Dräger Cato Instructions For Use Manual

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Cato edition

Anaesthetic Workstation

Instructions for Use

Software versions:

Ventilator: ...................... 7.n

Monitor: ......................... 2.n

MT-439-2000

Working with these Instructions for Use

In the header line... the subject of the main section

The sub-section title is given underneath the main title to help you find your way rapidly through the manual.

Page body Instructions for Use

in text-graphic combination. The information is translated directly into physical actions that teach the user in practical steps how to use the apparatus.

Left-hand column... the text

contains explanations and guides the user in the operation of the product with concise, clear and unmistakable instructions in ergonomic sequence. The bullets (dots) indicate separate steps, and, when several steps are described, the numbers indicate details in the illustrations and also specify the order of action.

Right-hand column... the illustrations

provide a visual reference for the text and make it easier to locate the various parts of the equipment. Details mentioned in the text are highlighted. Irrelevant details are omitted.

The user is also prompted by screen displays which confirm the operating sequence.

Working with these Instructions for Use

Manual / Spontaneous

Before connecting a patient

● Check workstation with checklist (see page 21).

– Check that breathing system is complete

(see page 20) and

– perform leakage test (see page 31).

Select Manual / Spontaneous mode

1 Press »MAN/SPONT« on ventilator for at least one

second –

2 Display in dialogue field:

MAN/SPONT

The standard screen appears with the alarm limits for MAN/SPONT mode.

Spontaneous breathing

»PEEP« and pressure limitation »Pmax« are inactive.

3 Set pressure limiting valve APL to »SPONT«.

It is now open, regardless of the set pressure.

To fill system:

4 Press »O2 +« to inflate the breathing bag rapidly –

5 Set fresh gas –

detailed information on setting the fresh gas flow can be found in the Annex on page 130.

Operation Manual / Spontaneous Select Manual / Spontaneous mode Spontaneous breathing

alarm limits

al. off

curve

list

alarm

info

Man./spont. alarm limits

SpO2 98 67

etCO2 38 MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

N2O 70 68

0.35

PAW

Volumeter 27s

5.5

0.5

Volumeter started. Re-start: confirm !

config

00128971 2402897000137224

Contents

Index 143

Contents

For your safety and that of your patients 4

Quick start in an emergency 7

Operating concept 9

Preparing for use 17

Operation 35

Monitor functions 49

Troubleshooting (messages - cause - remedy) 71

Care 79

Check operational readiness 101

What's what 107

Technical data 115

Descriptions 123

Intended use 5

For Your Safety and that of Your Patients

Strictly follow the Instructions for Use

Any use of the apparatus requires full understanding and strict observation of these instructions. The apparatus is only to be used for purposes specified here.

Maintenance

The apparatus must be inspected and serviced regularly by trained service personnel at six monthly intervals (and a record kept). Repair and general overhaul of the apparatus may only be carried out by trained service personnel. We recommend that a service contract be obtained with DrägerService and that all repairs also be carried out by them. Only authentic Dräger spare parts may be used for maintenance. Observe chapter "Maintenance Intervals".

Accessories

Do not use accessory parts other than those in the order list.

Not for use in areas of explosion hazard

This apparatus is neither approved nor certified for use in areas where combustible or explosive gas mixtures are likely to occur.

Safe connection with other electrical equipment

Electrical connections to equipment which is not listed in these Instructions for Use should only be made following consultations with the respective manufacturers or an expert.

Liability for proper function or damage

The liability for the proper function of the apparatus is irrevocably transferred to the owner or operator to the extent that the apparatus is serviced or repaired by personnel not employed or authorized by DrägerService or if the apparatus is used in a manner not conforming to its intended use.

Dräger cannot be held responsible for damage caused by non-compliance with the recommendations given above. The warranty and liability provisions of the terms of sale and delivery of Dräger are likewise not modified by the recommendations given above.

Dräger Medizintechnik GmbH

For Your Safety and that of Your Patients

Intended use

Anaesthetic Workstation Cato



Universally applicable anaesthetic workstation for

● Inhalation anaesthesia in semi-closed systems

● Inhalation anaesthesia in virtually closed systems with

»low flow« and »minimal flow« techniques for minimum gas and anaesthetic consumption, with:

● Inhalation anaesthesia in non-rebreathing systems

with separate fresh gas outlet for connecting e.g. Kuhn system.

● Automatic ventilation (IPPV)

● Synchronized intermittent mandatory ventilation

(SIMV)

● Manual ventilation (MAN)

● Spontaneous breathing (SPONT)

The workstation must only be used under the supervision of qualified medical staff, so that help is available immediately if any faults or malfunctions occur.

Explosive anaesthetic agents, such as ether or cyclopropane, must not be used due to the risk of fire!

The equipment cannot distinguish between different anaesthetics. Dräger cannot accept any liability if the wrong anaesthetic is used!

Additional electric devices clipped into the top of the unit must be connected to the base unit via an equipotential bonding (earthing) conductor.

Do not use mobile phones within a distance of 10 metres from the machine.

Mobile phones can cause interference to electrical and electronic medical appliances, thereby putting patients at risk.*

Do not use Cato for nuclear spin tomography.

The functioning of the apparatus may be impaired.

Since this equipment is not approved for use with inflammable anaesthetics (ether, cyclopropane, etc.), it is not necessary to use antistatic (conductive) breathing hoses or face masks.

Conductive breathing hoses and face masks may cause burns during high-frequency surgery and are therefore not recommended for this equipment.

The workstation should be moved using the handles only.

* Dräger medical appliances comply with the interference immunity

requirements of the specific standards for the products or EN 60601-1-2 (IEC 601-1-2). However, depending on the design of the mobile phone and situation of use, field strengths may occur in the immediate environment of a mobile phone that exceed the values of the standards quoted and therefore cause interference.

Measurement and monitoring functions:

● Measurement of the ventilation parameters:

pressure, flow, O2 concentration (inspiratory and expiratory)

● Continuous measurement of the CO2 concentration

and N2O/anaesthetic concentration (halothane, enflurane, isoflurane, sevoflurane, desflurane). The flow rate for sampling the measuring gas can be varied and is returned to the circulation.

● Automatic adjustment of the alarm limits for automatic

ventilation IPPV.

● Anaesthetic vaporizer with automatic Vapor

recognition1).

Optional:

❍ Continuous non-invasive measurement of the

functional O2 saturation.

❍ Measurement of the inspiratory breathing gas

temperature.

❍ Expiratory O2 value.

The following values are indicated:

● Continuous curve for airway pressure, peak and

plateau pressure, mean pressure and PEEP.

● Patient compliance.

● Expiratory minute volume, tidal volume and respiration

rate.

● Expiratory flow curve.

● Inspiratory and expiratory O2 concentration.

● Inspiratory and expiratory concentration of N2O and

anaesthetic halothane, enflurane, isoflurane, sevoflurane and desflurane.

● Inspiratory and end-expiratory CO2 concentration

(inCO2 and etCO2).

● Continuous CO2 curve.

● List entries and trend displays.

Optional:

❍ Functional O2 saturation, pulse rate, plethysmogram. ❍ Inspiratory breathing gas temperature. ❍ Expiratory O2 value.

1) Refer to the separate Instructions for Use for the Vapor!

Intended use

Anaesthetic Workstation Cato



The following parameters are monitored:

● Airway pressure.

● Expiratory minute volume.

● Inspiratory O2 concentration.

● Inspiratory and expiratory CO2 concentration.

● Inspiratory anaesthetic concentration.

Optional:

❍ Functional O2 saturation and pulse. ❍ Inspiratory breathing gas temperature with invariable

upper alarm limit.

Accessories

– Patient monitoring

Optional monitor PM 8060 vitara1).

Parameter box for patient monitoring and measurement of the haemodynamic patient values.

● ECG/arrhythmia analysis.

● Pulse rate.

● Respiration.

● Invasive (2 channels) and non-invasive blood

pressure.

● Functional O2 saturation and pulse.

● Body temperature (2 channels).

– Aquapor

for humidifying and heating the breathing gas.

– Secretion aspirator

– Vapor

Anaesthetic vaporiser for halothane, enflurane, isoflurane and sevoflurane.

– Connection for two "Vapor" anaesthetic vaporisers

– Devapor

Anaesthetic vaporiser for desflurane.

– Anaesthetic gas scavenging system

– Uninterruptible power supply

1) Refer to the separate Instructions for Use for this equipment!

Intended use Anaesthetic Workstation Cato



Accessories

Quick start in an emergency

● Plug the gas connectors into the gas supply wall

sockets.

1 The O2, AIR and N2O pressure gauges must be in

the green range.

● Plug the power plug into the mains.

2 Press the master switch.

All the LEDs on the ventilator light up.

3 Press the key for the desired operating mode on the

ventilator –

Recommendation: hold down M for longer than

1 second.

4 The following message is displayed in the display

window of the ventilator:

Test 3 x discont (example)

Number of times that the self-test has been interrupted for a quick start since it was last completed successfully.

● Set the selector switch to »N2O« or »AIR«.

5 Deliver fresh gas.

6 Press O2 flush – if necessary –

to fill the system and the breathing bag rapidly.

7 Switch the pressure limiting valve (APL) to »MAN«.

8 Set maximum pressure. Turn the lever of the pressure

limiting valve clockwise until the indicator (plate) stands at maximum pressure.

No more than ten consecutive quick-starts are allowed between two complete self-tests. This maximum is only permitted if the previous completed self-test revealed no fault. After the 10th consecutive quick-start, the following message appears in the ventilator display window:

last cancel

If a further attempt is made to cancel the self-test and carry out a quick start, the following message is displayed:

COMPLETE TEST

Quick-start not permitted. A complete self-test must be carried out before startup is possible.

However, in all cases, manual ventilation is always possible.

Quick-start can be started at any time, even while a selftest is in progress.

Cato edition

Quick start in an emergency

00237224

Power failure (manual ventilation is still possible)

● The master power switch must be pressed.

The audible power failure warning is muted after 45 seconds.

● Deliver fresh gas and set the pressure limiting valve

(APL). If necessary press the O2 Flush key (»O2 +«).

If there is a power failure, the ventilator piston is forced back to its end position by the airway pressure, thereby increasing the system volume by max. 1.4 litre.

Gas failure

If AIR (medical compressed air) fails

– Cato automatically switches over to O2.

If O2 fails

– Cato automatically switches over to AIR. An audible

warning is emitted (O2 shortage warning). N2O delivery is blocked:

If O2 and air fail:

Ventilate the patient immediately with the separate emergency ventilation bag!

Auto-WakeUp

Manual ventilation cannot be performed in standby mode. Any attempt to perform manual ventilation in standby mode is detected by the system on account of the pressure thrust in the breathing bag and it automatically switches to »MAN/SPONT« mode in which manual ventilation can then be performed. The background lighting of the flow measuring tubes goes on at the same time.

The system is protected against excess static pressures:

The system pressure is relieved automatically if an excess static pressure of more than 30 mbar is present for more than 60 seconds.

Dräger recommends that manual ventilation should always be started by pressing the »MAN/SPONT« key.

Quick start in an emergency Power failure Gas failure Auto-WakeUp

[

Contents

Page

Operating concept, general ................................................................... 10

Master switch for electricity supply .......................................................... 10

Operating concept of the ventilator ...................................................... 11

Keys with dedicated function ................................................................... 11

Display window without dialogue function ................................................ 12

Display window with dialogue function .................................................... 12

Operating concept of the monitor ......................................................... 13

Keys with dedicated function ................................................................... 13

Displays .................................................................................................. 13

Measured values with grey numerals ....................................................... 13

Screen structure ..................................................................................... 14

Screen saver ........................................................................................... 14

Rotary control.......................................................................................... 14

The various screen displays .................................................................... 16

Operating concept

Contents

Operating concept

Operating concept, general

Master switch for electricity supply

Master switch

1 Press to switch on

Dialogue:

Monitor and ventilator feature a dialogue with the user mediated by:

● keys,

● rotary controls,

● displays and

● beeps.

Basic conditions of the operating state are established by adjusting the delivery valves or pressure limitation (e.g. APL valve).

● Keys: For direct command input

● Rotary control:

For selection by ...

... turning

This causes a cursor frame (on the screen) to be moved or a variable numerical value (on the display window of the ventilator or on the screen) to be changed.

... pressing

The value selected with the rotary control is adopted as a valid parameter or a process is started or ended.

● Displays: For presenting all information on the

screen and on the display windows of the ventilator.

● Tone sequences:

As an acoustic supplement to the messages. They are coupled with certain sounds or tone sequences, according to priority classes.

Tone sequences accompanying warnings are output continuously, every 30 seconds with caution messages and only once in conjunction with advisory messages. These are to draw the user's attention to the messages which appear simultaneously in the displays.

European Standard EN 740 stipulates use of EN tones. Alternatively there are tones in keeping with Dräger conventions available.

Operating concept Operating concept, general Master switch for electricity supply

IPPV

MAN

SPONT

003372242432897000328970

Operating concept of the ventilator

Keys with dedicated function – for setting the operating modes

Left-hand side:

Key for manual ventilation or spontaneous breathing.

Key for IPPV mode.

Right-hand side:

Key for leakage test and compliance measurement.

Key for SIMV mode.

Standby key.

for setting ventilation parameters

Below the display window:

Key for setting the maximum pressure for IPPV and SIMV ventilation.

Key for setting the tidal volume.

Key for setting the ventilation frequency in IPPV mode.

Key for setting the time ratio between inspiration and expiration.

Key for setting the relative inspiratory pause.

Key for setting the PEEP pressure for IPPV mode.

Key for setting the ventilation frequency in SIMV mode.

Operating concept

Operating concept of the ventilator

Keys with dedicated function

†

004372240052897000628970

Operating concept Operating concept of the ventilator Display window without and with dialogue function

Display window without dialogue function

Top left:

Continuous indication of the relative piston movement (in % referred to the set stroke volume VT)

The set operating parameters correspond with the keys below:

– Indication of the maximum pressure Pmax in mbar.

– Indication of the tidal volume VT in mL or L.

– Indication of the ventilation frequency fIPPV in breaths

per minute.

Display window with dialogue function

(in combination with the rotary control)

Example: adjusting the maximum pressure

In the black field, beside the rotary control:

1 The set value appears on the right and left-hand sides

of the field when a parameter key (Pmax, VT, fIPPV) is pressed. Here: »23«.

2 The value on the right-hand side is changed by turning

the rotary control. Here: »28«. The old and new values are consequently always displayed together.

3 The value on the right («28«) is confirmed as the

definitive value by pressing the control.

If the rotary control is not pressed and not turned again, the machine is reset after 10 seconds without changing the setting.

● This dialogue window also displays advisory messages

(see page 78) –

Example: »Paed. hoses !«:

23 Pmax / mbar 28

Paed. hoses !

0% 100%

Pmax

600

fIPPV

mbar ml/L 1/min

0072897000828970009289700102897001128970

Operating concept of the monitor

Keys with dedicated function (Hardkeys)

The right-hand side is reserved for operating elements, the left-hand side for displays.

This key switches the monitor from standby to measuring mode and vice versa.

The monitor mode depends on the ventilator mode:

Standby can only be selected on the monitor if the ventilator is also in standby. The monitor starts up when the ventilator is started.

This key is used to deactivate the alarm tone for two minutes. It is reactivated by pressing the key again. The yellow LED in the key lights up while alarms are suppressed.

Inside the dark area, there are two keys acting directly on the screen contents:

This key is used to switch directly from one screen to the next in succession.

This key is always used to call up the »Standard

screen« (see page 57).

Displays

Two bar-shaped indicator lamps are located above the G key: these lamps continue to indicate the alarm states even when the acoustic alam is switched off.

Red (upper) lamp, flashing: Warning !!! Yellow (lower) lamp, flashing: Caution !! Yellow lamp, constant: Advisory !

Measured values with grey numerals

Measured values generated by an uncalibrated sensor are shown in grey type. This may be due to the following causes:

– Self-test has been aborted.

– Automatic sensor calibration is in progress.

– The measuring equipment for the anaesthetic gas

composition has not yet reached the required working temperature when the system is started.

Operating concept

Operating concept of the monitor

Keys with dedicated function, Displays

Measured values with grey numerals

01228970

00537224

01428970

Operating concept Operating concept of the monitor Screen structure, Screen saver Rotary control

Screen structure

● Status field top:

contains information on the current alarm mode of the monitor.

● Alarm field top:

indicates any alarms and their priority.

● Graphic field left:

for curves and bar graphs.

● Measured value field right:

for the most important numerical values.

● Operator prompts bottom right:

prompts to guide the operator.

● Softkeys right:

for rapid selection of the functions displayed on the screen.

Screen saver

If none of the operating elements on the monitor is operated in »standby« for approx. 2 minutes, the screen switches off and becomes dark. The yellow LED in the standby key and the word »standby« on the ventilator light up. The monitor display is immediately restored as soon as any key is pressed.

Rotary control

Selection and adjustment with a single control.

For example: Adjusting the volume of the pulse tone

after calling up the menu of default values via the softkey »config.« in standby (after entering a code).

● Turn rotary control = selection.

The cursor frame moves horizontally in the dashed area.

● Press rotary control = confirm selection.

The selection is confirmed and appears in dark type on a light background. The cursor frame is positioned over the arrow symbol ( z) to the next higher menu.

● Turn rotary control = the cursor frame moves vertically

inside the dashed area.

Select pulse tone.

anaesth. gas

warning calibrating

defaults

Standby / Configuration

Alarms inactive!

anaesth. gas

warning calibrating

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

Standby / Configuration

Alarms inactive!

anaesth. gas

warning calibrating

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

Menu for setting pulse tone volume.

Status field Alarm field

Measured value field

Operator prompts

Graphic field

Softkeys

002289710032897100428971

00528971

01628970

● Press rotary control = confirm selection.

The selection is confirmed and appears in dark type on a light background.

● Turn rotary control = select new setting.

● Press rotary control = confirm selection.

The cursor frame is now on the arrow symbol ( z) to the next higher menu.

● Turn rotary control = select new setting.

Or:

● Press rotary control again = close submenu

»defaults«.

The cursor frame is on the arrow symbol ( z) to the next higher menu.

The current configuration is indicated by the fields with grey background.

● Press rotary control again = exit menu.

Operating concept

Operating concept of the monitor

Rotary control

Standby / Configuration

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

✓

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

Standby / Configuration

Alarms inactive!

anaesth. gas

warning calibrating

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

Menu for setting pulse tone volume.

Standby / Configuration

Alarms inactive!

anaesth. gas

warning calibrating

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

006289710072897100828971

The various screen displays

1 The three different screen displays are invoked by

pressing W.

2 Press Q to return to the standard screen from any

screen display.

The standard screen

with the CO2 curve and another selectable curve. The most important measured values are grouped together on the right.

The data screen

contains all measured values with their units of measure; simplifies the completion of the anaesthesia record.

The trend screen

for displaying the changes in measured values since measurement started. The current measured values are shown on the right.

Operating concept Operating concept of the monitor The various screen displays

alarm limits

auto set vent. al.

list

IPPV alarm limits

alarm

info

10 - 03 - 97 8:00

PAW

peak 37 mbar plat. 30 PEEP 5 mean 20 compliance 15 ml/mbar

MV 6.0 L/min

0.60 L freq 10 1/min AW-temp 38

Fi Fet

SpO

98 67

% 1/min

0 36

29 25

0.8 0.6

70 68

mmHg

Hal.

N2O %

sys-compl. 1.5 from 10-03 leakage 5 8 : 00

config.

alarm

limits

auto set vent. al.

curve

list

config.

alarm

info

IPPV alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

SpO

pulse

AGas

IPPV alarm limits

compl.

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

11:00 12:00 13:00

PAW

full

trend

alarm

limits

009289710102897101128971 02328970

Contents

Page

Connecting the equipment .................................................................... 18

Electricity and gas supply ........................................................................ 18

Auxiliary electrical equipment ................................................................... 18

Anaesthetic gas scavenging system (AGS) ............................................. 19

Anaesthetic agent vaporiser .................................................................... 19

Uninterruptible power supply ....................................................................20

External equipment .................................................................................. 20

Checking readiness for operation with checklist .................................. 21

Vapor ...................................................................................................... 22

Anaesthetic gas scavenging .................................................................... 22

Breathing system .................................................................................... 23

Soda lime ................................................................................................ 23

Emergency ventilation bag ....................................................................... 23

Water traps ............................................................................................. 24

Reserve gas cylinders (optional) .............................................................. 24

Pipelinie gas supply ................................................................................. 24

Gas delivery ............................................................................................ 24

Oxygen Ratio Control (ORC) .................................................................. 25

O2 Flush ................................................................................................. 25

Secretion aspirator (optional) .................................................................. 25

Power supply .......................................................................................... 26

Self-test .................................................................................................. 26

Fresh gas - External outlet (optional) ........................................................ 27

Selecting anaesthetic agent ..................................................................... 28

Automatic calibration of O2/flow sensors ................................................. 29

Manual calibration of the O2 sensor ......................................................... 29

Manual calibration of the flow sensor ....................................................... 30

Ventilator start-up test ............................................................................. 31

Preparing for use

Contents

Preparing for use

Connecting the equipment

The equipment must have been stripped down and tested beforehand!

Electricity and gas supply

1 Plug the power cable into the mains socket.

2 Connect a ground lead for equipotential bonding to

one of the four pins on the rear of the workstation when it is used for intracranial or intracardiac surgery.

The other end must be connected to the specified point in the operating theatre.

3 Screw hoses for O2, AIR and N2O into the rear of the

equipment and plug connectors into the wall sockets.

● Check that the supply pressure is adequate on the

pressure gauges on the front (pointers must be in the green area).

4 Holder for anaesthetic gas scavenging.

Auxiliary electrical equipment

5 Connect to the three auxiliary power sockets

(max. current per socket: 2 A). The auxiliary power sockets are not controlled by the main switch.

If there is a power failure, the auxiliary power sockets will be de-energised, because they are not powered by the uninterruptible power supply (UPS).

Do not connect high-frequency surgery appliances to the auxiliary power sockets.

Do not connect any other multiple sockets, e.g. multiple socket adapters, to the auxiliary sockets.

The connection of equipment to the auxiliary sockets causes an increase in leakage current. The total leakage current in the power line must not exceed 500 uA (EN 60601-1).

6 Sub-D socket for connecting the uninterruptible

power supply (UPS), see page 20. On connection to the Sub-D socket, the UPS can be switched off using the main switch.

The auxiliary power sockets and UPS are not installed in the Cato ceiling version.

Preparing for use Connecting the equipment Electricity and gas supply Auxiliary electrical equipment

04237224

Anaesthetic gas scavenging system (AGS)

● Connect the transfer hose to the scavenging adapter

– first time only, it then remains in place.

1 Insert the scavenging adapter in the breathing system

from below until it engages.

2 Route the transfer hose round the equipment to the

rear.

3 Plug the transfer hose to the port on the collecting

system.

4 Connect the suction hose (sampling hose) to the port

on the collecting system.

5 Connect the anaesthetic scavenging connector to the

sampling hose.

6 Make sure that the second connector on the collecting

system is sealed with the screw plug.

● Follow the specific Instructions for Use of the

anaesthetic gas scavenging system.

Anaesthetic agent vaporiser

The illustration shows a Vapor 2000

● If using the double connector for two Vapors, the

automatic Vapor identification system is disabled.

● Only use Vapors listed in the Order List.

● Follow the specific Instructions for Use of the Vapor.

● For each anaesthetic agent, only use the specified

Vapor.

7 Always insert the sealing plug and

8 secure with lever.

9 Engage control dial at »0« when no fresh gas is set.

10 Always secure the Vapor with the locking lever (turn

lever to the left as far as it will go).

Preparing for use

Connecting the equipment

Anaesthetic gas scavenging system (AGS)

Anaesthetic agent vaporiser

0292897000637224

02828970

Uninterruptible power supply

(optional, see separate Instructions for Use)

Make sure that the status line is connected, so that the uninterruptible power supply (UPS) is controlled by Cato.

In the event of power failure, the machine is powered by the battery of the UPS, but the auxiliary mains socket on the back of the Cato will be de-energised.

However, auxiliary equipment powered by the refrigerator connector on the side of the Cato will still be powered.

1 Plug the power plug of the Cato into the socket of the

UPS.

2 Plug the power plug of the UPS into the mains

socket.

The UPS can supply the Cato and connected auxiliaries with electrical energy for about 45 minutes. It is automatically activated in the event of a power failure.

External equipment

See page 53 for the configuration of the interfaces.

Connection via the protocol interface

3 with data cable for printers with serial interface, e.g.

Desk-Jet (Hewlett-Packard)

e.g. the PM 8060 Vitara Patient Monitor with the MEDIBUS protocol. See page 53 for configuration.

Connection via the Dräger RS 232 C MEDIBUS interface

e.g. to connect the PM 8060 Vitara Patient Monitor.

4 Connect with data cable.

● The equipment plugs must be secured with the

screws provided.

Preparing for use Connecting the equipment Uninterruptible power supply External equipment

USV - Ein / On manuell

S 3 S 4

S 5

S 6

F2 F2 F3 F4

0312897003228970

Checking readiness for operation with checklist

It is assumed that the following conditions have been met:

● The equipment and its accessory parts have been

cleaned and disinfected –

refer to page.......................................... 83 onwards

● The unit is fully equipped for the application in

question –

refer to page.......................................... 89 onwards

● The user has a good knowledge of the Instructions for

Use and has been trained to use the equipment.

● An emergency ventilation bag with appropriate mask is

available on the equipment.

● A checklist is affixed to the equipment.

The equipment must always be checked against the checklist before it is used!

This check is mandatory as specified by EN 740!

Duration: approx. 5 minutes (depending on the scope of calibration).

The equipment is subsequently in »standby« mode when ready for use. Anaesthesia ventilation can immediately be started at any time in this mode –

refer to page.......................................... 36 onwards

● Update the checklist by adding or deleting points

in accordance with the Instructions for Use, the equipment type and configuration concerned and the various supplementary units connected. It will then contain all the requisite checks.

● Enter the model designation and serial number of the

equipment.

● Tick off ✔ the results of the checks in the ACTUAL

column.

● Remember to sign and date the checklist!

Test sequence

– Note any alterations and additions!

– Note the Instructions for Use of the individual units!

– If the checks do not proceed as planned, restore the

required status.

Preparing for use

Checking readiness for operation with checklist

Vapor

The illustration shows a Vapor 2000

1 The control dial is engaged at »0«.

2 Filling level OK – check filling level in viewglass.

– Last inspection less than six months ago.

Safety fill:

3 The sealing plug is inserted and secured with

the lever.

Plug adapter:

– The plug adapter lies horizontally and flush all round

on the sealing rings of the plug connection.

Interlock:

4 Plug-in system is locked – locking lever turned

clockwise until it engages.

Anaesthetic gas scavenging

– Is indicator in wall socket green? (Only when using

Dräger systems; note sounds of gas flow in other cases.)

– Hose connector engaged below breathing system?

– The auxiliary air holes in the tube below the connector

must not be sealed, otherwise the breathing system will be drained!

● Note the separate Instructions for Use for the

anaesthetic gas scavenging system.

Preparing for use Checking readiness for operation with checklist Vapor Anaesthetic gas scavenging

0073722403428970

Breathing system

Lift off table top:

1 Lever set to the position shown in black.

The following are complete:

2 Hose with manual ventilation bag Symbol:

(Connected from below – not shown)

– Correct breathing hoses installed.

(Adult or infant hoses)

3 Pressure measuring hose with filter connected.

4 Measured gas return hose Symbol:

connected.

5 Fresh gas hose plugged in.

(Connected from below – not shown)

6 Valve discs inserted.

– Pressure limiting valve (APL) present.

– Inspiratory microbial filter. Symbol:

– Expiratory microbial filter. Symbol:

Soda lime

7 Lime has not noticeably changed colour (purple).

– Filling level adequate (up to the mark).

– Soda lime container is securely tightened – up to the

end stop (clockwise).

Emergency ventilation bag

(not shown)

– Bag is complete with mask and hung from the side

of the Cato.

– Bag functions correctly.

✔Check and tick off.

Preparing for use

Checking readiness for operation with checklist

Breathing system, Soda lime

Emergency ventilation bag

275

APL

035289700362897003728970

Water traps

1 Water traps are recommended in both the inspiratory

and the expiratory lines during prolonged anaesthesia, low-flow anaesthesia and when using humidified breathing gas.

– Water traps must be fitted at the lowest point in the

hose and hang downwards.

– Check regularly and drain if necessary.

Observe hygiene regulations – risk of infection!

The hose system remains sealed. The container must be replaced securely!

»Tips on reducing condensation« on page 136.

Reserve gas cylinders (optional)

● Open cylinder valves.

✔Check and tick off:

● Pressure indicator on O2 cylinder exceeds 50 bar? –

Pressure indicator on N2O cylinder exceeds 30 bar? –

Replace cylinders if not.

● Close cylinder valves!

Pipelinie gas supply

● Have connectors been pressed right into the wall

sockets for O2, AIR and N2O (not in holding position!)?

✔Check and tick off:

2 Pointers of all three pressure indicators are in the

green range.

Gas delivery

3 Switch over to AIR.

4 Open O2 and AIR delivery valves until more than

9 L/min are indicated!

5 Open N2O delivery valve completely.

✔Check and tick off:

Does N2O measuring tube indicate 0?

3 Switch over to N2O.

✔Check and tick off:

Does N2O measuring tube indicate more than 9 L/min? Does AIR measuring tube indicate 0?

Preparing for use Checking readiness for operation with checklist Water traps, Reserve gas cylinders Pipelinie gas supply, Gas delivery

445

[

0382897000837224

Oxygen Ratio Control (ORC)

1 Slowly close O2 delivery valve –

– check:

the N2O flow decreases to less than 0.8 L/min proportionally with the O2 flow for ORC low-flow, the N2O flow decreases to »O« proportionally with the O2 flow for S-ORC.

2 Switch over to »AIR«.

N2O flow decreases to »O«.

● Close N2O and AIR delivery valve.

O2 flush

3 Press button »O2+« –

– Is there a distinctly audible flow noise?

– Does the manual ventilation bag inflate?

✔Check and tick off!

Secretion aspirator (optional)

4 Open ejector valve –

5 Seal the aspiration holes on aspirator hose with your

finger (or fold over the hose).

Negative pressure indicated approx. – 0.8 bar?

✔Check and tick off!

● Close ejector valve.

Secretion aspirator may only be used in »MAN/SPONT« mode or with disconnected Y-piece.

Preparing for use

Checking readiness for operation with checklist

Oxygen Ratio Control (ORC)

O2 Flush, Secretion aspirator

[

0093722401037224

Power supply

● Equipotential bonding conductor connected?

● Mains plug connected?

1 Switch on equipment –

Press main switch to I.

Self-test

✔Check the signals and tick off the following on the

checklist:

● Lamp and alarm test, in succession:

Ventilator:

– Indication of the software version, all indicators light

up for approx. 2 seconds while a single tone sounds.

Monitor:

– The machine runs through the self-test:

All LEDs and display elements light up for

approx. 2 seconds. The LED in the Standby key E

continues to light up.

– Two alarm tones sound.

– The internal program memories are tested.

– The self-test is completed after approx. 1 minute.

The following display appears on the monitor:

»Self-test«

is displayed on the ventilator.

If the self-test reveals a fault of no relevance to the safety of the equipment and not affecting any of the measuring functions, the following message appears on the monitor:

»Ready within limits«

together with a specific error message (refer to pages 74 onwards). However, the equipment can be operated nevertheless.

● Press the rotary control.

Call DrägerService.

Preparing for use Checking readiness for operation with checklist Power supply Self-test

Technology for life

Cato

SW-Version 2.05

02-05-00

self-test

00137225 0113722404428970

If the self-test reveals a fault impairing the equipment's safety, the following message appears on the monitor:

»Not ready«.

The machine cannot switch to Standby and cannot be switched to measuring mode. DrägerService must be called immediately.

● The configuration menu is displayed after the self-test

(example):

Fresh gas - External outlet (optional)

Fresh gas outlet for connecting to semi-open systems.

1 Fit the hose of the semi-open system to the external

fresh gas outlet.

● Make sure the anaesthetic gas scavenging hose is

connected.

2 Set the desired O2 and N2O flow-rates on the

flowmeter block.

3 Press »MAN SPONT« on the ventilator.

4 The lamp in the »FRESH GAS OUTLET« key does not

light up.

● Check that pressure is building up in the circle system.

4 Switch on the fresh gas outlet –

Press »FRESH GAS OUTLET« key. The lamp in the key lights up.

● Check that pressure builds up in the semi-open

system.

Preparing for use

Checking readiness for operation with checklist

Self-test

Fresh gas - External outlet

Standby / Configuration

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

✓

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

050

0132897101237224

Selecting anaesthetic agent

The machine automatically identifies the newer Vapor models with code for

halothane, enflurane and isoflurane,

sevoflurane and desflurane.

Sevoflurane and desflurane are only identified by equipment built after July 1994 or which has been upgraded.

Uncoded Vapors must be selected via the configuration menu on the monitor.

The setting »no anaesth. gas« must be selected in the configuration menu for ventilation without volatile anaesthetic. This setting is activated automatically if a Vapor is not connected.

The plug-in system of the new Vapor models features an optical code allowing the machine to identify the Vapor:

– when the equipment is started up – when the Vapor is changed during operation.

Incorrect anaesthetics are not detected! However, the user can quite deliberately select a different Vapor instead of that identified automatically. The following advisory message is then displayed in the alarm field on the monitor:

»AGT NOT SEL !«

If the Vapor has not been encoded:

The message

»Vapor not identified«

is displayed in the user advisory field of the configuration menu in »standby« mode.

● Set the appropriate anaesthetic for the Vapor used.

If a Vapor has not been connected:

The message

»Vapor not present«

is displayed in the user advisory field of the configuration menu in »standby« mode.

Preparing for use Checking readiness for operation with checklist Selecting anaesthetic agent

Automatic calibration of the O2/flow sensors

Sidestream calibration of the O2 measurement (O2 sampling) and flow measurement are performed automatically.

Automatic flow calibration is performed during the first breaths after starting ventilation. There is therefore no cause for panic if the measured values for the minute ventilation still appear in grey (i.e. uncalibrated values, see page 13) immediately after the self-test.

CO2 measurement must function correctly before automatic flow calibration can be performed, otherwise the flow sensor must be calibrated by hand.

Manual calibration of the O2 sensor

The O2 sensor must be calibrated by hand if O2 measurement has been set in the inspiratory line (see “Parameters“ on page 53).

Calibrate O2 sensor with 21% O2 by volume = air

– The O2 sensor can be calibrated while flow calibration

is still in progress.

1 Remove the sensor from the inspiratory valve and

expose it to the ambient air – place it on the table and wait at least two minutes.

2 Use the rotary control to select »calibrating« in the

»Standby/Configuration« menu and press to confirm.

● Move the cursor frame to

»O2 sensor 21Vol.%« by means of the rotary control.

● Press rotary control to confirm:

calibration starts.

1 Then plug O2 sensor onto the inspiratory valve again.

✔ Tick off in checklist.

Preparing for use

Checking readiness for operation with checklist

Automatic calibration of the O2/flow sensors

Manual calibration of the O2 sensor

The following symbols are used:

? = Enquires whether an action has been performed

or a setting made.

= Waiting period. The selected test step is being

performed by the machine.

✔ = The action has been completed successfully or

is not required.

Standby / Configuration

Alarms inactive!

calibrating

-sensor

21 Vol.%

flow sensor

Ventilatorstart up test

✓

Calibrate O

sensor after

replacing sensor and after 24 hrs.

Detach O

sensor and expose for 2 min. to ambient air. confirm !

✓

01428971 0472897004828970

Manual calibration of the flow sensor

– The flow sensor can be calibrated by hand while O2

calibration is still in progress, either in the machine or after being removed from the machine.

Without removal:

On the anaesthetic unit:

1 Set AIR/N2O selector to »AIR«.

2 Close the delivery valves for O2 and N2O, open the

delivery valve for air and thoroughly flush the breathing system with air.

3 Close the delivery valve for air.

● Press the rotary control on the monitor to start

calibration.

The question mark (?) disappears and is replaced by a timer icon ( u) on the screen.

A tick ( ✔ ) appears on the screen when calibration has been completed correctly.

✔Tick off in checklist.

The cursor frame has automatically jumped to »Ventilator start-up test«.

With removal:

4 Remove flow sensor:

– Unscrew expiration nozzle

– Remove flow sensor

– Briefly swing it to flush with ambient air

– Hold it horizontally with the cable connection pointing

downwards (calibration in installation position improves the measuring accuracy)

– Seal off one or both sides as shown on the right,

preferably with your thumb or palm.

● Press the rotary control on the monitor to start

calibration; continue as above.

4 Replace flow sensor!

Preparing for use Checking readiness for operation with checklist Manual calibration of the flow sensor

013372240512897005228970

Ventilator start-up test

The ventilator must not be connected to the patient during this test!

Quantitative test to establish the integrity of the anaesthetic system.

The test cannot be performed until O2 and flow calibration is complete and the relevant sensors have been installed in the anaesthetic system.

1 Use the rotary control to select

«Ventilator start-up test« under »Calibrating« in the »Standby/Configuration« menu and press to confirm. (If this has not already been done automatically after O2 and flow calibration).

● Screen display:

On ventilator:

2 Display: Digits 1 to 10 = test blocks during the self-

test –

refer to the flow chart on pages 124/125 for further details.

Messages in the display are accompanied by a brief advisory tone which is repeated every 15 seconds if the operator does not undertake some kind of action on the equipment.

The test pressure is displayed as an analog and digital value.

Display (example):

Preparing for use

Checking readiness for operation with checklist

Ventilator start-up test

Standby / Configuration

Alarms inactive!

calibrating

sensor

21 Vol.%

flow sensor

Ventilatorstart up test

✓

Test ventilator after system start up.

Not possible while operational

✓

Standby / Configuration

Alarms inactive!

60 mbar

Pressure in breathing system

✓

Take note of ventilator information. Confirm at ventilator!

Calibrating

sensor

21 vol.% flow sensor

ventilator start up test

0152897101628971 0532897005528970

The dialogue continues on the ventilator:

1 Test block No. 3 and display:

Fresh gas occl?

3 Close all three delivery valves!

Confirm:

2 Press rotary control on ventilator!

1 Display:

APL = 30 mbar?

4 Set pressure limiting valve to »MAN« and 30 mbar!

Confirm:

2 Press rotary control on ventilator!

1 Display:

Y-piece open?

5 Remove Y-piece from cone or exercise thorax!

Confirm:

2 Press rotary control on ventilator!

1 Display:

Self-test

1 Display:

Ypiece occluded?

5 Plug Y-piece onto cone!

(The sampling line is connected to the Y-piece and the water trap.) Confirm:

2 Press rotary control on ventilator!

1 Display with test block No. 4:

Self-test

The test then continues automatically, block by block:

● wait – approx. 1 minute!

1 Display:

Leaktest IPPV

Preparing for use Checking readiness for operation with checklist Ventilator start-up test

057289700143722405928970

1 Display:

Leak IPPV = xxx mL

If greater than 175 mL/min: Repair leak, particularly for low-flow, or continue if not problematical –

Confirm:

2 Press rotary control on ventilator!

1 Display with test block No. 9:

Leaktest MAN

1 Display:

Self-test

● Wait – approx. 1 minute!

A tick (✔) appears on the screen when the ventilator test has been completed successfully.

The prompt »Confirm« appears.

● Press rotary control on monitor.

The cursor jumps to the arrow symbol on the configuration menu and the vertical pressure indication disappears.

● Press the rotary control on the monitor again to

confirm and exit the configuration menu. Configuration is now complete.

✔Tick off the ventilator self-test and monitor self-test on

the checklist.

Preparing for use

Checking readiness for operation with checklist

Ventilator start-up test

Standby / Configuration

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

✓

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

01728971 06028970

1 Press rotary control on monitor –

The machine changes to »standby« mode and the following display appears (example):

2 On the ventilator:

Standby

»Standby« means that:

– the system can immediately be switched to any

operating mode;

– gas consumption is zero (neither drive gas nor

anaesthetic gas);

– power consumption is marginal;

– the piston cylinder unit is in withdrawal position.

Manual ventilation is not possible in standby mode!

Any attempt to undertake manual ventilation in »standby« mode is immediately detected and causes the system to start operation in MAN/SPONT mode. (»Auto-WakeUp« function, see page 8).

The equipment is now ready for operation!

The monitor and ventilator self-tests have been completed successfully.

✔Tick off in checklist, select the settings required for

the patient and

✔tick off in checklist.

● Remember to sign and date the checklist!

Preparing for use Checking readiness for operation with checklist Ventilator start-up test

erase trend

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

00237225 0622897006428970

Contents

Page

Manual / Spontaneous .......................................................................... 36

Select Manual / Spontaneous mode ........................................................ 36

Spontaneous breathing ........................................................................... 36

Manual ventilation .................................................................................... 37

Manual ventilation following a power failure ............................................. 37

Emergency ventilation following a gas failure ........................................... 37

Fresh gas - External outlet (optional) ........................................................ 38

IPPV ....................................................................................................... 39

Selecting IPPV mode .............................................................................. 39

Adjusting ventilation parameters ......................................................... 39

Automatic compliance correction ........................................................ 40

Ventilation with pressure limitation (PCV) ........................................... 40

Limit settings ...................................................................................... 40

SIMV ...................................................................................................... 41

Selecting SIMV mode ............................................................................. 41

Paediatric use ........................................................................................ 42

Anaesthesia ventilation with the Kuhn system .......................................... 43

Monitoring with reduced alarm limits ........................................................ 44

Checking water traps .............................................................................. 44

at the water separator in the gas sampling hose ................................. 44

in the breathing hoses ........................................................................ 44

Checking the soda lime ........................................................................... 45

Anaesthetic vaporiser .............................................................................. 45

Secretion aspirator (optional) .................................................................. 46

Changing patients ................................................................................... 46

Set machine to »standby« ........................................................................ 48

After use ................................................................................................. 48

Operation

Contents

Operation

Manual / Spontaneous

Before connecting a patient

● Check workstation with checklist (see page 21

onwards).

– Check that breathing system is complete

(see page 23) and

– perform leakage test (see page 31 onwards).

Select Manual / Spontaneous mode

1 Press »MAN SPONT« on ventilator for at least

one second (or press »MAN SPONT« and confirm with the rotary control. Setting by Dräger Service).

2 Display in dialogue field:

MAN/SPONT

The standard screen appears with the alarm limits for MAN/SPONT mode.

Spontaneous breathing

»PEEP« and pressure limitation »Pmax« are inactive.

3 Set pressure limiting valve APL to »SPONT«. It is

now open, regardless of the set pressure.

To fill system:

4 Press »O2 +« to inflate the breathing bag rapidly.

5 Set fresh gas –

detailed information on setting the fresh gas flow can be found in the Annex on page 128.

Operation Manual / Spontaneous Select Manual / Spontaneous mode Spontaneous breathing

alarm

limits

al. off

curve

list

alarm

info

Man./spont. alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

0.35

PAW

Volumeter 27s

5.5

0.5

Volumeter started. Re-start: confirm !

config.

01928971 0652897001537224

Manual ventilation

with breathing bag

»PEEP« and pressure limitation »Pmax« are inactive. The airway pressure is limited via the pressure limiting valve APL.

1 Set pressure limiting valve APL to »MAN« and set

required ventilation pressure: turn valve head.

To fill system:

2 Press »O2 +«.

3 Set fresh gas with O2, N2O or AIR delivery valve –

● start manual ventilation.

Manual ventilation following a power failure

with breathing bag

(Only relevant if the machine is not equipped with an uninterruptible power supply).

In the event of a power failure, the airway pressure pushes the ventilator piston into its limit position, thus increasing the system volume by up to 1.4 litres!

To compensate this:

1 Set pressure limiting valve APL to »MAN« –

3 temporarily increase fresh gas flow

2 press »O2 +«.

3 Set fresh gas with O2, N2O or AIR delivery valve –

● start manual ventilation.

Emergency ventilation following a gas failure

AIR changeover

The ventilator drive and ejector generating a negative pressure in the secretion aspirator are normally supplied with gas from the compressed air supply (AIR). If AIR fails, the system automatically switches over to O2.

N2O lock and O2 shortage alarm

If O2 fails, an O2 shortage is signalled and the supply of N2O disabled. The measuring tube block automatically switches to AIR, regardless of the lever setting.

The patient must immediately be ventilated with the separate emergency ventilation bag if both O2 and AIR fail.

Operation

Manual / Spontaneous

Manual ventilation

Manual ventilation following a power failure

Emergency ventilation following a gas failure

[

01637224

Fresh gas - External outlet (optional)

Only available in "MAN/SPONT" mode

1 Connect the anaesthetic gas scavenging hose, see

page 92.

2 Press »MAN SPONT« on the ventilator.

3 Switch on the external fresh gas outlet –

Press »FRESH GAS OUTLET« The lamp in the key lights up. The circle system is switched off.

● Perform anaesthesia ventilation using the external

fresh gas outlet.

● When switching over to another mode, e.g. IPPV, the

circle system is automatically switched on again. The external fresh gas outlet is then disabled.

4 Monitoring the breathing gas (O2 and anaesthetic

gases) in semi-open mode with aspiration measurement at the fresh gas supply connector of the semi-open system, and with the screen in HLM mode.

Intake measurement is performed without connection to the breathing phase. There is no pressure monitoring.

When switching on and in the event of a power failure lasting longer than 2 minutes, Cato switches automatically to the internal fresh gas outlet.

805

Operation Manual / Spontaneous Fresh gas - External outlet

[

0173722407028970

IPPV

Selecting IPPV mode

Secretion aspirator may only be used in »MAN/SPONT« mode or with disconnected Y-piece.

After switching on, the ventilation parameters set prior to delivery or subsequently programmed by DrägerService are active in IPPV mode.

1 Set the values required for the patient.

Default settings upon delivery of new equipment: (may be altered by DrägerService if requested by customer)

VT Tidal volume 0.6 L fIPPV IPPV frequency 12 breaths/min. Pmax Maximum ventilation pressure 25 mbar TI:TE Inspiration/expiration time ratio 1 : 1.7 TIP:TI Inspiration pause/inspiration

time ratio 10 %

2 Set PEEP – if necessary.

3 Press »IPPV«.

4 Display in dialogue field:

IPPV Mode ?

5 Press rotary control to confirm –

ventilation starts.

The parameters Pmax, VT, fIPPV, PEEP and piston movement are displayed on the ventilator.

The monitor is also started and the IPPV alarm limits are activated.

Adjusting ventilation parameters (Pmax for example):

6 Press »Pmax«.

1 The set value appears in the window above, while

4 the set value (left), the parameter and its unit of

measure (middle) and the value to be adjusted (right) appear in the dialogue window.

5 Turn rotary control:

4 the value on the right changes –

5 continue turning until the required maximum pressure

is reached. Press rotary control to confirm this value –

1 the new value is displayed –

if the new value is not confirmed, it will not be adopted by the system and the display disappears after approx. 10 seconds.

● fIPPV, VT, TI:TE, TIP:TI, PEEP and fIMV are adjusted

like Pmax after pressing the corresponding parameter key.

Operation

IPPV

Selecting IPPV mode

alarm limits

auto set vent. al.

curve

list

config.

alarm

info

IPPV alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

[

02028971 0712897007328970

Automatic compliance correction

Only set the effective tidal volume!

The compliance of the breathing system and of the hoses used is established by the equipment during the self-test or if a leakage test is started manually. The reduction in tidal volume due to system compliance is then corrected automatically during ventilation so that the patient actually receives the set tidal volume.

The leakage test should therefore be repeated whenever changes have been made in the hoses.

The patient must always be disconnected and the system set to »standby« before starting the leakage test! (see page 48 onwards)

A detailed description of automatic compensation of the system compliance can be found in the Annex on page 129.

Ventilation with pressure limitation

When the set maximum ventilation pressure Pmax has been reached, the inspiratory stroke is adjusted so that the pressure remains constant up to the end of inspiration.

The set tidal volume is not fully applied in this case!

1 Display on ventilator:

Pressure limit

2 The bar graph on the ventilator does not reach 100%.

If the pressure increases by more than 5 mbar above the maximum ventilation pressure Pmax, e.g. because the patient coughs, inspiration is immediately stopped and expiration starts.

Limit settings

– Pmax, PEEP

The minimum difference between Pmax and PEEP equals 10 mbar. Settings resulting in a smaller pressure difference are not accepted by the system.

– Max. inspiratory flow

The tidal volume, frequency, I:E ratio and inspiratory pause time cannot be set to values resulting in an inspiratory flow of more than 75 L/min.

– Max. minute volume

The tidal volume and frequency cannot be set to values resulting in a minute volume of more than 25 L/min.

Operation IPPV

[

07428970

SIMV

Selecting SIMV mode

Secretion aspirator may only be used in »MAN/SPONT« mode or with disconnected Y-piece.

In order to prevent the mechanical mandatory ventilation stroke from being applied during the expiratory spontaneous breathing phase, a special trigger ensures that the mandatory ventilation stroke is controlled by the patient and consequently synchronized with spontaneous breathing (this is described in detail on page 133).

PEEP is not active in SIMV mode!

After switching on, the ventilation parameters programmed upon delivery are active in SIMV mode.

The ventilation parameters of the preceding mode remain active when changing from IPPV to SIMV mode and vice versa!

Settings upon delivery of new equipment:

VT Tidal volume 0.6 L fIMV IMV frequency 12 breaths/min. Pmax Maximum ventilation pressure 25 mbar TI:TE Inspiration/expiration time ratio 1 : 1.7 TIP:TI Inspiration pause/inspiration

time ratio 10 %

If the ventilation frequency is equal to or greater than 6 breaths per minute in »SIMV« mode, the IPPV alarm limits become active and the alarm mode »IPPV alarm limits« is automatically displayed on the monitor.

If the ventilation frequency is less than 6 breaths per minute in »SIMV« mode, special SIMV alarm limits become active and the advisory message »SIMV alarm limits« flashes in the status field of the monitor for five seconds. This message does not require confirmation.

When setting frequencies of more than 5 breaths per minute, the system automatically reverts to the IPPV alarm limits and indicates this on the monitor. The ventilation parameters are adjusted in the same way as in IPPV mode:

1 Press »SIMV«.

2 Display in dialogue field:

SIMV Mode ?

3 Press rotary control to confirm –

ventilation starts.

The parameters Pmax, VT, fIMV, PEEP and piston movement are displayed on the ventilator –

the monitor is also started and the alarm limits for SIMV are activated. Refer also to the chapter describing the »Alarm concept« on page 65.

Operation

SIMV

Selecting SIMV mode

[

07528970

Paediatric use

Infant hose set

Infant hoses must be used for ventilation volumes of less than 200 mL.

If a breathing gas humidifier is used, water traps must be installed at the lowest points of the breathing hoses on both the inspiratory and the expiratory side.

Avoid pressure peaks

The fresh gas is stored in the breathing bag during inspiration. The pressure built up in the breathing bag when working with high flow rates and long inspiration times may be higher than the end-inspiratory pressure in the patient, particularly when using a 0.5 L breathing bag.

Even at a fresh gas flow of 4 L/min, a pressure peak may arise at the beginning of the expiration phase as fresh gas streams out of the breathing bag. This is particularly possible in combination with long inspiration times and can be avoided by reducing the fresh gas flow or using a 1.5 L breathing bag.

The adjustment intervals and metering accuracy for the tidal volume VT depend on the selected range.

The system must calculate its new system compliance following a change of hoses.

The patient must be disconnected for this purpose and the leakage test started!

(see overleaf)

The ventilation parameters are adjusted in the same way as in IPPV mode.

If a tidal volume of less than 200 mL is selected from a higher setting, the system automatically generates the

1 display:

Paed. hoses !

● Fit infant hoses –

2 press rotary control to confirm.

Operation Paediatric use

[

Range Interval Metering accuracy

< 20 mL 1 mL ± 30% or ± 6 mL

20 to 50 mL 2 mL ± 10% or ± 10 mL

50 to 100 mL 5 mL ± 10% or ± 10 mL

100 to 990 mL 10 mL ± 5% or ± 15 mL

1 L to 1.4 L 0.01L ± 5% or ± 15 mL

0762897007728970

Then switch to »standby« (see page 48) and call up the leakage test so that the new compliance can be calculated.

Invoking the leakage test

1 Press »TEST« on the ventilator for at least three

seconds.

2 Display in dialogue field on ventilator:

Leaktest IPPV

followed by:

Leak IPPV = xx mL

The calculated leakage and compliance values are saved and displayed on the data screen.

The manual ventilation bag and its hose are not included in the test!

The system switches back to »standby« after the test.

Anaesthesia ventilation with the Kuhn system

If the machine does not have an external fresh gas outlet (optional - see page 38), anaesthesia ventilation with the Kuhn system is performed as follows.:

● Prepare the Kuhn set in accordance with separate

Instructions for Use –

● connect anaesthetic gas scavenging hose

(see page 92).

3 Press »MAN/SPONT« on ventilator for at least one

second –

4 set pressure limiting valve APL to »MAN«.

● Connect inspiration hose via

5 connecting sleeve – Symbol:

6 Expiration connector remains open – Symbol:

7 Seal manual ventilation connector

with cap. Symbol:

The pressure indicated on the monitor is not identical with the actual airway pressure. Reason: higher flow resistance of the fresh gas hose in the Kuhn system. The higher the fresh gas flow, the greater the difference.

8 The anaesthetic and O2 concentration must be

monitored by means of intake measurement with the monitor in HLM mode.

Operation

Paediatric use

Anaesthesia ventilation with the Kuhn system

078289700792897008028970

Monitoring with reduced alarm limits

The »IPPV alarm limits« are automatically activated on the monitor when a ventilation frequency equal to or greater than 6 breaths per minute is set in »IPPV« and »SIMV« modes.

The »SIMV alarm limits« are automatically activated on the monitor if a ventilation frequency of less than 6 breaths per minute is set in »SIMV« mode.

The »MAN/SPONT alarm limits« are automatically activated on the monitor in »MAN/SPONT« mode. This prevents false alarms (see »Alarm concept«, page 65 onwards).

Checking water traps

WaterLock

(refer also to the separate Instructions for Use)

When fouled or if CO2 LINE ? ! is output although the sample line is clear.

● Replace water trap:

– when severely fouled,

– if the error message persists even after draining the

water trap,

– when the maximum service period of four weeks is

exceeded.

● Grasp the ribbed sides of the water trap and draw it

out.

● Remove a new water trap from the package.

● Enter the date in the field provided on the water trap.

● Grasp the ribbed sides of the water trap and slide it

into the holder – until it tangibly engages.

● Empty water trap:

● Insert an empty syringe without cannula, at least

20 mL, into the connector.

● Extract the water, remove syringe and dispose of the

full syringe as ordinary domestic waste.

● Push water trap back into holder – until it tangibly

engages.

Disposal:

● Water traps which have been dismantled must be

disposed of as ordinary commercial waste. Waste code number 91101.

Operation Monitoring with reduced alarm limits Checking water traps

0183722404137224

in the breathing hoses

– Water traps must be fitted at the lowest point in the

hose and hang downwards.

– They must be checked regularly and drained if

necessary.

Note hygiene regulations – risk of infection!

The hose system remains sealed. Container must be replaced securely.

"Tips on reducing condensation“, see page 136.

Checking the soda lime

The soda lime turns purple from the bottom upwards when saturated with CO2. To monitor CO2 absorption, the FiCO2 value is displayed in "data screen" mode. An alarm limit of 5 mmHg is set for monitoring CO2 absorption. The soda lime must be changed when two-thirds of the charge has changed colour! The colour may also fade again due to drying out after prolonged breaks.

Changing soda lime during operation

(see also page 91)

● Prepare a replacement soda lime container.

● Occlude the Vapor and stop N2O delivery.

● Set ventilator to »MAN/SPONT« and the pressure

limiting valve to »SPONT«.

1 Briefly turn the soda lime container anticlockwise and

pull it downwards.

● Insert the replacement soda lime container from

below and turn clockwise as far as possible.

● Gas and machine settings may be cancelled.

● Remove spent soda lime from the container.

Note hygiene regulations when dealing with infectious patients – risk of infection!

Operation

Replace water separator

Checking the soda lime

[

– MAX –

08428970

[

08228970

Anaesthetic vaporiser

The illustration shows a Vapor 2000.

– Control dial with scale in % anaesthetic agent by

volume.

– »0« button – engages in zero position »0«.

– Locking lever – Vapor is locked onto the plug adapter.

Metering anaesthetic agent:

1 Press »0« button and turn control dial anticlockwise –

until required setting is reached.

If Vapor has to be removed – turn control dial to »T«. Swing locking lever forwards – Vapor can now be removed.

Secretion aspirator (optional)

To prevent negative pressures in the breathing system and in the patient's lungs, we recommend that you only carry out suction with the Y-piece disconnected from the patient tube.

2 Open ejector valve –

3 cover the »Fingertip« with your index finger.

● The aspiration capacity can be adjusted very

accurately with the aid of auxiliary air on this surface.

– Check filling level of aspiration vessel regularly and

drain if necessary.

Note hygiene regulations – risk of infection!

Operation Anaesthetic vaporiser Secretion aspirator (optional)

466

[

0193722402037224

Changing patients

Changing parts

Refer to page 83 onwards for a schematic overview and description of methods for cleaning and disinfection.

Maintenance intervals: page 106.

● Machine in »standby« mode –

● Vapor: control dial set to »0« = Off.

The T-piece and filter are not required when using a Y-piece with Luer lock.

After treating an infectious patient

the entire machine must be cleaned, disinfected and sterilized.

Note hygiene regulations – risk of infection!

After treating a non-infectious patient

the following parts must be replaced before continuing with the next patient:

● Tube or mask

● Y-piece

● Both breathing hoses

● Temperature sensor and cable if applicable

1 T-piece of the measured gas hose and filter, if used

(disposable articles, household refuse)

2 Drain:

Insert an empty syringe without cannula, at least 20 mL, into the connector.

● Extract the water, remove syringe and dispose of the

full syringe as ordinary domestic waste.

● Push water trap back into holder – until it tangibly

engages.

An overfull container or a faulty water trap could lead to failure in sidestream measurement.

The following must also be changed when working without microbial filter:

3 O2 sensor with connecting lead, if used.

4 Flow sensor.

Disconnect lead from flow sensor, it remains on the machine.

● Breathing bag with hose

● Breathing system:

Disconnect fresh gas hose, it remains on the machine.

● Pressure measuring hose and filter: must be replaced.

Hose connector remains on the machine.

● Soda lime container – turn anticlockwise and pull

down – must be replaced.

● Anaesthetic gas scavenging hose – release (latch in

front of connector) and pull off, also at the central supply point.

Operation

Changing patients

[

08728970021372240892897009028970

Set machine to »standby«

In »standby« mode,

– the system can immediately be switched to any

operating mode,

– gas consumption is zero,

– power consumption is marginal and

– the piston cylinder unit is in withdrawal position.

1 Press A on the ventilator for at least three

seconds.

2 Display

Standby

The flow tubes are no longer lit up.

The monitor remains operational and should be set to »standby« by pressing E if not required.

The monitor can only be switched to standby if the ventilator is already in standby!

During breaks:

● Set fresh gas flow to »O«.

● On Vapor: set control dial to »0«.

After use

If operation is interrupted for several hours, we recommend that you do not leave the Cato in »Standby« mode but switch it off completely.

● Turn the master switch to »O« = Off –

the switch symbol is no longer white. After switching off, an OFF delay displays the message »Power off« in the Ventilator display for about 10 seconds.

● Disconnect the gas hoses from the wall sockets, or

close the cylinder valves of the gas cylinders.

● Roll up hoses and hang them over the holder at the

back of the machine.

● Disconnect the mains plug.

Operation Set machine to »standby« After use

erase trend

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

00337225 09128970

Contents

Page

Screen saver ........................................................................................... 50

Standby screen ....................................................................................... 50

Configuring monitor functions in »standby« .......................................... 51

Invoking the configuration menu .............................................................. 51

Changing default values .......................................................................... 51

Pulse tone, alarm tone, mode .................................................................. 52

Parameters, record, interfaces ................................................................ 53

Alarm limits, curves, basic configuration .................................................. 54

Calibration .............................................................................................. 55

Alarms, anaesthetic agent ....................................................................... 56

Monitor functions during operation ....................................................... 57

Changing to measuring mode from »standby« ......................................... 57

Select standard screen, select data screen ............................................. 57

Select trend screen with zoom function ................................................... 58

Other trend combinations ................................................................... 59

Return to full trend ............................................................................. 59

Erase trend memory ........................................................................... 59

Softkeys ................................................................................................. 60

Displaying and setting alarm limits during operation ................................. 60

Activate and deactivate CO2 alarms ........................................................ 61

Auto set/Ventilation alarm ........................................................................ 61

Alarm information .................................................................................... 62

Select list screen .................................................................................... 62

Select curves .......................................................................................... 63

Using the volumeter function .............................................................. 63

Configuration during operation ................................................................ 64

Alarm concept ....................................................................................... 65

Alarm priority ........................................................................................... 65

Displaying all alarms ........................................................................... 66

Suppressing the alarm tone ................................................................ 66

CO2 alarm on/off .................................................................................... 66

Adjusting to the ventilation mode ............................................................. 67

Heart/lung mode (HLM) .......................................................................... 68

Monitor functions

Contents

Monitor functions

Screen saver

If none of the operating elements on the Cato is operated in »standby« for approx. 2 minutes, the screen switches off and becomes dark. The yellow LED in the standby key and the word »Standby« on the ventilator light up. The monitor display is immediately restored as soon as any key is pressed.

Standby screen

The »standby« screen contains two softkeys with which to invoke menus for

– erasing the trend and list memory,

– monitor configuration.

Erase trend

e.g. for a new patient: The trend memory and list are erased together! This is only possible in »standby«!

● Press E on the screen in order to switch to

»standby«. This is only possible if the ventilator is also on »standby«!

● Press the softkey »erase trend«.

The system enquires again whether the trend is indeed to be erased.

● Press the softkey »erase« to confirm.

The former screen is restored without change if the softkey »Do not erase« is pressed.

The saved anaesthetic concentration trend is erased when changing the anaesthetic vaporizer!

Monitor functions Screen saver Standby screen

erase trend

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

Do not

erase

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

erase trend

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

004372250053722500637225

Configuring monitor functions in »standby«

Invoking the configuration menu

● The configuration menu is called up by pressing the

softkey »config«.

Configurations which are set under »defaults« in »standby« mode remain active whenever the machine is switched on again.

All other configurations, on the other hand, only apply temporarily.

The screen shown alongside appears on the monitor:

The – defaults, – calibration, – alarms and – anaesthetic gas can be altered with this menu.

These settings are always called up and changed in the same way:

● Turn rotary control

to displace the cursor frame.

● Press rotary control

to confirm the selection made with the cursor frame.

● Fields with grey background

represent the currently valid settings.

● Fields with white background

show the menu steps via which the momentary field was reached.

● The arrow (

)

means return to the preceding menu level.

Changing default values

● Turn rotary control on monitor until the cursor frame is

located over »defaults«.

● Press rotary control.

The operator is then prompted to enter a four-digit password (specified during the initial training) in order to prevent unauthorized changes to the basic functions. This function can be deactivated by DrägerService.

● Use the rotary control to select and confirm individual

numbers from the line displayed below. The password is represented by asterisks ( * * * ) below the line. When the correct password has been entered, the cursor frame jumps to the selection field for the default values.

Monitor functions

Configuring monitor functions in »standby«

Invoking the configuration menu

Changing default values

erase

trend

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

Standby / Configuration

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

✓

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

Standby / Configuration

Alarms inactive!

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

warning

default

✓

calibrating

-sensor

21 Vol.%

flow-sensor

Ventilator start up test

✓

defaults

These default settings are password protected. The default settings are active on start-up.

To change the default settings enter the password:

0 1 2 3 4 5 6 7 8 9

* * *

007372250262897102728971

The vertical selection area is displayed.

The menu for configuring the defaults appears with settings:

– pulse tone for setting the volume of the pulse tone.

– alarm tone for setting the volume of the alarm tone.

– mode for changing over between adult and

neonate mode.

– parameters for setting the measuring functions.

– record for setting the list entries and printer

output.

– interfaces for setting the parameters for data

transfer.

– alarm limits for selecting the alarm limits.

– curves for selecting the curve display.

– basic config. for setting the date, time, language

and tone.

Pulse tone

The volume of the pulse tone is set here.

»0« corresponds to OFF, »1« is the lowest volume and »9« the highest volume.

The tone is generated at the corresponding volume as it is adjusted.

Alarm tone

The volume of the alarm tone is set here.

»1« is the lowest volume and »9« the highest volume.

The tone is generated at the corresponding volume as it is adjusted.

Mode

This function is used to change over between adult and neonate mode:

– adult Adult mode

– neo Neonate mode

The volumeter functions and trend displays are scaled at the same time.

Monitor functions Configuring monitor functions in »standby« Changing default values Pulse tone, Alarm tone, Mode

Standby / Configuration

Alarms inactive!

Check ventilator !

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9

mode adult Neo.

parameters record interfaces alarm limits curves basic configuration

Standby / Configuration

Alarms inactive!

Check ventilator !

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

Standby / Configuration

Alarms inactive!

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits

Standby / Configuration

Alarms inactive!

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9

mode adult Neo. parameters record interfaces alarm limits

02828971029289710302897103128971

Parameters

The settings for the following parameters are defined via this menu:

– SpO2-measurement on • off

– sidestream

measurement O2 on • off

– sample rate 60 • 200 mL/min

– CO2 units mmHg • kPa • % by volume

Record

This menu is used to define which event triggers an automatic entry in the record list or printout on the on-line printer:

– time intervall Entry upon expiry of a fixed time

interval in minutes.

– NiBP started Entry after every NiBP

measurement with new results.

– warning started Entry is made whenever a warning

has been triggered.

– caution started Entry is made whenever a caution

has been triggered.

Interfaces

The interface for data transfer (Dräger MEDIBUS RS 232) and the printer port are configured here:

– baud rate Transmission rate (can be varied,

see Instructions for Use of the device to be connected)

– parity Cannot be changed in MEDIBUS and

is merely displayed for information.

– data bits Cannot be changed in MEDIBUS and

is merely displayed for information.

– stop bits Cannot be changed in MEDIBUS and

is merely displayed for information.

– protocol Allows the printer port to be used as

a second MEDIBUS interface.

Monitor functions

Configuring monitor functions in »standby«

Parameters, Record, Interfaces

Alarms inactive!

anaesth. gas

warning calibrating

Menu for configuration of Medibus and printer ports.

Standby / Configuration

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record

interfaces

alarm limits curves basic configuration

RS 232 (Medibus) : baud rate

1.2 9.6

parity even data bits 8 stop bits 1

record (printer) protocol

printer Medibus

baud rate 1.2 2.4 4.8 9.6 19.2 parity odd even none data bits 7 8 stop bits 1 2

Standby / Configuration

anaesth. gas

warning calibrating

SpO2 - measure. on off sidestream measurement O

2 on off

sample rate 60 200 mL/min CO2 units mmHg kPa Vol%

Menu for configuration of measurement-parameters.

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo.

parameters

record interfaces alarm limits curves basic configuration

Alarms inactive!

anaesth. gas

warning calibrating

Menu for configuration of list and print entries.

Standby / Configuration

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters

record

interfaces alarm limits curves basic configuration

list entry time

1 2 5 10 off

intervall NiBP started

on off

warning started on off caution started on off

printer entry time

1 2 5 10 off

intervall NiBP started

on off

warning started on off caution started on off

032289710332897103428971

Alarm limits

This menu is used to specify the standard alarm limits.

These alarm limits are automatically active after

– switching on the Cato,

– selecting »default«.

Two dashes (– –) in the table mean that this alarm limit is inactive and not monitored. It can be activated by turning the rotary control beyond the maximum or minimum value possible and confirming it.

Curves

This menu is used to specify the standard curves.

These curves are automatically active after

– switching on the Cato.

Basic configuration

The basic configuration comprises four items:

– time for the current time

– date for the current date

– language for the language version

The same language version is also used by the ventilator.

The following languages are available:

English GB French F German D Dutch NL Italian I Spanish E

– tone- for selecting the tone sequences for

sequence warnings, cautions and advisories.

Monitor functions Configuring monitor functions in »standby« Alarm limits, Curves Basic configuration

Standby / Configuration

Alarms inactive!

anaesth. gas

warning calibrating

Menu for setting default alarm limits.

-95

40 30

120

3.0

-20

0.6

0.0

SpO

etCO

FiO2

FiHal.

PAW

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces

alarm limits

curves basic configuration

Standby / Configuration

anaesth. gas

warning calibrating

Menu for configuration of screen displays.

default-curve IPPV PAW FLOW Volumeter

Pleth. O

default-curve PAW FLOW Volumeter Man./Spont.-SIMV Pleth. O2

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits

curves

basic configuration

Alarms inactive!

anaesth. gas

warning calibrating

Menu for setting time, date, language and tone sequence.

Standby / Configuration

defaults

pulse tone

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves

basic configuration

time

08 : 15

date 10- 03 - 97 language GB F D NL I E tone-sequence Dräger Euro

035289710362897103728971

Calibration

This menu is used for the following tests and calibrations:

– Calibrate O2-sensor with 21 Vol.% O2

– Calibrate flow sensor

– Perform Ventilator start up test

– more

The following can be realized under »more«:

–O2 sensor calibration with 100% O2 by volume,

– linearity check of the O2 sensor and

– calibration of the CO2 sensor.

The significance of the symbols is as before:

? = Enquires whether an action has been performed

or a setting made.

= Waiting period. The selected test step is being

carried out by the system.

✔ = The action has been completed successfully or

is not required.

Monitor functions

Configuring monitor functions in »standby«

Calibration

Standby / Configuration

Alarms inactive!

calibrating

-sensor

21 Vol.%

flow sensor

Ventilatorstart up test

✓

Calibrate O

sensor after

replacing sensor and after 24 hrs.

Detach O

sensor and expose for 2 min. to ambient air. confirm !

✓

Standby / Configuration

Alarms inactive!

calibrating

sensor

21 Vol.%

flow sensor

Ventilatorstart up test

✓

Only necessary if the automatic calibration fails (INOP instead of values).

With the flow sensor in place, flush with air. Close flowtubes or remove flowsensor and hold horizontally with both ends closed.

confirm !

✓

Standby / Configuration

Alarms inactive!

calibrating

sensor

21 Vol.%

flow sensor

Ventilatorstart up test

✓

Test ventilator after system start up.

Not possible while operational

✓

038289710392897104028971

Alarms

The standard alarm limits are activated by selecting and confirming the field »defaults«. The individual settings in the »limits« menu are then overwritten.

Anaesthetic agent

The anaesthetic vaporizer is automatically recognized by the Cato on account of an optical code. However, sevoflurane and desflurane vaporizers are only recognized by equipment built after July 1994 or which has been converted by DrägerService. The anaesthetic agent concerned is then highlighted by a grey background.

The machine can only recognize the Vapor, but not the anaesthetic agent!

The user is responsible for ensuring that the correct agent is used!

If the anaesthetic vaporizer does not feature an optical code which can be read electronically (older models can be upgraded by DrägerService on request), the anaesthetic agent must be selected by hand:

● Move the cursor frame to the required anaesthetic

agent with the aid of the rotary control.

● Press the rotary control to confirm.

The stored trend for the anaesthetic agent concentration is automatically erased when changing the anaesthetic vaporizer!

Monitor functions Configuring monitor functions in »standby« Alarms, Anaesthetic agent

Standby / Configuration

✓

warning

default

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

Standby / Configuration

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

warning

default

0412897104228971

Monitor functions during operation

Changing to measuring mode from »standby«

● The monitor automatically changes to measuring

mode when »standby« mode is deactivated on the ventilator or a ventilation pattern is set (»IPPV«, »SIMV«) or »MAN/SPONT«.

1 Press »standby« E on the monitor; the yellow LED

goes out.

● The standard screen with the basic parameters of

importance for anaesthesia ventilation is displayed on the monitor.

The data screen and the trend screen with zoom function can also be selected. These screens are described below.

Select standard screen

The standard screen can be selected at any time:

2 Press Q on the monitor.

Select data screen

to display all measured values.

3 Press W (repeatedly) until the data screen is

displayed.

● Display (example):

The airway pressure Paw is continuously indicated by the bar graph on the left-hand side of the screen.

Monitor functions

Monitor functions during operation

Changing to measuring mode from »standby«

Select standard screen, Select data screen

alarm

limits

auto set vent. al.

list

IPPV alarm limits

alarm

info

10 - 03 - 97 8:00

PAW

peak 37 mbar plat. 30 PEEP 5 mean 20 compliance 15 ml/mbar

MV 6.0 L/min

0.60 L freq 10 1/min AW-temp 38

Fi Fet

SpO

98 67

% 1/min

0 36

29 25

0.8 0.6

70 68

mmHg

Hal.

N2O %

sys-compl. 1.5 from 10-03 leakage 5 8 : 00

config.

alarm limits

auto set vent. al.

curve

list

config.

alarm

info

IPPV alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

0432897104428971 0223722402337224

Select trend screen with zoom function

This screen presents the development of measured values over time since measurement commenced.

Values can be saved for a maximum of eight hours.

The following combinations can be displayed: –CO2 / AMV – Agas / N2O –O2 / Compliance – SpO2 / Pulse rate

1 Press W (repeatedly) until the trend screen is

displayed.

Example:

(The bottom softkey »full trend« is only available here)

The zoom function can also be called up when the equipment has been in operation for more than 30 minutes. This function makes it possible to magnify part of the time range (possibly several times). The magnified section is marked by a dashed border. The past is on the left.

Example:

● Turn rotary knob – the dashed area moves until it

includes the interval of interest.

● Press rotary knob – the dashed area is enlarged to

the full display width.

When the monitor has been in operation for a sufficiently long time, a new dashed area appears and can be extended as described above.

The maximum has been reached when no new dashed border appears.

Monitor functions Monitor functions during operation Select trend screen with zoom function

SpO

pulse

AGas

IPPV alarm limits

compl.

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

11:00 12:00 13:00

PAW

full

trend

alarm

limits

SpO

pulse

AGas

IPPV alarm limits

Zoom locate: select ! Increase: confirm !

compl.

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

11:00 12:00 13:00

PAW

full

trend

alarm

limits

0452897104628971 02437224

Show other trend combinations

● Press the corresponding softkey, in this case

»Agas/N2O«; the combination is then set against a light background and the new trend curves appear on the screen.

The softkey remains blank if a measuring function (e.g. SpO2 measurement) is not available.

Return to full trend

● Press the softkey »full trend« in order to restore the

complete trend display.

Erase trend memory

The trend memory and list are erased together! This is only possible in »standby« mode!

● Press E on the monitor in order to switch to

»standby«. This is only possible if the ventilator is already on »standby«!

● Press the softkey »erase trend«.

The system enquires again whether the trend is indeed to be erased.

● Press the softkey »erase« to confirm.

The former screen is redisplayed without changes if the softkey »Do not erase« is pressed.

The saved anaesthetic concentration trend is erased when the anaesthetic vaporizer is changed!

Monitor functions

Monitor functions during operation

Select trend screen with zoom function

alarm

full

trend

AGas

IPPV alarm limits

Zoom locate: select! Increase: confirm!

compl.

etCO

AMV 6.0 Freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

N2O

Isoflurane

11:00 12:00 13:00

PAW

<18

SpO

pulse

limits

SpO

pulse

AGas

IPPV alarm limits

Zoom locate: select ! Increase: confirm !

compl.

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

11:00 12:00 13:00

PAW

full

trend

alarm limits

erase

trend

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

Do not

erase

Select ventilation mode at the ventilator or switch on screen by pressing

Standby

Cato

SW-Version 2.05

02-05-00

config.

04728971048289710083722500937225

Softkeys

Displaying and setting alarm limits during operation

This can be done in all screens.

– So that measured values can be displayed together

with their associated alarm limits.

– So that alarm limits can be corrected in line with

changed values.

● Invoked via the softkey »alarm limits«.

The display comprises the designation of the measured value (etCO2 in this example), the value actually measured on the patient in large numerals (38 in this example) and the set upper and lower alarm limits as small numerals following the symbol for alarm limits (

A deactivated alarm limit is indicated by two dashes in the numbers field.

The set limit values only apply temporarily! They are overwritten by the standard alarm limits when

– the Cato is switched off;

– the setting »default« is selected and confirmed under

»warning«.

To change alarm limits:

● Move the cursor frame to the value for the required

alarm limit with the rotary control and press to confirm.

● The value can then be altered by turning the rotary

control until the required value has been obtained.

● The value is confirmed by pressing the rotary control –

this value now represents the active limit.

The active alarm limits are shown as a dashed line in the graphs displayed on the monitor.

See page 65 for information on adjusting alarm limits.

Monitor functions Softkeys Displaying and setting alarm limits during operation

curve

list

IPPV alarm limits

PAW

alarm

info

auto set vent. al.

SpO

etCO

MV 6.0

FiO

FiHal. 0.8

PAW

-95

40 30

3.0

-20

1.0

0.0

120

alarm limits

Set limits ! confirm !

config.

etCO2 38

– –

05128971

Activate and deactivate CO2 alarms

In »MAN/SPONT« monitoring mode, the alarm limits for inspiratory and expiratory CO2 are deactivated; only the CO2-apnoea alarm is active. This alarm can also be deactivated by pressing the »CO2 al. on/off« key.

In this case, there will be no CO2 monitoring at all.

The CO2-apnoea alarm can be reactivated by pressing the key again.

The CO2 alarms are automatically activated on changing to »IPPV« or »SIMV« monitoring mode with a ventilation rate above 6 breaths/min.

The alarms remain deactivated when changing to »HLM« mode or »SIMV« with a ventilation rate of up to 6 breaths per minute.

When the CO2 alarm is activated, the inspiratory CO2 concentration of the breathing air is monitored with an invariable upper limit of 5 mmHg.

Auto set/Ventilation alarm

Prerequisite: The ventilator must be in »IPPV« mode

The ventilation alarms with new alarm limits can be automatically adjusted to the current ventilator settings by pressing the softkey »auto set vent. al.«.

The alarm limits previously set in the »limits« menu are erased and cannot be reactivated! See also »Alarm concept« on page 65.

The new tolerance ranges generated for the current measured values depend on the parameter in question:

The default alarm limits are not affected by Auto set and can be reactivated at any time via the functions »config«, »warning« and »defaults«. Deactivated alarm limits (– –) are not activated by Auto set!

Monitor functions

Softkeys

Activate and deactivate CO2 alarms

Auto set/Ventilation alarm

Parameter New measured value tolerance Unit

Lower Upper

aw PEEP + (Pmax- PEEP) / 4 Pmax + 10 mbar

AMV V

f * 0.6 VT * f * 1.4 L/min

but always: over 0.5 over 2.0

alarm

limits

al. on

curve

list

alarm

info

Man./spont. alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

config.

alarm limits

curve

list

alarm

info

IPPV alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

config.

auto set

vent. al.

Standby / Configuration

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

✓

calibrating

-sensor

21 Vol.%

flow sensor

Ventilator start up test

Alarms inactive!

defaults

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record interfaces alarm limits curves basic configuration

warning

default

052289710532897105428971

Alarm information

● The measured value field is erased and all active

alarms listed when this softkey is pressed.

The display can only be viewed as long as the key is pressed.

Select list screen

For retrospective documentation of former measured values and alarms. Generation of list entries is described in the section »record« on page 53.

On the standard screen,

● press the softkey »list«.

● The display changes and the list appears on the

screen (example):

Return to previous page:

● Select »previous page« and confirm.

Move to next page:

● Select »next page« and confirm.

Erase list:

● Press »standby« key E and softkey »erase trend«.

Press new softkey »erase« in response to system enquiry.

Monitor functions Softkeys Alarm information Select list display

IPPV-alarm limits

next page previous page

warning time HR/pulse NiBP/mmHg SpO2 etCO2 MV O2 AGas PAW sys/m/dia Fi/Fet Fi/Fet peak/Peep

% HAL HIGH !!! 12:13 65 99 40 6.0 30/26 1.6/0.6 33/10 % O2 LOW !!! 12:15 65 98 38 5.9 25/20 0.8/0.7 30/10 12:16 66 99 40 6.1 30/26 0.8/0.7 30/10

alarm limits

al. off

curve

list

alarm

info

Man./spont. alarm limits

SpO

98 67

etCO

MV 6.0 freq10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

config.

curve

list

IPPV alarm limits

ET CO2 LOW !!

PAW

alarm limits

alarm

info

auto set vent. al.

% HAL HIGH !!!

config.

055289710562897105728971

Curve selection

Only possible in the standard screen!

A second curve for the bottom half of the screen can be selected from the menu presented here to complement the CO2 concentration curve (CO2) which is always displayed.

The following can be selected:

– PAW Airway pressure

– flow Expiratory flow

– Volumeter Display showing the minute ventilation plus

Paw and VT as a bar graph. See below.

– Pleth. Plethysmogram (optional)

– O2 Oxygen concentration of the breathing gas

(optional).

● Press the softkey »curve«.

A selection menu appears. The option with grey background is currently set.

● Use the rotary control to move the cursor frame to the

designation of the required curve.

● Press rotary control. The selected curve is shown on

the screen.

Volumeter function

Depending on mode, the length of the bar represents a maximum measured value:

Mode Tidal volume VT Minute ventilation

Neonate 0.2 L 2 L/min Adult 1.0 L 10 L/min

Pressure indication:

– The airway pressure is shown in the upper bar graph.

Tidal volumeter:

– The expiratory volume of a breath (VT) is indicated

graphically by the middle bar and numerically on the left.

Minute volumeter:

– The minute volume represented by the bottom bar

runs for 60 seconds, during which the tidal volume is summed.

The time expired is shown in seconds above the bar, the total volume appearing on the left. The individual breaths are separated by segments in the bar graph. The volumeter automatically stops and outputs an advisory tone after 60 seconds. The measured values are displayed for 4 minutes and are then erased.

To start volumeter:

● Press rotary control. If the rotary control is pressed

again during the 60 seconds, the values will be erased and the volumeter restarted.

Monitor functions

Softkeys

Curve selection

alarm limits

al. off

curve

list

alarm

info

Man./spont. alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

0.35

PAW

Volumeter 27s

5.5

0.5

Volumeter started. Re-start: confirm !

config.

alarm limits

auto set vent. al.

list

alarm

info

IPPV alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

curve

PAW

flow Volumeter Pleth. O

config.

0582897105928971

Configuration during operation

The menu displayed during operation shows the functions required for measuring mode. The functions are selected as described for other menus. The settings made here only apply for the present operation.

● Press the softkey »config.«

The configuration menu is displayed. The values shown against a grey background currently apply.

● Turn the rotary control to move the cursor frame as

in the standby configuration menu. Refer to the description of that menu for further details (page 51 onwards).

set

– pulse tone For setting the volume.

– alarm tone For setting the volume.

– mode Change over between adult and

neonate modes.

– parameters For setting the parameters, see

page 53.

– record For determining which event

triggers an entry in the record list or printout on the printer, see page 53.

– activate defaults Activates the configured default

settings (see page 51 onwards).

calibrating

– calibration O2 and flow sensor, as well as

others.

warning

– default Activates all default alarm limits

configured in »standby«.

– CO2 Activates/deactivates all CO2

alarms (including »Apnoea«).

– SpO2 Activates/deactivates all SpO2

alarms.

– HLM mode Activates/deactivates the heart/lung

machine monitoring mode. See page 68.

– Pmax »on« Ventilator pressure limitation

generates a caution message.

»off« Ventilator pressure limitation

generates an advisory message.

The »off« setting is recommended for ventilation with intentional pressure limitation.

– anaesth. gas see »Configuring monitor functions

in « standby »« on page 56.

Monitor functions Softkeys Configuration during operation

Select and confirm !

✓

anaesth. gas

Halothane

Enflurane

Isoflurane

Sevoflurane

Desflurane

no anaesth. gas

calibrating

-sensor

21 Vol.%

flow-sensor

IPPV alarm limits

warning

default

on off

SpO2 on off

HLM on off

Pmax on off

set

pulse to.

0 1 2 3 4 5 6 7 8 9

alarm tone 1 2 3 4 5 6 7 8 9 mode adult Neo. parameters record activate defaults

alarm

limits

al. off

curve

list

alarm

info

Man./spont. alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

config.

0602897106128971

Alarm concept

Alarm priority

The monitor alarms are combined with those of the ventilator, arranged in order of priority and assigned to certain tones or tone sequences.

This information is presented in keeping with the situation, in separate fields for:

Warning marked »!!!« Caution marked »!!« Advisory marked »!«

Warnings are accompanied by a continuous tone, caution messages by a tone at 30 second intervals and advisory messages by a single tone. All tones are output at the same time as the messages appear in the displays.

European Standard EN 740 stipulates use of EN tones. Alternatively there are tones in keeping with Dräger conventions available.

Whenever a warning or caution message occurs, the corresponding LED lights up above the G key:

1 Warning Red, flashing 2 Caution Yellow, flashing 2 Advisory Yellow, continuous

The summary of alarm limit settings appears on the screen. The parameters which have been exceeded are shown in inverted form.

Example:

The lower alarm limit for etCO2 is set at 30 but the actual value is lower. A value of 28 is measured.

– The settings menu appears automatically. The violated

alarm limit is shown in inverted form.

– The symbol for the lower alarm limit < and the

parameter designation »etCO2« appear in the advisory

field for caution messages. – The yellow LED lights up. – The corresponding tone is heard.

The value can be altered by turning the rotary control

and confirmed by pressing the control.

The alarm limit can be confirmed directly if it is to

remain unchanged. The limit value menu is always

closed whenever a value is confirmed.

If several alarms occur simultaneously, the alarm limits which have been exceeded are shown against a grey background. When the first alarm has been confirmed (by pressing the rotary control on the monitor), the alarm limit of the alarm with the next lower priority is activated and displayed. All alarms received are recorded for the anaesthesia record if list entry has been configured accordingly.

Monitor functions

Alarm concept

Alarm priority

curve

list

IPPV alarm limits

PAW

alarm

info

auto set

vent. al.

SpO

etCO

!! 28

MV 6.0

FiO

FiHal. 0.8

PAW

-95

3.0

-20

1.0

0.0

120

alarm

limits

Alarm limit OK ? confirm !

ET CO2 LOW !!

config.

06228971 02537224

Displaying all alarms

● Press the softkey »alarm info« and keep pressed.

The alarm texts of all warning, caution and advisory messages are displayed in order of priority.

● Release the softkey »alarm info«.

The alarm texts disappear.

Suppressing the alarm tone

1 Press G on the monitor for which the yellow LED

lights up. The alarm tone is then suppressed for two minutes. Any new messages occurring during this

time, however, are indicated once with their appropriate specific tone.

2 The red (upper) or yellow (lower) LED continues to

light up and the text remains on display.

To reactivate the alarm tone during the 2 minutes:

1 Press G again and the corresponding yellow LED

goes out.

CO2 alarm on/off

The CO2 alarms can be deactivated by the »CO2 al. on/off« key.

In this case, CO2 is not monitored.

Press the key again to reactivate the alarm.

When the CO2 alarm is on, the inspiratory CO2 concentration in the breathing air is monitored with a fixed maximum limit of 5 mmHg!

Monitor functions Alarm concept Alarm priority CO2 alarm on/off

curve

list

IPPV alarm limits

ET CO2 LOW !!

PAW

alarm limits

alarm

info

auto set vent. al.

% HAL HIGH !!!

config.

alarm limits

al. on

curve

list

alarm

info

Man./spont. alarm limits

SpO

98 67

etCO

MV 6.0 freq 10

Fi Fet

29 25

Hal. 0.8 0.6

O 70 68

PAW

config.

0632897106428971 02637224

Adjusting to the ventilation mode

For »IPPV", »MAN/SPONT« and »SIMV« ventilation modes

The alarm limits are switched over automatically with the change of ventilation mode.

In »IPPV« and »SIMV« modes, the »IPPV alarm limits« alarm mode is automatically activated on the monitor if the ventilation rate is equal to or greater than 6 breaths per minute.

The MAN/SPONT alarm limits are automatically activated for »MAN/SPONT« and the SIMV alarm limits for »SIMV« mode with a ventilation frequency of less than 6 breaths per minute.

The currently active alarm mode at any time is displayed in the status field and flashes for the first five seconds.

The full range of alarms (»IPPV alarm limits« alarm mode) can be reactivated by selecting IPPV mode or by setting the ventilation frequency to a value equal to or greater than 6 breaths per minute.

Monitor functions

Alarm concept

Adjusting to the ventilation mode

Alarm limits in MAN/ SIMV SIMV with fIMV ≥ 6 MAN/SPONT IPPV/SIMV

ventilation mode SPONT with fIMV < 6 and IPPV HLM HLM

Minute ventilation AMV off on on off on

off on on off on

Insp. anaesthetic gas on on on on on

off on on off on

Airway pressure Paw on on on on on

off on on off on

Exsp. CO2 concentration et CO2 on on on on on

on on on on on Insp. CO2 concentration in CO2 on on on on on Insp. O2 concentration FiO2 off on on off on

on on on on on Apnoea pressure off 30 s 15 s off off Apnoea flow off 30 s 15 s off off Apnoea CO2 1 min. 30 s 30 s off off Functional oxygen saturation SpO2 on on on off off

on on on off off

HR on on on off off

on on on off off

alarm activated after

Heart/lung mode (HLM)

A special alarm mode can be activated during operation for the function »warning« in the »Configuration« menu for operation with a heart/lung machine (»HLM« mode).

All apnoea alarms are deactivated in this mode and the gas values are displayed continuously without connection to the respiratory phase.

SpO2 alarms are deactivated in HLM mode. They are automatically reactivated when pulsations are detected again after ending HLM mode.

In this alarm mode, the parameters are monitored with the same limits as are set in the ventilation mode from which »HLM« was selected.

Heart/lung mode can be deactivated either

– via the »Configuration« menu or

– via the softkey »HLM off«.

Monitor functions Alarm concept Heart/lung mode (HLM)

alarm

limits

HLM

off

curve

list

alarm

info

Man./spont. alarm limits

SpO

-- --

etCO

MV 6.0 freq 0

Fi Fet

98 98

Hal. 0.8 0.8

O 0 0

PAW

HLM

config.

06528971

Contents

Page

Where messages occur .......................................................................... 72

Location of valves and subsystems .......................................................... 73

Messages on the monitor ........................................................................ 74

Messages on the ventilator ...................................................................... 78

Messages, cause and remedy

Inhalt

Messages, cause and remedy

Where messages occur

Warning, caution and advisory messages

These are the three types of message output by the system and displayed in the alarm field. They are classified in order of priority and listed alphabetically in the following tables.

User prompts

appear in the bottom right-hand corner of the screen.

Messages on the ventilator

These are always output during operation. Refer to the chapter entitled »Anaesthesia ventilation«.

In exceptional cases, messages may also appear in the dialogue field during operation and the self-test. Refer to the table on page 78.

Malfunctions and system faults

Eliminate the cause where possible as indicated by the user prompt on the screen. Inform DrägerService if necessary, specifying the malfunction number and software number.

Call DrägerService if the malfunctions and/or advisory messages cannot be remedied in accordance with the descriptions or by repeatedly switching off and on again (with a delay of approx. 5 seconds in between) via the master power switch and repeating the self-test!

All malfunctions are signalled acoustically.

In the event of particularly serious problems, e.g. »Control pressure low«, it is possible that when manual ventilation is attempted no pressure will be generated in the breathing system. Simultaneous failure of the compressed air and compressed oxygen supply would be such a serious fault.

In these cases, immediately ventilate the patient with the separate emergency breathing bag.

Messages, cause and remedy Where messages occur

Alarm field

Operator

prompts

Dialogue field

06628971

06728971

Messages, cause and remedy

Location of valves and subsystems

Simplified pneumatic schematic showing valves and subsystems:

Piston pump

Fresh gas

Breathing bag

Exp.(V5)

V8 V9

Insp.(V4)

PEEP (V6)

APL

Pressure O2

MAN/SPONT changeover

Legend

Subsystem 1

Subsystem 3

Sensor

Filter

Pilot-operated diaphragm valve

Variable-resistance valve

Directional valve

Spring-loaded directional valve

Manually actuated two-way valve

Subsystem 2

Measured gas return line

A-Gas, CO2, O2

⁄

Patient

Absorber

POP-OFF

Inspiration

Exspiration

Pressure limitation

APL

Location of valves in the breathing system:

Location of the subsystems:

Subsystem 1 Subsystem 2

Subsystem 3

Piston pumpe

Vapor Pneumatic

interface

The valves are numbered as shown in the following schematic – V1, V2, ...

06828971

0692897107028971

Messages, cause and remedy Messages on the monitor

Messages Cause Remedy

% HAL HIGH !!!

% ISO HIGH !!!

% ENF HIGH !!!

% DES HIGH !!!

% SEV HIGH !!!

The inspiratory anaesthetic concentration exceeds the upper alarm limit in each case.

The upper alarm limit has been exceeded for at least two breaths.

Check setting of anaesthetic vaporizer.

% HAL LOW !!

% ISO LOW !!

% ENF LOW !!

% DES LOW !!

% SEV LOW !!

Applicable inspiratory anaesthetic concentration below lower alarm limit.

Value below lower alarm limit for at least two breaths.

Check setting of anaesthetic vaporizer.

% O2 ERR ! Sensor for inspiratory O2 measurement incorrectly

calibrated? Sensor changed and/or not calibrated?

Calibrate sensor.

Sensor exhausted? Sensor not plugged in? Sensor lead defective? Dräger sensor cell not used?

Replace and calibrate cell. Plug in sensor connector. Replace sensor housing. Use original sensor cell.

% O2 HIGH !! Inspiratory O2 concentration exceeds upper alarm

limit. O2 flush used?

Check O2 concentration in fresh gas flow.

% O2 LOW !!! The inspiratory O2 concentration is below the

lower alarm limit.

Check O2 supply. Check setting on O2 flow meter.

AGT ERR ! Anaesthetic gas measurement faulty. Call DrägerService.

AGT NOT SEL ! Anaesthetic agent not selected or selection differs

from that detected by Vapor identification.

Check and select anaesthetic agent.

APNOEA CO2 !!! Breathing/ventilation at a standstill. No breath

detected by expiratory CO2 for 30 seconds.

(No breath has been detected for 60 seconds in alarm mode »Man/Spont alarm limits«.)

Patient must immediately be ventilated by hand!

Check patient's spontaneous breathing ability.

Check hoses, tube and ventilator.

Messages on the monitor

Alarm messages are assigned to three priority classes (alarm priority) on the monitor of the Cato:

– Warning ! ! ! – Caution ! ! – Advisory !

The patient's condition must be checked first, before the machine is examined on account of a possible measuring error!

Alarm field

07128971

Messages, cause and remedy

Messages on the monitor

Messages Cause Remedy

APNOEA PRES !!! Ventilation at a standstill.

No change of pressure detected for 15 seconds; 30 seconds in the case of SIMV alarm limits.

Inadequate supply of fresh gas.

Leak in hose system.

Patient must immediately be ventilated by hand!

Check fresh gas setting on anaesthetic unit.

Check hoses and tube.

Check ventilator.

APNOEA VOL !!! Ventilation at a standstill. No expiratory tidal volume

for 15 seconds; 30 seconds in the case of SIMV alarm limits.

Inadequate supply of fresh gas.

Tube kinked. Leak in hose system.

Patient must immediately be ventilated by hand!

Check ventilator.

Check fresh gas setting on anaesthetic unit.

Check tube and hose system.

AW-TEMP HIGH !!! Inspiratory breathing gas temperature over 40 °C. Disconnect breathing gas

humidifier. Set lower heating level when temperature has

dropped to 37 °C.

CO2 ERR ! Sidestream measurement is faulty. Call DrägerService.

CO2 LINE BLK ! Sample line blocked. Replace sample line and water

trap if necessary. Check sample line is not kinked. Examine measuring gas return line for stenosis, replace microbial filter if necessary.

CO2 OFF ( _ ) ! CO2 alarm deactivated.

COM VENT ERR !!! Communication between ventilator and monitor

interrupted or faulty.

Alarm limits do not change over automatically. Set alarm limits by hand if necessary. Call DrägerService.

Valve discs in the breathing system defective.

Set the sampling rate to 200 mL/min due to the high frequency and time constant of the CO2 sensor.

COOLING 8050 ? ! Temperature inside machine too high. Clean filter at rear.

Call DrägerService.

ET CO2 HIGH !! Upper alarm limit for end-expiratory CO2

concentration has been exceeded for at least two breaths.

Check ventilation.

14828970

Messages, cause and remedy Messages on the monitor

Messages on the monitor

Messages Cause Remedy

ET CO2 LOW !! End-expiratory CO2 concentration below lower

alarm limit for at least two breaths.

Check ventilation.

EXP-VALVE ? !! Fault in expiration valve. Measured value for minute

ventilation may be excessive.

Check expiration valve. This message can be deactivated until the next leak test by pressing the key for muting the audible alarmtone.

FRESH GAS ? !! Too little gas in manual ventilation bag. Increase fresh gas flow. Repair

any leaks in hose system.

INSP CO2 HI ! Inspiratory CO2 concentration is above upper

alarm limit of 5 mmHg.

Replace the soda lime in the circle system of the anaesthetic workstation.

MIN VOL HIGH !! Minute volume exceeds upper alarm limit. Correct tidal volume or

respiration rate on ventilator.

MIN VOL LOW !! Minute volume below lower alarm limit.

Tube clogged / kinked? Leak in breathing system?

Ventilation volume limited by pressure limitation?

Check tube and hoses.

Seal breathing system.

Correct ventilation pattern.

N2O ERR ! N2O gas measurement faulty. Call DrägerService.

NO SPO2 PULS !!! No pulse signal detected by SpO2 measurement

for approx. 10 seconds.

Check SpO2 sensor (dropped off? NiBP measurement on same arm?).

O2 < xx % ! The alarm limit appears after the parameter

designation if the alarm limit for the inspiratory O2 concentration is below 21%.

PAW HIGH !!! Airway pressure exceeds the upper alarm limit.

Ventilation hose kinked? Stenosis? Pulmonary problem? Cough?

Check patient's condition!

Check hose system, tube and fresh gas flow.

PAW NEGATIVE !!! Negative airway pressure measured. Check hose system and tube on

ventilator.

PRESS ERR ! Pressure sensor defective. Call DrägerService.

PRESS EXP HI !!! End-expiratory pressure more than 10 mbar over

PEEP.

Extend expiration period.

Check hose system and microbial filter.

Empty water traps.

14828970

Messages, cause and remedy

Messages on the monitor

Messages Cause Remedy

PRESSURE LTD !!, (!) Ventilator operating with pressure limitation.

Change in lung compliance? Tube kinked? Microbial filter in inspiratory line soiled?

Check tube/filter.

Increase Pmax or decrease VT if necessary.

If pressure-limited ventilation is intentional: Press softkey »Config«, select »Alarms« and switch »Pmax« »off«.

RS232COM ERR ! RS 232 communication interrupted. Check plug connection.

SPEAKER FAIL ! No alarm sound, loudspeaker defective. Call DrägerService.

SPO2 ERR ! SpO2 measurement faulty. Call DrägerService.

SPO2 HIGH !! Oxygen saturation exceeds set upper alarm limit. Check O2 concentration in fresh

gas. Check ventilator.

SPO2 LOW !!! Oxygen saturation is below the set lower alarm

limit.

Check O2 concentration of fresh gas. Check ventilation.

SPO2 OFF ( _ ) ! SpO2 alarm deactivated.

SPO2 PULS LO !!! Pulse rate has dropped below the set alarm limit. Check patient's condition!

SPO2 PULSE HI !! Pulse rate exceeds upper alarm limit. Check patient's condition!

Correct alarm limit if necessary.

SPO2SEN DISC ! No pulse detected by pulsoxymeter although heart

is clearly beating.

Check patient's condition (disturbed circulation?).

Check SpO2 sensor positioned correctly.

VENT ERR !!! Fault in ventilator pressure sensor.

Filter in pressure measuring hose blocked (water absorption!)

Control pressure in ventilator too low.

Hardware fault in ventilator.

Machine not operational!

Patient must immediately be ventilated by hand!

If no pressure build-up in the breathing system: immediately

ventilate the patient with the separate emergency breathing bag.

Check pressure gas supply. Replace filter in pressure measuring hose. If not possible:

Switch off machine, call DrägerService.

VOL ERR ! Flow sensor calibrated incorrectly?

Flow sensor / flow sensor lead defective? Flow sensor not plugged in? Flow sensor soiled?

Calibrate sensor.

Replace lead / sensor and calibrate sensor. Plug in sensor connector.

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Messages, cause and remedy Messages on the ventilator

Messages on the ventilator

Messages Cause Remedy

???? Internal electronic fault. Call DrägerService.

compliance test The hose compliance is being tested during the

leakage test in »standby« mode.

Equipment fault Attempt to cancel self-test when

– a malfunction has been signalled beforehand or – self-test has already been broken off 10 times!

(Mechanical ventilation is only possible when selftest has been completed successfully!)

This message precedes the message »Malfunction No. XXX«.

Acknowledge to cancel alarm tone. Restart.

For information.

Note malfunction number and call DrägerService.

GB. Version .... Message displayed at the beginning of the self-test. Software version number is

indicated when switching on. Inform DrägerService of version number when reporting malfunctions.

Leak test IPPV The IPPV leakage rate is being determined during

the leakage test in »standby« mode.

Paed. hoses ! When changing the V

T setting from values above

200 mL to less than 200 mL.

Use infant hoses. Run leakage test to measure new compliance, otherwise limited accuracy! Press rotary control to confirm!

piston test The system occasionally runs a self-test to detect

major leaks and faults in the inspiration valve.

Pressure release A static excess pressure continued for too long

after AutoWakeUp. The system is relieved.

Switch ventilator to »standby«. Disconnect fresh gas.

Restart Transient system fault.

Power supply briefly interrupted.

Manual ventilation is not possible for approx. 10 seconds while the message »Warmstart« is displayed; wait for 10 seconds, the ventilator then continues with the former settings. Check parameter settings. Set up a substitute system if warmstart is repeated. Call DrägerService.

Self-test Self-test has been started.

Self-test ... x discont Message displayed after cancelling the self-test.

Only possible 10 times!

A complete self-test must then be performed.

Operating mode can be selected. Skipping calibration functions and internal alignment procedures can impair the accuracy of measurements!

Standby Machine on standby.

Supply pressure? Pressure supply inadequate. Correct pressure supply.

Use spare cylinders if necessary.

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Contents

Page

Stripping down machine ....................................................................... 80

Dismantling parts .................................................................................. 81

Disinfection – cleaning – sterilization .................................................... 83

Care methods ........................................................................................ 84

Care schematic ....................................................................................... 84

Care intervals .......................................................................................... 84

Disposing of consumable articles ............................................................ 85

Wipe cleaning ......................................................................................... 85

Disinfectant cleaning in machines ............................................................ 85

Disinfection with formaldehyde vapour ..................................................... 85

Sterilization with ethylene oxide ............................................................... 86

Steam sterilization (121 °C / 134 °C) ...................................................... 86

Tabular summary ..................................................................................... 87

Disposal of used batteries and O2 sensors .............................................. 88

Disposal of apparatus ............................................................................. 88

Reassembling system ........................................................................... 89

SpO2 measurement (optional) ............................................................... 95

Safety and precautions ............................................................................ 95

Choice of sensor .................................................................................... 95

C-Lock-ECG synchronization (optional) ................................................... 96

Tips to avoid artefacts ............................................................................. 97

Applying sensors .................................................................................... 98

Durasensor DS-100 A ........................................................................ 98

Oxisensor D-25 and D-20 .................................................................. 98

Oxisensor I-20 ................................................................................... 99

Oxisensor R-15 ................................................................................ 100

Care

Contents

Care

Stripping down machine

Swing up table top to remove piston pump:

(only possible in »standby«)

1 Swing lever as far as possible to unlock.

2 Hold breathing system by handle and lift out.

Do not damage flat seals – avoid contact with sharp edges. It must be put down so that the sealing elements are not subject to constant pressure!

3 Caution!

Temperature of hotplate for breathing

system equals approx. 60 °C.

4 Handle pointing up – lift out piston pump

– do not use force –

Do not damage flat seals – avoid contact with sharp edges. It must be put down so that the sealing elements are not subject to constant pressure!

1 Swing lever back to original position, otherwise table

top cannot be reclosed.

Remove anaesthetic gas scavenging system

Refer to separate Instructions for Use for anaesthetic gas scavenging system.

● Unplug anaesthetic gas scavenging hose from

anaesthetic gas scavenging system.

5 Press button to unlock hose connector and pull

downwards. Hose remains on connector.

Care Stripping down machine Remove anaesthetic gas scavenging system

150289701512897015228970

Dismantling parts

T-piece of measured gas hose (if used)

1 Remove filter.

Inspiratory O2 sensor (if used)

● Must not be disinfected in liquid or autoclaved!

● Wipe any dirt off housing or lead with damp

disposable cloth.

● Unscrew O2 sensor and remove O2 cell. Do not

touch wire mesh of O2 cell, otherwise it loses its water-repellent property and measurement becomes inaccurate.

Dirt on wire mesh of sensor cell is simply wiped off with a disposable cloth moistened with distilled water.

Temperature sensor (breathing gas) (optional)

● Draw temperature sensor out of Y-piece, remove

Y-piece from ventilation hoses.

Prise lead out of hose clips.

● Pull connector out of socket.

● Wipe dirt off with damp disposable cloth.

Flow sensor

The flow sensor cannot be disinfected or sterilized.

Contamination by infectious patients: dispose of as directed!

If contamination is unlikely, the flow sensor can be reused as long as it can be calibrated correctly.

Care

Dismantling parts

T-piece of measured gas hose

Inspiratory O2 sensor

Temperature sensor, Flow sensor

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Breathing system

● Remove flow sensor.

● Unscrew pressure limitation valve APL.

● Dismantle breathing valves –

valve discs must be handled with care.

● Replace measured gas return hose if contamination

is possible.

1 Release the five quick-release screws by turning

through a quarter-turn with a 6 mm hexagon key. Remove upper part.

2 The two valves are only unscrewed if soiled.

● Empty soda lime container (see page 45).

Dispose of with household refuse (but not when treating infectious patients!).

Piston pump

3 Release the two quick-release screws by turning

through a quarter-turn with a 6 mm hexagon key.

4 Remove cylinder head.

5 Completely unscrew the central screw on the piston

(no quick-release).

6 Remove piston and roller diaphragm.

● The remainder of the piston pump does not come in

contact with breathing gas and does not require sterilization!

Care Dismantling parts Breathing system Piston pump

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Disinfection – cleaning – sterilization

Agents and methods for disinfection, cleaning and sterilization

Only products from the list of surface disinfectants may be used for disinfection. Products based on

– aldehydes,

– alcohols and

– quaternary ammonium compounds

(e.g. Buraton 10 F or Terralin diluted as specified. Both are registered trademarks of Messrs. Schülke & Mayr, D-22846 Norderstedt.)

may be used to ensure material compatibility.

The following are not suitable:

– phenols,

– compounds liberating halogen,

– strong organic acids and

– compounds liberating oxygen.

Users in the Federal Republic of Germany are advised to use disinfectants specified in the current list published by the German Society for Hygiene and Microbiology (DGHM). The list also specifies the active agent in each disinfectant.

Users in countries in which the DGHM list is not available are advised to use the agents mentioned above.

Alcohol and agents containing alcohol must not be allowed to seep into the sample line!

Alcohol results in incorrect results when measuring the anaesthetic agent!

Care

Disinfection – cleaning – sterilization

Agents and methods for disinfection,

cleaning and sterilization

Care methods

Care Care methods Care schematic

Care schematic

Machine without parts in contact

with patient gas

Manual preliminary

cleaning

In automatic disinfection

unit ANDA / Purfactor

Manual, scrubbing,

wipe disinfection

Care, rinsing and drying

Steam sterilization at 134°C / 121°C

Reassemble machine

Assembly

Manual, scrubbing, wipe and

instrument disinfection

Dismantle parts in contact

with patient gas

Strip down machine

Use

Check machine according to

checklist immediately before use

Care intervals

A number of steps can be omitted if microbial filters are used in the inspiratory and expiratory lines. The following table is intended as a guide; it does not replace the directions of the hospital's hygiene officer!

Non-infectious patients Infectious patients

Component: with microbial filters: without microbial filters: with or without

microbial filters:

Tube, mask after every patient after every patient after every patient Y-piece after every patient after every patient after every patient Both breathing hoses after every patient after every patient after every patient Temperature sensor with lead after every patient after every patient after every patient T-piece and filter of measured gas sampling system after every patient after every patient after every patient Flow sensor downstream of expiration nozzle daily after every patient after every patient Breathing bag with hose daily after every patient after every patient Breathing system weekly after every patient after every patient Soda lime container daily after every patient after every patient Anaesthetic gas scavenging hose weekly weekly after every patient Piston pump weekly after every patient after every patient

Machine ready for use

Check operational readiness

in acc. with

Instructions for Use

In automatic dis-

infection unit Aseptor

Disposal of consumable articles

Consumable articles are listed at the bottom of page 87. Consumable articles and articles with limited service life (e.g. microbial filters, soda lime) can be disposed of as household refuse if used for treating non-infectious patients. Infectious waste must be disposed in

accordance with regulations!

Wipe cleaning

Cato parts which can be wipe-cleaned are listed in the table on page 87.

Use a disposable cloth moistened with disinfectant cleaner.

Note effective time – parts must only be wiped, not immersed – do not allow liquid to seep inside the machine!

Cleaning and disinfection in automatic cleaning and disinfection machines

Cato parts which can be cleaned and disinfected in this way are listed in the table on page 87.

Set »Disinfection with moist heat«

(at least 93 °C, at least 10 minutes).

Alkaline or chlorinated cleaning and disinfectant agents must not be added due to the risk of corrosion!

Disinfection with formaldehyde vapour

Cato parts which can be treated in this way are listed in the table on page 87.

Parts in contact with breathing gas (breathing hoses, breathing bag, breathing system, soda lime container, piston pump) must not be disinfected with formaldehyde vapour!

Parts containing water, such as the humidifier or water traps, should be removed since formaldehyde accumulates here to a particularly large extent.

The machine can be disinfected with the supplementary Dräger units in place when using formaldehyde vapour. Electrical devices not made by Dräger and which may not be resistant to formaldehyde must be removed first.

After disinfection in formaldehyde vapour, the machine must be rinsed in fresh gas as specified in the Instructions for Use of the disinfection equipment in order to eliminate all formaldehyde residues (two rinses: O2 / AIR and then O2 / N2O)! The rinsing effect can be verified by measuring the formaldehyde concentration at the fresh gas outlet (e.g. using Dräger formaldehyde test tubes 0.2/a).

Care

Care methods

Disposal of consumable articles

Wipe cleaning

Cleaning and disinfection in automatic machines

Disinfection with formaldehyde vapour

Sterilization with ethylene oxide

Only the sensor cell of the O2 sensor can be sterilized in

this way – no other parts! Maximum temperature: 50 °C. Flash-off time: at least 24 hours at 50 °C with 60-fold

exchange of air. This impairs the service life of the O2 cell!

Steam sterilization at 121 or 134 °C

Cato parts which can be sterilized in this way are listed in the table on page 87.

Steam sterilization must be preceded by sterilization with moist heat and/or wipe cleaning. All parts must be dry! Steam sterilization is only required after treating an infectious patient!

Minimum exposure times: 20 minutes at 121 °C and 10 minutes at 134 °C. Parts should preferably be sterilized at 134 °C since less time is required for the

procedure.

Care Care methods Sterilization with ethylene oxide

Steam sterilization at 121 or 134 °C

Care

Care methods

Tabular summary

Method

Disinfection by Cleaning with Formaldehyde Steam sterilization

Machine components wiping or immersion automatic cleaners vapour at 121 °C at 134 °C

Stripped down basic machine Wipe ● Parameter box (optional) Wipe

Rubber parts:

Tube / mask ●● ●● Y-piece ●● ●● Breathing hoses ●● ●● Breathing bag ●● ●● Breathing bag hose ●● ●● Roller diaphragm of piston pump ●● ●● Anaesthetic gas scavenging system ●● ●● Pressure measuring hoses ●● ●● Connecting hoses for measured gas return system ●● ●●

Metal parts:

Cylinder head of piston pump ●●● Piston of piston pump ●●● Parts of breathing system ●●● Valves of breathing system ●●●

Plastic parts:

Housing of piston pump ●● ●● Soda line container with screen ●● ●● T-piece for sidestream gas measurement ●● ●● Water trap for measured gas ●● ●● Water traps for airway ●● ●●

Filters:

Microbial filter 24 times

Sensors:

Temperature sensor ● (airway temperature) Temperature sensor ● (skin/rectal/oesophagus) O2 sensor (housing) ● Flow sensor externally

The following parts cannot be processed and prepared:

(must be replaced if damaged or possibly contaminated)

Filter of pressure measuring hose: Change every 6 months or when resistance increases (e.g. water absorption).

The warning message P-Sensor fault resp. VENT ERR !!! is output.

Filter of measured gas return hose: Replace every 6 months.

for sidestream gas measurement: Water separator: Replace, depending on degree of contamination Connecting hoses: Replace after each patient Filter in T-piece: Replace after each patient

Disposal of used batteries and O2 sensors

Batteries and O2 sensors:

● must not be thrown in the fire. Danger of explosion.

● must not be forced open. Risk of chemical burns.

● batteries must not be recharged.

Used batteries must be treated as special waste:

● Dispose of used batteries in accordance with local

waste disposal regulations.

Used O2 sensors can be returned to Dräger.

Disposal of apparatus

– at the end of its useful life.

Cato can be returned to Dräger for disposal in accordance with environmental regulations.

Care Disposal of used batteries and O

sensors

Disposal of apparatus

Reassembling system

Reassemble cleaned, disinfected and sterilized parts

Assemble the piston pump

● Check individual parts:

Gaskets: pressure marks? cracks? Diaphragm: cracks? holes? deformation?

Defective parts must be replaced!

1 Fit roller diaphragm –

production mark visible at the outside (arrow).

2 Insert piston – carefully place the rolled edge round

the edge of the piston.

3 Screw piston into position (no quick-release catch).

4 Fit cylinder head and secure in position (two quick-

release catches).

Assemble the breathing system

● Check individual parts:

Gaskets: pressure marks? cracks? Diaphragms: cracks? holes? deformation? Valve discs: chipped?

Defective parts must be replaced!

5 The six holes must be clear!

6 Fit valves if necessary.

● Place upper and lower parts of breathing system on

top of one another.

7 Secure the five quick-release catches.

(6 mm hexagon key).

Care

Reassembling system

Assemble piston pump and breathing system

160289701612897016228970

Fit the piston pump

● Swing up table top

1 Handle in starting position.

Do not damage gaskets when fitting pump!

● Hold piston pump by its handle and insert in machine

– do not use force –

2 Swing handle as far as possible to the left (black).

Fit the breathing system

Hold breathing system by its

3 handle and insert in machine –

4 lock in direction of arrow –

swing as far as possible (black).

Do not damage gaskets when fitting breathing system!

Replace O2 sensor for gas sampling system

(if the measuring cell is worn)

5 Unscrew the knurled screw on the back of the machine

(behind the monitor) by turning anticlockwise.

● Draw used sensor or blank out of the knurled screw

and insert new sensor.

● Screw knurled screw back into place.

When operating without sidestream O2 sensor:

● Insert blank instead of O2 sensor to seal the

measuring system.

Fit valves

6 Fit valve discs in expiration and inspiration valves –

screw on valve caps.

7 Screw on pressure limitation valve APL –

scale facing the front.

Assemble and fit the inspiratory O2 sensor

(if used)

● Do not touch wire mesh on cell!

Insert cell with conductors facing wiring –

● screw sensor housing together –

8 plug sensor onto inspiration valve.

Care Reassembling system Fit piston pump and breathing system Replace O2 sensor for gas sampling system Fit valves Assemble and fit the inspiratory O

sensor

1632897016428970165289701662897016728970

Connect fresh gas hose

1 to breathing system from below with plug connector.

Connect pressure measuring line with filter

2 Plug pressure measuring line into coupling – until it

engages.

Fill soda lime container

The container can hold approx. 1.5 L soda lime »Drägersorb 800« (see separate Instructions for Use). This is sufficient to bind approx. 150 L CO2 or for a period of approx. 6 hours.

The soda lime should be replaced daily, at the latest when two-thirds of the charge has changed colour.

The indicator colour changes back as it dries although the absorption capacity is exhausted!

● Place the chain on the bottom of the container.

● Insert mesh – must not be forgotten!

Absolutely essential for absorption!

● Uniformly fill the container with fresh soda lime all

round, until the

– MAX –

mark is reached (approx. 3 cm below top edge).

● Gently shake the container or knock against the table

to settle the contents.

● Remove any dust and granulated material on the edge

of the container.

3 Fit the soda lime container into the breathing system

from below and turn clockwise as far as it will go.

Care

Reassembling system

Connect fresh gas hose

Connect pressure measuring line with filter

Fill soda lime container

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027372241692897017028970

Connecting anaesthetic gas scavenging system (AGS)

1 Insert the transfer hose, complete with scavenging

adapter, into the breathing system from underneath until it engages, or connect the hose to the scavenging adapter of the semi open system.

2 Route the extractor hose round the equipment to the

rear and

3 connect it to the connector on the collecting system.

● Refer to the separate Instructions for Use of the AGS

anaesthetic gas scavenging system.

Connect sample line

For sampling CO2, anaesthetic agent and O2.

4 Screw filter into T-piece.

5 Insert T-piece into the patient connection of the

Y-piece – filter facing upwards to prevent congestion by droplets of liquid.

6 Securely screw sample line onto filter and water trap.

Only use original sample lines, others may lead to changes in the machine's technical specifications!

7 The Y-piece with direct connection for the sample line

can also be used instead of the T-piece and filter.

Alcohol or agents containing alcohol must not be allowed to enter the sample line!

Alcohol will result in incorrect measurement of the concentration.

Care Reassembling system Connecting anaesthetic gas scavenging system (AGS) Connect sample line

17128970172289700283722402937224

Fit flow sensor

1 Unscrew expiration nozzle.

2 Slide flow sensor into housing.

1 Screw expiration nozzle back into place.

Fit microbial filter

● Fit a microbial filter with ISO nozzle on both the

inspiration and expiration legs.

Fit temperature sensor

(Optional) with: Y-piece M 30 543 and hose clips 84 04 047.

The T-piece must be used for anaesthetic gas measurement in this case!

3 Insert temperature sensor 84 05 371 as far as

possible into the hole in the Y-piece.

After securing the Y-piece, align the sensor to face upwards so that it remains free from condensation.

4 Route the sensor lead back to the machine with hose

clips along the inspiration hose of the anaesthetic system.

Install secretion aspirator

● Position the secretion aspirator on the mount on the

frame with two secretion collecting vessels.

5 Install hose between negative pressure outlet and

secretion collecting vessels.

6 Connect the gas outlet on the Cato to the ejector.

7 Plug the aspiration hose with handpiece onto the inlet.

● Secure the aspiration hose in the clamp.

Secretion aspirator may only be used in »MAN/SPONT« mode or with disconnected Y-piece.

Care

Reassembling system

Fit flow sensor and microbial filter

Fit temperature sensor

Install secretion aspirator

[

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03037224

Connecting external equipment

Configuration of the interfaces is described on page 53.

Connection via the protocol interface

1 with data cable for printers with serial interface,

e.g. Desk-Jet (Hewlett-Packard)

for e.g. the PM 8060 Vitara Patient Monitor with the MEDIBUS protocol. See page 53 for configuration.

Connection via the Dräger RS 232 C MEDIBUS interface

e.g. to connect the PM 8060 Vitara Patient Monitor.

2 Connect with data cable.

● The equipment plugs must be secured with the

screws provided.

Connecting equipotential bonding

e.g. for intracardiac or intracranial operations.

3 Connect one end of the grounding cable to the pin at

the rear.

● Connect the other end to the equipotential bonding

pin on the operating table or ceiling pendant.

Connecting to electricity supply

The mains voltage must correspond to that specified on the rating plate on the rear of the machine.

4 Plug the mains plug into the wall socket.

5 The auxiliary power sockets are always switched on.

Care Reassembling system Connecting external equipment Connecting equipotential bonding Connecting to electricity supply

1792897018028970

SpO2 measurement (optional)

Safety and precautions

– The sensor must not be applied to limbs together with

an arterial catheter, infusion or sphygmomanometer cuff.

– Blood circulation must not be impeded during

application of the sensor. If possible, the site should be changed from time to time in order to avoid pressure necroses at the measuring point.

– The sensor should be protected against bright light

(covered).

– Nellcor sensors should be used exclusively and

applied as described below.

– Damaged sensors must not be used.

– The adhesive strip of the Oxiband sensor must be

discarded after use. It should not be stretched unduly. Never use two strips together.

Choice of sensor

Nellcor sensors must be used exclusively. Note the Instructions for Use of the sensors. Tissue damage may result if they are positioned or used incorrectly.

The choice of sensor should be based on the following criteria: – Patient's weight – Mobility of the patient – Possible application site – Perfusion of the patient – Period of use The following table listing the various sensors available and their specific characteristics may prove useful here.

OXISENSOR  I-20, OXISENSOR  D-20, DURASENSOR  DS-100A, OXISENSOR  D-25 and

OXISENSOR

 R-15 are registered trademarks.

in undamaged, unopened packaging.

Care

Reassembling system

SpO2 measurement

Safety and precautions

Choice of sensor

Type of OXISENSOR OXISENSOR DURASENSOR OXISENSOR OXISENSOR sensor I-20 D-20 DS-100A D-25 R-15

Age group Infants Children Adults Adults Adults

Weight of 1 to 20 kg 10 to 50 kg > 40 kg > 30 kg > 50 kg patient

Period of use Short and long-term Short and long-term Short-term Short and long-term Short and long-term

monitoring monitoring monitoring monitoring monitoring

Mobility of Limited activity Limited activity Inactive patients Limited activity Inactive patients patient only only

Preferred site Toe Finger Finger Finger Nose

Sterility

In sterile packaging In sterile packaging ____ In sterile packaging In sterile packaging

1 Choose the appropriate sensor.

Plug the sensor connector into the rear of the monitor.

Do not let the sensor lead hang over the monitor, as it may impair SpO2 measurement!

C-Lock ECG synchronization (optional)

If the patient is extremely mobile or has a very low arterial flow, the signals from the SpO2 measurement can be amplified with the aid of C-Lock ECG synchronization. In this case, the monitor receives two separate signals reflecting the cardiac activity: an optical signal from the SpO2 sensor and an electrical signal from the ECG monitor. The monitor uses the R-wave of the ECG signal to detect the pulse and for synchronization with the SpO2 measurement.

● Connect the ECG signal from the ECG monitor to the

rear of the monitor by means of a lead and pawl-type plug. Prerequisites for the electrical signal and pin assignment can be found in the »Technical Data« on page 121.

In the event of a delayed ECG signal

Synchronization may be impaired if the ECG signal is delayed by more than 40 milliseconds relative to the QRS complex. The monitor must be operated without C-Lock ECG synchronization whenever there is any suspicion of such a fault existing.

Care Reassembling system SpO2 measurement Choice of sensor C-Lock ECG synchronization

1812897018228970

Tips to avoid artefacts

Nellcor sensors must be used exclusively and positioned correctly in order to avoid the risk of measuring errors and tissue damage.

Damaged sensors with exposed electric wires must not be used – risk of electric shock.

Adhesive strips of the Oxiband OXI-A/N and OXI-P/I sensors must not be reused: they may not adhere properly. The strips must not be stretched unduly. Never use two strips together, as this may lead to venous pulsation and failure of the pulse signal.

High intrathoracic pressure, pressure on the thorax and other consecutive impairments of the venous flow can lead to venous pulsation with failure of the pulse signal.

The pulse signal may fail in the presence of shock, low blood pressure, severe vasoconstriction, major anaemia, hypothermia, arterial occlusion proximal to the sensor and asystolia.

The sensor must be covered in bright light (e.g. surgical lamps and direct sunlight), otherwise the pulse signal may fail or inaccurate results may be obtained.

The sensor should not be positioned on limbs together with an arterial catheter, sphygmomanometer cuff or intravascular venous infusion: pulse signal may fail and measurement becomes inaccurate.

Major concentrations of dyshaemoglobins, such as carboxyhaemoglobin or methaemoglobin, can make the measurement inaccurate.

Intravascular dyes, such as methylene blue, may similarly result in inaccurate measurement.

Electrocautery can impair the measuring accuracy; the leads and sensor should therefore be positioned as far away as possible from the electrocautery and its neutral electrode.

Sensor performance may be impaired if the patient moves violently, thus leading to inaccurate results. The sensor should be applied to a different site in such cases in order to reduce the risk of artefacts due to movement.

Care

Reassembling system

SpO2 measurement

Tips to avoid artefacts

Applying the sensors

Durasensor DS-100 A

Reusable sensor for short-term monitoring of relatively quiet patients weighing over 40 kg.

The sensor is preferably positioned on the index finger, although other fingers can also be used. The fifth finger should be used if the patient is particularly large or obese.

● Open the clip slightly and slide the sensor onto the

finger. The tip of the finger must touch the end, the soft padding resting on the nail and tip of the finger. The lead should be on top of the finger.

● Ensure that the finger is not compressed or hurt by

the clip.

Oxisensor D-25 und D-20

Adhesive sensors for short and long-term monitoring of patients with limited mobility and weighing from 15 to more than 50 kg.

Long nails make application of the sensor more difficult and coloured nail varnish impairs the accuracy of measurement.

● Cut the nail if necessary.

● Remove nail varnish if necessary.

● Draw the protective film off the adhesive strip.

● Place the sensor on a flat surface with the adhesive

side facing upwards.

● Place the tip of the index finger onto the middle of the

optical element on the side of the sensor opposite the lead and wrap the adhesive strips round the finger.

● Fold the other side of the sensor over the tip of the

finger and align it on the underside so that the markings are lined up correctly. Press the sensor into place and wrap the adhesive strips round the finger.

A thinner finger should be used instead of the index finger if the patient is very obese.

Care Reassembling system SpO2 measurement Applying the sensors

183289701842897018528970

Oxisensor I-20

Adhesive sensor for short and long-term monitoring of patients with limited mobility and weighing between 3 and 15 kg.

● Peel the protective film off the adhesive strip.

● Place the sensor underneath the big toe so that the

dotted line corresponds to the inner edge of the toe and the marking is in the middle of the toe.

● Wrap the sensor round the toe so that the other

marking rests exactly on top of the toenail.

● Secure the sensor lead to the foot with the additional

adhesive tape.

Reusing the sensor:

The sensor can be reused if the tape is still tacky. Adhesion is improved by small additional adhesive spots.

● Hold the adhesive spots by the blue tags, peel them

off the backing paper and remove the protective film.

● Affix one spot to the middle of each optical element.

● Position the sensor as described above.

Other measuring point: The sensor is preferably applied to the big toe because it moves less than the patient's hand. If the big toe is not available, however, the sensor can also be applied to the thumb.

● Peel off the protective film on the adhesive strip.

● Position the sensor under the thumb so that the

dotted line corresponds with the edge of the thumb and the marking is in the middle of the thumb.

● Wrap the sensor round the thumb so that the other

marking lies exactly on top of the thumb nail.

● Secure the sensor lead to the hand with the additional

adhesive tape.

Care

Reassembling system

SpO2 measurement

Applying the sensors

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Oxisensor R-15

Disposable adhesive sensor for short and long-term monitoring of inactive patients weighing more than 50 kg. Preferably used for patients possibly suffering from severe vasoconstriction or poor circulation.

● Clean the bridge of the nose with the liquid in the

enclosed ampoule – keep away from the eyes.

● Peel off the protective film on the sensor.

● Align the sensor symmetrically on the bridge of the

nose: the two symbols should lie on the bone/cartilage boundary.

● Press the sensor firmly into place and hold for

10 seconds to ensure good adhesion.

● The R-15 sensor must not be used on patients with

nasal intubation or a mask.

100

Care Reassembling system SpO2 measurement Applying the sensors

19028970G102

Dräger Cato Instructions For Use Manual

Specifications and Main Features

Frequently Asked Questions

User Manual