SECTION 5 MAINTENANCE AND SERVICE TESTS
LifeCare PCA
5 - 20
Technical Service Manual
5.5.1
PM/PVT
CHECKLIST
ICU Medical
LifeCare PCA with ICU Medical MedNet Infusion System
Preventive Maintenance (PM) and Performance Verification Test (PVT) Checklist
Note:
The PM process and the PVT process must each be performed at least once every 12 months to ensure proper
performance of the LifeCare PCA infuser. In addition, inspect the infusion system after repair or during cleaning.
Replace any damaged or defective external parts as required.
• If any section will NOT be performed, check the applicable N/A box and leave that section blank.
• Circle
PASS
or
FAIL
in the respective box after each inspection or test is performed.
• Enter the device model and serial number in the space provided.
• Sign and date this checklist in the space provided.
Item
Inspection
Test
Prev
entive Mainten
an
ce
❒
N/
A
Labels Inspection
PASS / FAIL
AC Power Cord Inspection and Test
PASS / FAIL
PASS / FAIL
Front Enclosure, Rear Enclosure, Cradle Assembly, and
Security Door Inspection and Test
PASS / FAIL
PASS / FAIL
Rubber Foot Pad Inspection
PASS / FAIL
Pole Clamp Assembly Inspection and Test
PASS / FAIL
PASS / FAIL
Keypad, Displays (LED/LCD), and Indicators Inspection
PASS / FAIL
PASS / FAIL
Patient Pendant Inspection
PASS / FAIL
PASS / FAIL
Barcode Reader Window Inspection, Test, and Cleaning
PASS / FAIL
PASS / FAIL
Per
form
anc
e Ve
rific
atio
n
T
est
❒
N/A
Stuck Injector Switch Pin Test
PASS / FAIL
Self Test
Biomed Mode Tests
PASS / FAIL
RAM Test
PASS / FAIL
FLASH Test
PASS / FAIL
CPU Test
PASS / FAIL
Clock Test
PASS / FAIL
LCD Test
PASS / FAIL
Backlight Test
PASS / FAIL
LED Test
PASS / FAIL
Indicator Test
PASS / FAIL
Keypad Test
PASS / FAIL
Door Test
PASS / FAIL
Syringe Test
PASS / FAIL
Empty Syringe Test
PASS / FAIL
Alarm Test
PASS / FAIL
Rotation Test
PASS / FAIL
Barcode Test
PASS / FAIL
Delivery Accuracy Test
PASS / FAIL
Occlusion Test
PASS / FAIL
Electrical Safety Test
PASS / FAIL
Othe
r
❒
N/A
Network Connectivity Checks
PASS / FAIL
Mechanism Replaced?
(every 60 months)
YES / NO
SLA Battery Replaced?
(every 24 months)
YES / NO
TECHNICIAN
INFUSER
Signature: ________________________________
Date: ____________________________________
Model: ________________________________
Serial Number: __________________________