AAMI News February 2018

Tech World: What to Do When Things Go Bump in the Night

Eben Kermit
Eben Kermit, CCE, is a biomedical engineering supervisor at Stanford Health Care in Palo Alto, CA.

One night not too long ago, I was sound asleep when I was awakened by the sound of my cellphone ringing. Rousing myself out of bed, I noted it was 3:30 a.m., and the service desk from the hospital was calling me. I routinely take the evening “on-call” responsibility as a biomed supervisor in rotation with my colleagues; however, I wasn’t supposed to be on call that night. Nevertheless, I was now awake.

“Hello, what’s going on?” I asked as I picked up the phone.

The story unfolded from there.

“We have the OR [operating room] on hold, may we connect you?”

“Sure,” I replied, trying to shake the cobwebs from my sleepy head. “How can I help you?”

“Hi, this is OR 4, and we need biomed to assist us. We have a patient on the table … a heart transplant surgery. We have an hour to two to go before finishing. There is an alarm indicator and message on the anesthesia ventilator. I’ve never seen this before and don’t know what to do.”

At this point, I was thinking to myself: I have not been trained on this ventilator and am unfamiliar with the alarm messages and their implications.

“Describe what you are seeing to me, please,” I replied as calmly as I could muster, feeling uncomfortable and vulnerable, and recognizing my own lack of preparation for this event.

“There is a blue light and a message to ‘shut down the machine’—something about a high oxygen level,” the voice on the other end of the phone explained.

Right then, I knew I needed more help. I needed someone with hands-on familiarity with the machine. So, I put the call on hold while I dialed my supervisor, knowing full well the consequences of that decision.

After a few rings, I got a groggy, “Hi. What’s up?”

“I have the OR on the line. They are having trouble with an anesthesia machine. The warning message is directing them to shut down,” I explained, looping my supervisor into the call. The anesthesia/OR tech gave a brief summary of the events and status of the machine. The cool, calm voice was overlaid by words of “… I’ve never seen this before,” “… not sure of what to do,” and “We requested and staged a ventilator outside the room.” The discussion continued with quick, specific questions and answers.

“What color is the patient? Is he pink?”

“Yes.”

“Are vital signs in normal range? Verify the SpO2 is stable.”

“Yes, confirmed. All normal.”

“Are the ventilator settings normal for volume, respiratory rate, and ETCO2?”

“Yes all OK.”

“Medical gases—are these within normal range?”

“Yep! All normal.”

“Where are you in the procedure? How much longer before closing?”

“An hour, maybe two is all. We are close to finishing.”

“OK. Is the anesthesiologist aware of the situation, and is the patient stable?”

“Yes.”

Then, finally, a resolution: “The recommendation from biomed is to continue the case without changing the anesthesia machine or the ventilator. We believe the issue is a small fan that is not working properly. The fan is used to prevent oxygen buildup inside the cabinet. Finish the case, and we will service the unit later.”

I heard the anesthesia tech thank us for our assistance. We provided call-back numbers, just in case there were additional complications or issues, and ended the conference call. I went back to bed and tried to fall asleep, confident in our assessment and suggestion of “continued monitoring.” By the time I got to the hospital the next morning and checked things out, the OR biomed team had already replaced the suspected cabinet fan and had returned the unit to service.

Sometimes, the things that go bump in the night are not gremlins, monsters, or boogeymen, rather they are minor issues that can wait for the light of day.