Wake Forest University Baptist Medical Center

Department of Anesthesiology

TECHNICIAN
ABBREVIATED CHECKLIST OF RESPONSIBILITIES

For Anesthesia Apparatus Checkout

Specific to the Draeger APOLLO anesthesia machine
(This document assumes knowledge and understanding of the
“Apollo Master Checklist Dated 3-28-07-2”)

First thing in the morning:

1. Assemble the circuit with accessories (e.g. aerovent chamber, gas sampling line, water
trap connections)
2. Power up the machine and bypass the automated checkout.
3. Check power cord, pipelines, and cylinder gas supplies
4. Auxiliary oxygen flow meter
5. Vaporizer seating, interlock, fill port tight
6. Carbon dioxide absorbent: replace if necessary
7. Scavenger vacuum setting
8. Patient suction
9. Backup ventilation and emergency ambu, LMA, Cook stylette and needle
10. Ventilator diaphragm
11. O2 flush for manual to/fro ventilation through circuit, reservoir bag, test lung, and
ventilator
12. Virtual flow meter calibration and nitrous oxide maximum flow (79% with O2)
13. Power-down the machine so it is ready for a complete auto-check by provider
14. Perform a “time-out” looking at machine and thinking about what you did
15. Document your performance of the checkout procedure

In preparation for subsequent case:

1. Double check that backup Ambu bag, LMA, Cook stylette and needle are present
2. Machine is in, or place it in stand-by mode. Press “Reset Defaults”
3. Patient suction prepared and ready
4. Assemble the circuit with accessories as before
5. Vaporizer fill port, new sampling line are tight
6. Carbon dioxide absorbent: replace if necessary
7. Perform the manual to/fro ventilation test and ventilator test
8. Place in “Stand-by Mode”
9. Perform the automatic “Leak Test”
10. Reset “defaults”
11. Place into “Stand-by Mode” with ALL fresh gas flows OFF
12. Document your performance of the checkout procedure

Upon room closure for the evening or weekend (non-emergency rooms):

1. In addition to “In preparation for subsequent case”:
2. Power-down the machine after performing the automatic “Leak Test”

Working version 3-28-07-2 subject to Departmental approval.

Drafted by Dr. Olympio and reviewed by clinical members of
The Capital Equipment Committee
 Wake Forest University Baptist Medical Center
Department of Anesthesiology

PROVIDER
ABBREVIATED CHECKLIST OF RESPONSIBILITIES

For Anesthesia Apparatus Checkout

Specific to the Draeger APOLLO anesthesia machine
(This document assumes knowledge and understanding of the
“Apollo Master Checklist Dated 3-28-07-2”)

Always VERIFY that your machine can do the following:

• Oxygen can be delivered to the patient

• Positive pressure ventilation can be performed
• Positive pressure in the breathing circuit can be relieved
• Anesthetic vapor can be delivered if intended as part of the anesthetic plan
• A backup method of positive pressure ventilation is readily available
• Suction is available
• Ventilation, oxygenation, temperature, and hemodynamics can be monitored and
enunciated with audible alarms

First thing in the morning:

1. Begin with the Apollo machine powered to OFF, or press button to OFF.
2. Verify presence, operation, and audible alarms of required monitors, particularly later, as
they are attached to patient.
3. Power-up the machine
4. READ and FOLLOW ALL of the automated checkout guidelines
5. Document completion of your checkout on the anesthetic record

During the case:

1. Verify adequacy of carbon-dioxide absorption as evidenced by zero capnometric baseline
during pre-oxygenation with tight mask fit, or initial connection to endotracheal tube.
2. Re-verify the absence of breathing circuit obstruction as patient is pre-oxygenated
3. Verify expected volatile agent measurement when initiated
4. Calibrate “automatic” alarm limits when patient is stable
5. Turn OFF all FGF at end of case and place into STANDBY MODE
6. Power OFF at the end of the day’s list

In preparation for subsequent case:

1. Visual inspection after TECH setup
2. Activate mode and FGF as indicated
3. Double check patient suction

Working version 3-28-07-2 subject to Departmental approval.

Drafted by Dr. Olympio and reviewed by clinical members of
The Capital Equipment Committee
 Suggested Apollo Checklist
Final 3-28-07 (Wake Forest University-Olympio)

Master Checklist for Draeger Who is Frequency to

Notes/Rationale
Apollo responsible? Check How to Check?

Although the machine can operate for

at least 30 minutes on battery, it
Verify electrical cord connection. Power on
should always be operated on wall
Electrical power source Provider AND machine, listening for acoustic tone; look for
Daily supply. With loss of all power, note
and battery supply. Tech appropriate LED, confirming wall and battery
that none is required to deliver
supply.
fresh gas, vapor, and manual
ventilation.

When pipeline oxygen is the primary

Verify proper wall gas Provider AND Scan the LEDs to verify that they are green, if intended source, then there must be
Each use.
supply pressure. Tech the wall supply is at least 39psi. adequate pressure before beginning
the case.

The oxygen cylinder should be opened while

observing the digital display of cylinder
pressure. The oxygen pressure LED should be
green, indicating a minimum (site-specific)
Backup oxygen must be ensured, both
Verify adequate oxygen Provider AND value. Change the cylinder if the LED is not
Each use. by checking the pressure, and by
cylinder gas supply Tech green. Close the valve after checking. Flashing
closing the valve after checking.
green LED indicates a faulty sensor. Note the
backup Bourdon gauges behind the machine. Verify
that the LEDs remain green, even after the
cylinders are shut.

Depress button with circuit Y occluded on the The function of the oxygen flush
Check Oxygen Flush
Tech Daily plug, and APL fully open. Listen for usual flow valve and scavenger evacuation are
through Scavenger
and ascertain circuit pressure is <10 cmH2O. critical to safe operation.

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Auxiliary oxygen, when available, is

Check auxiliary oxygen
Tech Daily Turn on while watching indicator, then turn off. a basic requirement during monitored
flowmeter
care, and a critical safety backup.

Volatile anesthetics are a typical

Verify that vaporizers Check the site glass on each vaporizer and fill
Provider Each use. component of general anesthetics and
are adequately filled. if necessary.
an adequate supply must be available.

Check for level seating and proper position of

Check vaporizer
lever. Open one vaporizer dial at a time and Ensure that obvious leak sources are
connection, safety
Tech Daily attempt to open the others. Repeat for each. identified, and that two vaporizers
interlock, and fill
Ensure dials are then set to zero. Make sure cannot be on simulataneously.
port.
fill port is closed tightly.

The circuit needs to be prepared for

Breathing circuit
Connect breathing hoses, extensions, filters, the case at hand before leak testing,
connection and Tech Each use.
etc., as needed. Adjust hose length as desired. and before the machine determines the
preparation
compliance compensation value.

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Routine evidence of exhaustion would

be that a majority of the agent is
purple. Clinical evidence for
Absorbent is exhausted and will turn purple from
Look for exhaustion of exhaustion is the rebreathing of
Provider AND bottom up. Desiccation may be indicated by
carbon dioxide Each use. inspired carbon dioxide detected by
Tech purple at the top, or by discovery of fresh gas
absorbent capnometry. Purple color may revert
flow ON at the start of the day.
back to white in some absorbents, or
the coloration may be hidden
internally.

Absorption capacity of the agent

When using loose-fill, change when a majority is
should be adequate for the case. New
purple, or if flows were left on overnight.
Replace CO2 absorbent When absorbents that are designed to
Tech Either Draeger CLIC, or loose-fill absorbent may
when exhausted. necessary. prevent destruction of volatile agent
be exchanged during use, especially if evidence
when desiccated, should not be wasted
of inspired carbon dioxide is present.
by early disposal.

Adequate suction is required to

prevent contamination of the OR with
Check scavenger vacuum Open the needle valve just enough to bring the
Tech Daily waste anesthetic gasses. Excessive
level top of the float above the bottom line.
suction is not necessary and is
wasteful.

The gas sampling line is an integral

part of the breathing system and is
Ensure firm, straight connections, and tubing
Gas sampling line and included in the leak testing. Sampled
Tech Each use. routed away from the APL valve. Empty the water
water trap gas is returned to the breathing
trap if liquid is present.
circuit and does not contribute to
any "leak".

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Adequate suction is essential to

Verify that patient Tech AND Ensure that connections are tight, Yankauer is
Each use. remove unwanted secretions from the
suction is adequate. Provider present, and that suction is adequate.
patient's airway.

Test non-rebreathing bag with and without thumb

Verify backup The clinician must be prepared to
occlusion of the inspiratory port, while
ventilation equipment Tech AND ventilate and oxygenate the patient
Daily squeezing the bag. Ascertain presence of oxygen
is available & Provider in the event of machine failure or
tubing, Cook transtracheal needle, oxygen jet
functioning patient difficulty.
ventilator and its function.

Remove the breathing circuit housing from the Water accumulation in the ventilator
Ventilator Diaphragm Tech ventilator cylinder. Inspect diaphragm for diaphragm can impair ventilator
absence of water. operation.

Occlude the circuit Y piece on the knob, set APL

If the breathing system, or APL
to 30 cmH2O, depress and hold oxygen flush.
APL valve pressure valve, or scavenger system were not
Provider Daily Pressure should rise to 30 but not exceed 45
regulation functioning appropriately, then a
cmH2O. Then release. Verify that pressure does
high or low pressure might occur.
not drop below 15 cmH2O.

Start the "Self Test". Leaks below 150 ml/min in

the Man-Spont circuit are acceptable to the
machine (green), and are not reported. If the Leaks in the breathing circuit may
LED is yellow, attempt to correct the leak and prevent adequate delivery of oxygen,
Verify there are no
retest. If necessary, use the short blue tubing anesthetic, fresh gas, or gas
leaks in the fresh gas
segment to isolate the test to the machine. The pressure to the patient. They may be
supply to, and in, the Provider Daily
clinician may or may not accept the leak based created with each application of a
manual breathing
on his/her clinical judgement. The vaporizer O- circuit or device. Leaks are
system.
ring seal to the backbar is checked in this wasteful and contaminate the
test. Fill-port leaks must be independently environment.
tested for each vaporizer by turning the dial on
before each repeated test.

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The automated self test checks

Automatic during "Self Test". Note information
multiple components within the
boxes. Follow Draeger recommendations for any
Machine solenoids, machine and ventilator circuit.
"orange" or "red" results. Note all component
valves, and internal Provider Daily Draeger recommends that it be
checks and LEDs under "Gas Delivery",
components performed at least once per day to
"Ventilator", and "Monitoring". Note values for
ensure proper function of the
compliance and system leak.
machine.

The oxygen sensor is automatically tested and

calibrated to room air during the "Self test". An accurate oxygen monitor is
Oxygen monitor and There is no mechanism for the user to directly essential to determine the inspired
Provider Daily
alarm. calibrate the monitor. Test the low FiO2 alarm oxygen concentration. An audible
by temporarily raising it above current alarm will alert the clinician.
concentration, then reset.

The "Self Test" includes a negative aspiration Effective and reliable closure and
of the Man-Spont circuit, while the "Leak opening of the breathing circuit
Breathing system
Provider Each morning (system)" test performs a positive pressure leak valves is essential to allow safe
pressure/leak test
and compliance test of the mechanical positive pressure ventilation of the
inspiratory limb of the circuit. lung.

Additional Manual Tests

Attach the dedicated test lung to the Y-piece;

The Manual APL valve check and the
Verify gas flow through set APL to 20, activate the Man/Spont mode,
Self Test may detect obstructions to
breathing circuit flush fill the circuit, and then ventilate back
Tech Each use. flow, but not all. Human hands can
during both inspiration and forth between the two bags. Check for any
sense restrictions or obstruction
and exhalation obstruction or abnormal resistance. Return the
within the breathing circuit.
system to standby.

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The initiation and electronic

Turn O2 to 5 L/min and N2O to 5 L/min and measurement of oxygen and/or nitrous
Check virtual flowmeter
compare to the "total flow tube" bobbin, which flow is essential to deliver desired
calibration and Tech Daily
should read approximately 10 L/min. Attempt to concentrations to the patient, and a
proportionator.
create a mixture of <21% oxygen. Turn flows off. redundant system for measurement is
therefore provided.

Accurate output of the vaporizer is

expected, although it is not
The clinician should ascertain that expected
Verify proper vaporizer appropriately or accurately measured
Provider Each use. levels of volatile agents are shown on the
output at the endotracheal tube. Vaporizer
anesthetic gas analyzer.
calibrations are checked by
biomedical PM.

The function of numerous monitors is verified as

Verify availability and they are connected to the patient. Default
Audible and visual alarms help to
proper function of alarm limits must be checked for appropriateness
Provider Each use. alert the clinician to potentially
required monitors and while "auto-set" limits are convenient once the
dangerous situations.
alarms. patient is connected and has stable, desired
vital signs.

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 Suggested Apollo Checklist
Final 3-28-07 (Wake Forest University-Olympio)

The clinician is ultimately

responsible for basic operation of
The Apollo machine automatically documents when the machine, and responsible for
Document completion of
Tech AND it was checked, and documents the outcome of proper response to an intraoperative
checkout procedure per Each case.
Provider that check. Also document the checkout on the machine failure. To promote backup
department policy
anesthetic record. safety measures, the anesthesia
technician will perform the indicated
tests.

The clinician should follow customary

Confirm ventilator settings and evaluate JCAHO recommendations for "TIME OUT"
TIME OUT! Provider Each case.
readiness to deliver anesthesia care. to overcome potential errors or
omissions from distractions.

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 Suggested Apollo Checklist
Final 3-28-07 (Wake Forest University-Olympio)

Checking and testing

between cases

Any changes to the circuit may induce

a leak or new compliance value. The
Performing the "Leak While in "Standby Mode" depress the "Leak Test"
Tech Each use. negative and positive pressure
Test". and follow instructions, noting results.
circuit tests are performed during
the "Leak Test".

All gas flows OFF Provider AND Turn fresh gas flow knobs to the off position Leaving flows on is wasteful and may
Each use.
between cases. Tech whenever the machine is not in use. desiccate the absorbent.

This will prompt the Tech or next

Place the machine in Standby mode after turning
Machine to "Standby" user to perform the "Leak Test" and
Provider Each use. off all fresh gas flow. Press the "Default
between cases. will reset the patient parameters to
Parameters" key.
the default values.

Shutting down the power will mandate

At the conclusion of the day's list, power down performance of the daily checkout as
Provider AND the machine. On-call machines should be left in recommended by Draeger. On-call
Power shut-off. Daily
Tech standby, and re-booted in the morning for machines should be left in standby so
checkout procedures. that they are immediately ready to
use.