Form 671B
CONTROL # __________
Baxter 6301 Infusion Pump Checkout
1.0 SELF-TESTS
1.1 Plug unit in, turn on and verify the following displays illuminate momentarily:
ALARM, PUMPING, and ALERT LEDs
OPTIONS and NEXT indicators
COMPUTER CONTROL and MONITOR icons
All segments of LCD displays
AC Plug icon (remains on constantly) _____
1.2 The following are momentarily displayed in the upper Message Display window,
indicating correct configuration selections:
OCCLUSION LEVEL 2
AUTO RESTART _____
1.3 With door open, verify the following alarms in the upper Message Display window:
DOOR OPEN
CLOSE CLAMP _____
2.0 BATTERY CHECK / OCCLUSION TESTS
2.1. Install the Occlusion Calibration Test Shims by laying pump on it’s back, and laying the
shims on both upstream and downstream occlusions sensors. Close the door and turn the pump on in
Calibration Mode 1. (This is done by holding the CLEAR TOT VOL and the “1” keys while pressing
the ON/OFF CHARGE key.)
LEFT RIGHT
a. Verify the Upstream Occlusion value (upper left of pump’s
main display) reads between 3242 and 3314. ____
____
b. Verify the Downstream Occlusion value (lower left of pump’s
main display) reads between 2967 and 3039. ____
____
c. Verify the Main Battery value (upper right of pump’s main display) reads
between 688 and 714 for a fully charged battery. ____ ____
d. Verify the Backup Battery value (lower right of pump’s main display) reads
between 574 and 737. ____ ____
To exit Calibration Mode, press ON/OFF CHARGE button.
2.2 Unplug unit and verify Battery icon is illuminated. Install a fluid filled
tubing set, and set PRI RATE to 1999 ml/hr, and VTBI to 30ml. Run till the volume
delivers, and verify no alarms. ____ ____
2.3 Verify while unit is infusing, the message FLOW CHECK - NORM OCC
is displayed in upper Message Display window. ____ ____
2.4 Upon completion of delivery, verify unit activates an audible alert,
illuminates the ALERT LED, and switches to a KVO rate. ____
____
2.5 Plug unit back in and lower the PRI RATE to 125 ml/hr and run for 1 minute.
Pinch off tubing below pump, and verify OCCLUSION is displayed in Message Display
window, the red ALARM LED flashes, an audible alarm sounds, and the pump stops. ____ ____
2.6 Clear the occlusion and run unit again. Pinch off tubing above the pump, and
verify UPSTREAM OCCLUSION is displayed in Message Display, the
red ALARM LED flashes, an audible alarm sounds, and the pump stops. ____ ____
3.0 SAFETY / SLIDE CLAMP TESTS
3.1 Remove the tubing set, and reinstall it into pump but without installing the
Blue Slide Clamp (install straight tubing only). Verify unit alarms INSERT SLIDE
CLAMP, and will not allow unit to run. ____ ____
3.2 Remove and install the tubing set properly by installing tubing and inserting the Blue
Slide Clamp. Close the door, but don’t run pump. Observe the distal end of the tubing for
60 seconds after closing door. Verify that no more than 1/2 ml of fluid is allowed to flow. ____
____
3.3 Open the door and press the red safety clamp arm with moderate force.
Verify that the latch will NOT lock in the open position. ____ ____
3.4 Pull on the Blue Slide Clamp with moderate force, and verify that it can
NOT be removed. ____ ____
3.5 Push in the Blue Slide Clamp, and verify that the red safety clamp arm can
now be latched open. ____ ____
4.0 AIR ALARM TEST / PANEL LOCKOUT / ALARM VOLUME
4.1 Run pump at 200 ml/hr. While pump is running, press the rear PANEL LOCK
push-button. Verify the word LOC is displayed in the window, and no front panel keys work
except BACKLIGHT, and TOT VOL/STATUS. Press PANEL LOCK again, and LOC
message disappears, and unit works as normal. ____ ____
4.2 Using syringe, inject a 100 microliter air bubble into administration set through
the upper Y-site injection port. Verify AIR alarm occurs when the air bubble goes through
the pump, and the red ALARM LED flashes, an audible alarm is heard, and the pump stops.____
____
4.3 While the alarm is active, verify the VOLUME adjustment on rear of unit works
properly, and can’t be completely muted. Leave VOLUME at maximum when finished. ____
____
5.0 ACCURACY TEST
5.1 Clear air bubble from tubing, and set unit up for PRI RATE of 200 ml/hr.
Set VTBI for 20ml. Hook up tubing set to Datrend Infutest infusion tester. On Infutest,
set Test for Single Rate, and flush unit with 10-20ml sterile water with 60 cc syringe.
Press GO, and press PRI START on infusion pump. ____
____
5.2 Upon completion of the infusion, stop the pump, and stop the Infutest.
LEFT: Record the Volume Infused on the Infutest: _________ ml (18.6 and 21.4 ml)
Record the Average Rate on the Infutest: __________ ml/hr (186.0 and 214.0 ml/hr)
RIGHT: Record the Volume Infused on the Infutest: _________ ml (18.6 and 21.4 ml)
Record the Average Rate on the Infutest: __________ ml/hr (186.0 and 214.0 ml/hr)
6.0 ELECTRICAL SAFETY TESTS
6.1 Grounding Resistance:________ohms (Acceptable range is less than 0.5 ohms)
NAME:______________________________ DATE:_____________ TIME USED:________
Control # _________
6.2 Chassis Leakage Current:________microamps (Acceptable range is less than 300
microamps)
