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CADD-Prizm
®
PCS II pump Cleaning and Functional Testing Checklist
The following checklist is provided as a guide only to assist in establishing documentation of
cleaning and functional testing for the CADD‑Prizm
®
PCS II pump. If service is provided, fill out
this sheet and return it with the device.
Serial # _______________ Reference Number _______________________ Date _______________________
(Refer to the Technical Manual procedures.)
I. Cleaning Completed
Yes
No
II. Visual Inspection
LCD
Lock
Data In/Out Jack
Occlusion Sensor Seals
Cassette Sensors (3)
Air Detector or Port Cover
Valves and Expulsors
Keyboard
Pump Housing
Reservoir Hinge Area
Indicator Light
Battery Door
Latch
Power Jack
Battery Compartment
III. Mechanical Inspection
Keyboard
Cassette Latch
Battery Door
Cassette Lock
IV. Functional Inspection
Power‑up
RES VOL Alarm
Dose Given / Attempted
Latch / Lock
Stop / Start
MG Given
Cassette Sensor
Activation Timing
Air Detector
LCD
Remote Dose Cord
Printer Tests
Motor / Gear Train
V. Occlusion Tests (Only need to perform 1 or 2; not both)
Downstream Option 1 Activations Before Alarm ___________
Downstream Option 2 High Pressure Alarm At ____________ psi
Upstream Occlusion Sensor Test
Pass ________Fail __________
VI. Accuracy Testing (Only need to perform 1 or 2; not both)
Volumetric Accuaracy Test
Intended
Actual
Inaccuracy
Accuracy
Accuracy
Delivery
Delivery
Volume
Error
Error
Volume
Volume
Percentage
ml
ml
ml
%
Gravimetric Accuracy Test
Pre-Delivery
Post-Delivery
Amount
Intended
Inaccuracy
Accuracy
Accuracy
Weights
Weight
Delivered
Delivery
Volume
Error
Error
Volume
g
g
ml
ml
ml
%