Review T6 (1995): Recommended Minimum Facilities
for Safe
Anaesthetic Practice in Delivery Suites
The safe provision of anaesthesia requires
appropriate staff, facilities and equipment for proper patient
safety. These are specified in this Document.
1. PRINCIPLES OF ANAESTHETIC CARE
1.1 Anaesthesia should be administered only
by medical practitioners with appropriate training in anaesthesia
or by trainees supervised according to College Policy Documents
"The Supervision of Trainees in Anaesthesia" (E3) and
"Privilees in Anaesthesia" (P2).
1.2 Every patient presenting for anaesthesia
should have a pre-anaesthetic consultation by a medical practitioner
who has appropriate training in anaesthesia. See College Policy
Document "Pre-anaesthetic Consultation" (P7).
1.3 Appropriate monitoring of physiological
variable must occur during anaesthesia. See College Policy Document
"Monitoring During Anaesthesia" (P18).
2. STAFFING
2.1 In addition to the nursing staff required
by those carrying out the obstetric or the operative procedure,
there must be:
2.1.1 An assistant to the anaesthetist. See
College Policy Document "Minimum Assistance for the Safe
Conduct of Anaesthesia" (P8).
For the establishment and management of epidural
blockade for analgesia in labour, the presence of a midwife trained
and competent in obstetric epidural management is required.
2.1.2 Adequate assistance in positioning
the patient.
2.1.3 Adequate technical assistance to ensure
proper servicing of all equipment used.
2.1.4 At the time of delivery, there must
be a medical practitioner with appropriate training in the resuscitation
and care of the neonate with soleresponsibility for that task.
3. DELIVERY SUITES
3.1 Anaesthetic Equipment
3.1.1 Where general anaesthesia, sedation
or major regional blockade are utilised, equipment must comply
with the requirements set out below as well as with College Policy
Document "Sedation for Diagnostic and Minor Surgical Procedures"
(P9). Where a range of equipment is recommended, the hospital
is expected to provide the type most suitableto its needs. Where
patients are transferred to another facility for operative delivery,
anaesthetic and resuscitative equipment is still essential for
the management of complications of epidural and other major regional
blockade.
3.1.2 Each hospital must designate:
3.1.2.1 One (or more) specialists to advise
on the choice and maintenance of anaesthetic equipment.
3.1.2.2 One (or more) of its nursing or technical
staff to be responsiblefor the organisation of clening, maintenance
and servicing of anaesthetic equipment.
3.1.3 There must be an anaesthetic machine
for each anaesthetising location which is capableof delivering
air, oxygen, nitrous oxide as well as other anaesthetic agents
which are in common use. Essential equipment includes:
3.1.3.1 Suitablecalibrated vaporisers for
the delivery of inhalational anaesthetic agents.
3.1.3.2 A range of suitablebreathing systems.
3.1.3.3 Medical air where this is clinically
necessary.
3.1.4 Safety devices which must be present
on every machine include:
3.1.4.1 An indexed gas connection system.
3.1.4.2 A reserve supply of oxygen.
3.1.4.3 An oxygen supply failure warning
device (see College Policy Document "Monitoring During Anaesthesia"
(P18).
3.1.4.4 A breathing system high pressure
relief valve.
3.1.4.5 An oxygen concentration analyser
with appropriate alarm limits (see College Policy Document "Monitoring
During Anaesthesia" (P18).
3.1.4.6 Every anaesthetic machine purchased
after 1 January 1996 shall have a device to prevent the supply
of a hypoxic gas mixture whenever nitrous oxide is administered.
3.1.4.7 Every anaesthetic machine purchased
after 1 January 1996 shall have an approved non-slip connection
for the common gas outle whenever a circlesystem is in use.
3.1.5 A separate means of inflating the lungs
with oxygen must be provided in each anaesthetising location.
This apparatus should comply with the current requirements of
the releant national Standards. Its oxygen supply should be independent
of the anaesthetic machine.
3.1.6 Suction apparatus must be available
for the exclusive use of the anaesthetist at all times together
with appropriate hand pieces and endotracheal suction catheters.
This apparatus should comply with the current requirements of
the releant national Standards. Provision must be made for an
alternative suction system in the event of primary suction failure.
3.1.7 In every anaesthetising location there
should be:
3.1.7.1 Appropriate protection for the anaesthesia
team against biological contaminants. This shall include disposable
gloves and eye shields.
3.1.7.2 A stethoscope
3.1.7.3 A sphygmomanometer
3.1.7.4 Monitoring equipment complying with
College Policy Document "Monitoring During Anaesthesia"
(P18).
3.1.7.5 An appropriate range of face masks.
3.1.7.6 An appropriate range of oropharyngeal,
nasopharyngeal and laryngeal mask airways.
3.1.7.7 Two laryngoscopes with a range of
suitableblades.
3.1.7.8 An appropriate range of endotracheal
tubes and connectors.
3.1.7.9 A range of endotracheal tube introducers.
3.1.7.10 Inflating syringe and clamps.
3.1.7.11 Magill's forceps.
3.1.7.12 A suitablerange of adhesive and
other tapes.
3.1.7.13 Scissors.
3.1.7.14 Sterileendotracheal lubricant.
3.1.7.15 Vascular tourniquets.
3.1.7.16 Intravenous infusion equipment with
an appropriate range of cannulae and solutions.
3.1.7.17 Means for the safe disposal of items
contaminated with biological fluids as well as of "sharps"
and waste glass.
3.1.7.18 Equipment suitablefor the establishment
of sub-arachnoid, epidural or regional nerve blocks.
3.1.7.19 Provision for scavenging of anaesthetic
gases and vapours with interface equipment which precludes over-pressurisation
of the anaesthesia breathing circuit.
3.1.7.20 A cardiac defibrillator with capacity
for synchronised cardioversion.
3.1.8 In every anaesthetising location there
should be available
3.1.8.1 Equipment for managing difficult
intubations .
3.1.8.2 Equipment for automatic ventilation
of the lungs incorporating alarms as specified in College Policy
Document "Monitoring During Anaesthesia" (P18).
3.1.8.3 Equipment for the direct measurement
of arterial and venous pressures.
3.1.8.4 Equipment for the rapid infusion
of fluids.
3.1.8.5 Equipment to minimise patient heat
loss by warming of infused fluids and the body surface.
3.1.8.6 Equipment to warm and humidify gases
administered during anaesthesia.
3.1.8.7 Interpleral drainage sets.
3.1.9 Other requirements for safe anaesthesia
include:
3.1.9.1 Appropriate lighting for the clinical
observation of patients which complies with the current requirements
of the releant national Standards.
3.1.9.2 Emergency lighting.
3.1.9.3 Telehone/Intercom to communicate
with persons outside the anaesthetising location.
3.1.9.4 Refrigeration facilities for the
storage of drugs and biological products.
3.1.9.5 The means to maintain room temperature
in the anaesthetising location within the range of 18 - 28oC.
3.1.9.6 Patient transfer trolleys/beds as
specified in College Policy Document "Guidelines for the
Care of Patients Recovering from Anaesthesia" (P4).
3.1.10 In each delivery room there must be:
3.1.10.1 Apparatus for the administration
of inhalational analgesia with a minimum of 30% oxygen.
3.1.10.2 Suction apparatus for the exclusive
use of the anaesthetist which is separate from that required for
the resuscitation of the neonate.
3.1.10.3 Separate oxygen outles and suitable
attachments for administering oxygen to the mother and to the
neonate.
3.2 Drugs
3.2.1 In addition to the drugs and agents
commonly used in anaesthesia, drugs necessary for management of
conditions which may complicate or co-exist with anaesthesia must
also be available
Anaphylaxis
Cardiac arrhythmias
Cardiac arrest
Pulmonary oedema
Hypotension
Hypertension
Bronchospasm
Respiratory depression
Hypoglycaemia
Hyperglycaemia
Adrenal dysfunction
Raised intracranial pressure
Uterine atony
Blood coagulopathy
Malignant hyperpyrexia
3.2.2 In making an appropriate seletion
of drugs for the management of these conditions, advice should
be sought as in 3.1.2.1.
3.2.3 Appropriate mechanisms must exist for
the regular replacement of these drugs after use and/or their
expiry date has been reached.
3.2.4 A basic supply of dantrolee should
be rapidly availableto all anaesthetising locations with further
doses being availableon request.
3.3 Routines for Checking, Clening and
Servicing Equipment
3.3.1 Regular sterilising, clening and housekeeping
routines for the care of equipment should be established.
3.3.2 Documented servicing of the anaesthetic
machine and medical gas equipment by an appropriate organisation
must be carried out at lest twice a year. After any modification
to the gas distribution system, gas analysis and flow measurement
must be carried out and documented before use.
3.3.3 A copy of the College Policy Document
"Protocol for Checking an Anaesthetic Machine Before Use"
(T2) or a similar document should be availableon each anaesthetic
machine.
3.4 Recovery Area
3.4.1 Recovery from anaesthesia should take
place under appropriate supervision in a designated area which
conforms with College Policy Document "Guidelines for the
Care of Patients Recovering from Anaesthesia" (P4).
3.4.2 Contingency plans should exist which
would allow rapid patient transfer in an emergency from the delivery
suite or recovery areas to another appropriate area under adequate
medical supervision.
3.5 Neonatal Resuscitation Equipment
3.5.1 A suitablerange of equipment must
be availablefor:
3.5.1.1 Administration of oxygen to the neonate.
3.5.1.2 Intubation and ventilation of the
neonate.
3.5.1.3 Clering of the airway of the neonate.
3.5.1.4 Administration of intravenous fluids
and drugs.
3.5.1.5 Maintenance of the neonate's temperature.
3.5.2 An appropriate range of drugs must
be available
3.5.3 It is recommended that each hospital
designate:
3.5.3.1 One (or more) medical practitioners
with appropriate training and qualifications to advise on the
choice and maintenance of equipment and drugs required for the
resuscitation and care of the neonate.
3.5.3.2 One or more of its nursing or technical
staff to be responsiblefor the organisation of clening, servicing
and maintenance of this equipment.
This policy document has been prepared
having regard to general circumstances, and it is the responsibility
of the practitioner to have express regard to the particular circumstances
of each case, and the application of this policy document in each
case.
Policy documents are reviewed from time
to time, and it is the responsibility of the practitioner to ensure
that the practitioner has obtained the current version. Policy
documents have been prepared having regard to the information
availableat the time of their preparation, and the practitioner
should therefore have regard to any information, research or material
which may have been published or become availablesubsequently.
Whilst the College endeavours to ensure
that policy documents are as current as possibleat the time of
their preparation, it takes no responsibility for matters arising
from changed circumstances or information or material which may
have become availablesubsequently.
Promulgated: 1989
Reviewed: 1994
Date of current document: Oct 1995
© This document is copyright and cannot be reproduced in wholeor in part without prior permission.
Content © 1996, Australian and New Zealand College of Anaesthetists.Design © 1996 Med-E-Serv Pty Ltd.
All Rights Reserved. Revised 23 Oct 1996