Cause of Device-Related Incident
*Not stated

Clinical Specialty or Hospital Department
Anesthesia; Pulmonary / Respiratory Therapy

Device Factors
*Not stated

Document Type
Checklists/Emergency Procedures

External Factors
*Not stated

Mechanism of Injury or Death
Barotrauma; Suffocation

Support System Failures
*Not stated

Tampering and/or Sabotage
*Not stated

User Errors
*Not stated

Pre-Use Verification of Breathing Circuits



Checklist

The following checks should be performed by caregivers and clinicians whenever disposable breathing circuits are changed.

Inspect the breathing circuit package and labeling as follows:

  • Confirm that the breathing circuit package has not been previously opened. Previously opened packages may lack components or include contents that are contaminated with dirt or debris.
  • Verify from the package label that the breathing circuit is the correct model for the type of ventilator that will be used.
  • Verify that the package contains all of the components that are listed on the package insert, that no excess debris is contained in the package, and, if you switch to a new brand of circuit, that all of the required components are enclosed. Components such as humidifier tubing and patient connection adapters are not a standard part of some manufacturers' circuits and may have to be specifically requested or purchased separately from a different manufacturer.

After removing the breathing circuit from its package, inspect the breathing circuit as follows:

  • Verify that the breathing circuit tubing length is sufficient. The inspiratory limb is typically 5 ft or longer; pediatric patients may require substantially longer lengths.
  • Verify that there are no obstructions in the breathing circuit tubing and connectors. (Note: This should be done by looking through the translucent components, rather than by disassembling the breathing circuit.)
  • Verify that the proximal pressure line and exhalation drive line tubing are clear of debris.
  • Ensure that the connections are tight by pressing the fittings together, then tugging moderately to verify that they do not loosen easily.
  • Verify that the tubing at the ventilator end of the proximal pressure line and exhalation drive line is compatible with the portable ventilator's connectors.
  • While connecting the breathing circuit to the ventilator and the patient's artificial airway, verify that the end fittings connect securely. Immediately after the breathing circuit is attached to the patient, verify proper functioning of the breathing circuit as follows:*
  • Observe the patient for rhythmic rise of the chest.
  • Listen for the sound of the exhalation valve venting during exhalation, and verify that the ventilator's pressure gauge indicates that the pressure returns to baseline (i.e., ambient pressure or the PEEP level). Immediately disconnect the inspiratory tubing before delivery of the next breath if pressure does not return to baseline, and if necessary, manually ventilate the patient.
  • Verify that the peak inspiratory pressure does not change significantly after the breathing circuit is replaced. A significant drop in pressure could be caused by leaks in the circuit or by an exhalation valve that does not seal properly during inspiration.
  • For patients using the assist or synchronized intermittent mandatory ventilation (SIMV) modes, verify that the patient's inspiratory efforts continue to initiate machine breaths with the new breathing circuit. The exhalation valve diaphragm may vary between circuits, and it may not close on one circuit in response to the same breathing effort that was sufficient to close it on another.
  • If the breathing circuit does not function properly in any of these checks, replace it.
  • After 15 minutes, reinspect the breathing circuit to verify that connections are still secure after being warmed by the heated humidifier.

 

____________________________

* When changing the breathing circuit, perform step 10 with a test lung if one is available and if an alternate means of ventilating the patient (i.e., a backup ventilator or a manual resuscitator) is available or if the patient can breathe spontaneously for this time. Then connect the breathing circuit to the patient, and resume the procedure at step 9.


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