technical checklist

1. Collect cylinder and ensure that it contains 1000ppm NO in nitrogen, check label attached to
top of cylinder and the value printed on side of cylinder.

2. Check cylinder is turned off then attach regulator to cylinder and make sure it is tight. If
regulator is of a type that has its own on/off switch check it is switched off.

3. Take cylinder to bedside and attach regulator to flowmeter, ensure flowmeter is switched off.

4. Make sure cylinder is secured to a wall or trolley - falling cylinder may cause injury or result
in accidental discharge of NO.

5. Turn on cylinder (and if applicable, regulator) and check for leaks around cylinder head,
regulator and flowmeter by listening or using leak detection spray.

6. Using regulator gauge nearest cylinder check there is sufficient gas supply in the cylinder (see
technical guidelines)

7. Attach NO delivery tubing to flowmeter output but not to ventilator circuit.

8. Purge the system of any possible build-up of nitrogen dioxide (NO₂) that has occurred when
not in use - individual units should agree how this will be done.

   -If the required ventilator is not in use then at the end of the set-up a test lung can be
   attached and the system run until a low NO₂ level is confirmed.
   -If the NO is to be attached to a ventilator in use then purging should be done for 30-60
   seconds before connecting the flowmeter tubing to the ventilator circuit. Purging can be done
   into room air away from nearby personnel.

IF HIGH NO FLOWS ARE USED FOR PURGING THEY MUST
BE TURNED OFF BEFORE CONNECTION TO A BABY,THEN
RESET AT AN APPROPRIATE LEVEL

9. Connect the flowmeter output tubing to the ventilator, and the monitoring tubing to the NO/
NO₂ analyser (see Technical Guidelines for sample circuits).

10. Attach scavenger system to the ventilator exhaust.

11. Turn on NO/NO2 analyser.

12. Set the NO flowmeter to the level required, calculated using the formula:

Nitric Oxide flow rate(Litres/min)	X 1000ppm = Dose ppm
Ventilator flow rate(Litres/min)

13. Make sure regulator and cylinder are turned on and if required the output pressure is adjusted
to a suitable level (usually 1-2 bar but varies with different systems - check).

14. Allow the analyser a few minutes to settle, then adjust the NO flow as necessary to give the
required dose.

15. Set up a hand ventilation circuit as per policy of individual unit.

16. Make sure there are spare cylinders easily to hand to swap with the ones in use when
required.

17. Check a methaemaglobin level after 1 hour and then every 12 hours.

18. Monitor NO dose on analyser-adjust flow to maintain desired dose.

19. Monitor NO₂ reading on analyser. High readings may be due to inadequate purging.

20. Ensure environmental monitors are working - maximum recommended levels are 25ppm of NO
and 3ppm of NO₂ over an 8 hour period.