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Just as a Jedi must build their own Light Saber, A Biomed must be able to build a PM cart. My Cart is used in the Main Operating Room at Massachusetts General Hospital for doing PM on our fleet of over 200 Draeger Vaporizers and 100 Draeger Anesthesia machines.
I do Anesthesia and Surgical Systems support in the Hospital that introduced Anesthesia into surgical practice in the Ether Dome on October 16th 1846. The Photo was taken in an OR, in a Building that stands on what was once the site of the original Harvard Medical School Building.
On top of the cart is my Dell Win7 Laptop that runs “Draeger Service Connect”, the application that allows me to log into the machine and enable service mode, review error logs and run diagnostic routines. To the right of the Laptop, is a mouse pad and a PM check sheet I developed to track and document my steps in the PM and collect data for doing the PM work order entry.
Each tool on the top of the cart is specific to various tasks in the PM. Hex keys and screwdrivers for the various fasteners that hold the Apollo, the Solar and GCX brackets together. Many things need to be checked and tightened during PM. “Water Pump” Pliers are used for removing/tightening Gas hose Fitting as needed. Small snips are used with the wire ties in the jar on the cart’s bottom shelf for cable management duties that can be complex, depending on the surgical service the machine serves.
The Second shelf sits at chair height. On it are the various test devices I use during the PM. From Right to Left, A set of glass “Rotameter” flow tubes for measuring Gas Flows in LPM. A “Magnehelic” gage for checking respiratory pressures in cmH2O and doing leak tests. There is an Extech digital manometer that measures the very low 2 cmH2o range for checking the PEEP valve offset.
In the small Blue Bin you will Find a Woodhead tester and a Outlet tester I use for doing PM on power strips that are on most IV poles around an anesthesia machine. Also, there is a nut driver with a socket ground down to a thin edge for loosening the nuts that hold the gas flow knobs on the fresh gas flow valves when one has to adjust for a “Phantom Flow”. The other key item in the blue bin is a blunt needle and a blood pressure hose fitting. together these two things help me to press very tiny O-rings onto the fittings in the Anesthesia gas module. To The left of the bin, one 60cc syringe contains O2 compatible Krytox grease. The Other 60cc syringe contains DOW Corning silicon Grease. Front and center is my test lung and test circuit connected together by the flow cell for the Novametrix respiratory mechanics analyzer I use to QC the ventilator performance. Left of that is a can of calibration gas for the anesthesia gas analyzer.
My “gasser” has a .5L bag on it and a sample to tube to connect it to the Apollo or SAM module. The most important thing on the cart is the Apollo PM procedure. The copy in the photo is rev#14. I started with the OEM manual written in “German/English”, I have been refining the translation one rev at a time, since my 1st PM. By understanding the nature and refining the ordering of the tasks and steps, one can do the OEM PM in the most efficient sequence of actions.
Thanks to the evolved PM sheet, what first took most of two work days in my lab, in now done in less than 6-8 hours in the OR room, depending on the PM parts that need to be installed. I follow the procedure step by step on every PM.
Behind the 4 page procedure sheet, is a box containing my piped gas pressure gage/test manifolds. And next to it is a box that stores my flow meter and magnehelic and test tubes. On the bottom shelf, I have A can of wire ties, an antique B/D AA battery powered electric screw driver, a vintage 1986 hoover data vacuum, a bottle of Spic and Span, and (not visible) a small bucket and microfiber cleaning cloth.
Just above the Vacuum is the Draeger T wrench that takes apart the Apollo Breathing system. Behind the Vacuum is a tool box filled with CAT5 cables, power cords, cable clamps and clips, rarely needed tools and various spare parts.
The Cart itself is a 1980’s era film projector cart, I rescued it from the O.R. trash room. Not visible under the top shelf is a power strip for my computer and other test equipment and a USB powered speaker that plays music from my Laptop while I do the PM.
This is a great cart and the items on it, let me go into any operating room and do a complete anesthesia machine PM in the most efficient manner possible. The Cart sits just to the left of the Anesthesia machine and everything is at my fingertips. Each tool is in the right place at the right time. Each gage is hung from a hook on the cart at eye level. The vacuum hose is in just the right place to clean the filters and computer vents. The PM documents are right there in plain sight too. After the PM I have a cover for the cart and a great storage place.
For me this cart is a great example of how any Biomed can make a work practice better and more efficient AND how one nurse’s trash can be one Biomed’s treasure.
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