START

❶ Inform the theatre team of the problem, including theatre coordinator (Box A).

❷ Call for help, but be aware failure may be widespread.

❸ Switch to cylinder oxygen supply.

❹ Check remaining cylinder content (Box B):

• Ensure at least one further cylinder always available.

❺ Prolong duration of cylinder oxygen supply:

• Use circle system.
• Use lowest possible fresh gas flow.
• Use lowest possible FiO₂.
• Check FiO₂

❻ Minimise auxiliary gas usage:

• Some ventilator systems are gas-driven. If so, switching to manual ventilation will prolong oxygen cylinder supply.

❼ Evaluate moving to nearby area if oxygen supply there preserved.

❽ Continue to monitor and ensure adequacy of inspired oxygen and volatile agent.

❾ Workflow:

• Do not start any new case unless clinical priority absolutely requires it.
• Expedite conclusion of current case if clinically appropriate.
• Consider recovering the patient in theatre if recovery also affected (Box C).

❿ Disconnect from failed outlets and do not re-connect until safe to do so (Box D).

Box A: ORGANISATIONAL ISSUES

Theatre coordinator or equivalent should:

• Ensure no new case is started unless clinical priority absolutely requires it.
• Ascertain the extent of the failure throughout the hospital.
• Ascertain the reserve supplies of oxygen.
• Evaluate implications for ongoing supply.
• Ensure any other relevant emergency plans are initiated.
• Coordinate delivery of further oxygen cylinders in good time.
• Ensure individual theatres are kept informed.

Box B: OXYGEN CYLINDER: REMAINING CONTENTS

Box C:  RECOVERY

• Recovery area must be appropriately supplied with cylinder oxygen if also affected.
• Identify patients who do not require supplemental oxygen.

Box D:  RE-ESTABLISHMENT OF SERVICES

• Disconnect equipment from failed wall/pendant outlets.
• When re-established, output may not initially be 100% oxygen.
• Do not re-use outlet until gas composition and quality satisfactorily confirmed by a competent authority.