Anaesthetic machine check

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Anaesthetic machine

• Medical gas supply checked to theatre

  Yes

  No

  N/A

• Pipeline gas attached securely

  Yes

  No

  N/A

• Pipeline gas pressure 3-4 ATM

  Yes

  No

  N/A

• Oxygen cylinder pressure > 100,000 kPa

  Yes

  No

  N/A

• Gas supply alarm checked (oxygen alarm)

  Yes

  No

  N/A

• Vapourisers seated, interlock checked and full

  Yes

  No

  N/A

• All rotameters workings and bobbins spinning

  Yes

  No

  N/A

• Antihypoxic device functional (nitrous/oxygen ratio)

  Yes

  No

  N/A

• Back bar check (Negative pressure check or bouncing bobbin)

  Yes

  No

  N/A

• Circuit pressurises to 40cm H2O with no fall in 5 seconds

  Yes

  No

  N/A

• APL pop-off valve works

  Yes

  No

  N/A

• APL valve opens rapidly and pressure remains low with high flow

  Yes

  No

  N/A

• Inspiratory and expiratory valves working

  Yes

  No

  N/A

• Oxygen flush works

  Yes

  No

  N/A

• Ventilator works with test lung and minimal gas flow

  Yes

  No

  N/A

• Soda lime canister colour normal

  Yes

  No

  N/A

• Scavenging working (-75mmHg)

  Yes

  No

  N/A

Monitoring, airway and other equipment

• Monitoring turned on

  Yes

  No

  N/A

• Gas monitoring functional

  Yes

  No

  N/A

• Suction working

  Yes

  No

  N/A

• Two laryngoscopes

  Yes

  No

  N/A

• ETT several sizes, LMA several sizes

  Yes

  No

  N/A

• Oral and nasopharyngeal airways

  Yes

  No

  N/A

• Lubrication

  Yes

  No

  N/A

• Face masks, varying sizes

  Yes

  No

  N/A

• Cricothyroidotomy kit and cricothyroid cannula equipment present

  Yes

  No

  N/A

• Intubating bougie and stylet present

  Yes

  No

  N/A

• Self inflating bag and mask present

  Yes

  No

  N/A

• Scissors, clamp and Magill forceps present

  Yes

  No

  N/A

• Tapes, ties

  Yes

  No

  N/A

• Monitoring cables present

  Yes

  No

  N/A

Drugs

• Salbutamol present

  Yes

  No

  N/A

• Suxamethonium present

  Yes

  No

  N/A

• Metaraminol, ephedrine, adrenaline, atropine present

  Yes

  No

  N/A