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What This Guide Helps With
Troubleshooting high airway pressure caused by circuit restrictions, closed valves, accessories, ventilator settings, breathing-system assembly, or pressure-sensing faults.
Step-by-Step Troubleshooting
1. Ensure Patient Safety First
Do not perform extended troubleshooting while the Avance is ventilating an active patient.
If a high airway pressure alarm occurs during a procedure:
- Notify the anesthesia provider immediately.
- Have clinical staff assess the patient and airway.
- Establish manual ventilation or transfer the patient to another verified anesthesia machine when clinically appropriate.
- Ensure a functioning manual resuscitator and independent monitoring are available.
Expected: Patient ventilation is maintained without relying on equipment with an unresolved pressure alarm.
Once the patient is safely supported, continue troubleshooting in a controlled Clinical Engineering environment.
2. Confirm the Exact Alarm Condition
Record the complete alarm message and determine:
- Whether the alarm occurs during mechanical or manual ventilation.
- Whether it occurs on every breath or intermittently.
- The displayed peak airway pressure.
- The configured pressure alarm limit.
- The ventilation mode and current settings.
- Whether the pressure waveform rises abruptly or gradually.
Expected: The reported condition is clearly documented and can be safely reproduced using an approved test lung.
Do not recreate the problem on a patient.
3. Check the High-Pressure Alarm Limit
Review the configured airway-pressure alarm limit.
Confirm that the limit is appropriate for the ventilation mode and test conditions. A limit set unusually low may produce an alarm even when the machine and circuit are functioning normally.
Do not change clinical settings solely to silence an alarm. Setting adjustments must be approved by qualified anesthesia personnel or performed during controlled testing.
Expected: The alarm limit is appropriate and is not the sole cause of the complaint.
If correcting an improperly configured limit resolves the issue and the unit passes operational testing, stop troubleshooting.
4. Inspect the Patient Circuit
Disconnect the circuit from clinical use and inspect its entire length for:
- Kinked or compressed tubing.
- Tubing trapped beneath equipment or cart components.
- Internally collapsed disposable tubing.
- Incorrect inspiratory or expiratory limb routing.
- Foreign material or packaging left inside a connector.
- Water accumulation that could restrict flow.
- Damaged or incompatible circuit components.
Replace questionable disposable components rather than attempting to repair them.
Expected: The breathing circuit is open, correctly routed, and free of visible restrictions.
If replacing or repositioning the circuit resolves the alarm, complete functional testing and stop.
5. Check the Patient Connection and Accessories
Inspect all accessories installed between the breathing circuit and test lung, including:
- Bacterial or viral filters.
- Heat-and-moisture exchangers.
- Catheter mounts.
- Elbows and adapters.
- Gas-sampling connectors.
- Nebulizer adapters.
- Flow sensors or specialty airway accessories.
Remove unnecessary accessories during bench testing and substitute known-good components.
Expected: No accessory is blocked, saturated, incorrectly installed, or adding excessive resistance.
If removing or replacing an accessory resolves the alarm, stop after completing the required operational checks.
6. Inspect the Adjustable Pressure-Limiting Valve
When evaluating manual ventilation, verify that the adjustable pressure-limiting valve moves normally and is not set fully closed.
Inspect the control externally for physical damage, binding, contamination, or evidence of liquid intrusion.
Expected: The valve adjusts smoothly and allows pressure to be relieved appropriately during manual ventilation.
If the valve remains difficult to operate or pressure cannot be relieved, remove the machine from service for repair evaluation.
7. Check the Bag-to-Ventilator Control
Confirm that the bag-to-ventilator selector is fully positioned in the intended operating mode.
A partially positioned or mechanically obstructed selector may interfere with the breathing-gas pathway or produce abnormal ventilation behavior.
Expected: The selector moves completely between positions and the displayed operating mode agrees with its physical position.
If the selector does not move correctly or the mode indication is inconsistent, stop troubleshooting and escalate for repair.
8. Inspect the Breathing System Assembly
Verify that externally removable breathing-system components are correctly installed, including:
- Inspiratory and expiratory valve assemblies.
- Absorber canister.
- Breathing-system seals.
- Circuit ports.
- Reservoir bag connection.
- Exhalation components accessible without internal disassembly.
Look for incorrect seating, damaged seals, accumulated moisture, debris, or improperly assembled components.
Expected: The breathing system is correctly assembled with no visible obstruction or misalignment.
If correcting an assembly problem resolves the alarm, complete the manufacturer-required checkout and stop.
9. Check for Blocked Inspiratory or Expiratory Flow
Using an approved test lung, determine whether abnormal pressure occurs during inspiration, expiration, or both.
A rapid pressure increase with little test-lung expansion may indicate an inspiratory restriction. Incomplete exhalation or increasing baseline pressure may indicate an expiratory restriction.
Inspect external valves, ports, tubing, and accessories associated with the affected flow path.
Expected: The test lung inflates and deflates freely without pressure stacking or abnormal resistance.
Do not disassemble internal pneumatic assemblies during this check.
10. Review Ventilator Settings
Verify that the ventilation settings are reasonable for the test lung being used, including:
- Tidal volume or inspiratory pressure.
- Respiratory rate.
- Inspiratory time.
- Inspiratory-to-expiratory ratio.
- PEEP.
- Flow settings.
- Ventilation mode.
High tidal volume, short inspiratory time, excessive flow, elevated PEEP, or an inappropriate test-lung configuration can produce high airway pressure without a device failure.
Expected: The machine operates normally with settings appropriate for the connected test load.
If appropriate settings eliminate the alarm and the machine passes testing, document the configuration issue and stop.
11. Substitute a Known-Good Test Lung and Circuit
Connect a verified test lung using a simple, known-good breathing circuit without unnecessary accessories.
Operate the Avance in applicable ventilation modes and gradually increase settings while observing:
- Peak airway pressure.
- Pressure waveform.
- Delivered and exhaled volume.
- PEEP.
- Alarm activation.
- Test-lung inflation and deflation.
Expected: Pressure remains proportional to the selected settings and the alarm activates only when the configured limit is reached.
If the problem disappears with the known-good setup, the original circuit, accessory, or test load was the likely cause.
12. Run the Approved Machine Checkout
After all external components are correctly installed, perform the normal preoperative checkout or system-check procedure specified for the facility’s Avance configuration.
Do not bypass failed checks or return the machine to service based only on the disappearance of the alarm.
Expected: The machine completes its checkout without breathing-system, valve, ventilator, pressure-monitoring, or leak-related failures.
If the checkout fails, record the exact test name and displayed message.
13. Evaluate Pressure Monitoring During Bench Testing
Compare the displayed airway pressure with an approved external pressure analyzer during controlled ventilation.
Allow for normal measurement tolerance, analyzer uncertainty, and differences in measurement location.
Expected: The Avance pressure reading tracks the external analyzer consistently and the alarm occurs near the configured pressure limit.
A significant or inconsistent discrepancy may indicate a pressure-sensing, calibration, tubing, or ventilator-control problem requiring service evaluation.
If the Problem Persists
If the high airway pressure alarm continues after the circuit, accessories, valve positions, breathing-system assembly, settings, and test load have been verified, common external causes have been ruled out.
The issue may involve an internal flow restriction, pressure-sensing pathway, ventilator valve, pneumatic component, or control-system fault.
The device should be:
- Removed from service.
- Labeled Out of Service.
- Sent for qualified repair or bench evaluation.
- Serviced according to GE Healthcare documentation and facility policy.
Do not perform undocumented internal adjustments or board-level repairs. Knowing when to stop and escalate is proper troubleshooting.
Clinical Use Tip
Never troubleshoot a recurring high airway pressure alarm while the machine remains responsible for an active patient. Patient airway problems and equipment restrictions can produce similar symptoms, so clinical staff must secure ventilation before Clinical Engineering testing begins.
Move the patient to a verified backup device or approved ventilation method before troubleshooting. Maintain therapy continuity and appropriate independent monitoring throughout the transition.
Work Order Documentation (CCR Method)
CCR = Complaint, Cause, Resolution
Complaint
What was reported by the clinical staff.
Example:
"Anesthesia staff reported repeated high airway pressure alarms during mechanical ventilation on the GE Healthcare Avance."
Cause
What was observed during troubleshooting.
Example:
"Bench testing found a saturated breathing-circuit filter restricting flow and causing peak pressure to exceed the configured alarm limit."
Resolution
What action was taken.
Example:
"Replaced the restricted filter, installed a verified circuit, completed the machine checkout, and confirmed normal pressure and alarm operation with a test lung."
Helpful Details to Include (If Known)
- Exact alarm message.
- Ventilation mode and settings.
- Displayed peak airway pressure.
- Configured pressure limit.
- Whether the alarm occurred in bag or ventilator mode.
- Circuit and accessories inspected.
- Filters or tubing replaced.
- Adjustable pressure-limiting valve condition.
- Bag-to-ventilator selector position.
- Test-lung type.
- External analyzer readings.
- Checkout results.
- Alarm behavior.
- Accessories swapped.
- Power behavior.
- Environmental factors.
- Indicator lights.
- Unusual sounds, heat, odor, or physical damage.
- Final device status.
Final Thought
High airway pressure alarms require a patient-safety-first response followed by logical evaluation of the circuit, accessories, valves, settings, and breathing system. Clear CCR documentation supports safe escalation when the problem cannot be resolved externally.
That is successful troubleshooting.