Datex-Ohmeda Avance User Reference Manual

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Avance

User’s Reference Manual

Software Revision 6.X

Datex-Ohmeda, Inc., a General Electric Company, doing business as GE Healthcare.

User Responsibility

This Product will perform in conformity with the description thereof contained in this User’s Reference manual and accompanying labels and/or inserts, when assembled, operated, maintained, and repaired in accordance with the instructions provided. This Product must be checked periodically. A defective Product should not be used. Parts that are broken, missing, plainly worn, distorted, or contaminated should be replaced immediately. Should repair or replacement become necessary, Datex-Ohmeda recommends that a telephonic or written request for service advice be made to the nearest Datex-Ohmeda Customer Service Center. This Product or any of its parts should not be repaired other than in accordance with written instructions provided by Datex-Ohmeda and by Datex-Ohmeda trained personnel. The Product must not be altered without the prior written approval of Datex-Ohmeda. The user of this Product shall have the sole responsibility for any malfunction which results from improper use, faulty maintenance, improper repair, damage, or alteration by anyone other than Datex-Ohmeda.

CAUTION U.S. Federal law restricts this device to sale by or on the

order of a licensed medical practitioner. Outside the U.S.A., check local laws for any restriction that may apply.

Datex-Ohmeda products have unit serial numbers with coded logic which indicates a product group code, the year of manufacture, and a sequential unit number for identification. The serial number can be in one of two formats.

AAAX11111 AAAXX111111AA The X represents an alpha

character indicating the year the product was manufactured;

H = 2004, J = 2005, etc. I and O are not used.

Avance, Advanced Breathing System, ComWheel, D-fend, EZchange, Disposable Multi Absorber, Reusable Multi Absorber, PSVPro, SmartVent, Tec 6 Plus, and Tec 7 are registered

trademarks of Datex-Ohmeda, Inc.

Other brand names or product names used in this manual are trademarks or registered trademarks of their respective holders.

The XX represents a number indicating the year the product was manufactured; 04 = 2004,

05 = 2005, etc.

1 Introduction

Intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Symbols used in the manual or on the equipment . . . . . . . . 1-4

Typeface conventions used . . . . . . . . . . . . . . . . . . . . . . . . . 1-7

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7

2 System Controls and Menus

System overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

Advanced breathing system (ABS) components . . . . . . . . . 2-5

Optional ABS components . . . . . . . . . . . . . . . . . . . . . . . 2-7

Non-circle circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-8

ACGO (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-9

Scavenging the ACGO sample flow . . . . . . . . . . . . . . . . 2-9

Scavenging from an auxiliary manual breathing circuit 2-10

Scavenging a gas monitor sample flow . . . . . . . . . . . . 2-10

Vaporizer controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11

Display controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Anesthesia system display . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

Waveform fields . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Digit field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

Using menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17

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3 Operation

Turning on the system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2

Start case (start gas flow) . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3

Using default settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4

Using customized settings . . . . . . . . . . . . . . . . . . . . . . . 3-4

Minimum Alveolar Concentration (MAC) . . . . . . . . . . . . 3-5

End case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

Ventilator setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

Using quick keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

Using Vent Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

Changing ventilator modes and settings . . . . . . . . . . . . 3-8

Gas setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Using quick keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Using Gas Setup menu . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Changing gas and settings . . . . . . . . . . . . . . . . . . . . . . 3-9

Changing circuit type . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10

Spirometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11

Setting loop type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12

Scaling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-13

Spirometry setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14

Setting patient and sensor type . . . . . . . . . . . . . . . . . . 3-14

Selecting a data source . . . . . . . . . . . . . . . . . . . . . . . . 3-15

Setting spirometry split screen . . . . . . . . . . . . . . . . . . . 3-15

Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16

Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17

Cardiac bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-18

Fresh gas usage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19

Screen configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-20

Select page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-20

Screen setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-21

ii M1145956

4 Preoperative Checkout

Table of Contents

Alarm setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23

Setting alarm limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23

Volume apnea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-24

MV/TV alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-24

CO2 alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-24

Auto MV limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-25

Alternate O2 control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-26

EZchange canister (optional) . . . . . . . . . . . . . . . . . . . . . . . 3-27

Condenser (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28

Passive AGSS (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . 3-29

Active AGSS (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-30

Connecting active AGSS with a flow indicator . . . . . . . 3-31

Connecting active adjustable AGSS . . . . . . . . . . . . . . 3-31

5 Preoperative Tests

Every day before your first patient . . . . . . . . . . . . . . . . . . . . 4-2

Before every patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

Inspect the system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2

Vaporizer installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

Flow and pressure calibration . . . . . . . . . . . . . . . . . . . . . . . 5-4

Circuit compliance compensation . . . . . . . . . . . . . . . . . . . . 5-4

Checkout menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Leak < 250 ml . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Machine check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

Machine check - system . . . . . . . . . . . . . . . . . . . . . . . .5-6

Machine check - circuit . . . . . . . . . . . . . . . . . . . . . . . . .5-7

Machine check -circuit O2 . . . . . . . . . . . . . . . . . . . . . . . 5-7

Machine check - monitor . . . . . . . . . . . . . . . . . . . . . . . . 5-7

Individual checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8

System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8

Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8

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6 Airway Modules

Circuit O2 cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9

Low P leak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9

Low P leak (machines with ACGO) . . . . . . . . . . . . . . . . 5-9

Positive low pressure leak test (ACGO systems only) . . . . 5-10

Vaporizer back pressure test . . . . . . . . . . . . . . . . . . . . . . . 5-11

Airway modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2

Connection to a patient . . . . . . . . . . . . . . . . . . . . . . . . . 6-4

Parameters setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Data source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

CO2 setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

O2 setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Agent setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Spirometry setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Automatic agent identification . . . . . . . . . . . . . . . . . . . . . . . 6-6

Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

7 Alarms and Troubleshooting

Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

List of alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Alarm ranges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12

Alarm tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14

Breathing system problems . . . . . . . . . . . . . . . . . . . . . . . . 7-16

Electrical problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-17

Alarm priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Silencing alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

Display changes during alarms . . . . . . . . . . . . . . . . . . . 7-2

De-escalating alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Battery indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Internal failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

Pneumatic problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-18

iv M1145956

8 Setup and Connections

Table of Contents

Setup warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2

Canister setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4

When to change the absorbent . . . . . . . . . . . . . . . . . . . 8-5

Removing a canister . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6

Removing an EZchange canister . . . . . . . . . . . . . . . . . . 8-6

Reusable Multi Absorber canister filling . . . . . . . . . . . . . 8-7

Electrical connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9

Mains inlet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9

Outlets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-9

Serial port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10

Pneumatic connections . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11

Pipeline inlets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11

Scavenging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11

9 User Maintenance

Sample gas return port . . . . . . . . . . . . . . . . . . . . . . . . 8-12

Vacuum suction regulator (optional) . . . . . . . . . . . . . . 8-12

Venturi suction regulator (optional) . . . . . . . . . . . . . . . 8-13

Auxiliary O2 flowmeter (optional) . . . . . . . . . . . . . . . . . 8-13

How to install gas cylinders . . . . . . . . . . . . . . . . . . . . . . . . 8-14

Pin indexed cylinder yokes . . . . . . . . . . . . . . . . . . . . .8-14

DIN cylinder connections . . . . . . . . . . . . . . . . . . . . . . . 8-14

High-pressure leak test . . . . . . . . . . . . . . . . . . . . . . . . 8-15

How to attach equipment to the top of the machine . . . . . . 8-16

Repair policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2

Maintenance summary and schedule . . . . . . . . . . . . . . . . . 9-2

Datex-Ohmeda approved service . . . . . . . . . . . . . . . . . 9-3

Circuit O2 cell replacement . . . . . . . . . . . . . . . . . . . . . . . . . 9-4

Calibration menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5

Flow and pressure calibration . . . . . . . . . . . . . . . . . . . . . . . 9-5

Circuit O

cell calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6

21% O

calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6

Airway gas calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6

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10 Parts

Backlight test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7

How to help prevent water buildup . . . . . . . . . . . . . . . . . . . . 9-7

Flow sensor module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2

Breathing circuit module . . . . . . . . . . . . . . . . . . . . . . . . . . 10-3

Bellows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4

Complete Advanced Breathing System . . . . . . . . . . . . . . . 10-5

Absorber canister . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6

Exhalation valve assembly . . . . . . . . . . . . . . . . . . . . . . . . . 10-7

AGSS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8

EZchange canister system . . . . . . . . . . . . . . . . . . . . . . . . . 10-9

Condenser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-10

Test tools and system parts . . . . . . . . . . . . . . . . . . . . . . . 10-11

11 Specifications and Theory of Operation

System pneumatic circuits . . . . . . . . . . . . . . . . . . . . . . . . . 11-2

Gas supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4

O2 flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4

Air and N2O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4

Mixed gas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4

EZchange canister . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4

Condenser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

Gas supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

ACGO Port relief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

Non-circle circuit relief . . . . . . . . . . . . . . . . . . . . . . . . . 11-5

Electrical block diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6

Electrical power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-8

Power cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-8

Battery information . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-9

Flow specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-9

Breathing system specifications . . . . . . . . . . . . . . . . . . . . 11-10

Gas scavenging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-11

Physical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-12

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Table of Contents

Environmental requirements . . . . . . . . . . . . . . . . . . . . . . 11-12

Airway module specifications . . . . . . . . . . . . . . . . . . . . . . 11-13

Gas specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-13

Typical performance . . . . . . . . . . . . . . . . . . . . . . . . . 11-14

Suction regulators (optional) . . . . . . . . . . . . . . . . . . . . . . 11-15

Ventilator theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-16

O2 monitoring theory of operation . . . . . . . . . . . . . . . 11-17

Ventilation modes . . . . . . . . . . . . . . . . . . . . . . . . . . .11-17

Ventilator operating specifications . . . . . . . . . . . . . . . . . . 11-25

Pneumatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-25

Fresh gas compensation . . . . . . . . . . . . . . . . . . . . . . 11-25

Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-25

Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-25

Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-25

Ventilator accuracy data . . . . . . . . . . . . . . . . . . . . . . . . . 11-26

Electromagnetic compatibility (EMC) . . . . . . . . . . . . . . . . 11-27

Guidance and manufacturer’s declaration -

electromagnetic emissions . . . . . . . . . . . . . . . . . . . . . 11-27

Guidance and manufacturer’s declaration -

electromagnetic immunity . . . . . . . . . . . . . . . . . . . . . 11-28

Power immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-28

Radiated immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-29

Recommended separation distances . . . . . . . . . . . . . 11-30

Electrical safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-31

IEC 60601-1 Classification . . . . . . . . . . . . . . . . . . . . . . . . 11-32

Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-32

System components . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-33

Integral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-33

Not integral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-33

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12 Super User Mode

Index

Install/Service menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2

Using super user mode . . . . . . . . . . . . . . . . . . . . . . . . 12-3

Menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4

Cumulative gas usage . . . . . . . . . . . . . . . . . . . . . . . . . 12-4

Volume apnea setup . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5

Setting time and date . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6

Trends setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7

Setting colors and units . . . . . . . . . . . . . . . . . . . . . . . . 12-9

Parameter settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10

Page Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10

Configuring case defaults . . . . . . . . . . . . . . . . . . . . . 12-12

Warranty

viii M1145956

1 Introduction

WARNING Read each component’s User’s Reference manual and

understand the following before using this system:

• All system connections.

• All warnings and cautions.

• How to use each system component.

• How to test each system component.

w Before using the system:

• Complete all of the tests in the “Preoperative Tests” section.

• Test all other system components.

w If a test fails, do not use the equipment. Have a

Datex-Ohmeda trained service representative repair the equipment.

In this section Intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

Symbols used in the manual or on the equipment . . . . . . . . 1-4

Typeface conventions used . . . . . . . . . . . . . . . . . . . . . . . . . 1-7

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7

M1145956 1-1

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Intended use

The Avance anesthesia system combines our highly advanced anesthesia delivery, the very best in patient monitoring, and care information management. The contemporary, compact design addresses many ergonomic considerations including an efficient cable management solution and storage system and an extra large work surface area. Optional, integrated features include auxiliary O2 and suction control. The Avance system offers improved usability through integration of ventilation, gas delivery and gas monitoring (E and M-Series respiratory gas module capable) on a full-color 12-inch display. This system also features electronic gas mixing of up to three gases.

The Avance system uses SmartVent ventilation technology offering Volume Control Ventilation with tidal volume compensation and electronic PEEP. The proven SmartVent technology also features optional Pressure Control Ventilation, Pressure Support Ventilation with an Apnea Backup (PSVPro) that is used for spontaneously breathing patients, Synchronized Intermittent Mandatory Ventilation (SIMV) modes, Pressure Control Ventilation-Volume Guarantee (PCV-VG), and VCV cardiac bypass. These advanced features allow for the ventilation of a broad patient range: from neonates and compromised patients to routine cases.

The Avance system uses the Advanced Breathing System (ABS). This integrated breathing system is easy to remove and disassemble, is made of highly durable polymers, and is fully autoclavable. Its fully integrated design enhances the system’s elegance while minimizing tube connections, minimizing circuit volume, and increasing the work surface area.

The anesthesia system is designed for expansion and upgrades, so it is easy to add new technologies and ventilation capabilities without investing in a new system.

This anesthesia system is not suitable for use in an MRI environment.

This system must only be operated by authorized medical personnel well trained in the use of this product. It must be operated according to the instructions in this User’s Reference manual.

WARNING Explosion Hazard. Do not use this system with flammable

anesthetic agents.

Note Configurations available for this product depend on local market and

standards requirements. Illustrations in this manual may not represent all configurations of the product. This manual does not cover the operation of every accessory. Refer to the accessory documentation for further information.

1-2 M1145956

1 Introduction

AB.91.108

Figure 1-1 • Front view

M1145956 1-3

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Symbols used in the manual or on the equipment

Symbols replace words on the equipment, on the display, or in Datex-Ohmeda manuals.

Warnings and Cautions tell you about dangerous conditions that can occur if you do not follow all instructions in this manual.

Warnings tell about a condition that can cause injury to the operator or the patient.

Cautions tell about a condition that can cause damage to the equipment. Read and follow all warnings and cautions.

On (power) Off (power)

Standby

Type BF equipment Type B equipment

Airway module indicator ACGO active

Dangerous voltage Frame or chassis ground

Protective earth ground Earth ground

Direct current Alternating current

Caution/Warning Attention, refer to product instructions

Refer to product instructions Pinch hazard

O2+

O2 Flush button

Electrical input Electrical output

Electrical input/output Sample gas inlet to scavenging

1-4 M1145956

Pneumatic inlet Pneumatic outlet

1 Introduction

Serial number

Equipotential Lamp, lighting, illumination

Variability Variability in steps

Suction bottle outlet Vacuum inlet

Maximum Vacuum

Exhaust Bellows volumes are approximate

Plus, positive polarity

Bag position/manual ventilation Mechanical ventilation

Inspiratory flow Expiratory flow

REF

Stock number

Minus, negative polarity

134°C

Movement in one direction Movement in two directions

Lock Unlock

Isolation transformer Low pressure leak test

Autoclavable Not autoclavable

This way up

APL settings are approximate Anesthetic Gas Scavenging System

O2%

O2 cell connection

M1145956 1-5

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Caution: federal law prohibits dispensing without prescription.

O2% indicator on left and balance gas indictor on right. Colors associated with gas settings.

Alarm silence Submenu

No battery/battery failure Battery in use. Bar indicates amount of

Read to center of float EZchange canister (CO2 bypass)

Open drain (remove liquid) Close drain

Pipeline Cylinder

Alarm silence touch key (Tec 6 Plus)

Gas indicator. Color associated with gas settings.

battery power remaining.

Systems with this mark agree with the European Council Directive (93/42/ EEC) for Medical Devices when they are used as specified in their User’s Reference manuals. The xxxx is the certification number of the Notified Body used by Datex-Ohmeda’s Quality Systems.

Date of manufacture Manufacturer

Indicates that the waste of electrical and electronic equipment must not be disposed as unsorted municipal waste and must be collected separately. Please contact an authorized representative of the manufacturer for information concerning the decommissioning of equipment.

This product consists of devices that may contain mercury, which must be recycled or disposed of in accordance with local, state, or country laws. (Within this system, the backlight lamps in the monitor display contain mercury.

Authorized representative in the European Community

GOST R Russian certification

1-6 M1145956

Typeface conventions used

Names of hard keys on the display and modules are written in bold typeface; for example,

Menu items are written in bold italic typeface; for example, Vent Setup.

Messages that are displayed on the screen are enclosed in single quotes; for example, ‘Check sample gas out.’

When referring to different sections and other documents, the names are written in italic typeface and enclosed in double quotes; for example, “System Controls and Menus.”

Abbreviations

Abbreviation Definition

AA Anesthetic agent

ABS Advanced breathing system

ACGO Auxiliary Common Gas Outlet

AGSS Anesthesia Gas Scavenging System

Alt O2 Alternate O2

APL Adjustable pressure-limiting

APN Apnea

1 Introduction

Normal Screen.

CGO Common Gas Outlet

CO2 Carbon dioxide

Compl Compliance

ET End-tidal concentration

EtCO2 End-tidal carbon dioxide

EtO2 End-tidal oxygen

Exp Expiratory

FI Fraction of inspired gas

FiCO2 Fraction of inspired carbon dioxide

FI-ET Difference between inspiratory and expiratory

concentrations

FiO2 Fraction of inspired oxygen

F-V Flow-volume loop

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Abbreviation Definition

I:E Inspiratory-expiratory ratio

Insp Inspiratory

Insp Pause Inspriatory pause time

MAC Minimum Alveolar Concentration

MV Minute volume

MVexp Expired minute volume

MVinsp Inspired minute volume

N2O Nitrous oxide

O2 Oxygen

Pair Air supply pressure

Paux Auxiliary pressure

Paw Airway pressure

PCV Pressure controlled ventilation

PCV-VG Pressure controlled ventilation - volume guaranteed

PEEP Positive end expiratory pressure

PEEPe Extrinsic positive end expiratory pressure

Pexp Expiratory pressure

P-F Pressure-flow loop

Pinsp Inspiratory pressure

Plimit High pressure limit

Pmax Maximum pressure

Pmean Mean pressure

PO2 Oxygen supply pressure

Ppeak Peak pressure

Pplat Plateau pressure

Psupp Support pressure

PSV Pressure supported ventilation

PSVPro Pressure supported ventilation with apnea backup

P-V Pressure-volume loop

Rate Respiratory rate

Raw Airway resistance

RR Respiratory rate

1-8 M1145956

1 Introduction

Abbreviation Definition

SIMV/PSV Synchronized intermittent mandatory ventilation with

pressure supported ventilation

SIMV-PC Synchronized intermittent mandatory ventilation -

pressure controlled

TV Tidal volume

TVexp Expired tidal volume

TVinsp Inspired tidal volume

VCO2 Carbon dioxide production

VCV Volume controlled ventilation

Vol Volume

M1145956 1-9

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1-10 M1145956

2 System Controls and Menus

WARNING Do not use antistatic or electrically-conductive breathing

tubes or masks. They can cause burns if used near highfrequency surgical equipment.

w Explosion Hazard. Do not use this system with flammable

anesthetic agents.

In this section System overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

Advanced breathing system (ABS) components . . . . . . . . . 2-5

Vaporizer controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11

Display controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

Anesthesia system display . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

Using menus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17

M1145956 2-1

Avance

AB.91.111

3 4

System overview

1. Light switch 7. Integrated suction (optional)

2. Dovetail 8. Brake

3. Vaporizer 9. O2 flush button

4. Alternate O2 control 10. Advanced breathing system

5. System switch 11. Auxiliary O2 flow control (optional)

6. Mains indicator 12. Anesthesia display

Figure 2-1 • Front view

2-2 M1145956

2 System Controls and Menus

Item, Figure 2-1 Description

4 Alternate O2 control Alternate O2 control activates automatically in the case of certain failures or errors. It

can also be activated manually by pushing the Alternate O2 control button if the display fails. Turn the knob counterclockwise to increase the flow. Turn the knob clockwise to decrease the flow. See “Alternate O2 control” in the Operation section.

5 System switch Set the switch to the On (|) position to permit gas flow and to turn on the system.

6 Mains indicator The mains indicator will come on when AC power is connected. 7 Integrated suction

(optional)

Turn the switch to MAX for full vacuum. Turn the switch to Off (0) for no vacuum. Turn the switch to On (|) for adjustable vacuum. When in adjustable vacuum, turn the knob clockwise to increase the vacuum and counterclockwise to decrease the vacuum.

8 Brake Push down to lock. Lift to release.

9 O2 flush button Push the O2 flush button to supply high flows of O2 to the breathing system.

11 Auxiliary O2 flow

control (optional)

Turn the knob counterclockwise to increase the flow. Turn the knob clockwise to decrease the flow.

M1145956 2-3

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AB.91.029

1 2

1. Outlet circuit breaker 7. AGSS (Anesthesia Gas Scavenging System)

2. Isolated electrical outlet (optional) 8. Equipotential stud

3. Cable access door 9. Mains inlet

4. Vacuum connection 10. System circuit breaker

5. Collection bottle connection 11. Pipeline connections

6. Cylinder yoke

Figure 2-2 • Rear view

2-4 M1145956

2 System Controls and Menus

AB.91.110

Advanced breathing system (ABS) components

1. Expiratory check valve 9. Manual bag port

2. Inspiratory check valve 10. Adjustable pressure-limiting (APL) valve

3. Inspiratory flow sensor 11. Bag/Vent switch

4. Expiratory flow sensor 12. Bellows assembly

5. Absorber canister 13. Sample gas return port

6. Absorber canister release 14. AGSS indicator (only on some AGSS versions)

7. Leak test plug 15. Airway module (optional)

8. Breathing system release

Figure 2-3 • Advanced breathing system

M1145956 2-5

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Item, Figure 2-3 Description

3, 4 Inspiratory flow sensor

Expiratory flow sensor

6 Absorber canister release Push to remove the canister. This causes the breathing system to vent to

Flow sensors provide volume measurements for some monitoring functions and tidal volume delivery.

the room (unless the EZchange canister option is installed). Be sure to hold the canister by the handle before releasing the canister.

10 Adjustable pressure-limiting

(APL) valve

Adjusts breathing system pressure limit during manual ventilation. The scale shows approximate pressures. Above 30 cmH2O, the knob will click as it turns.

11 Bag/Vent switch Selects between manual ventilation (bag) or mechanical ventilation

(ventilator).

2-6 M1145956

Optional ABS

AB.91.109

AB.82.043

components

2 System Controls and Menus

1. Bag support arm

2. Auxiliary Common Gas Outlet (ACGO) switch

3. ACGO port

4. EZchange canister module (CO2 bypass)

5. EZchange canister release

6. Condenser drain button

7. Condenser

Figure 2-4 • Breathing system options

Item, Figure 2-4 Description

1 Bag support arm Squeeze the button to raise or lower the arm.

2 Auxiliary Common Gas

Outlet (ACGO) switch

5 EZchange canister

release

6 Condenser drain button Push to drain water out of the condenser.

Set switch to ACGO position for fresh gas to flow through the ACGO port. The ACGO may be used to provide fresh gas to an auxiliary manual breathing circuit.

Push to drop the canister to EZchange position. This seals the breathing circuit, permitting continued ventilation and rebreathing of exhaled gases. Be sure to hold the canister by the handle before releasing the canister.

M1145956 2-7

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Non-circle circuit Fresh gas flow is diverted around the inspiratory check valve and out

through the inspiratory port when non-circle ventilation is selected. This fresh gas source may be used with circuits without CO2 absorbent capability (for example, Mapleson variants). Mechanical ventilation is not available when using the non-circle circuit. Tidal volume monitoring is not available.

O2 monitoring of fresh gas is available automatically when using the non-circle circuit if the system has the airway module option or the O2 cell monitoring option.

Fresh gas oxygen concentration is displayed on the screen. Set the alarm limits appropriately. Note that fresh gas oxygen concentration may not reflect FiO2 when using these types of circuits. Use an external O2 monitor when using a rebreathing circuit with the noncircle circuit.

Systems with both an airway module and an O2 cell will display the circuit O2 value obtained from the airway module.

Do not use an external ventilator when using the non-circle circuit. Do not use the non-circle circuit to drive external ventilators or for jet ventilation.

WARNING The maximum pressure at the non-circle circuit can be up

to 27 kPa (4 psi). Use a breathing circuit with pressure relief.

2-8 M1145956

2 System Controls and Menus

ACGO (optional) Fresh gas flow is directed through the Auxiliary Common Gas Outlet

(ACGO) on the front of the machine when the ACGO switch is in the ACGO position. Mechanical ventilation is not available when operating an auxiliary manual breathing circuit with fresh gas from the ACGO. The Bag/Vent switch, APL valve, and bag arm are not part of the external circuit. Volume and pressure monitoring are not available.

O2 monitoring of fresh gas is available automatically when the ACGO is selected if the system has the airway module option or the O2 cell monitoring option. A sample of the fresh gas is diverted to the O2 cell in the breathing system. The sample flow to the O2 cell is dependent on the pressure in the external circuit. The sample flow reduces the fresh gas flow rate to the auxiliary breathing circuit equal to the amount diverted to the O2 cell.

Fresh gas oxygen concentration is displayed on the screen. Set the alarm limits appropriately. Note that fresh gas oxygen concentration may not reflect FiO2 during spontaneous breathing or in rebreathing circuits. Use an external O2 monitor if using a rebreathing circuit on ACGO.

Systems with both an airway module and an O2 cell will display the circuit O2 value obtained from the airway module.

Do not use an external ventilator on the ACGO. Do not use the ACGO to drive external ventilators or for jet ventilation.

WARNING The maximum pressure at the ACGO can be up to 55 kPa

Scavenging the

ACGO sample flow

(8 psi). Use a breathing circuit with pressure relief.

A sample of the fresh gas is diverted to the airway module or the O2 cell in the breathing system to show the O2 numerics on the screen. This sample flow should be scavenged when an auxiliary manual breathing circuit is used with N2O or volatile anesthetics. If scavenging is not connected, the sample flow is emptied into the room. To connect the scavenging:

1. Attach a circle breathing circuit to the inspiratory and expiratory ports.

2. Occlude the breathing circuit by connecting the Y-piece to the leak test plug located behind the expiratory port.

3. Check for clinically correct settings.

4. Check the position of the Bag/Vent switch.

• If the Bag/Vent switch is set to mechanical ventilation mode,

the bellows fills slowly with the sample flow. When the bellows is full, the sample flow goes to the AGSS. (Mechanical ventilation does not start when the ACGO switch is set to ACGO.)

• If the Bag/Vent switch is set to the bag mode, set the APL

valve to MIN, and attach a bag. The bag fills slowly with the sample flow. When the bag is full, the sample flow goes to the AGSS.

M1145956 2-9

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Scavenging from an

auxiliary manual breathing circuit

Scavenging a gas

monitor sample flow

Scavenge the exhaust if an auxiliary manual breathing circuit is used with N2O or volatile anesthetics.

An auxiliary inlet is available for active and passive AGSS units. It provides a female connection with 30 mm - 30 mm male connector (or a 30 mm -19 mm male connector) into the auxiliary port under the breathing system. Do not use these connectors as an outlet for exhaust flow.

The auxiliary inlet is a convenience inlet to the air brake of active AGSS units. There is a reservoir to capture exhaust flows higher than the extract flow.

A separate exhaust hose is needed from the auxiliary manual breathing circuit to the disposal point for all AGSS units.

Sample gas from a gas monitor can be scavenged using the sample gas return port or the AGSS.

• To scavenge from a gas monitor using the sample gas return port, connect the tubing from the monitor to the sample gas return port.

• To scavenge from a gas monitor using the AGSS, connect tubing from the monitor to the male luer inlet on the bottom of the AGSS underneath the breathing system.

2-10 M1145956

Vaporizer controls

AB.80.009

AA.43.051

2 System Controls and Menus

Refer to the vaporizer User’s Reference manual for more detailed information on the vaporizer.

1. Tec 6 Plus

2. Tec 7

3. Lock lever

4. Concentration control and release

5. Indicators (Tec 6 Plus)

6. Silence alarm touch key (Tec 6 Plus)

Figure 2-5 • Vaporizer controls

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Åben

Item, Figure 2-5 Description

3 Lock lever Turn the lever fully clockwise to lock the vaporizer in position.

4 Concentration control and

release

Push the release and turn the concentration control to set the agent concentration. The Tec 6 Plus concentration control does not turn as long as the warm-up indicator is on.

5 Indicators (Tec 6 Plus) All indictors come on briefly at the start. The warm-up indicator goes off

after approximately 10 minutes and the operational indicator comes on. Other indicators come on to advise the user of required action.

6 Silence alarm touch key

(Tec 6 Plus)

Push to silence alarms. Hold for 4 seconds to sound the speaker and light all indicators (alarm test).

2-12 M1145956

Display controls

AB.91.107

2 System Controls and Menus

1. Silence Alarms key Push to silence any active, silenceable high and medium priority alarms or to suspend/acknowledge any non-active medium or high priority alarms. Alarm is silenced for 120 seconds or alarm is suspended for 90 seconds.

2. Menu keys Push to show corresponding menu.

3. ComWheel Push to select a menu item or confirm a setting. Turn clockwise or counterclockwise

4. Normal Screen key Push to remove all menus from the screen.

5. Quick keys Push to change corresponding gas setting or ventilator setting. Turn the ComWheel

6. Timer keys Push to start or stop the timer. Push to reset the timer back to zero.

7. MV/TV Alarms key Push to turn off the MV and TV alarms. Push again to turn the MV and TV alarms on.

8. Alarm LEDs Turn on solid or flash to indicate alarm priority.

to scroll menu items or change settings.

to make a change. Push the ComWheel to activate the change.

Figure 2-6 • Display controls

M1145956 2-13

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Measured

l/min

Air

Plug in power cable. On battery.

Paw

Agent

CO2

Fresh Gas: O2+Air PCV-VG: Ventilator On Exp Flow

Total Flow

l/min

/min

I:E PEEP

cmH2O

MV l/min

TVexp ml

Pmean

Ppeak

cmH2O

PEEP

RR /min

Et %

Fi %

MAC 40

FiO2 %EtO2 %

45 6

9101112

AB.91.125

Timer:

EtCO2 %s

FiCO2 %s

Off

Anesthesia system display

1. Split screen area showing electronic gas flow indicators

2. Alarm silence symbol and countdown

3. Alarm message fields

4. Waveform fields

5. General message field or timer field

6. Clock

7. Battery indicator field

8. Measured values field

9. Pipeline and cylinder supply or respiratory data or digit field

10. Ventilator settings

11. Ventilation mode

12. Gas settings

Figure 2-7 • Normal view

2-14 M1145956

2 System Controls and Menus

Fresh Gas: O2+Air PCV-VG: Ventilator On Exp Flow

Total Flow

l/min

/min

I:E PEEP

cmH2O

MV l/min

TVexp ml

Pmean

Ppeak

cmH2O

PEEP

RR /min

Et %

Fi %

MAC 40

FiO2 %EtO2 %

AB.91.124

EtCO2 %s

FiCO2 %s

Off

Main Menu

Trends

System Status

Cardiac Bypass

Off

Fresh Gas Usage

Screen Setup

Parameters Setup

Calibration

Normal Screen

Show trends.

When a menu key is selected, the menu field overlays the gas flow indicators and the waveform fields start at the right edge of the menu.

1. Menu

2. Waveform fields

Figure 2-8 • Menu view

M1145956 2-15

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Waveform fields Up to three waveforms can be shown on the normal screen view.

Each waveform can be set to show specific information such as Paw, agent, flow, or CO2 data. The corresponding numeric information shows in the measured values field to the right of the waveform. If the waveform is set to show the agent and no airway module is inserted, that waveform and numeric areas are blank.

When one waveform is turned off, that waveform and the corresponding numerics information are removed from the normal screen view. The remaining waveforms and numerics increase in size to fill the waveform area. When two waveforms are turned off, those waveforms and the corresponding numerics information are removed from the normal screen view. The remaining waveform increases in size and is centered in the waveform area.

See “Screen configuration” in the “Operation” section for more information.

Digit field The digit field can be set to show specific information such as gas

supply, flow, or agent. If the digit field is set to show agent and no airway module is inserted, the area is blank.

Paw, O2, and either TVexp or CO2 must show on the display during a case. If any of these parameters is not selected to show on the display, the digit field information is replaced with the missing parameter.

See “Screen configuration” in the “Operation” section for more information.

2-16 M1145956

Using menus

AB.91.126

Main Menu

Trends

System Status

Cardiac Bypass

Fresh Gas Usage

Screen Setup

Parameters Setup

Calibration

Off

On suspends the volume, apnea, low agent, and low CO2 alarms.

Normal Screen

2 System Controls and Menus

Push a menu key to display the corresponding menu. Use the ComWheel to navigate the menu.

1. Menu title

2. Current selection

3. Adjustment window

4. Submenu

5. Instructions or help information

6. Menu items

Figure 2-9 • Menu example

1. Push the menu key to display the corresponding menu.

2. Turn the ComWheel counterclockwise to highlight the next menu item. Turn the ComWheel clockwise to highlight the previous menu item.

3. Push the ComWheel to enter the adjustment window or a submenu.

4. Turn the ComWheel clockwise or counterclockwise to highlight the desired selection.

5. Push the ComWheel to confirm the selection.

6. Select Normal Screen or push the

Normal Screen key to exit

the menu and return to the normal monitoring display. (Select Previous Menu to return to the last displayed menu, if available.)

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2-18 M1145956

3 Operation

WARNING Ventilator alarms indicate potential hazard conditions. All

alarms that occur should be investigated to help ensure adequate patient safety.

w Maintain sufficient fresh gas flow when using sevoflurane.

w Desiccated (dehydrated) absorbent material may produce

dangerous chemical reactions when exposed to inhalation anesthetics. Adequate precautions should be taken to ensure that absorbent does not dry out. Turn off all gases when finished using the system.

In this section Turning on the system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2

Start case (start gas flow) . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-3

End case. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

Ventilator setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

Gas setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

Spirometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11

Spirometry setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14

Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16

Screen configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-20

Alarm setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23

Alternate O2 control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-26

EZchange canister (optional) . . . . . . . . . . . . . . . . . . . . . . . 3-27

Condenser (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28

Passive AGSS (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . 3-29

Active AGSS (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-30

M1145956 3-1

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AB.91.044

Turning on the system

1. Plug the power cord into an electrical outlet. Make sure the system circuit breaker is on.

• The mains indicator is lit when AC power is connected.

• Battery is charging if it is not already fully charged.

1. System switch

2. Mains indicator

Figure 3-1 • Mains indicator and system switch

2. Check that the breathing system is properly connected.

CAUTION Do not turn on the system with the right-hand (inspiratory)

port plugged.

3. Turn the System switch to On.

• The display shows the power-up screen.

• The system does a series of automated self tests.

4. Perform a Machine Check before the first case of the day.

5. Perform a preoperative checkout before each case. See the “Preoperative Checkout” section.

Note The system must perform a power-up self test after 12 hours of

remaining on. If the system has been on longer than 12 hours without a power-up self test, the ‘Turn power Off and On for self tests’ alarm occurs. Turn the power off and then back on between cases to resolve the alarm.

3-2 M1145956

Start case (start gas flow)

Access the Start Case menu by pushing the Start/End Case key or by selecting Start Case from the Checkout menu. Use the Start Case menu to set the case data and to start the gas flow.

Default Settings

Set Vent By Weight

Start Case Now

The Default Settings has five selections. The first four selections are case types. The fifth selection is Last Case. The case type in the first slot shows as the default when the Start Case menu is opened.

Case types are configured in the Install/Service - Case Defaults menu. The Install/Service menu is only accessible by a Super User or a service person. See the “Super User Mode” section for more information on the Start Case menu defaults.

3 Operation

Start Case

Patient Weight

Patient Age

Other Gas

CO2 Alarms

Volume Apnea

The values of Patient Weight, Patient Age, Other Gas, and Volume

Apnea are configured to the default case type by the Super User. CO2 Alarms setting is set to ‘On’ when the Start Case menu is

opened.

Note Volume Apnea is not shown on the Start Case menu when the

Volume Apnea Selection is set to Disable in the Install/Service

menu.

The Set Vent By Weight menu item is accessible when the ventilation mode is set to VCV or PCV-VG. Use this setting for breath rate and tidal volume calculations based on the set patient weight. The Default Settings selection shows ‘Weight’ when Set Vent By Weight is selected.

M1145956 3-3

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Using default

settings

Using customized

settings

1. Set the Bag/Vent switch to Bag.

2. Push the

• The case defaults are shown on the menu.

•The Default Settings selection shows the preset case type.

3. Verify or change the settings on the Start Case menu.

4. Select Start Case Now. Gas flow starts.

The case type, ventilator settings, ventilation mode, alarm settings, and gas settings can be changed before starting a case. Use the Vent Setup menu, Alarm Setup menu, or Gas Setup menu to change settings not shown on the Start Case menu before starting a case. Return to the Start Case menu from these menus to make additional adjustments or to start a case.

1. Set the Bag/Vent switch to Bag.

2. Push the

3. Verify or change the settings on the Start Case menu.

• Select a case type or Last Case from the Default Settings.

• Make adjustments to the other settings as appropriate for the

•The Default Settings selection changes to show ‘Preset’ if

4. To change the alarm settings:

• Push the

•Select Adjust Settings.

• Change the settings.

•Select Back.

• Make any other changes to the alarm setup.

•Select Previous Menu to return to the Start Case menu to

5. To change ventilator settings:

• Push the

•Select Adjust Settings.

• Change the settings.

•Select Exit to return to the Start Case menu.

6. To change the ventilation mode:

• Push the

• Select the desired mode.

•Select Confirm or adjust the settings and select Confirm to

Start/End Case key.

case.

any changes to the settings are made.

Alarm Setup key.

make additional adjustments.

Vent Setup key.

return to the Start Case menu.

3-4 M1145956

3 Operation

7. To change the gas settings:

• Push the

•Select Adjust Settings.

• Change the settings.

•Select Exit to return to the Start Case menu.

8. To change the balance gas:

• Push the

• Select the balance gas to use with O2.

•Select Exit or adjust the settings and select Exit to return to

the Start Case menu.

9. To change the circuit type:

• Push the

• Select the circuit type.

•Select Confirm or adjust the settings and select Confirm to

return to the Start Case menu.

10. From the Start Case menu, select Start Case Now. Gas flow starts.

Gas Setup key.

Minimum Alveolar

Concentration (MAC)

The adjusted Minimum Alveolar Concentration (MAC) is calculated based on the patient age entered in the Start Case menu. The default patient age of selected case type is used if no patient age is entered.

The MAC value is calculated from the exhaled gas concentration and the related affects based on the age of the patient. Typically, younger patients have better liver function and can clear a drug faster, resulting in a higher MAC value. The MAC calculation used is based on the Eger formula. When two agents are detected, the MAC values of each agent are added together. The MAC value range is 0.0 to 9.9.

The adjusted MAC value shows on several areas of the screen including in the mini-trend, agent waveform numeric information, gases digit field, and graphical trends page. MAC data shows as dashes if there is not an airway module installed in the module bay.

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End case

Use the End Case menu to stop gas flow and end the patient alarms.

End Case

End Case Now Normal Screen

1. Set the Bag/Vent switch to Bag.

2. Push the

Start/End Case key.

3. Select End Case Now to put the system in standby (stops gas flow and patient alarms).

3-6 M1145956

Ventilator setup

3 Operation

Access the Vent Setup menu by pushing the Vent Setup key. The system has up to six modes of mechanical ventilation:

• Volume Control Ventilation (VCV).

• Pressure Control Ventilation (PCV) (optional).

• Synchronized Intermittent Mandatory Ventilation/Pressure Support (SIMV/PSV) (optional).

• Pressure Support Ventilation (PSVPro) (optional).

• Synchronized Intermittent Mandatory Ventilation-Pressure Control (SIMV-PC) (optional).

• Pressure Control Ventilation-Volume Guarantee (PCV-VG) (optional).

Ven t Setup

Adjust Settings Mode: VCV PCV

Spirometry Normal Screen

WARNING Most anesthetic agents will cause patients to have

reduced ventilatory responses to carbon dioxide and to hypoxemia. Therefore, triggered modes of ventilation may not produce adequate ventilation.

w The use of neuromuscular blocking agents will reduce the

patient’s breathing response, which will interfere with triggering.

Important Refer to the “Specifications and Theory of Operation” section for

more information on ventilation modes.

Using quick keys The four main ventilator settings for each mode can easily be

changed using the ventilator quick keys.

1. Push a ventilator quick key to select the corresponding ventilator setting.

2. Turn the ComWheel to make a change.

3. Push the ComWheel to activate (confirm) the change.

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Using Vent Setup

Changing ventilator modes and settings

1. Push the Vent Setup key.

• Adjust Settings is selected by default.

• An arrow to the right of the mode indicates the current mode.

2. Push the ComWheel to enter the adjustment window for the selected mode.

3. Use the ComWheel to navigate the adjustment window and to change a value.

4. Push the ComWheel to activate the change.

5. Push the

1. Push the Vent Setup key.

2. Select the mode and push the ComWheel to enter the adjustment window.

3. Use the ComWheel to navigate the adjustment window and to change a value.

4. Select Confirm to activate the mode.

Normal Screen key or select Exit.

3-8 M1145956

Gas setup

3 Operation

Access the Gas Setup menu by pushing the Gas Setup key. Use the Gas Setup menu to adjust the O2% and total flow, to change the balance gas, and to change the circuit type.

Gas Setup

Adjust Settings Gas: N2O Air Circuit: Circle Non-Circle Normal Screen

Using quick keys The O2% and total flow can easily be changed using the gas quick

keys.

1. Push a gas quick key to select the corresponding gas setting.

2. Turn the ComWheel to make a change.

3. Push the ComWheel to activate (confirm) the change.

Using Gas Setup

Changing gas and

settings

1. Push the Gas Setup key.

• An arrow to the right of the balance gas indicates the gas

currently being used with O2.

• Adjust Settings is selected by default.

2. Push the ComWheel to enter the adjustment window.

3. Use the ComWheel to navigate the adjustment window and change a value.

4. Push the ComWheel to activate the change.

5. Push the

1. Push the Gas Setup key.

2. Select the balance gas to use with O2 and push the ComWheel to enter the adjustment window.

Normal Screen key or select Exit.

3. Use the ComWheel to navigate the adjustment window and change a value.

4. Push the ComWheel to activate the change.

5. Push the

M1145956 3-9

Normal Screen key or select Exit.

Avance

Changing circuit type 1. Push the Gas Setup key.

• Adjust Settings is selected by default.

• An arrow to the right of the circuit type indicates the circuit

currently in use.

2. Use the ComWheel to select Circle or Non-Circle and enter the adjustment window.

3. Confirm or change and confirm the settings.

4. Push the

Normal Screen key or select Exit.

3-10 M1145956

Spirometry

3 Operation

There are three types of spirometry loops: Pressure-Volume (P-V), Flow-Volume (F-V) and Pressure-Flow (P-F). View, save, and erase spirometry loops and set the loop scaling in the Spirometry menu. Access the Spirometry menu by pushing the selecting Spirometry.

Use the Spirometry menu to:

• View a specific loop type; select Loop Type and set the loop type.

• Adjust the loop scaling; select Scaling and set the scale type.

• Access the Spirometry Setup menu; select Spiro Setup.

• Store a loop to memory; select Save Loop. Up to six loops can be saved.

• View a saved loop; select Reference Loop and the time at which the loop was saved.

• Erase a saved loop; select Erase Loop and the time at which the loop was saved.

Vent Setup key and

Spirometry

Loop Type P-V Scaling Spiro Setup Save Loop Reference Loop None Erase Loop None Previous Menu

M1145956 3-11

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AB.98.039

Setting loop type The spirometry loops show in the spirometry window and can be set

to show alongside the waveforms as the split screen.

1. Volume axis

2. Pressure axis

3. Real-time loop

4. Reference loop (appears on display in white)

Figure 3-2 • Example of a P-V loop

To set the loop type:

1. Push the

2. Select Spirometry - Loop Type and set the loop type.

•Set to P-F for Paw-Flow.

•Set to F-V for Flow-Volume.

•Set to P-V for Paw-Volume.

Note The loop type can also be set in the Spirometry Setup menu. Push

the

Main Menu key, and select Parameters Setup - Spirometry

Setup - Loop Type.

Vent Setup key.

3-12 M1145956

3 Operation

Scaling The scales shown in the spirometry loop graph are set in the Scaling

menu. The available settings for the volume, Paw, and flow graph axes are dependent on the set patient type of adult or pediatric.

The AUTO selection automatically adjusts the volume, Paw, and flow axes of the loop graph based on the minimum and maximum breath reading shown in the waveform.

The Linked selection links the adjustment of the volume, Paw, and flow axes of the loop graph together. Change one of the scales and the remaining two scales automatically change based on the one set scale.

The Indep selection allows the axes of the loop graph to be changed separately for the volume, Paw, and flow axes.

Scaling

Scaling AUTO

Vol Scale

Paw Scale

Flow Scale

Previous Menu

1. Push the

2. Select Spirometry - Scaling.

3. Set the scale type to AUTO, Linked, or Indep.

•If AUTO is selected, the scales are automatically set.

•If Linked is selected, set one of the scales volume, Paw, or

•If Indep is selected, set the volume scale, set the Paw scale,

Vent Setup key.

flow. The other two scales adjust based on the set scale.

and set the flow scale.

M1145956 3-13

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Spirometry setup

Push the Vent Setup key and select Spirometry - Spiro Setup to access the Spirometry Setup menu. Use the Spirometry Setup menu to:

• Set the patient and sensor type.

• Select a data source.

• Set the loop type.

• Change the volume shown on the spirometry split screen to MVexp or TVexp.

• Set split-screen view.

• Access the Paw and MVexp alarm limits.

Note The Spirometry Setup menu is also accessible through

Setting patient and

sensor type

Main Menu

- Parameters Setup - Spirometry Setup.

Spirometry Setup

Patient and Sensor Type Adult

Data Source Vent

Loop Type P-V

TV or MV TV

Split Screen None

Paw Alarm

MVexp Alarm

Previous Menu

Patient and sensor type refer to the style of airway adapter used with the airway module. If spirometry data is obtained from the airway module, ensure that the sensor type matches the airway adapter used.

If the sensor type is not set correctly, the information displayed may not be accurate.

1. Push the

2. Select Spirometry.

Vent Setup key.

3. Select Spiro Setup - Patient and Sensor Type.

4. Select Adult or Pedi depending on the sensor used.

• Adult refers to the D-lite sensor.

• Pedi refers to the Pedi-lite sensor.

3-14 M1145956

3 Operation

Selecting a data

source

Several monitoring parameters can be obtained from the ventilator or the airway module.

When setting the airway module as the data source, make sure that a D-lite or Pedi-lite sensor is properly connected on the airway module. If the sensor is not properly connected, but the airway module is installed, the waveform shows no flow. The gas monitor samples and displays room air.

If information is not available through the airway module, information comes from the internal ventilator sensors. If the internal ventilator sensor readings disagree with the airway module sensor readings, the associated alarm occurs.

Information that is retrieved from the airway module is identified with the module data indicator. See the “Airway Modules” section for more information.

Figure 3-3 • Airway module data indicator

Setting spirometry

split screen

1. Push the

2. Select Spirometry.

3. Select Spiro Setup - Data Source.

4. Select Patient or Vent as the primary source for information.

•If Patient is selected, the airway module will be the first

•If Vent is selected, the internal sensors of the ventilator will

5. Push the

Spirometry loops can be viewed alongside the waveforms on the normal screen. To set up the spirometry split screen:

1. Push the

2. Select Spirometry.

3. Select Spiro Setup.

4. Select Split Screen - Spiro.

5. Push the

Vent Setup key.

source for information.

be the first source for information.

Normal Screen key or select Previous Menu.

Vent Setup key.

Normal Screen key.

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Main Menu

Menus and settings available through the Main Menu include Trends, System Status, Cardiac Bypass, Fresh Gas Usage, Screen Setup, Parameters Setup, and Calibration.

System Status shows the status of gas supplies, electrical supplies,

and software settings.

See “Screen configuration” for information on the Screen Setup menu item.

See “Parameters setup” in the “Airway Modules” section for more information on the Parameters Setup menu item.

See the “User Maintenance” section for more information on calibrations.

Main Menu

Trends

System Status

Cardiac Bypass Off

Fresh Gas Usage

Screen Setup

Parameters Setup

Calibration

Normal Screen

3-16 M1145956

3 Operation

Trends There are three views for patient trends: measured (numerical),

settings, and graphical. Trend information is saved every 1 minute for the most recent 24 hours.

Tre nds

Cursor Next Page View Measured Settings Graphical Time Scale Previous Menu

1. Push the

Main Menu key.

2. Select Trends.

3. Select the desired view.

• An arrow indicates the current trend view.

4. Select Cursor to scroll through the current trend view.

5. Push the ComWheel to return the highlight to Cursor.

6. Select Next Page to view additional parameters.

7. Push the

Normal Screen key or select Previous Menu.

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Cardiac bypass There are two types of cardiac bypass. Manual ventilation cardiac

bypass is standard. VCV cardiac bypass is optional.

Manual ventilation

cardiac bypass

WARNING Manual ventilation cardiac bypass and VCV cardiac

VCV cardiac bypass

(optional)

Manual ventilation cardiac bypass suspends alarms for patients on cardiac bypass when the ventilator is not mechanically ventilating. The volume, apnea, low agent, CO2, and respiratory rate alarms are suspended. The alarms are enabled when cardiac bypass is turned off or mechanical ventilation is started.

bypass modes should only be used when the patient is receiving extra-corporeal oxygenation by means of a heart-lung machine. These modes of ventilation are not intended to provide metabolic levels of ventilation to the patient.

1. Set the Bag/Vent switch to Bag.

2. Push the

3. Set Cardiac Bypass to On.

• The general message ‘Cardiac Bypass’ shows in the

Systems with VCV cardiac bypass enabled can mechanically ventilate while in VCV mode. The VCV mode is the only ventilation mode available while using VCV cardiac bypass. The volume, apnea, low agent, CO2, low Paw, and respiratory rate alarms are suspended. The alarms are enabled when VCV cardiac bypass is turned off or mechanical ventilation is stopped.

Main Menu key.

waveforms and in the general message field when manual ventilation cardiac bypass is active.

WARNING Manual ventilation cardiac bypass and VCV cardiac

1. Start mechanical ventilation in VCV mode.

2. Push the

3. Set Cardiac Bypass to On.

• The PEEP is set to 5 cmH2O.

• TV settings of less than 170 ml prior to starting cardiac

• TV settings of more than 170 ml prior to starting cardiac

• PEEP and TV settings can be changed after entering cardiac

4. The general message ‘VCV Cardiac Bypass’ shows in the waveforms and in the general message field when VCV cardiac bypass is active.

Main Menu key.

bypass remain at the set TV.

bypass change to 170 ml.

bypass mode.

3-18 M1145956

3 Operation

Fresh gas usage Use the Fresh Gas Usage selection to view the volume of O2, Air,

N2O, and agents used for the three most recent cases. Data only shows for gases available on the system. Agent data shows the three most recently used agents.

1. Push the

2. Select Fresh Gas Usage.

3. Select the patient case to view.

4. Push the

Main Menu key.

Normal Screen key or select Previous Menu.

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Screen configuration

Select page Use the Select Page menu to quickly change or return the normal

Each case type selected on the Start Case menu has a corresponding screen configuration for the normal screen. Four additional normal screen views are available through the Select Page menu. The case type screen configurations and the normal screen views are set by the Super User in the Install/Service menu.

Areas of the normal screen can be customized to show specific information. Use the Screen Setup menu to customize the normal screen view.

screen view to a case type view.

Select Page

Page:

Default Screen

PAW TUBES

LOOPS

BIG WAVE

LOCAL

Normal Screen

1. From the normal screen with no menus showing, push the ComWheel.

• An arrow to the right of the menu item indicates the page

view that is in use.

• A corresponding message shows in the general message

area.

• If no arrow shows on the Select Page menu, a customized

normal screen view is in use.

2. Select a view or select Normal Screen to leave the selections unchanged.

3-20 M1145956

3 Operation

Screen setup Waveform, digit field, fresh gas control style, split screen, sweep

speed, and brightness are adjusted in the Screen Setup menu. Changes made to all settings (except Brightness) during a case are not saved when the case is ended. The set Brightness remains until it is changed again or until the system power is turned off.

Screen Setup

Waveform Field 1 Paw Waveform Field 2 Flow Waveform Field 3 CO2

Digit Field AA

Fresh Gas Controls O2%

Split Screen None

Sweep Speed Fast

Brightness 4

Install/Service

Previous Menu

Waveform fields The waveforms can be set to show agent, CO2, flow, Paw, or can be

set to off. Waveforms cannot be set to the same value (except for off). If waveform is set to the same value as another waveform, the previously set waveform changes to off and is removed from the normal screen

1. Push the

2. Select Screen Setup.

Main Menu key.

3. Select the waveform field and make the change.

4. Push the

Normal Screen key or select Previous Menu.

Digit field The digit field can be set to show gas supply, flow, or agent.

1. Push the

2. Select Screen Setup - Digit Field.

3. Select the Supply, Flow, or AA.

•If AA is selected, an airway module must be inserted or the

4. Push the

Main Menu key.

digit field will be blank.

Normal Screen key or select Previous Menu.

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Setting gas controls and

screen configuration

Split screen Gas and agent delivery, trends, spirometry loops, or a Paw gauge

There are two ways to configure gas controls: O2% with total flow or individual gas flow. The Super User can set the gas control for the facility. Or the Super User can set the gas control to allow the user to select the setting.

Selecting O2% shows O2% as the first quick key and total flow l/min as the second quick key. This gas control configuration adjusts the balance automatically when either the O2% or the total flow is changed.

Selecting Flow shows balance gas l/min as the one quick key and O2 l/min as the other quick key. This gas control/screen configuration allows individual control of the gasses.

1. Push the

2. Select Screen Setup - Fresh Gas Controls.

3. Select the desired view.

4. Push the

can be shown as a split screen alongside the waveforms on the normal screen. To change the normal screen to show a split screen:

1. Push the

2. Select Screen Setup - Split Screen.

3. Select the desired view.

4. Push the

Main Menu key.

Normal Screen key or select Previous Menu.

Main Menu key.

Normal Screen key or select Previous Menu.

Sweep speed The waveform draw rate can be set to fast (6.25 mm/s) or slow

(0.625 mm/s). When the sweep speed is changed, the waveforms are redrawn at the new rate.

1. Push the

2. Select Screen Setup - Sweep Speed.

3. Set the speed.

4. Push the

Main Menu key.

Normal Screen key or select Previous Menu.

3-22 M1145956

Alarm setup

3 Operation

Alarm limits, alarm volume, and other alarm settings are adjusted in the Alarm Setup menu. Alarm history is also accessed through this menu. Selecting Default Limits loads the default settings as set by the Super User or the factory defaults if no Super User settings have been entered.

Setting Leak Audio to Off silences audio alarms for small leaks. Leak Audio is automatically set to On and cannot be changed when either the Low MV alarm limits are off or the MV/TV Alarms is set to Off.

The apnea time delay is the amount of time that can pass without the system detecting a measured breath before the apnea alarm occurs. The apnea time delay range is 10 to 30 seconds. Set the Apnea Time in 1 second increments.

Alarm Setup

Adjust Settings Volume Apnea Off MV/TV Alarms On Leak Audio On CO2 Alarms On Auto MV Limit Off Default Limits Alarm Volume 3 Apnea Time 30 Alarm History Previous Menu

Setting alarm limits 1. Push the Alarms Setup key.

2. Select Adjust Settings.

3. Scroll to the desired alarm.

4. Select alarm limit and set the limit.

5. Push the

Normal Screen key or select Back.

M1145956 3-23

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Volume apnea Volume Apnea is not shown on the Alarm Setup menu when the

Volume Apnea Selection is set to Disable in the Install/Service menu.

Set Volume Apnea to Off to disable the volume apnea alarm during manual ventilation. ‘Volume Apnea Off’ shows in the general message field. The volume apnea alarm remains disabled until the Bag/Vent switch is set to ventilator or Volume Apnea is set to On.

1. Push the

2. Select Volume Apnea and set to On or Off.

Alarm Setup key.

3. Push the

Note When Volume Apnea is set to Off during manual ventilation and then

mechanical ventilation is started, the volume apnea alarms are active. Volume Apnea - Off requires confirmation through a pop-up window when manual ventilation is resumed.

Normal Screen key or select Previous Menu.

MV/TV alarms The MV and TV alarms can be turned off. When the volume alarms

are disabled, ‘MV/TV Alarms Off’ appears in the general message field. The volume alarm limits waveform numerics show as dashes during a case.

If the MV and TV alarms are set to Off during manual ventilation, the alarms remain off until the Bag/Vent switch is set to ventilator or the

MV/TV Alarms

The MV and TV alarms retain the last value set during mechanical ventilation. If MV/TV Alarms is set to On during mechanical ventilation, it remains on when manual ventilation starts. If MV/TV Alarms is set to Off during mechanical ventilation it remains off when manual ventilation starts.

1. Push the

2. Select MV/TV Alarms and set to On or Off.

3. Push the

is set to On.

Alarm Setup key.

Normal Screen key or select Previous Menu.

CO2 alarms CO2 information is obtained from the airway module installed in the

anesthesia system module bay. The CO2 alarms setting has no affect if there is no airway module in the anesthesia system.

Set CO2 Alarms to Off during manual ventilation to disable the CO2 ‘Apnea’ alarm, ‘EtCO2 low,’ ‘EtCO2 high,’ and ‘FiCO2 high. Absorbent OK?’ alarms. The ‘CO2 Alarms Off’ message shows in the general message field. The CO2 and O2 alarm limits waveform numerics show as dashes during a case.

If CO2 Alarms is set to Off, the alarms remain disabled until the Bag/ Vent switch is set to ventilator, the case is ended, or the CO2 Alarms is set to On.

1. Push the

2. Select CO2 Alarms and set to On or Off.

3. Push the

3-24 M1145956

Alarm Setup key.

Normal Screen key or select Previous Menu.

3 Operation

Auto MV limit MV alarm limits can be calculated automatically for mechanical

ventilation when in VCV or PCV-VG modes and volume compensation is enabled. Set Auto MV Limit to On for automatic calculations of the MV alarm limits. The MV alarm limits continue to be automatically calculated until Auto MV Limit is set to Off or until an MV alarm limit is manually adjusted during mechanical ventilation.

If the automatic calculation of the low or high minute volume alarm limit exceeds the allowable limit, the minimum or maximum alarm limit is used.

1. Push the

2. Select Auto MV Limit and set to On.

Alarm Setup key.

3. Push the

Normal Screen key or select Previous Menu.

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AB.91.077

Alternate O2 control

WARNING The Alternate O2 control is not an auxiliary source of O2.

WARNING When Alternate O2 control is enabled, flow from the

Alternate O2 control delivers agent and O2 through an independent pneumatic path to the selected patient circuit and is connected to the system O2 supply. Alternate O2 control activates automatically in the case of certain failures or errors. It can also be activated manually. O2 flow is 0.5 l/min to 10 l/min as indicated on the flow tube.

electronic mixer is stopped. O2 is flowing through the Alternate O2 control to the breathing system. To activate anesthetic agent flow to the breathing system, set the agent to the desired concentration.

The Alternate O2 control is available approximately 20 seconds after the system is turned on. The minimum flow can be preset to 0.5 to 10 l/min.

1. Push the Alternate O2 ON/OFF button.

2. The O2 flow is indicated on the flow tube.

3. Use the flow control to adjust the O2 flow.

4. Set the agent to the desired concentration.

5. To end Alternate O2 control, push the Alternate O2 ON/OFF button.

1. ON/OFF button

2. Flow tube

3. Flow control

Figure 3-4 • Alternate O2 control

3-26 M1145956

EZchange canister (optional)

AB.82.042

AB.74p.043

Push the absorber canister release to activate the EZchange canister mode. The canister will swing down to the EZchange position. The EZchange canister mode seals the breathing circuit when the canister holder is down. This permits continued ventilation and rebreathing of exhaled gases while easily replacing the absorber canister.

Systems with EZchange canister have the following label on the canister holder. When the system is in EZchange position, the message ‘CO2 Absorber Out of Circuit’ shows in the waveform area on the anesthesia display.

3 Operation

To return to absorber mode, reinsert the canister into the holder and push the canister back up and snap it into absorber position. When the canister is in the absorber position, the exhaled gas flows through the absorber, removing CO2.

Note Check the absorber canister to ensure it has side rails. If the canister

does not have side rails, it will not work in the EZchange canister holder.

1. Side rails

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AB.75p080

Condenser (optional)

The condenser removes water in the system that is produced from the reaction of CO2 gas with the absorbent. When fresh gas flow settings of less than the patient minute volume are used during ventilation, the amount of re-breathed gas increases. More CO2 flows through the breathing system increasing the absorbent consumption. The moisture buildup in the breathing system is also increased.

The condenser is connected between the outlet of the absorber canister and the inlet of the circuit module. Moisture in the gas is condensed into water droplets, which run into the condenser’s reservoir.

Visually check the condenser reservoir daily. Drain the reservoir daily.

1. Place a container under the reservoir.

2. Push the drain button to empty any water in the condenser.

1. Drain button

2. Reservoir

3. Condenser

Figure 3-5 • Condenser

3-28 M1145956

Passive AGSS (optional)

WARNING Always verify the proper operation of any gas scavenging

system; ensure the scavenging system is not occluded.

The passive AGSS (Anesthesia Gas Scavenging System) contains both positive and negative pressure relief valves to protect the breathing system and the patient. The outlet is a 30-mm tapered connector on the bottom of the receiver.

There is also a connector that may be used for scavenging the sample from a gas monitor. The male luer inlet connection is located near the 30 mm connector.

Passive AGSS is intended primarily for use in operating room environments which have no active gas extraction system for waste gas disposal. The disposal system generally consists of large diameter tubing directly linking the passive AGSS with the building exterior. The tubing should be as large in diameter and as short as possible for the particular application.

Passive AGSS may also be used with a non-recirculating ventilation system for waste gas disposal. The tubing connection from passive AGSS to the non-recirculating ventilation system should be an open connection, essentially at atmospheric pressure. For example, to an exhaust grill.

3 Operation

M1145956 3-29

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Active AGSS (optional)

WARNING Always verify the proper operation of any gas scavenging

system; ensure the scavenging system is not occluded.

There are several versions of the optional active AGSS (Anesthesia Gas Scavenging System) available depending on the hospital’s type of waste gas disposal system.

Each version has a two-liter reservoir to capture peak exhaust flows that briefly exceed the extract flow. The disposal system normally entrains room air through an air brake (located in a receiver underneath the breathing system), but will spill from this port during extended periods of high exhaust flow. Its effectiveness is limited by the extract flow of the particular active AGSS device.

• The active low flow system is for use with high vacuum disposal

• The active high flow system is for use with low vacuum (blower

• Another version is the active adjustable flow. It provides the

• The active low flow system with a 12.7 mm hose barb connector

• The active low flow system with a 25 mm barb connector is for

• The active low flow system with 30 mm ISO taper is for use with

systems. It requires a vacuum system capable of a continuous nominal flow of 36 l/min and 300 mmHg (12 inHg) or greater vacuum pressure. A flow indicator on the system indicates when the unit is in operation.

type) disposal systems. This requires a system capable of providing a continuous nominal flow of 50 l/min. A flow indicator on the system indicates when the unit is in operation.

capability to adjust the flow with a needle valve (located in a receiver underneath the breathing system) and a visual indicator bag which should be properly inflated. It requires a vacuum system capable of a continuous nominal flow of 36 l/min and 300 mmHg (12 inHg) or greater vacuum pressure.

is for use with low vacuum disposal system. It requires an external venturi system with flowmeter and 36 l/min extract flow.

use with low vacuum disposal systems. It requires an external venturi/ejector system with 36 l/min extract flow. A flow indicator on the system indicates when the unit is in operation.

low vacuum disposal systems. It requires an external venturi/ ejector system with 36 l/min extract flow. A flow indicator on the system indicates when the unit is in operation.

3-30 M1145956

3 Operation

AB.91p093

Connecting active

AGSS with a flow

indicator

To use the optional active AGSS on a system that has a flow indicator, connect it as follows.

1. Connect the proper hose to the AGSS outlet connector on the bottom of the AGSS underneath the breathing system. Attach the other end to the hospital disposal system.

2. With the AGSS operating, verify that the flow indicator ball on the flow indicator rises to the green zone, indicating adequate flow.

Note The ball in the upper red zone indicates excessively high extraction

Connecting active

adjustable AGSS

flow. The ball in the lower red zone indicates extraction flow rate is too low or a blocked filter.

3. Complete the tests in the “Preoperative Tests” section of this manual.

The active adjustable AGSS option flow rate is limited to 30 l/min with this option.

To use the optional active AGSS installed on the system which uses the three-liter bag as a visual indicator, connect it as follows:

1. Connect a disposal hose to the DISS connector on the needle valve on the bottom of the AGSS (underneath). The hose should be flexible and reinforced to help prevent kinking and crushing.

2. Attach the other end of the hose to the hospital disposal system.

3. Attach the three-liter bag to the 30 mm auxiliary 1 port on the bottom of the AGSS.

M1145956 3-31

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AB.75p.110

4. Use the needle valve to adjust the flow rate to match the amount of gas being scavenged. Use the visual indicator bag when adjusting the flow rate. The bag should remain partially inflated when the flow rate is adequate.

5. Complete the tests in the “Preoperative Tests” section of this manual.

3-32 M1145956

4 Preoperative Checkout

WARNING Read each component’s User’s Reference manual and

understand the following before using this system:

• All system connections.

• All warnings and cautions.

• How to use each system component.

• How to test each system component.

w Before using the system:

• Complete all of the tests in the “Preoperative Tests” section.

• Test all other system components.

w If a test fails, do not use the equipment. Have a

Datex-Ohmeda trained service representative repair the equipment.

In this section Every day before your first patient . . . . . . . . . . . . . . . . . . . . 4-2

Before every patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

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Every day before your first patient

 Check that necessary emergency equipment is available and in good

condition.

 Check that the equipment is not damaged and that components are

correctly attached.

 Check that pipeline gas supplies are connected and cylinders are

installed.

 Check vaporizer installation:

• Make sure that the top of each vaporizer is horizontal (not on

crooked).

• Make sure each vaporizer is locked and cannot be removed.

• Make sure the alarms and indicators operate correctly (Tec 6

series vaporizer).

• Make sure more than one vaporizer cannot be turned on at

the same time.

• Make sure that the vaporizers are adequately filled.

 Check that the breathing circuit is correctly connected, not damaged,

and the breathing system contains sufficient absorbent.

 Turn the System switch to On.

 Connect scavenging and verify operation.

 Calibrate the flow sensors. Do a Flow and Pressure calibration in the

Calibration menu.

 Do a Machine Check in the Checkout menu.

 To check the vaporizers, do a Low P Leak check in the Checkout

menu.

 Check that an adequate reserve O2 supply is available.

 Check that the ventilator functions correctly:

• Connect a test lung to the patient Y.

• Set the ventilator to VCV mode and the settings to TV at 400

ml, RR at 12, I:E at 1:2, Tpause at Off, PEEP at Off, and Pmax at 40.

• Set the gas flow to the minimum settings.

• Start a case.

• Set the Bag/Vent switch to ventilator.

• Fill the bellows using O2 flush.

• Check that mechanical ventilation starts. Check that the

bellows inflate and deflate. Check that the display shows the correct ventilator data. Check that there are no inappropriate alarms.

 Set the appropriate controls and alarm limits for the case.

4-2 M1145956

Before every patient

Note This check does not need to be done before the first case of the day if

 Check that necessary emergency equipment is available and in good

 Check vaporizer installation:

 Do a Low P Leak check in the Checkout menu.

 Check that the breathing circuit is correctly connected, not damaged,

4 Preoperative Checkout

the “Every day before your first patient” checklist was done.

condition.

• Make sure that the top of each vaporizer is horizontal (not on

crooked).

• Make sure each vaporizer is locked and cannot be removed.

• Make sure the alarms and indicators operate correctly (Tec 6

series vaporizer).

• Make sure more than one vaporizer cannot be turned on at

the same time.

• Make sure that the vaporizers are adequately filled.

and the breathing system contains sufficient absorbent.

 Leak check the breathing system:

• Set the Bag/Vent switch to Bag, close the APL valve (set to

70), and occlude the patient Y.

• Pressurize the breathing system to approximately 30 cmH2O

using the O2 flush button.

• Ensure that the pressure remains fixed for at least 10

seconds.

 Check that the ventilator functions correctly:

• Connect a test lung to the patient Y.

• Set the ventilator to VCV mode and the settings to TV at

400 ml, RR at 12, I:E at 1:2, Tpause at Off, PEEP at Off, and Pmax at 40.

• Set the gas flow to the minimum settings.

• Start a case.

• Set the Bag/Vent switch to ventilator.

• Fill the bellows using O2 flush.

• Check that mechanical ventilation starts. Check that the

bellows inflate and deflate. Check that the display shows the correct ventilator data. Check that there are no inappropriate alarms. Make sure that the alarms function. See the “Alarm

tests.”

 Set the appropriate controls and alarm limits for the case.

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4-4 M1145956

5 Preoperative Tests

In this section Inspect the system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2

Vaporizer installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

Flow and pressure calibration. . . . . . . . . . . . . . . . . . . . . . . . 5-4

Circuit compliance compensation . . . . . . . . . . . . . . . . . . . . . 5-4

Checkout menu. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Leak < 250 ml . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

Machine check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6

Individual checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8

Positive low pressure leak test (ACGO systems only) . . . . 5-10

Vaporizer back pressure test . . . . . . . . . . . . . . . . . . . . . . . 5-11

M1145956 5-1

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Inspect the system

WARNING The top shelf weight limit is 34 kg (75 lb).

w Make sure that the breathing circuit is correctly connected

w Do not leave gas cylinder valves open if the pipeline

and not damaged. Replace the breathing circuit if it is damaged.

supply is in use. Cylinder supplies could be depleted, leaving an insufficient reserve supply in case of pipeline failure.

Before using the system, ensure that:

• The equipment is not damaged.

• Components are correctly attached.

• The breathing circuit is correctly connected, not damaged, and the breathing system contains sufficient absorbent.

• The vaporizers are locked in position and contain sufficient agent.

• Pipeline gas supplies are connected and the pressures are correct.

• Cylinder valves are closed.

• Models with cylinder supplies have a cylinder wrench attached to the system.

• Models with cylinder supplies have a reserve supply of O2 connected to the machine during system checkout.

• The necessary emergency equipment is available and in good condition.

• Equipment for airway maintenance, manual ventilation, tracheal intubation, and IV administration is available and in good condition.

• Applicable anesthetic and emergency drugs are available.

• If an optional O2 flowmeter is present, ensure there is adequate flow.

• If an optional suction regulator is present, ensure there is adequate suction.

• The casters are not loose and the brakes are set and prevent movement.

• The power cord is connected to an electrical outlet. The mains indicator comes on when AC Power is connected. If the indicator is not on, the system does not have mains (electrical) power. Use a different outlet, close the circuit breaker, or replace or connect the power cable.

5-2 M1145956

Vaporizer installation

WARNING Use only the Datex-Ohmeda Selectatec series vaporizers

w Do not use a vaporizer that lifts off of the manifold when

w Do not use this anesthesia system if more than one

w Tec 6 Plus vaporizers will not align correctly unless the

5 Preoperative Tests

Tec 4 or greater.

the lock lever is in the locked position.

vaporizer can be turned on at the same time.

power cable goes through the channel on the bottom of the vaporizer.

1. Make sure the top of the vaporizer is horizontal. If not, remove the vaporizer and reinstall it.

2. Set each vaporizer lock lever to the locked position.

3. Try to lift each vaporizer straight up off the manifold rather than pulling forward. Do not rotate the vaporizer on the manifold.

4. If a vaporizer lifts off of the manifold, install it again and repeat steps 1, 2, and 3. If the vaporizer lifts off a second time, do not use the system.

5. With a Tec 6 Plus vaporizer:

• Make sure that the vaporizer is connected to an electrical

outlet.

• Hold down the Auditory Alarm Mute button for a minimum of

4 seconds.

• Make sure all indicators turn on and the alarm speaker starts.

• Release the Auditory Alarm Mute button.

• Do not continue until the operational indicator turns on. The

concentration control will not turn if the operational indicator is off.

6. Try to turn on more than one vaporizer at the same time:

• Test each possible combination.

• If more than one vaporizer turns on at the same time, remove the vaporizers, install them again, and repeat the test.

M1145956 5-3

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Flow and pressure calibration

Calibrate the flow sensors by removing them from the system. Onscreen instructions are available through Flow and Pressure.

Important Room temperature fluctuations of more than 5°C may affect sensor

measurements. Recalibrate the flow sensors if the room temperature changes by more than 5°C.

1. Set the Bag/Vent switch to Bag.

2. Remove the flow sensor module.

3. Wait for ‘No insp flow sensor’ and ‘No exp flow sensor’ alarms to occur.

4. Reinsert the flow sensor module. Wait for alarms to clear.

5. Start mechanical ventilation when ready.

Circuit compliance compensation

Circuit compliance is determined during the Machine Check-System check or when the System check is done as an individual check.

Main Menu - Calibration -

The ventilator adjusts gas delivery and monitoring to compensate for the compliance of the patient circuit if:

• The system has a gas analyzer installed.

•The Machine Check is completed after the system is turned on.

In volume modes, circuit compliance compensation increases the volume delivered at the inspiratory port by taking into consideration the circuit compliance value. In all modes, circuit compliance compensation adjusts the exhaled volume measurements. Circuit compliance compensation provides consistent ventilator accuracy at the patient circuit.

WARNING Perform a Machine Check after changing the patient tube

type. Changing the patient breathing circuit after completing a Machine Check affects the volume delivery in volume ventilation modes and affects the exhaled volume measurements in all modes.

5-4 M1145956

Checkout menu

5 Preoperative Tests

The Checkout menu shows on the display after turning on the system. To access the Checkout menu between cases, push the

Checkout key. Step-by-step instructions show in the right window

next to the Checkout menu during the checks. Use the Checkout menu to:

•Perform a Machine Check.

• Perform any of the individual checks.

• Set the Leak < 250 ml setting.

• View the Check Log.

• Start a case.

Checkout

Machine Check

Leak < 250 ml No

Individual Checks

System

Circuit

Circuit O2 Cell

Low P Leak

Check Log

Leak < 250 ml

Start Case

The Leak < 250 ml setting is used during the circuit leak check portion of the checkout procedures. This check tests for leaks in the machine, breathing circuit, patient circuit, and manual bag. The default setting is No.

Note Extraction of gas by external gas monitors may cause failure of the

leak checks during tests.

No When No is selected, the leak test will pass for leaks below 250 ml at

3 kPa (30 cmH2O) pressure with no user interaction required. For leaks between 250 ml and 750 ml, the user can fix the leak and rerun the test or accept the leak and continue. For leaks above 750 ml, the test will fail and the user must fix the leak and rerun the test.

Yes Set to Yes to measure small leaks above 100 ml during the checkout

procedures. Selecting Yes will display the measured leak at 3 kPa (30 cmH2O) pressure and result in the test taking somewhat longer.

M1145956 5-5

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Machine check

The Machine Check or the individual checks must be performed at least once within every 24-hour period.

Perform the Machine Check at the start of each day. The machine check runs automatically and beeps to indicate when it is finished or if interaction is required.

The Machine Check does a Machine Check-System check, Machine Check-Circuit check, and a Machine Check-Circuit O2 cell check (if circuit O2 cell is present). When one of the checks is completed, the next check begins.

1. Turn the System switch to On.

2. Select Machine Check and follow the instructions.

3. If a check fails, follow the instructions to perform a recheck or accept the results.

4. When the Machine Check is completed, start a case.

Note In case of a patient emergency, the Machine Check may be

bypassed by selecting Start Case from the Checkout menu. The general message ‘Please Do Checkout’ is displayed if a Machine Check is not completed with passing results within 24 hours.

Machine check -

system

The Machine Check-System checks the Bag/Vent switch, proper gas supply pressures, ventilator operation and leak, battery and electrical power, circuit compliance, and flow control operation. This is a two-step check.

1. Set the Bag/Vent switch to Vent.

2. Open the patient Y.

3. (ACGO option only.) Set the ACGO switch to Circle.

4. Select Start. The display shows the checks being run.

• The system beeps when this portion of the check is done.

• The results are shown on the display.

5. Make sure the bellows is fully collapsed.

6. Occlude the patient Y.

7. Select Continue. The display shows the checks being run.

8. When the check passes, the next check starts.

5-6 M1145956

5 Preoperative Tests

Machine check -

circuit

Machine check -

circuit O2

The Machine Check-Circuit checks the Bag/Vent switch, proper gas supply pressures, airway pressure measurement transducer, APL valve, and manual circuit leak.

1. Occlude the patient Y.

2. Set Bag/Vent switch to Bag.

3. Set the APL valve halfway between 30 and 70.

4. (ACGO option only.) Set the ACGO switch to Circle.

5. Select Start. The display shows the checks being run.

• The system beeps when the check is done.

• The results are shown on the display.

6. When the check passes, the next check starts.

The Machine Check-Circuit O2 check measures the O2%.

1. Open the patient Y.

2. Set the Bag/Vent switch to Vent.

3. (ACGO option only.) Set the ACGO switch to Circle.

4. The display will show the O2%. Do not select Done when 21 is first displayed. Allow the reading to stabilize, then select Done. Calibrate the O2 cell if necessary.

Machine check -

monitor

When External Gas Monitor is set to Yes by the Super User, the Machine Check-Monitor check occurs. This check is not a test. This

check is a reminder to connect a respiratory gas monitor.

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Individual checks

System The System check checks the Bag/Vent switch, proper gas supply

The Machine Check or the individual checks must be performed at least once within every 24-hour period.

Individual checks allow the user to perform any combination of single checks. These checks are helpful if there is a specific problem/alarm and the user wishes to test only that portion of the system.

The checks do not automatically move on to the next check. After completing a check, do another check or start a case. If a check fails, follow the instructions to perform a recheck or accept the results.

pressures, ventilator operation and leak, battery and electrical power, circuit compliance, and flow control operation. This is a two-step check.

1. Set the Bag/Vent switch to Vent.

2. Open the patient Y.

3. (ACGO option only.) Set the ACGO switch to Circle.

4. Select Start. The display shows the checks being run.

• The system beeps when this portion of the check is done.

• The results are shown on the display.

5. Make sure the bellows is fully collapsed.

6. Occlude the patient Y.

7. Select Continue. The display shows the checks being run.

8. When the check passes, select Back.

9. Select another check or select Start Case to go to the Start Case menu.

Circuit The Circuit check checks the Bag/Vent switch, proper gas supply

pressures, airway pressure measurement transducer, APL valve, and manual circuit leak.

1. Occlude the patient Y.

2. Set Bag/Vent switch to Bag.

3. Set the APL valve halfway between 30 and 70.

4. (ACGO option only.) Set the ACGO switch to Circle.

5. Select Start. The display shows the checks being run.

6. When the check passes, select Back.

7. Select another check or select Start Case to go to the Start Case menu.

5-8 M1145956

5 Preoperative Tests

Circuit O2 cell The Circuit O2 Cell check measures the O2%.

1. Open the patient Y.

2. Set the Bag/Vent switch to Vent.

3. (ACGO option only.) Set the ACGO switch to Circle.

4. The display will show the O2%. Do not select Done when 21 is first displayed. Allow the reading to stabilize, then select Done. Calibrate the O2 cell if necessary.

5. Select another check or select Start Case to go to the Start Case menu.

Low P leak The positive pressure Low P Leak check measures machine leaks

before the breathing system, between the common gas outlet and the high pressure pneumatics and includes the gas mixer and vaporizer. It measures low pressure pneumatic leaks with a pass or fail limit of 50 ml.

1. Make sure that the vaporizers to be used during the case are mounted on the machine and turned off.

2. Occlude the inspiratory (right-hand) port.

Low P leak

(machines with

ACGO)

3. Select Start.

4. The display shows the checks being run. The system beeps when the check is done.

5. Repeat the check once for each vaporizer with one vaporizer turned on at a time.

6. When the checks pass, turn the vaporizer off.

7. Open the inspiratory port and reconnect the breathing circuit. Select another check or select Start Case to go to the Start Case menu.

The negative Low P Leak check measures machine leaks before the breathing system, between the common gas outlet and the high pressure pneumatics and includes the gas mixer and vaporizer. It measures low pressure pneumatic leaks with a pass/fail limit of 50 ml.

1. Make sure that the vaporizers to be used during the case are mounted on the machine and turned off.

2. Make sure the ACGO switch is set to ACGO.

3. Attach the squeeze bulb to the ACGO outlet.

4. Squeeze (collapse) the bulb.

5. If the bulb inflates in less than 30 seconds, select Fail.

6. If the bulb remains collapsed, repeat the check once for each vaporizer with one vaporizer turned on at a time.

7. When the checks pass, turn the vaporizers off and remove the squeeze bulb from the ACGO outlet.

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Positive low pressure leak test (ACGO systems only)

Note For ACGO machines, perform either a negative Low P Leak check in

the Checkout menu or positive low-pressure leak check depending on local requirements.

CAUTION Do a positive-pressure leak test at the ACGO port only.

1. Connect the leak test device to the ACGO port with the positivepressure leak test adapter. Push the adapter into the ACGO port throughout the test to get a good seal.

2. Fully open the needle valve on the test device. Keep the test device flow tube vertical for accurate results.

CAUTION If the needle valve is not fully open, this test can damage

the pressure gauge on the test device.

3. Turn the ACGO switch to the ACGO position.

4. Set the O2 flow to 500 ml.

5. Make sure that the total flow through the flowmeter on the test device is 0.5 l/min.

6. Make sure that the pressure gauge on the test device reads zero.

7. Close the needle valve on the test device until the test gauge reads 20 kPa (3 psi) (BSI) or 3 kPa (0.4 psi) (ISO).

8. If the flow through the test device is less than 0.45 l/min (ISO) or 0.4 l/min (BSI), there is a low pressure leak in the anesthesia machine. See the “Alarms and Troubleshooting” section for more information.

9. Repeat this low-pressure leak test for each vaporizer.

• Set the applicable vaporizer to 1%.

• Turn the vaporizer off after the test.

WARNING Agent mixtures from the low-pressure leak test stay in the

system. Always flush the system with O2 after the lowpressure leak test (1 l/min for at least one minute).

w Turn all vaporizers off at the end of the low-pressure leak

test.

10. Remove the adapter and leak test device.

11. Set the O2 flow to 1 l/min and continue flow for one minute.

5-10 M1145956

Vaporizer back pressure test

WARNING Anesthetic agent comes out of the circuit during this test.

Use a safe, approved procedure to collect and remove the agent.

1. Set the System switch to On.

2. Start a case.

3. Set the O

4. Slowly adjust the vaporizer concentration from 0 to 1%.

• Make sure that the O2 flow stays constant.

• Verify that the system continues to operate without issuing

any related alarms.

5. Repeat this test for both vaporizer positions.

flow to 6 l/min.

5 Preoperative Tests

M1145956 5-11

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5-12 M1145956

6 Airway Modules

In this section Airway modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2

Parameters setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Automatic agent identification. . . . . . . . . . . . . . . . . . . . . . . . 6-6

Calibration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

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Airway modules

WARNING Remove the airway sampling line from the patient’s

The optional compact airway modules measure and monitor gases delivered to the patient and exhaled through the breathing circuit. The modules consist of an infrared sensor for measuring CO2, N2O, and anesthetic agents; a paramagnetic O2 sensor; and a gas sampling system with the D-fend water separation system.

Systems with both an airway module and an O2 cell will display the patient inspired O2 value obtained from the airway module.

Respiratory rate is the frequency of peak (end tidal) CO2 measurements per minute. A breath is defined as a change in the CO2 signal that exceeds 1% (8 mmHg). All concentrations are measured and displayed breath by breath.

airway and seal the sample port while nebulized medications are being delivered. Nebulized medications interfere with accurate gas reading.

w If the Data Source is set to Patient in the Spirometry

Setup menu, no Paw, Flow, Agent, or CO2 waveforms or

numeric information is displayed during the airway gas module warm-up period (approximately 2 minutes). Set the Data Source to Vent to display the waveforms and numeric information during the airway gas module warmup period.

CAUTION Use only cables and accessories approved by

Datex-Ohmeda. Other cables and accessories may damage the system or interfere with measurement. Single-use accessories are not designed to be reused.

w Strong scavenging suction on the monitor exhaust port

may change the operating pressure of the monitor and cause inaccurate readings or internal damage.

6-2 M1145956

6 Airway Modules

MD.60.008

Use only airway modules that have anesthetic agent monitoring and O2 monitoring on this system. The following modules can be used on this system: E-CAiO, E-CAiOV, E-CAiOVX, M-CAiO, M-CAiOV, and M-CAiOVX. (E series modules must be software version 4.5 and above. M series modules must be software version 3.2 and above.)

Letters in the name of the airway modules stand for:

• E = plug-in gas module

• M = plug-in gas module

• C = CO2 and N2O

• A = anesthetic agents

• i = agent identification

• O = patient O2

• V = patient spirometry

• X = Gas exchange

1. D-fend water trap

2. Sampling line connector

3. Water trap latch

4. Reference gas inlet

5. Sample gas outlet

6. Cooling fan

Figure 6-1 • Compact airway module

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AB.91.010

Connection to a

patient

WARNING Before connecting the exhaust line to the sample gas

1. Check that the airway gas module is installed.

2. Check that the airway adapter connections are tight and that the adapter is correctly installed.

3. Check that the water trap container is empty and properly attached.

outlet on the compact airway module, ensure the other end is connected to the sample gas return port on the anesthesia machine. Incorrect connections may cause patient injury.

4. Connect the exhaust line from the sample gas return port to the sample gas outlet if N2O or volatile agents are used. (See the

“Parts” section.)

5. Attach the gas sampling line to the sampling line connector on the water trap.

6. Turn the system on. The system does a series of automated self tests. The automatic agent identification is activated.

7. Connect the sampling line to the airway adapter. Take the gas sample as close to the patient’s airway as possible. Position the adapter’s sampling port upwards to prevent condensed water from entering the sampling line.

1. Airway module

2. Gas sampling line

6-4 M1145956

3. Airway adapter with sampling line connector

Figure 6-2 • Airway gases setup with compact airway module

Parameters setup

Data source Several monitoring parameters can be obtained from the ventilator or

6 Airway Modules

Use the Parameters Setup menu to change the monitoring settings of the data source, CO2, O2, agent, and spirometry. Push the

key. Select Parameters Setup.

the airway module. Information that is retrieved from the airway module is identified with the module data indicator.

Figure 6-3 • Airway module data indicator

Set the Data Source to Patient or Vent to select the primary source for information. If Patient is selected, the airway module will be the first source for information. If Vent is selected, the internal sensors of the ventilator will be the first source for information.

Main

CO2 setup Change the size of the CO2 waveform by changing the scale height.

The scale units (%, kPa, and mmHg) are set by the Super User. Select CO2 Alarm or Resp Rate Alarm to access and change the alarm limits for the corresponding alarm.

O2 setup Select O2 Alarm to access and change the O2 alarm limits.

Agent setup Change the size of the agent waveform by changing the scale height.

Select Agent Alarm to access and change the agent alarm limits.

Spirometry setup Change the size of the Paw and Flow waveforms by changing the

corresponding scale heights. Select Paw Alarm or MVexp Alarm to access and change the alarm limits for the corresponding alarm.

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Automatic agent identification

Airway modules with agent identification will automatically identify and select Halothane, Enflurane, Isoflurane, Sevoflurane, and Desflurane. The inspiratory and expiratory concentrations of the agent appear in the number field or the agent waveform field if selected.

Minimum concentration for the identification is 0.15% volume. The agent selection remains active even if the concentration decreases below 0.15% volume during the case.

Automatic agent identification operates after the normal warm up of the gas module (approximately five minutes).

Calibration

Calibrate airway modules once every six months or whenever there are indications of errors in the gas readings. Use a Datex-Ohmeda calibration gas and regulator to calibrate the modules. See the

“Parts” section for the stock numbers of the calibration gas and

regulator.

WARNING Only use Datex-Ohmeda calibration gas. Do not use any

other calibration gases or the calibration will not succeed.

During gas calibration, % units are used for CO2 regardless of selected measuring units.

1. Turn on the power. Let the module warm up for 30 minutes before starting calibration.

2. Attach the regulator to the calibration gas cylinder.

3. Attach a new sampling line to the water trap. Connect the loose end of the sampling line to the regulator on the calibration gas cylinder.

4. Push the

5. Select Calibration.

6. Select Airway Gas.

7. Wait until Feed Gas appears after each gas name:

• ‘CO2 Feed Gas.’

• ‘O2 Feed Gas.’

• ‘N2O Feed Gas.’

• ‘Agent Feed Gas.’

8. Open the regulator until the gauge reads between 5 to 7 psi. Feed the calibration gas until the message ‘OK’ or ‘Adjust’ appears.

• If an error occurs during calibration or if no gas is fed, Calibr

Main Menu key.

Error appears after the gas name. Push the ComWheel to perform a new calibration.

6-6 M1145956

6 Airway Modules

9. If adjustments are needed:

• Do not close the regulator until all the adjustments have been

made.

• Select the gas to be adjusted and press the ComWheel.

• Use the ComWheel to change the value until it matches the

calibration gas cylinder value. Push the ComWheel to confirm the change.

• Repeat for each gas requiring adjustment.

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7 Alarms and Troubleshooting

CAUTION No repair should ever be attempted by anyone not having

experience in the repair of devices of this nature. See the “Repair policy” in the “User Maintenance” section.

WARNING If an alarm occurs, safeguard the patient first before

performing troubleshooting or doing repair procedures.

In this section Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

List of alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Alarm ranges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12

Alarm tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14

Breathing system problems . . . . . . . . . . . . . . . . . . . . . . . . 7-16

Electrical problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-17

Pneumatic problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-18

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Alarms

Alarm priorities Alarm priority is indicated by the color of the alarm message and the

Alarms are divided into technical alarms and parameter alarms. These alarms may be high priority, medium priority, or informational. When an alarm occurs during a case, an alarm tone sounds and the alarm message is displayed in the alarm message field.

Technical alarms result from a technical problem and occur whether or not a patient is connected to the system. Parameter alarms are calculated limits and limits that are set by the user on the Alarm Setup menu. Parameter alarms occur only during a case.

alarm LED located next to the alarm silence button.

High-priority alarm messages appear in white text on a red background. During a high-priority alarm, the red LED flashes.

Medium-priority alarm messages appear in yellow text on a gray background. During a medium-priority alarm, the yellow LED flashes.

Informational alarms appear in white text on a gray background. During an informational alarm, the yellow LED is on solid.

When a high-priority alarm is active at the same time as a mediumpriority alarm or an informational alarm, the red and yellow LEDs flash. When a high-priority alarm is active at the same time as an informational alarm, the red LED flashes and the yellow LED is on solid. When a medium-priority alarm is active at the same time as an informational alarm, the yellow LED flashes. Pushing the

Silence

Alarms key changes the LED from flashing to on solid until the end

of the alarm silence.

Silencing alarms Silencing an alarm stops the audible tone for 120 seconds. The alarm

message shows in the alarm message field. Pushing the

Alarms

suspends audible alarm tones for 90 seconds.

Alarms in the apnea alarm family have special silence behavior to reduce apnea nuisance alarms. Apnea family alarms include ‘Apnea,’ ‘TVexp low,’ ‘EtCO2 low,’ ‘MVexp low,’ and ‘RR low.’

When silencing an apnea family alarm, the audio tone for the active alarm is silenced for 120 seconds. The audible tone for any additional apnea family alarm that occurs during the silence period is silenced for the remain time shown on the alarm silence countdown. Only the audible alarm tone is silenced. The alarm messages still show in the alarm message fields. ‘APN’ shows above the alarm silence countdown when the audible tone silence is in affect for the apnea family alarms.

key when no medium or high priority alarms are active

Silence

Display changes

during alarms

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Messages may appear in the waveform field during some alarms. If more than one alarm has a message, the message for the highest priority alarm is displayed. The message is removed when the alarm is resolved.

7 Alarms and Troubleshooting

The color of the alarm text shown in the alarm message fields is dependent on the alarm priority. Messages for high-priority alarms use red text. Messages for medium-priority alarms use yellow text. Informational messages use white text.

When the O psi), the lower-right corner of the display toggles between the O supply information and the set digit field.

Some patient parameter alarms, such as ‘Ppeak high’ and ‘FiO2 low,’ will latch when the alarm condition is corrected. When an alarm is latched, it is displayed in white text on a black background. The parameter box will stop flashing. All the associated waveform, numeric, and digit field messages are removed from the display. The flashing LED associated with that alarm changes from flashing to on solid. The alarm will remain in this condition until it is acknowledged by pushing the When the alarm is acknowledged, it is removed from the screen. If an alarm has latched and the alarm re-occurs before it is acknowledged, the alarm will revert to an active state.

pipeline supply pressure drops to less than 252 kPa (36

Silence Alarms key or until the alarm re-occurs.

De-escalating alarms Some device related alarms, such as ‘Reverse Flow’ and ‘No insp

flow sensor,’ will de-escalate priority when the alarm is acknowledged by pushing the stopped for that active alarm until the alarm condition is resolved. The alarm message shows at the informational alarm level until the alarm condition is resolved and the alarm is cleared. If that alarm reoccurs after it has been resolved, the alarm occurs at its standard priority level.

Silence Alarms key. The audible alarm tone is

Battery indicator The color and fill amount of the battery in use symbol indicates the

amount of battery power remaining. Green indicates greater than 10 minutes of battery power remaining. Yellow indicates less than 5 minutes battery power remaining.

Internal failure ‘Internal problem prevents normal operation.’ shows on the display

during a software or hardware failure that requires service. If this message occurs, contact a Datex-Ohmeda trained service representative.

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List of alarms

If the corrective action does not resolve the alarm message, contact a Datex-Ohmeda trained service representative

Circuit pressures and volumetric flows are measured by the ventilator and airway gas module. If the Data Source is set to Patient, the displayed waveforms and numeric information are measured by the airway gas module. Although not displayed, the ventilator measurements continue and if a measured value violates an alarm setting, the appropriate alarm occurs. The value highlighted in the parameter numeric box may not appear to have violated the alarm setting. Changing the Data Source to Vent will display the circuit pressures and volumetric flows measured by the ventilator.

Message Priority Cause Action

AA, CO2 monitoring not connected

Air pressure low. Increase O2 %.

Air supply pressure low

Apnea Medium Apnea time delay (10-30

Medium External Gas Monitor setting is

set to No on the menu. External Gas Monitor setting is No on the Install/ Service menu and the monitor condition changes to disconnected.

High O2% is set to Air at 21%. Air

pipeline pressure is less than 252 kPa (36 psi) and the air cylinder pressure dropped below 2633 kPa (381 psi) for one second.

Medium Air pipeline pressure is less than

252 kPa (36 psi) and the air cylinder pressure dropped below 2633 kPa (381 psi) for one second.

seconds) has passed without a measured breath. Apnea time delay (20 - 30 seconds) has passed without a changed in the measured CO2 by at least 1%.

Install/Service

Set External gas monitor setting to Yes if the system uses a stand-alone monitor for O2, AA, and CO2.

Ensure the air pipeline and cylinder are properly connected. Increase the O2% flow.

Ensure the air pipeline and cylinder are properly connected. Contact a Datex-Ohmeda trained service representative.

Check for leaks in the patient circuit. Check for patient disconnection.

Apnea >120 s High Apnea time exceeds 120

seconds.

Backup Mode active

Breathing system loose

Informational No spontaneous breaths in set

period of time (Backup Time) and 30 seconds have passed since starting PSVPro mode.

Informational The breathing system is not

latched.

Check for leaks or blockages in the breathing circuit. Ensure the Bag/Vent switch is in the Vent position. Check the patient.

Select a new ventilation mode. The number of consecutive patient triggered breaths reaches the Exit Backup setting.

Push the breathing system onto the frame and ensure it latches.

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Message Priority Cause Action

7 Alarms and Troubleshooting

Calibrate (remove) flow sensors

Calibrate O2 sensor

Calibrate, dry, or replace flow sensors

Cannot monitor Air pipeline

Cannot monitor gas supplies

Cannot monitor O2 pipeline

Cannot read gas supply pressures

Check circuit connections

Informational Flow calibration failure or more

Calibrate the flow sensors. than 24 hours have passed since the last flow sensor calibration.

Informational Calibration failure or measured

O2 is greater than 110%.

Informational Patient volume mismatch

occurred during the last case.

Calibrate the O2 cell. Replace the O2 cell if

necessary.

Calibrate, dry or replace the flow sensors.

Start a new case.

Medium Air pipeline pressure is invalid. Check pipeline supply pressure.

Contact a Datex-Ohmeda trained service

representative.

Informational Hardware failure. Contact a Datex-Ohmeda trained service

representative.

Medium O

pipeline pressure is invalid. Check pipeline supply pressure.

Medium Transducer failure. Contact a Datex-Ohmeda trained service

representative.

Medium Breaths detected in circle circuit

Check circle circuit connections and settings. while non-circle circuit is selected.

Check D-Fend Medium Water trap not attached. Check that the water trap is properly attached

to the airway module.

Check flow sensors

Medium System has detected an

improper flow pattern in the

Ensure the internal flow sensors are

connected correctly. breathing circuit.

Check sample gas out

Circuit leak Medium Vent TVexp is less than half of

Circuit leak silenced

Medium Possible blockage in airway

module sample gas outlet.

Check for blockage in the airway module

sample gas outlet. Remove blockage.

Check for leaks in the patient circuit. vent TVinsp for at least 30 seconds.

Calibrate flow sensors. If problem persists,

replace flow sensors.

Informational Setting on Alarm Setup menu. Vent TVexp is less than 50% of vent TVinsp

for at least 30 seconds. Message indicates

that the Leak Audio alarm is turned off.

Circuitry >75C shutdown

Medium Power supply temperature

exceeds 75°C.

Shut down system as soon as possible.

Then, check cooling fans and filters.

possible

Cooling fan needs service.

Medium Fan reporting error. Shut down system as soon as possible.

Then, check cooling fans and filters.

System OK.

Cooling fans failed. May overheat.

Medium Fan reporting error. Shut down system as soon as possible.

Contact a Datex-Ohmeda trained service

representative.

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Message Priority Cause Action

Display panel controls failure

EtCO2 high High EtCO2 is greater than high alarm

EtCO2 low Informational

Medium Communication lost between

panel and key pad.

limit.

EtCO2 is less than alarm limit.

Medium after 1 minute

Priority escalates to Medium if alarm is not resolved after 1

Turn the system off and back on.

Check the patient and EtCO2 settings. Check

if absorbent needs to be changed.

Ensure the patient is properly intubated.

Check for leaks or blockages in the patient

circuit. minute.

EtDES high Medium

EtDES is greater than alarm limit.

Set the alarm limits appropriately. Decrease

the agent concentration.

EtDES low Informational EtDES is less than alarm limit. Check the fill level on the vaporizers. Set

alarm limit appropriately. Increase the agent

concentration.

EtENF high Medium

EtENF is greater than alarm limit.

Set the alarm limits appropriately. Decrease

the agent concentration.

EtENF low Informational EtENF is less than alarm limit. Check the fill level on the vaporizers. Set

alarm limit appropriately. Increase the agent

concentration.

EtHAL high Medium

EtHAL is greater than alarm limit. Set the alarm limits appropriately. Decrease

the agent concentration.

EtHAL low Informational EtHAL is less than alarm limit. Check the fill level on the vaporizers. Set

alarm limit appropriately. Increase the agent

concentration.

EtISO high Medium

EtISO is greater than alarm limit. Set the alarm limits appropriately. Decrease

the agent concentration.

EtISO low Informational EtISO is less than alarm limit. Check the fill level on the vaporizers. Set

alarm limit appropriately. Increase the agent

concentration.

EtO2 high Medium EtO2 is greater than high alarm

limit.

Set the alarm limits appropriately. Decrease

concentration.

the O

EtO2 low Medium EtO2 is less than low alarm limit. Set the alarm limits appropriately. Increase

the O

concentration.

EtSEV high Medium EtSEV is greater than alarm

limit.

Set the alarm limits appropriately. Decrease

the agent concentration.

EtSEV low Informational EtSEV is less than alarm limit. Check the fill level on the vaporizers. Set

alarm limit appropriately. Increase the agent

concentration.

FiCO2 high. Absorbent OK?

FiDES high Medium

High FiCO2 is greater than alarm limit. Check if absorbent needs to be changed.

Check the patient.

FiDES is greater than alarm limit. Set the alarm limits appropriately. Decrease

the agent concentration.

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Datex-Ohmeda Avance User Reference Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

User Responsibility

1 Introduction

2 System Controls and Menus

Table of Contents

3 Operation

4 Preoperative Checkout

5 Preoperative Tests

6 Airway Modules

7 Alarms and Troubleshooting

8 Setup and Connections

9 User Maintenance

10 Parts

11 Specifications and Theory of Operation

12 Super User Mode

Index

Warranty

1 Introduction

Intended use

Symbols used in the manual or on the equipment

Typeface conventions used

Abbreviations

2 System Controls and Menus

System overview

Advanced breathing system (ABS) components

Non-circle circuit Fresh gas flow is diverted around the inspiratory check valve and out

ACGO (optional) Fresh gas flow is directed through the Auxiliary Common Gas Outlet

Vaporizer controls

Display controls

Anesthesia system display

Waveform fields Up to three waveforms can be shown on the normal screen view.

Digit field The digit field can be set to show specific information such as gas

Using menus

3 Operation

Turning on the system

Start case (start gas flow)

End case

Ventilator setup

Using quick keys The four main ventilator settings for each mode can easily be

Changing ventilator modes and settings

Gas setup

Using quick keys The O2% and total flow can easily be changed using the gas quick

Changing circuit type 1. Push the Gas Setup key.

Spirometry

Setting loop type The spirometry loops show in the spirometry window and can be set

Scaling

Spirometry setup

Main Menu

Tre nds

cardiac bypass

2. Select Fresh Gas Usage.

Screen configuration

Select Page

Screen Setup

Alarm setup

Setting alarm limits 1. Push the Alarms Setup key.

Volume apnea Volume Apnea is not shown on the Alarm Setup menu when the

MV/TV Alarms

CO2 alarms CO2 information is obtained from the airway module installed in the

Auto MV limit MV alarm limits can be calculated automatically for mechanical

Alternate O2 control

EZchange canister (optional)

Condenser (optional)

Passive AGSS (optional)

Active AGSS (optional)

4 Preoperative Checkout

Every day before your first patient

Before every patient

5 Preoperative Tests

Inspect the system

Vaporizer installation

Flow and pressure calibration

Circuit compliance compensation

Checkout menu

Leak < 250 ml

Machine check

The Machine Check-System checks the Bag/Vent switch, proper gas supply pressures, ventilator operation and leak, battery and electrical power, circuit compliance, and flow control operation. This is a two-step check.