possible. If the contents are adminis- tered manually there is no record on the history screen of the pump. Inspection of the pump after this does not reveal any signs of damage. Interrogation of the pump by computer following such an episode only gives the message ‘cover open’, and gives no indication that the access was unauthorised. Since discovering this we have replaced these pumps with an alternat- ive design. The new pumps have a security system which the author has been unable to defeat. One of the safety factors inherent in PCA machine design is the inability to gain unauthorised access to the syringe contents. As this may be bypassed in the Graseby 3300 pump, I feel that this design fault should be brought to the attention of the anaesthetic community. C. Peady The Canberra Hospital, ACT Canberra, Australia E-mail: Cliff.Peady@act.gov.au A reply Thank you for the opportunity to reply to the letter from Dr Peady. Dr Peady’s description of the Graseby 3300 PCA Pump is correct in that the syringe is protected by a clear syringe cover. This cover is intended to protect the syringe and to help deter unauthorised tamper- ing with the syringe; however, it is not intended to make the syringe and its contents totally secure. While the syringe cover can be locked with a key, someone who is intent on gaining access to the syringe and its contents could exert force to pry open the cover as described by Dr Peady. There is a significant number of these pumps in the global market being used to deliver pain medications with very few reported incidents of tampering. J. Charters Quality Assurance Manager Smiths Medical International Watford WD24 4LG, UK Anaesthetic ‘in-flight’ checks: the ABC sweep New recruits to anaesthesia and oper- ating department practice, finding them- selves in a completely new environment, often have difficulty in knowing what is going on and take in intra-operative data in a haphazard manner which can slow decision making. They are often una- ware of the myriad range of items to check mentally during the course of an anaesthetic. The ‘ABC’ approach natur- ally lends itself to anaesthesia and can be used during induction, on transfer from anaesthetic room to theatre, at regular intervals throughout the anaesthetic, in an emergency or unexpected situation, and as a check after any significant event. A familiar concept, an ‘ABC sweep’ is intuitive to learn, easy to practise, and, if the trainee speaks out as they use it, allows the trainer to follow thought patterns and to understand both how the trainee sees the situation and, import- antly, the areas which he or she has not yet understood as being significant to patient safety. The idea of it being performed as a ‘sweep’ is important. It should be performed as a swift and smooth sensory survey of the state of play. ‘A for Airway’: checks the tube, laryngeal mask airway, etc., ties, drapes, the potential for dislodgement, and any approaching airway problems such as intraoral bleeding or packs to be removed. ‘B for Breathing’: looks at skin col- our, watches the chest move, moves along the tubing checking for kinks or disconnection, sees the bellows moving, takes in the airway pressure and the ventilator settings and alarms, and con- firms capnography readings. Next, checking the pulse oximeter leads naturally to ‘C for Circulation’: pulse, capillary refill, heart rate, blood pressure, invasive pressures are assessed, and alarms set. The cannula site, intra- venous fluids and urine output are checked. Surgical bleeding, suction vol- umes and swabs are assessed. ‘D for Drugs and Depth of Anaes- thesia’: have all planned drugs, inclu- ding antibiotics, been given? Vapour fluid levels and settings or plasma or effect site target levels are checked against patient parameters and surgical onslaught. ‘E for Environment’: checks posi- tioning, corneal protection, pressure areas and vulnerable nerves. Are attached devices such as warming blan- kets, fluid warmers, calf compressors and infusion and drug delivery pumps switched on, correctly set and running? As in Life Support course teaching, major or potentially life-threatening problems are corrected as soon as they are encountered. Likewise, problems simple to solve such as switching on the fluid warmer, are corrected imme- diately. Intermediate problems, such as a rising pulse rate, can be mentally ‘parked’ until the end of the swift assessment, when all the information gathered in the sweep is assessed and an informed decision made and appropri- ate action taken. The sweep is then repeated from the beginning to ensure that the action has had the desired result. If the sweep is interrupted for any reason, it begins again at ‘A for Airway’. Constant vigilance and safety in anaes- thesia are aims to which we all aspire. I offer the ABC sweep as a contribution to those aims. E. G. N. Williams Glan Clwyd Hospital Rhyl LL18 5UJ, UK E-mail: Eileen.Williams@cd-tr. wales.nhs.uk Anaesthetic gas monitoring devices – the new gadget for the motorhome owner The July 2006 edition of Practical Motorhome has four separate advertise- ments for anaesthetic gas alarms with prices ranging from £74.99 to £169. Motorhome owners are not alone in buying anaesthetic gas alarms; long distance lorry drivers are also interested. Apparently, there is a new crime of stealing from these vehicles while the occupants are asleep, the robber having sprayed a narcotic gas into the vehicle. The gas ensures that the occupants do not wake up during the robbery. A study in Truck and Driver [1] reported that 16% of long distance lorry drivers questioned had experienced either a cab break in or a personal attack between 2000 and 2003. Of these, 11% claimed the attack involved ‘gas’ and a further 11% were unsure if it had been used or not. Anaesthesia, 2007, 62, pages 88–100 Correspondence ..................................................................................................................................................................................................................... Ó 2007 The Association of Anaesthetists of Great Britain and Ireland 99