Ventilator connections
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BREATHING SYSTEM Troubleshooting

Answer:
Turns out, the clear
observation dome on the
absorbers inspiratory check
valve was cracked when the
machine was moved. Dr.
Law replaced the dome to
restore proper, leak free
operation.
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Automatic Vent Mode:
1. Exhaled gas is routed
to ventilator bellows.
2. When the vent
cycles, the exhaled
gas is forced down
through the
absorbent granules.
3. Patient rebreaths a
scrubbed gas / fresh
gas mixture.

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Manual Bag Mode:
1. Exhaled gas is
routed to breathing
bag.
2. When bag is
compressed, the
exhaled gas is
forced down
through the
absorbent granules.
3. Excess gas is
diverted to waste
system via APL.
4. Patient rebreaths a
scrubbed / fresh 51
Circuit Selector
Switch:
• In Bag mode,
exhaled gas is routed
to breathing bag.
• The Adjustable
Pressure Limiting
(APL) valve limits
airway pressure to ~
70 cmH2O in bag
mode.
• In Vent mode, excess
gas is routed to the
ventilator bellows.
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The Datex-Ohmeda 7900 Ventilator

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The 7900 Ventilator uses innovative
Flow Sensor Technology

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More than just a hollow tube !!!

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 The Flow Sensor’s provide feedback to the control
circuitry of the 7900 ventilator. This feedback
allows the ventilator to:
1. Compensate for Absorber Compliance losses
2. Compensate for changes in Fresh Gas Flow
3. Compensate for Oxygen Flush
4. Detect Flow direction
5. Monitor ventilator and patient activity to drive
alarms

WOW !!

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Scenario:
Pat Hill, CRNA, is working in OR 3 at Frick
Hospital. The OR is equipped with a GE
Avance/7900 anesthesia system. Pat has a
TV of 700ml set but the Delivered TV is
showing about 600ml. Pat is confident she
knows what to do.

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Ventilator / Absorber Troubleshooting
Pat calibrates the flow sensors to solve the problem.

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Scenario:
Today, Pat Hill, CRNA, is working in OR 2 at
Frick Hospital. The OR is equipped with an
Aestiva/7900 anesthesia system. In the
middle of a case, the ventilator begins to
alarm “Expiratory Reverse Flow.” Pat is
confident she knows what to do.

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Ventilator / Absorber Troubleshooting

Pat replaces the expiratory flow sensor to solve the problem. She
notices that there is not a lot of water in the flow sensor which can also
cause the alarm. Nancy visualizes the flow sensor and how it works;
she wonders if a leaking flow sensor line could have been the problem.

Question: Could she be right?

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MYSTERY Troubleshooting ???????

Dr. Carl is working in OR 5 during an open heart

procedure. OR 5 is small for an open heart room so
things are packed in tight. During the case, Dr. Carl
moves the anesthesia machine around to make room
for the TEE system. Shortly after, Dr. Carl notices that 7
cm of PEEP is being displayed on the pressure gauge.
Dr.
Carl can not determine what is causing the
unintentional PEEP and asks the attending CRNA for
some troubleshooting help. You jump into action!

Scenario: 61
 SCAVENGER Troubleshooting

Question:
You notice that the reservoir bag on the scavenging
system is ballooned out and that one of the machines
wheels is sitting right on top of the scavenger output
hose. You move the machine and clear the hose and the
problem is resolved. Why did the PEEP only reach 7
cmH2O; what prevented it from going any higher?

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SCAVENGER Troubleshooting

Answer:
The scavenger interface valve
has a built in positive relief
valve that will relieve at a
pressure of approx. 5 cmH2O
should the outlet tube become
kinked or if the vacuum is lost.
As the pressure in the reservoir
bag begins to build, the
positive relief valve will open
up.
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Waste Gas Scavenging
System:
• Offers multiple 19 mm
intake ports.
• Connects to facilities
waste gas system; active
or passive.
• Reservoir bag offers
visual indicator.
• Prevents barotrauma
via pressure relief
valves. ~ 5 cmH2O
positive, .25 cmH2O
negative.
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Waste Gas
Scavenging System:
• Controls exposure to
waste anesthetic gases.
NIOSH recommends
limiting N2O exposure
to 25 ppm.
• Popular spot for
disconnects and
occlusions.

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Summary of Required components of an Anesthesia system:
Discussed:
 Cylinder supplies
 Pipeline supplies
 Flow-meters
 O2 Flush
 Breathing circuit pressure limited
 Various monitors
 Vaporizers
 Only one Common Gas Outlet
Not Discussed:
 Battery back-up
 Grouped alarms
 Pre-op Check-list
 Digital Interface 66
Question:
Several items on Datex-Ohmeda machines are
autoclavable. How can you determine what parts are?

Answer: The parts are marked with “134 degrees C”

Question:
What does the Pro in PSVPro stand for?

Answer: Protection, as in apnea backup protection.

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QUESTIONS?

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Thank You
References

Kolek, Bob and Janice Rice.

Explore, the Anesthesia System.
1996 ed.
Wabiszewski, Jodi. Explore, the
Anesthesia System – Aestiva 5.
2005 ed.

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