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What This Guide Helps With
Troubleshooting collapsed, partially rising, or irregularly cycling bellows caused by gas supply, circuit leaks, assembly problems, settings, or breathing-system restrictions.
Step-by-Step Troubleshooting
1. Ensure Patient Safety First
Do not perform extended bellows troubleshooting while the Avance is supporting an active patient.
If the bellows collapses, stops cycling, or ventilation becomes unreliable:
- Notify the anesthesia provider immediately.
- Establish ventilation using another verified anesthesia machine or approved backup method.
- Maintain independent patient monitoring.
- Follow the facility’s anesthesia-machine failure procedure.
Expected: Patient ventilation no longer depends on equipment with questionable mechanical ventilation.
The Avance uses ascending bellows. Bellows that fail to rise can indicate inadequate circuit volume, a significant leak, insufficient gas supply, or a ventilator problem.
If the patient is safely supported elsewhere, continue troubleshooting in a controlled Clinical Engineering setting.
2. Confirm the Exact Failure Condition
Operate the machine using an approved test lung and determine whether the bellows:
- Remains fully collapsed
- Rises only partially
- Rises slowly between breaths
- Cycles irregularly
- Falls during expiration
- Reaches the top but does not descend normally
- Works in manual ventilation but not mechanical ventilation
- Produces an “Unable to drive bellows” or related ventilator message
Record the selected ventilation mode, tidal volume, respiratory rate, fresh-gas flow, and displayed airway pressures.
Expected: The failure can be reproduced consistently and tied to a specific operating condition.
3. Check the Medical-Gas Supply
Verify that the required pipeline gases are connected securely and that supply-pressure indicators are within the normal operating range.
Check for:
- Disconnected pipeline hoses
- Loose or partially engaged gas fittings
- Closed or unavailable wall outlets
- Pipeline-pressure alarms
- Depleted backup cylinders
- Kinked or damaged gas hoses
Do not disconnect an active oxygen source while the machine is supporting a patient.
Expected: Adequate drive gas and fresh gas are available without supply alarms.
If restoring the gas supply returns normal bellows movement, complete an operational checkout and stop.
4. Confirm Adequate Fresh-Gas Flow
Set an appropriate fresh-gas flow in a controlled test configuration and observe whether the bellows begins filling.
A temporarily increased fresh-gas flow may help determine whether the bellows is collapsed because the breathing system lacks sufficient gas volume. GE guidance for a collapsed bellows condition includes checking drive gas and increasing fresh-gas flow.
Do not use the oxygen-flush control as a substitute for correcting a persistent leak or ventilator fault.
Expected: The bellows fills and reaches a stable position between mechanical breaths.
If normal cycling returns and remains stable, continue with the complete pre-use checkout before returning the machine to service.
5. Inspect the Patient Circuit and Test Lung
Check the complete breathing circuit from the machine to the test lung.
Look for:
- Disconnected inspiratory or expiratory limbs
- Loose Y-piece connections
- Split, punctured, or stretched tubing
- Open sampling ports
- Loose adapters
- Incorrectly installed filters or HMEs
- Damaged test-lung connections
- Circuit components installed backward
- Excessive circuit compression or kinking
Replace questionable disposable components with known-good compatible parts.
Expected: The breathing circuit is complete, unobstructed, and capable of holding volume.
If correcting a circuit connection restores normal bellows cycling, perform a leak test and stop.
6. Inspect the Bellows Assembly Externally
With the machine out of service and depressurized, visually inspect the bellows housing and bellows assembly without internal disassembly.
Check for:
- Bellows not seated evenly
- Folded, twisted, or visibly damaged bellows material
- Bellows sticking against the housing
- Cracks or damage in the transparent housing
- Moisture or contamination affecting movement
- A loose housing or improperly secured assembly
- Foreign material restricting travel
Do not lubricate the bellows or apply unapproved cleaning products.
Expected: The bellows moves freely, appears properly seated, and has no visible damage.
If the bellows is damaged, distorted, or repeatedly sticks, remove the device from service for repair.
7. Verify the Absorber Canister and Breathing-System Assembly
Inspect the absorber canister and surrounding breathing-system components.
Verify that:
- The canister is fully inserted and latched.
- Reusable components are assembled correctly.
- Disposable absorber components are compatible and seated properly.
- Seals are present, clean, and undamaged.
- The condensate drain or reservoir is closed correctly.
- No breathing-system component was left loose after cleaning or replacement.
A poorly seated canister or breathing-system seal can create enough leakage to prevent the bellows from filling normally.
Expected: The absorber and breathing system are securely assembled without visible gaps or damaged seals.
If reseating a component resolves the issue, complete the machine’s leak and system checks before returning it to service.
8. Check the Manual/Mechanical Ventilation Selection
Confirm that the bag-to-ventilator selector is fully positioned for mechanical ventilation.
Move the selector through its normal range while the machine is not connected to a patient, then return it firmly to the ventilator position.
Check for:
- Selector positioned between modes
- Binding or unusual resistance
- Loose external controls
- Failure of the display to recognize the selected mode
- Bellows behavior changing when the selector is moved
Expected: The machine consistently recognizes mechanical ventilation and the bellows cycles normally.
If the selector does not engage properly or its displayed status is inconsistent, remove the device from service.
9. Review Ventilator Settings
Verify that the selected settings are appropriate for the installed circuit and test lung.
Check:
- Ventilation mode
- Tidal volume or pressure target
- Respiratory rate
- Inspiratory time
- Pressure limit
- PEEP setting
- Trigger settings in supported modes
- Minimum-flow or low-flow conditions
Temporarily select a basic controlled ventilation mode with reasonable test settings to determine whether the problem is mode-specific.
Expected: Bellows movement corresponds consistently with the selected ventilation settings.
If the bellows operates normally in one mode but not another, document the affected mode and continue evaluation according to authorized service procedures.
10. Check for Excessive Leakage
Run the approved machine checkout, breathing-system leak test, or system test with the patient disconnected.
If the test fails, isolate external components systematically:
- Replace the breathing circuit.
- Replace the test lung.
- Reseat the absorber.
- Check sampling-line connections.
- Inspect circuit adapters and filters.
- Confirm the bag and bag-arm connection.
- Remove optional accessories that may introduce leaks.
Do not continue replacing components randomly. Change one item at a time and repeat the test.
Expected: Leakage remains within the machine’s acceptable limits and the bellows rises fully.
If the leak cannot be isolated externally, stop troubleshooting and escalate for bench evaluation.
11. Check the Scavenging Connection for Restriction
Inspect the AGSS or scavenging connection for:
- Kinked evacuation tubing
- Crushed hoses
- Incorrect wall connection
- Excessive facility suction
- Blocked scavenging components
- Fluid accumulation
- Improperly assembled scavenging accessories
A scavenging restriction or abnormal suction condition may interfere with normal ventilator exhaust and bellows operation.
Temporarily disconnect the device from the facility scavenging interface only when permitted by facility policy and in a properly ventilated service area.
Expected: The scavenging pathway is open, correctly connected, and not applying excessive suction.
If correcting the scavenging connection restores normal cycling, repeat the full operational checkout.
12. Power-Cycle and Repeat the Checkout
After confirming the device is not connected to a patient:
- Place the machine in Standby.
- Turn the system off according to normal shutdown procedures.
- Wait for the shutdown process to complete.
- Restore power.
- Allow startup checks to finish.
- Repeat the system checkout using a known-good circuit and test lung.
Do not return the machine to service merely because a restart temporarily clears the symptom.
Expected: The Avance completes its checkout and maintains repeatable bellows movement through multiple ventilation cycles.
If the problem returns, treat it as an unresolved equipment fault.
If the Problem Persists
If gas supply, fresh-gas flow, circuit connections, absorber seating, bellows condition, controls, settings, leakage, and scavenging have been checked, common external causes have been ruled out.
The problem may involve the ventilator drive system, internal valves, pressure regulation, electronic control, internal pneumatic leakage, or bellows-interface components.
The device should be:
- Removed from service
- Labeled Out of Service
- Sent for repair or controlled bench evaluation
- Evaluated using authorized GE Healthcare service documentation and appropriate test equipment
Do not perform unsupported internal pneumatic or ventilator repairs. Knowing when to stop is proper Clinical Engineering troubleshooting.
Clinical Use Tip
Never troubleshoot abnormal bellows movement while relying on the affected machine for patient ventilation. Move the patient to verified equipment before manipulating circuits, gas supplies, or breathing-system components.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Anesthesia staff reported that the Avance bellows remained partially collapsed and did not rise normally between mechanical breaths."
Cause
What was observed during troubleshooting.
Example:
"Inspection found the expiratory circuit limb loose at the breathing-system connection, creating a significant leak that prevented the bellows from filling."
Resolution
What action was taken.
Example:
"Secured the circuit connection, replaced the stretched tubing, completed the system leak test, and verified normal bellows cycling with a test lung."
Helpful Details to Include (If Known)
- Medical-gas pipeline pressures verified
- Backup cylinder status
- Exact alarm or message displayed
- Bellows fully or partially collapsed
- Manual ventilation performance
- Mechanical ventilation mode and settings
- Fresh-gas flow used during testing
- Circuit and test lung replaced
- Absorber seating inspected
- Leak-test results
- Scavenging hose condition
- Visible moisture or contamination
- Unusual pneumatic sounds
- Final device status
Final Thought
Abnormal bellows movement can indicate a serious loss of ventilation capability. Protect the patient first, evaluate external gas, circuit, assembly, and setting-related causes logically, and escalate when the failure cannot be safely isolated. Clear CCR documentation preserves both the technical findings and the reason for the final service decision.
That is successful troubleshooting.