Abstract
We note the correspondence of Ballisat and Hart highlighting a potentially hazardous incident concerning a wrongly connected oxygen cylinder 1. In 2012, the AAGBI published updated guidelines for checking anaesthetic equipment 2. These recommend the completion of a routine physical check of the integrity of gas supplies at the commencement of each operating session. In addition to this, an automated machine check is required. In a recent retrospective audit in Cork University Hospital, Ireland, we looked at the compliance with the automated check of Aisys™ (GE Healthcare, Helsinki, Finland) anaesthetic machines. In the study, we looked at the integrated logbook records of 19 anaesthetic machines with Aisys system software ≥ v.3, generating 756 operating sessions for analysis. For the purpose of the analysis, machines were grouped according to: frequency of overall use; frequency of after-hours use; and the location within the hospital campus. A ‘fail’ occurred if all steps of the automated machine check were not completed in full. An operating session was defined as either a routine surgical list or after-hours emergency surgery. Overall compliance with once-daily anaesthetic machine checks was 690/756 (91.2%). We noticed, however, that compliance dropped very significantly in relation to machines used less frequently (75/116 (64.7%), p < 0.0001). The anaesthetic machine located in the CT scanning room in the radiology department was least likely of all machines to be checked before use (8/36 (22.2%)). Compliance with automated machine checks was less for out-of-hours cases than during routine lists (297/360 (82.5%) vs 306/320 (95.6%), respectively, p < 0.0001). This finding largely relates to emergency use in the obstetric setting, where the machine had not been checked in the 12 hours before use. This may reflect, however, on-call patterns rather than opportunistic violations. Finally, there was no significant difference found in compliance with automated checks when location was considered. We found compliance to be (281/320 (87.8%) in the main theatre block (n = 8 machines) compared with 361/436 (82.9%) in remote locations (n = 11; p = 0.064). Given that the availability of senior support in remote locations could be potentially delayed, this finding was reassuring. We recommend that all anaesthetists remain diligent with the completion of the automated machine check. Furthermore, particular attention should be paid to machines used less frequently and those commonly used after hours. Many anaesthesia departments use both newer automated machines such as the Aisys and more traditional machines requiring manual machine checks. This raises the important question of whether all machines are checked equally, given that many newer trainees have only used modern machines with automated checks. The automated machine check, for instance, does not prompt the user to check the gas hoses or wall-mounted Schrader sockets, or to inspect the cylinders mounted on the back of the machine. We think that it is possible, therefore, that the scenario described by Ballisat and Hart will arise repeatedly if anaesthetists fail to inspect gas hoses routinely in addition to performing an automated check.
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