Carestation 620/650/650c (A1/A2) TRM 2076163-001

Planned Maintenance Checklist

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Customer Name:
Service Record Number: Serial Number:
Equipment ID: Software Version:
Performed by: Date:

□ 12-month check □ 24-month check □ 48-month check

Parts Replacement
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Part Number Part Description 12-Month 24-Month 48-Month Replaced Comments

Yes/No
1102-3016-000 Vaporizer port O-rings kit X
2071067-001-S Breathing system check valve kit X
0211-1454-100 Free breathing flapper valve X
1503-3208-000 Free breathing valve O-ring X
1009-5800-000 Display battery X
M1801706-S System batteries X

Visual Inspection Procedures

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Procedure Expected Results Actual Results Outcome / Comments

Pass-Fail-NA
Check filter in lower rear enclosure Filter is clean
□ Pass

□ Fail
Check condition and tightness of all All parts are in good
displays, frame, drawers, arm, and top condition and tightened □ Pass
shelf parts; Check screws with marks
□ Fail
Check the casters for proper operation Casters roll and lock as
and mounting needed. Casters are □ Pass
firmly mounted to
machine
□ Fail

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Procedure Expected Results Actual Results Outcome / Comments
Pass-Fail-NA
Check labels All labels are in place and
clearly legible □ Pass

□ Fail
Check external tubing, silicone tubes, No visible deterioration
hoses, and pipeline hoses and securely attached □ Pass

□ Fail
Check external electrical cabling All are correctly
connected and not □ Pass
deteriorated
□ Fail
Verify proper display arm adjustment Display arm
counterbalance, side to □ Pass
side movement, and tilt
are adjusted
□ Fail

Verify Annunciators
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Procedure Expected Results Actual Results Outcome / Comments

Pass-Fail-NA
Verify audible “beep” after system is An audible “beep” is
turned on heard after system is □ Pass
turned on.
□ Fail
Verify a second audible “beep” A second audible “beep”
is heard. □ Pass

□ Fail
Verify a third and fourth audible “beep” A third and fourth audible
“beep” are heard. □ Pass

□ Fail

Pipeline and cylinder tests

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Procedure Expected Results Actual Results Outcome / Comments

Pass-Fail-NA
Disconnect the pipeline supplies and All pressure values read
close all cylinder valves zero □ Pass

□ Fail

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Procedure Expected Results Actual Results Outcome / Comments
Pass-Fail-NA
Connect pipeline supplies one at a time Corresponding reading
indicates facility pipeline □ Pass
pressure
□ Fail

□ NA
Test O2 cylinder for high pressure Initial reading
leaks After 1 minute
Pressure decay < 690
kPa (100 psi) □ Pass

□ Fail

□ NA
Test N2O cylinder for high pressure Initial reading
leaks After 1 minute
Pressure decay < 690
kPa (100 psi) □ Pass

□ Fail

□ NA
Test Air cylinder for high pressure Initial reading
leaks After 1 minute
Pressure decay < 690
kPa (100 psi) □ Pass

□ Fail

□ NA
Perform the “O2 supply alarm test” Low O2 supply alarm
occurs □ Pass

□ Fail
N2O and O2 flows stop
□ Pass

□ Fail
Air flow continues
□ Pass

□ Fail

□ NA

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AGSS Inspection and Testing
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Visual-Mechanical Inspection System in working order
□ Pass

□ Fail
Scavenger Positive Relief The pressure should not
Functional Check indicate a pressure rise of more □ Pass
than 10 cmH2O
□ Fail

□ NA

Breathing system inspection

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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Flow sensors and Sensor System inspected
Interface Board inspection □ Pass

□ Fail
O2 sensor inspection System inspected
□ Pass

□ Fail
Absorber canister inspection System inspected
□ Pass

□ Fail
Bellows assembly inspection Bellows does not fall within one
minute □ Pass

□ Fail
APL valve inspection System inspected
□ Pass

□ Fail
Bag to vent switch inspection System inspected
□ Pass

□ Fail

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Ventilator inspection
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Free breathing valve maintenance System inspected; parts
at 24 months replaced □ Pass

□ Fail

□ NA
Exhalation valve inspection Valve inspected; parts replaced
as necessary □ Pass

□ Fail

□ NA

Ventilator Tests
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
View or Copy Logs View or Copy Logs work
normally □ Pass

□ Fail
Flow and Pressure calibration ‘Pass’ is displayed
□ Pass

□ Fail
Weekly O2 Cell calibration ‘Pass’ is displayed
□ Pass

□ Fail

□ NA
Monthly O2 Cell calibration ‘Pass’ is displayed
□ Pass

□ Fail

□ NA
Airway Gas calibration ‘Pass’ is displayed
□ Pass

□ Fail

□ NA

2087476-001 C 05 2015 5
Procedure Expected Results Actual Outcome / Comments
Results Pass-Fail-NA
Manifold P Span calibration ‘Pass’ is displayed
□ Pass

□ Fail
Inspiratory flow valve calibration ‘Pass’ is displayed
□ Pass

□ Fail
Bleed Resistor calibration ‘Pass’ is displayed
□ Pass

□ Fail
Paw Span calibration ‘Pass’ is displayed
□ Pass

□ Fail

□ NA
Paw and ACGO Span calibration ‘Pass’ is displayed
□ Pass

□ Fail

□ NA
Zero Gas Transducers ‘Pass’ is displayed
□ Pass

□ Fail
Mixer Flow Sensor Zero ‘Pass’ is displayed
□ Pass

□ Fail
Zero ACGO / Zero AGSS / Zero ‘Pass’ is displayed
ACGO and AGSS □ Pass

□ Fail

□ NA
Pressure limit circuit test Gas flow stops as airway
pressure reaches □ Pass
approximately 109 cmH2O
□ Fail
MOPV pressure relief valve test Pressure relief weight relieving
and popping off □ Pass

□ Fail

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Display Diagnostics
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Test LEDs LEDs flash 5 times
□ Pass

□ Fail
Test speaker Speaker sounds for 2 seconds
□ Pass

□ Fail
Test battery ‘Pass’ is displayed for battery
test □ Pass

□ Fail
Test hard keys Speaker sounds when each
key is pressed □ Pass

□ Fail
Test LCD Display sequences through the
color screens □ Pass

□ Fail
Calibrate touch Touch targets calibrated
□ Pass

□ Fail

Flow control tests

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Procedure Expected Results Actual Results Outcome / Comments

Pass-Fail-NA
Check the Link proportioning system concentration
Set the N2O flow (l/min) Measured O2
0.2 21% minimum
□ Pass

□ Fail
1.6 21% to 34%
□ Pass

□ Fail
5.0 21% to 34%
□ Pass

□ Fail

2087476-001 C 05 2015 7
Procedure Expected Results Actual Results Outcome / Comments
Pass-Fail-NA
9.0 21% to 34%
□ Pass

□ Fail
Check the proportioning system concentration
Set the O2 flow (l/min) Measured O2
2.5 21% to 34%
□ Pass

□ Fail
1.0 21% to 34%
□ Pass

□ Fail
0.4 21% to 34%
□ Pass

□ Fail
Check the linearity of the Air flow control
Setting Measured O2
O2 set to 4.0 l/min, Air set to 61% to 71%
3.0 l/min □ Pass

□ Fail

□ NA
O2 set to 3.5 l/min, Air set to 45% to 55%
6.0 l/min □ Pass

□ Fail

□ NA
O2 set to 1.5 l/min, Air set to 28% to 38%
8.0 l/min □ Pass

□ Fail

□ NA

Flow sensing test

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Procedure Expected Results Actual Results Outcome / Comments

Pass-Fail-NA
Perform the flow sensing test
Set Flow on the flow test Flow Sensor Reading
device

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Procedure Expected Results Actual Results Outcome / Comments
Pass-Fail-NA
100% O2 at 1.5 l/min Flow sensor reading reads
between 1.3 l/min and 1.7 □ Pass
l/min
□ Fail
100% O2 at 12 l/min Flow sensor reading reads
between 10.8 l/min and 13.2 □ Pass
l/min
□ Fail
100% Air at 1.5 l/min Flow sensor reading reads
between 1.3 l/min and 1.7 □ Pass
l/min
□ Fail
100% Air at 12 l/min Flow sensor reading reads
between 10.8 l/min and 13.2 □ Pass
l/min
□ Fail
100% N2O at 1.2 l/min Flow sensor reading reads
between 1.1 l/min and 1.3 □ Pass
l/min
□ Fail
100% N2O at 10 l/min Flow sensor reading reads
between 9.0 l/min and 11.0 □ Pass
l/min
□ Fail

ACGO pressure relief valve test

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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
ACGO pressure relief valve test Pressure relief weight relieving
and popping off □ Pass

□ Fail

□ NA

2087476-001 C 05 2015 9
Auxiliary O2 flowmeter tests
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Shut off the flow Ball rests at bottom
□ Pass

□ Fail

□ NA
Increase flow Ball rises and maintains steady
as flow increases □ Pass

□ Fail

□ NA
Flowmeter set to 1 l/min Flow tester reads 0.5 to 1.5
l/min □ Pass

□ Fail

□ NA
Flowmeter set to 3 l/min Flow tester reads 2.5 to 3.5
l/min □ Pass

□ Fail

□ NA
Flowmeter set to 5 l/min Flow tester reads 4.5 to 5.5
l/min □ Pass

□ Fail

□ NA
Flowmeter set to 10 l/min Flow tester reads 9.0 to 11.0
l/min □ Pass

□ Fail

□ NA
Flowmeter set to Maximum (fully Flow tester reads >=12.0 l/min
open) □ Pass

□ Fail

□ NA

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Integrated suction regulator tests (if equipped)
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Test vacuum gauge accuracy at following points:
Suction regulator in Off position The suction vacuum gauge
needle should come to rest □ Pass
within the zero range bracket
□ Fail

□ NA
Suction vacuum set to 100 mmHg Test gauge reads 62 - 138
(13.3 kPa) mmHg (8.3 - 18.4 kPa) □ Pass

□ Fail

□ NA
Suction vacuum set to 300 mmHg Test gauge reads 262 - 338
(40 kPa) mmHg (35 - 45 kPa) □ Pass

□ Fail

□ NA
Suction vacuum set to 500 mmHg Test gauge reads 462 - 538
(66.7 kPa) mmHg (61.6 - 71.7 kPa) □ Pass

□ Fail

□ NA
Flow test - suction control knob Test flowmeter reads at least
fully clockwise 20 l/min □ Pass

□ Fail

□ NA
Regulation test Vacuum gauge returns to 100
mmHg/13kPa within a tolerance □ Pass
of ± 10 mmHg/1.3 kPa
□ Fail

□ NA
Vacuum bleed test Gauge needle returns to zero
range within 10 seconds □ Pass

□ Fail

□ NA
Vacuum leak test Gauge reading does not
increase when regulator is off □ Pass

□ Fail

□ NA

2087476-001 C 05 2015 11
Flush flow test
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Flush flow test The bellows fills in 1.3 to 3
seconds □ Pass

□ Fail

Vaporizer back pressure and interlock test

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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Vaporizer back pressure test O2 flow does not decrease
more than 1 L/min through the □ Pass
full range
□ Fail
Vaporizer interlock test Can not turn on more than one
vaporizer at the same time □ Pass

□ Fail

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Calibrating the airway module
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Perform Airway Module Displayed CO2 value is
calibration calibrated to 5.0% □ Pass

□ Fail

□ NA
Displayed O2 value is
calibrated to 54.5% □ Pass

□ Fail

□ NA
Displayed N2O value is
calibrated to 36.0% □ Pass

□ Fail

□ NA
Displayed AA/DES value is
calibrated to 2.0% □ Pass

□ Fail

□ NA

System checkout
.

Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Full Test Full Test passes
□ Pass

□ Fail
Low pressure leak test Bulb inflation time greater than
30 seconds □ Pass

□ Fail

2087476-001 C 05 2015 13
Alarm tests
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Perform Alarm tests ‘FiO2 Low’ alarm occurs
□ Pass

□ Fail
‘FiO2 High’ alarm occurs
□ Pass

□ Fail
‘MVexp low’ alarm occurs
□ Pass

□ Fail
‘Ppeak high’ alarm occurs
□ Pass

□ Fail
‘PEEP high. Blockage?’ alarm
occurs □ Pass

□ Fail
‘Ppeak low. Leak?’ alarm
occurs □ Pass

□ Fail

Power failure test

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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
With power cord connected to The mains indicator comes on
mains outlet □ Pass

□ Fail
With system turned on, start case: The power failure alarm comes
unplug power cord on □ Pass

□ Fail
Plug in power cord Alarm cancels
□ Pass

□ Fail

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Electrical safety checks
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Measure the ground resistance Less than or qual to 0.20 Ω
□ Pass

□ Fail
Measure the leakage current 100/120 Vac: <300 μAmps
□ Pass

□ Fail

□ NA
220/240 Vac: <500 μAmps
□ Pass

□ Fail

□ NA

2087476-001 C 05 2015 15
Final machine checks
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Procedure Expected Results Actual Outcome / Comments

Results Pass-Fail-NA
Verify the following: Pipeline hoses connected
□ Pass

□ Fail
Work lights operate correctly
□ Pass

□ Fail
All vaporizers are off
□ Pass

□ Fail
Panels and tray tops are
attached □ Pass

□ Fail
Cylinders off
□ Pass

□ Fail
AC mains connected
□ Pass

□ Fail

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