RESUMEN
BACKGROUND: controls performed at the opening of the operating room include the anesthesia machine auto-test. Omitting the preoperative checklist is unsafe for the patient and increases the risk of possible breakdowns. The purpose of this study was to evaluate the incidence and the situations in which the auto-test of the machine was not performed at the opening of the operative room. METHODS: from a database including 55 195 cases between 1st January 2002 and 31st July 2009, a query identified cases in which the auto-test of the anaesthesia machine was omitted and the cases in which anaesthesia was made in spite of the failure of this test. Clinical circumstances were analyzed and anaesthetist and/or nurse anaesthetist were identified from the computerized anaesthesia record. RESULTS: one hundred and ninety cases (1.24%) were identified. Seventy-three percent of the omissions of the auto-test occurred while on duty whereas 85% of the failures of the auto-test took place at the beginning of the scheduled program. Individual factor was identified since three anaesthesiologists out of 22 were responsible for 49% of omissions on duty and one nurse anesthetist was responsible for 18% of the use of a failed machine and 30% of the omission of the auto-test. CONCLUSION: the auto-test of the anesthesia machine was correctly made in most cases but there are still situations where the checklist wasn't carried out. Therefore, the human factor seems important and justifies to be taken into account.
Asunto(s)
Anestesiología/instrumentación , Quirófanos , Administración de la Seguridad , Lista de Verificación , HumanosRESUMEN
OBJECTIVE: To assess the incidence and the causes of failures of anaesthesia machines in relation to aging. Study design. - Prospective survey from january 1996 to july 2000. MATERIAL AND METHODS: The causes (mechanical or electronic), the moment of identification (checklist, maintenance operation or quality-control operation) of each anaesthetic machine failure, the repair cost and the maintenance cost of 14 anaesthetic machines have been collected and entered into a database. RESULTS: Over 31,948 anaesthesia delivered during the period of the study, 614 failures have been declared: 53% were related both to mechanical problems or monitoring failure and 40% were identified during the pre-operative checklist. In half of the cases, a specially trained anaesthetic nurse was able to correct the failure in the operating theatre. The annual rate of anaesthetic machine failure remained stable over the study period and the annual maintenance cost is approximatively 10% of the initial machine value. No procedure was cancelled because of a machine technical failure. CONCLUSION: Anaesthetic machine failure rate change according to the time should not be criteria for remplacement if rigorous quality control and maintenance operation are used.
Asunto(s)
Anestesia por Inhalación/economía , Anestesia por Inhalación/instrumentación , Falla de Equipo/economía , Mantenimiento/economía , Costos y Análisis de Costo , Quirófanos/economía , Estudios Prospectivos , Control de CalidadRESUMEN
OBJECTIVE: To assess the incidence and the causes of failures of anaesthesia machines. STUDY DESIGN: Prospective survey from August 1995 to September 1997. MATERIAL: Check-list and machine failure forms. METHODS: Failures of anaesthetic machines have been collected and entered into a database. Causes and treatment of each failure have been analysed. RESULTS: Of 5,096 foreseen forms, 3,926 (77%) have been completed after check-list or anaesthesia machine failure. Overall, 233 incidents have been declared (4.5%). Failures identified during the preoperative check-list (n = 96) were mainly related to mechanical problems, especially the gas proportioning device (35%). Perioperative failures (n = 137) were mostly related to electronic problems (ventilator: 27% and monitor: 57%). In more than half of the cases, a specially trained anaesthetic nurse was able to correct the failure in the operating theatre. Using 14 anaesthetic machines for 12 operating rooms, no procedure was cancelled because of a technical failure of a machine. CONCLUSIONS: This study emphasizes the value of the check-list and the failure report. The presence of a specially trained anaesthetic nurse allows immediate correction of the majority of technical problems.
Asunto(s)
Anestesiología/instrumentación , Anestesiología/estadística & datos numéricos , Electrónica , Falla de Equipo/estadística & datos numéricos , Humanos , Periodo Intraoperatorio , Estudios Prospectivos , Respiración Artificial/instrumentaciónRESUMEN
OBJECTIVE: To assess the value of quality control tests after routine maintenance procedures of anaesthesia machines. STUDY DESIGN: Prospective laboratory study. MATERIAL AND METHODS: Over a 4-year-period, anaesthesia machines were checked after regular maintenance procedures, in order to detect unrecognized dysfunctions before clinical use. RESULTS: Overall 106 tests were performed on 14 machines and five dysfunctions were identified. Three of them concerned gas proportioning devices, which delivered a hypoxic gas mixture (FO2 < 15%). This defect was recognized by gas analysis at their outlet, whereas mechanical controls were satisfactory. The last two concerned pressure relief valve linearity and gas leak at PEEP valve. CONCLUSIONS: This study underlines the necessity of both postmaintenance controls and gas analysis at the outlet of the gas proportioning device. These controls should be performed by hospital technicians, independent from those involved in regular maintenance procedures.
Asunto(s)
Anestesiología/instrumentación , Ventiladores Mecánicos , Seguridad de Equipos , Humanos , Responsabilidad Legal , Control de CalidadRESUMEN
OBJECTIVE: To assess whether the pressure gauges at the downstream part of pressure regulators are accurate enough to ensure that pressure in O2 pipeline is always higher than in Air pipeline and that pressure in the latter is higher than pressure in N2O pipeline. A pressure difference of at least 0.4 bar between two medical gas supply systems is recommended to avoid the reflow of either N2O or Air into the O2 pipeline, through a faulty mixer or proportioning device. STUDY DESIGN: Prospective technical comparative study. MATERIAL AND METHODS: Readings of 32 Bourdon gauges were compared with data obtained with a calibrated reference transducer. Two sets of measurements were performed at a one month interval. RESULTS: Pressure differences between Bourdon gauges and reference transducer were 8% (0.28 bar) in average for a theoretical maximal error less than 2.5%. During the first set of measurements, Air pressure was higher than O2 pressure in one place and N2O pressure higher than Air pressure in another. After an increase in the O2 pipeline pressure and careful setting of pressure regulators, this problem was not observed at the second set of measurements. DISCUSSION: Actual accuracy of Bourdon gauges was not convenient enough to ensure that O2 pressure was always above Air pressure. Regular controls of these pressure gauges are therefore essential. Replacement of the faulty Bourdon gauges by more accurate transducers should be considered. As an alternative, the increase in pressure difference between O2 and Air pipelines to at least 0.6 bar is recommended.