Breast Pump Assessment Chart
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1
2Breast Pump Assessment Chart
Clinic Location ________________________________________
Elevation ___________________________
Standard Values
Symphony
50 – 250 mmHg
Pump in Style
First phase
50 – 200 mmHg
Lactina
Second phase
100 – 250 mmHg
• MIN setting
• Low setting
90 – 100 mmHg
90 – 100 mmHg
• MAX setting
• High setting
240 – 250 mmHg
240 – 250 mmHg
(Values should go up as dial is adjusted from MIN to MAX)
Is pump function
Serial Number (if
Value on
Value on
Name of
Date
normal?
Comments
applicable)
MIN/Low
MAX/High
Tester
Yes
No
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