GE auisys cs2 User's Reference Manual

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Aisys CS²

User's Reference Manual

Software Revision 10.X

User responsibility

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

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

CAUTION

U.S. Federal law restricts this device to sale by or on the order of a licensed medical practitioner.Outside the U.S.A., check the local laws for any restriction that may apply.

1 Introduction

Table of Contents

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

Indications for use ..............................1-2

General information .............................1-2

Serial numbers .................................1-4

Trademarks ...................................1-5

Symbols used in the manual or on the equipment ........1-6

Symbols used on the equipment ...................1-6

Symbols used on the user interface ................1-9

Typeface conventions used ........................ 1-10

Abbreviations ....................................1-11

System information ...............................1-14

System classification ...........................1-14

System safety ................................... 1-16

2 System controls and menus

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

Advanced breathing system components ...............2-6

Device standards IEC 60601-1:2005 .............. 1-14

Device standards IEC 60601-1:1988 .............. 1-14

Integral system components .....................1-15

Not integral system components ..................1-15

System accessories ............................1-15

Preparing for use ..............................1-16

Inspecting the system ..........................1-17

Electrical safety ...............................1-18

Using the brake ................................2-4

Using the O2 flush button ........................2-4

Positioning the display ...........................2-4

Using the bag support arm .......................2-7

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Aladin cassette controls ............................ 2-8

Display controls ...................................2-9

Touch points ................................. 2-10

Measured value touch points .................... 2-10

Active alarm touch points ....................... 2-11

Anesthesia system display .........................2-12

Digit fields ................................... 2-13

Waveform fields ...............................2-13

Split screen field .............................. 2-13

Display navigation ................................2-15

Using menus .................................2-15

Using the ComWheel .......................... 2-16

Using quick keys ..............................2-16

3 Operation

System operation safety ............................3-2

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

Start a case ......................................3-4

Minimum Alveolar Concentration .................. 3-4

Starting a case using default settings ...............3-5

Starting a case using custom settings .............. 3-5

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

Turning off the system ..............................3-7

Ventilator setup ...................................3-8

Changing ventilator mode ........................3-8

Changing ventilator settings ......................3-8

Optional ventilator procedures .................... 3-8

Auto limits ....................................... 3-9

Setting auto limits .............................. 3-9

Gas setup ...................................... 3-10

Changing gas settings ..........................3-10

Changing balance gas ..........................3-10

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

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System setup ....................................3-13

Patient demographics ..........................3-13

Screen setup menu ............................3-13

Fresh gas usage ..............................3-16

Alarm setup .....................................3-17

Setting CO2 alarms ............................3-17

Setting MV TV alarms ..........................3-18

Setting alarm limits ............................ 3-18

Viewing alarm history .......................... 3-19

Setting alarm volume ...........................3-19

Setting apnea delay ............................3-19

Silencing leak audio alarms ..................... 3-19

Setting auto MV limits ..........................3-20

Setting to default limits ......................... 3-20

Alarms On Off ...................................3-21

Disable alarm limits ............................3-21

Next page ...................................... 3-22

Trends .........................................3-23

Setting trends ................................ 3-23

Spirometry ......................................3-24

Setting loop type ..............................3-24

Setting loop graph scaling .......................3-25

Setting patient and sensor type ...................3-25

Setting the data source .........................3-25

Setting spirometry volume type ...................3-26

Saving, viewing, and deleting spirometry loops ......3-26

Procedures ..................................... 3-27

Pause gas flow ............................... 3-27

Cardiac bypass ...............................3-27

Vital capacity .................................3-28

Cycling ......................................3-29

Timer function ...................................3-31

Using the timer ............................... 3-31

ecoFLOW .......................................3-32

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4 Preoperative checkout

Using ecoFLOW .............................. 3-33

Alternate O2 control ...............................3-34

Using Alternate O2 control ...................... 3-34

EZchange canister mode .......................... 3-36

Using EZchange canister mode ..................3-37

Condenser ......................................3-38

Draining the condenser .........................3-38

Auxiliary Common Gas Outlet .......................3-40

Using the ACGO ..............................3-40

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

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

5 Preoperative tests

Aladin cassette installation ..........................5-2

Flow and pressure calibration ........................5-3

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

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

Full test ......................................... 5-6

Vent and gas ..................................5-6

Circuit leak ....................................5-6

Circuit O2 cell ................................. 5-7

External gas monitor ............................5-7

Individual tests ....................................5-8

Vent and gas ..................................5-8

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

Circuit O2 cell ................................. 5-8

Low P leak ....................................5-8

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

Agent delivery .................................5-9

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

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6 Airway modules

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

Connecting the airway module .......................6-5

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

Automatic agent identification ........................6-7

Calibrating the airway module ........................6-8

7 Alarms and troubleshooting

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

Table of Contents

E and M series airway modules ................... 6-3

CARESCAPE airway modules .................... 6-4

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

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

8 Setup and connections

Pausing alarms ................................7-2

Cancelling audio pause ..........................7-3

Display changes during alarms ....................7-3

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

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

Internal failure .................................7-4

Informational tones .............................7-4

List of alarms .....................................7-5

Sustained pressure threshold ....................7-12

Alarm ranges ....................................7-13

Alarm tests ......................................7-15

Breathing system problems .........................7-17

Electrical problems ............................... 7-18

Pneumatic problems ..............................7-19

Setup safety ......................................8-2

Moving and transporting the system ...................8-4

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Setting up the absorber canister ......................8-5

When to change the absorbent ....................8-6

Removing a canister ............................8-7

Removing an EZchange canister ..................8-7

Filling the Reusable Multi Absorber canister ......... 8-8

Electrical connections .............................8-10

Mains inlet ...................................8-10

Equipotential stud .............................8-10

Outlets ......................................8-10

Serial port ................................... 8-11

Pneumatic connections ............................8-12

Pipeline inlets ................................ 8-12

Scavenging ..................................8-12

Sample gas return port .........................8-14

9 User maintenance

Pneumatic power outlet .........................8-15

Vacuum suction regulator (optional) ...............8-15

Venturi suction regulator (optional) ................8-16

Auxiliary O2 flowmeter (optional) ................. 8-16

Installing gas cylinders ............................ 8-18

Installing cylinders with pin indexed yokes ..........8-18

Installing cylinders with DIN connections ...........8-18

Performing a high-pressure leak test .............. 8-18

Attaching equipment to the top of the machine ......... 8-20

Passive AGSS ...................................8-21

Connecting passive AGSS ......................8-21

Active AGSS ....................................8-22

Connecting active AGSS with a flow indicator .......8-22

Connecting active adjustable AGSS ...............8-23

Maintenance safety ................................9-2

Repair policy .....................................9-3

Maintenance summary and schedule ..................9-4

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Table of Contents

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

Calibration menu ..................................9-6

Flow and pressure calibration .....................9-6

Circuit O2 cell ................................. 9-6

Airway gas calibration ...........................9-7

Water buildup ..................................9-7

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

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

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

Complete advanced breathing system ................10-5

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

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

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

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

Condenser .....................................10-11

Test tools and system parts ....................... 10-12

11 Specifications and theory of operation

System pneumatic circuit .......................... 11-2

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

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

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

Mixed gas ................................... 11-5

EZchange canister .............................11-5

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

Pneumatic specifications ...........................11-6

Gas supplies .................................11-6

ACGO port relief .............................. 11-6

Non-circle circuit relief ..........................11-6

Pneumatic power outlet .........................11-7

Electrical block diagram ........................... 11-8

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Electrical power .................................11-10

Power cord ..................................11-10

Battery information ........................... 11-10

Flow specifications .............................. 11-12

Breathing system specifications ....................11-13

Gas scavenging ..............................11-14

Physical specifications ........................... 11-16

Lower dovetail loading .........................11-16

Upper dovetail loading .........................11-17

Environmental requirements .......................11-18

Airway module specifications ...................... 11-19

Gas specifications for E-, M-series modules ....... 11-19

Gas specifications for CARESCAPE modules ......11-20

Typical performance ..........................11-21

Suction regulators (optional) .......................11-22

Ventilator theory ................................ 11-23

O2 monitoring theory of operation ............... 11-23

ecoFLOW theory of operation ...................11-24

Ventilation modes ............................11-24

Ventilation modes factory default settings ......... 11-35

Ventilation mode transition .....................11-36

Ventilator operating specifications .................. 11-37

Pneumatics .................................11-37

Fresh gas compensation .......................11-37

Pressure ................................... 11-37

Volume .....................................11-37

Oxygen .................................... 11-38

Ventilator accuracy data ..........................11-39

Electronically controlled vaporizer and Aladin cassette ..11-40

Aladin2 cassettes ............................ 11-44

Aladin cassettes ............................. 11-44

Electromagnetic compatibility (EMC) ................11-46

Cables .....................................11-46

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12 Super user mode

Table of Contents

Guidance and manufacturer’s declaration -

electromagnetic emissions .....................11-47

Guidance and manufacturer’s declaration -

electromagnetic immunity ......................11-47

Power immunity ..............................11-48

Radiated immunity ............................11-48

Recommended separation distances .............11-50

Super user mode .................................12-2

Gas usage ......................................12-3

Resetting cumulative gas usage ..................12-3

Setting ecoFLOW ............................. 12-3

Setting agent costs ............................12-3

System configuration ..............................12-5

Display settings ...............................12-5

Ventilator settings .............................12-5

Alarm settings ................................12-6

Parameter settings ............................ 12-6

Trends setup .................................12-8

Page setup ...................................12-8

Case defaults ...................................12-10

Configuring case defaults ......................12-10

Setting case name ............................12-10

Setting volume apnea defaults ..................12-10

Default case type settings ......................12-11

Gas controls ....................................12-15

Setting gas preset values ......................12-15

Setting fresh gas controls ......................12-15

Procedures setup ............................... 12-16

Setting vital capacity defaults ...................12-16

Setting cycling controls and settings ..............12-16

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13 Vaporizer cassettes

Vaporizer .......................................13-2

Aladin2 cassette variants ....................... 13-2

Aladin cassette variants ........................ 13-3

Changing a cassette during a case ...................13-6

Removing a cassette ..............................13-7

Installing a cassette ...............................13-8

Cassette maintenance .............................13-9

Cleaning .....................................13-9

Draining cassettes .............................13-9

Draining halothane cassettes ...................13-10

Filling Aladin2 cassettes ..........................13-11

Filling with Easy-Fil system .....................13-11

Index

Filling with Quik-Fil system .....................13-13

Filling with Saf-T-Fill bottle ..................... 13-14

Filling Aladin cassettes ...........................13-16

Filling with keyed filler system ...................13-16

Filling with Quik-Fil system .....................13-17

Filling with Saf-T-Fil bottle ......................13-18

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1 Introduction

Introduction

In this section

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

Symbols used in the manual or on the equipment........1-6

Typeface conventions used........................1-10

Abbreviations................................... 1-11

System information...............................1-14

System safety...................................1-16

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Intended use

The Aisys CS2 is scalable, flexible, and functionally integrated, featuring the most advanced design, ventilation, respiratory monitoring, and breathing system. Module bays allow for the physical integration of legacy Datex-Ohmeda patient monitors and supports mounting of other GE Healthcare monitors. Optionally, the open architecture design supports mounting of non-Datex-Ohmeda patient monitors, record keeping, and connections to the hospital information system. The INview movable display arm helps keep the anesthetist’s focus on the patient by offering control of all hemodynamic, gas delivery, anesthetic agent, and ventilation parameters.

This anesthesia system is designed for mixing and delivering inhalation anesthetics, Air, O2, and N2O.

The anesthesia system’s small breathing system volume allows an anesthetic agent delivery response time of less than 7 seconds. (Agent response time defined as achieving 90% of the setting change measured while in non-circle circuit with a 2 l/min fresh gas flow.)

This anesthesia system uses SmartVent ventilation technology offering Volume Control Ventilation with tidal volume compensation and electronic PEEP. The proven SmartVent technology also features optional Pressure Control Ventilation, Pressure Support Ventilation with an Apnea Backup (PSVPro) that is used for spontaneously breathing patients, Synchronized Intermittent Mandatory Ventilation (SIMV) modes, Pressure Control VentilationVolume Guarantee (PCV-VG), Continuous Positive Airway Pressure + Pressure Support Ventilation (CPAP + PSV), and VCV Cardiac Bypass. In Volume Control Ventilation, a patient can be ventilated using a minimal tidal volume of 20 ml. In Pressure Control Ventilation, volumes as low as 5 ml can be measured. These advanced features allow for the ventilation of a broad patient range.

WARNING

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

Indications for use

The system is intended to provide general inhalation anesthesia and ventilatory support to a wide range of patients (neonate, pediatric, and adult). The device is intended for volume or pressure control ventilation.

General information

This anesthesia system uses the Advanced Breathing System (ABS). This integrated breathing system is easy to remove and disassemble and is autoclavable. Its fully integrated design

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1 Introduction

enhances the system’s elegance while minimizing tube connections, minimizing circuit volume, and increasing the work surface area.

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

The anesthesia system is suitable for use in a patient environment. The system must only be operated by personnel trained and qualified in the administration of general anesthesia. The User’s Reference manual is intended to provide training on the operation of the system. Operate the system from the front with a clear view of the display. It must be operated according to the instructions in this User’s Reference manual. Make sure that all user documents are obtained from the manufacturer.

Refer to the Technical Reference manual for service information including: special installation instructions, installation checklist, means of isolating the supply mains, and replacement of fuses, supply cord, and other parts.

WARNING

Note

Explosion Hazard. Do not use this system with flammable anesthetic agents.

Configurations available for this product depend on local market and standards requirements. Illustrations in this manual may not represent all configurations of the product. This manual does not cover the operation of every accessory. Refer to the accessory documentation for further information.

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AB.75.253

Figure 1-1 • Front view

Serial numbers

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

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Trademarks

1 Introduction

AAAX11111 AAAXX111111AA The X represents an alpha character

indicating the year the product was manufactured; H = 2004, J = 2005, etc. I and O are not used.

Aisys, Carestation, Advanced Breathing System, ComWheel, Dfend, EZchange, Disposable Multi Absorber, Reusable Multi Absorber, PSVPro, SmartVent, Easy-Fil, Aladin, and Aladin2 are

registered trademarks of Datex-Ohmeda, Inc. Other brand names or product names used in this manual are

trademarks or registered trademarks of their respective holders.

The XX represents a number indicating the year the product was manufactured; 04 = 2004, 05 = 2005, etc.

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Symbols used in the manual or on the equipment

Symbols replace words on the equipment, on the display, or in product manuals.

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

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

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

Symbols used on the equipment

O2 Flush button O2 cell connection

Air Air

APL settings are approximate Anesthetic Gas Scavenging System

Maximum Vacuum

Serial number Stock number

Exhaust Bellows volumes are approximate

Plus, positive polarity Minus, negative polarity

Maximum mass of configured mobile equipment

Autoclavable

On (power) Off (power)

Standby Interference

Type BF equipment Type B equipment

Dangerous voltage Frame or chassis ground

Protective earth ground Earth ground

Direct current Alternating current Caution Refer to instruction manual or booklet

Caution: federal law prohibits dispensing without prescription.

(blue background)

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1 Introduction

Operating instructions General warning (yellow background)

Electrical input/output Sample gas inlet to scavenging

Pneumatic inlet Pneumatic outlet

Equipotential Lamp, lighting, illumination

Variability Variability in steps

Suction bottle outlet Vacuum inlet

Bag position/manual ventilation Mechanical ventilation

Inspiratory flow Expiratory flow

Movement in one direction Movement in two directions

Lock Unlock

Open drain (remove liquid) Low pressure leak test

This way up Not autoclavable

Read to center of float EZchange canister (CO2 bypass)

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

Date of manufacture Manufacturer

Authorized representative in the European Community

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

Stepping prohibited When moving or transporting

Device contains phthalates XXXX indicates phthalate Possible phthalates include: DBP: Di-n-butyl phthalate DNPP: 1,2-Benzenedicarboxylic acid, dipentylester, branched and linear; Npentyl-isopentylphthalate; Di-n-pentyl phthalate; Diisopentylphthalate BBP: Benzyl butyl phthalate DEHP: Bis(2-ethylhexyl) phthalate; Di(2-ethylhexyl) phthalate DMEP: Bis(2-methoxyethyl) phthalate DIBP: Dissobutyl phthalate

Union made Stacking limit by mass

GOST R Russian certification

anesthesia machine, place the display arm and shelf in the transport position as shown.

Single use device

Keep dry Do not stack

Temperature limitation Fragile, handle with care

Protect from heat and radioactive sources

Humidity limitation Electrical test certification

USB port Network

Not a USB port VGA connection

Serial connection Pinch hazard

Recyclable material

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Atmospheric limitation

Symbols used on the user interface

1 Introduction

Lock Indicates the touchscreen is locked.

Lock/unlock button Button label to lock or unlock the touchscreen.

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

Gas indicator. Color associated with gas settings.

gas settings. Audio Pause Submenu

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

battery power remaining.

Airway module indicator ACGO active

Drop-down menu Start/end case

Pediatric Adult

Lung procedure Home screen

Timer Alarm off

Pipeline Cylinder

Test indicator: red for failure, yellow for

Alarm low and alarm high limit indicator conditional outcome, and green for pass.

Manual ventilation Enhanced temperature sensing

Agent level sensing supported. Bar

Agent level unknown indicates amount of agent remaining.

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Typeface conventions used

Soft keys and menu items are written in bold italic typeface; for example, System Setup.

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

When referring to different sections and other documents, the names are written in italic typeface and enclosed in double quotes; for example, "System controls and menus".

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Abbreviations

1 Introduction

Abbreviation Definition

AA Anesthetic agent ABS Advanced breathing system ACGO Auxiliary common gas outlet AGSS Anesthesia gas scavenging system Alt O2 Alternate O2 APL Adjustable pressure-limiting APN Apnea ATPD Ambient temperature and pressure, dry humidity

conditions

BTPS Body temperature, ambient pressure, saturated humidity

conditions

CGO Common gas outlet CO Carbon monoxide CO2 Carbon dioxide Compl Compliance CPAP + PSV Continuous positive airway pressure + pressure support

ventilation

EMC Electromagnetic Compatibility ET End-tidal concentration EtCO2 End-tidal carbon dioxide EtO2 End-tidal oxygen Exp Expiratory

FI Fraction of inspired gas FiCO2 Fraction of inspired carbon dioxide FiO2 Fraction of inspired oxygen Flow-Vol Flow-volume loop

I:E Inspiratory-expiratory ratio Insp Inspiratory Insp Pause Inspiratory pause time

kg Kilogram

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Abbreviation Definition

MAC Minimum alveolar concentration MV Minute volume MVexp Expired minute volume MVinsp Inspired minute volume

N2O Nitrous oxide

O2 Oxygen

Paw Airway pressure PCV Pressure control ventilation PCV-VG Pressure control ventilation - volume guaranteed PEEP Positive end expiratory pressure Paw-Flow Pressure-flow loop Pinsp Inspiratory pressure Pmax Maximum pressure Pmean Mean pressure Ppeak Peak pressure Pplat Plateau pressure Psupport Support pressure PSV Pressure support ventilation PSVPro Pressure support ventilation with apnea backup Paw-Vol Pressure-volume loop

Raw Airway resistance RF Radio frequency RR Respiratory rate

SIMV PCV Synchronized intermittent mandatory ventilation -

pressure control ventilation

SIMV PCV-VG Synchronized intermittent mandatory ventilation -

pressure control ventilation - volume guaranteed

SIMV VCV Synchronized intermittent mandatory ventilation - volume

control ventilation

Texp Expiratory time Tinsp Inspiratory time Tpause Time where breath is paused with no flow TV Tidal volume TVexp Expired tidal volume TVinsp Inspired tidal volume

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Abbreviation Definition

VCV Volume control ventilation Vol Volume

1 Introduction

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System information

System classification

Device standards IEC 60601-1:2005

This system is classified as follows:

• Class I Equipment.

• Type B Equipment.

• Type BF Equipment (airway modules).

• Ordinary Equipment.

• Not for use with flammable anesthetics.

• Continuous operation.

Devices used with this anesthesia system shall comply with the following standards where applicable:

• Breathing system and breathing system components ISO 80601-2-13.

• Anesthetic gas scavenging systems ISO 80601-2-13

• Anesthetic vapor delivery devices ISO 80601-2-13.

• Anesthetic agent monitors ISO 80601-2-55.

• Oxygen monitors ISO 80601-2-55.

• Carbon dioxide monitors ISO 80601-2-55.

• Exhaled volume monitors ISO 80601-2-13.

Device standards IEC 60601-1:1988

Devices used with this anesthesia system shall comply with the following standards where applicable:

• Breathing system and breathing system components ISO 8835-2.

• Anesthetic gas scavenging systems ISO 8835-3

• Anesthetic vapor delivery devices ISO 8835-4.

• Anesthetic agent monitors ISO21647.

• Oxygen monitors ISO 21647.

• Carbon dioxide monitors ISO 21647.

• Exhaled volume monitors IEC 60601-2-13.

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Integral system components

This anesthesia system contains the following integral components, monitoring devices, alarm systems, and protection devices that comply with European, international, and national standards:

• Breathing system pressure-measuring device.

• Airway pressure-limitation device.

• Exhaled-volume monitor.

• Breathing system integrity alarm.

• Breathing system continuing-pressure alarm.

• O2 monitor (optional O2 cell).

• Anesthesia ventilator.

• Breathing system.

• Anesthetic vapor delivery device.

Not integral system components

1 Introduction

System accessories

These devices are not integral to this anesthesia system:

• CO2 monitor.

• Anesthetic agent monitor.

• O2 monitor (when O2 cell is not installed).

• Suction regulator.

• EZchange canister system.

• Condenser.

When adding devices to the anesthesia system, follow the installation instructions provided by the device manufacturer. Whoever adds individual devices to the anesthesia system shall provide instructions on how to enable the individual devices. For example, a preoperative checklist.

These devices can be used as accessories on this anesthesia system:

• Suction regulator.

• EZchange canister system.

• Condenser.

• Aladin and Aladin2 vaporizer cassettes.

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System safety

Preparing for use

WARNING

Read each component’s User’s Reference manual and understand the following before using this system:

• All system connections.

• All warnings and cautions.

• How to use each system component.

• How to test each system component.

Before using the system:

•

• Complete all of the tests in the "Preoperative tests" section.

• Test all other system components.

• If a test fails, do not use the equipment. Have an authorized service representative repair the equipment.

European, international, and national standards require

•

the following monitoring be used with this system:

• Exhaled volume monitoring.

• O2 monitoring.

• CO2 monitoring.

• Anesthetic agent monitoring be used when anesthetic vaporizers are in use.

Single-use products are not designed or validated to be

•

reused. Reuse may cause a risk of cross-contamination, affect the measurement accuracy, system performance, or cause a malfunction as a result of the product being physically damaged due to cleaning, disinfection, resterilization, or reuse.

Be aware of the risks and precautionary measures

•

related to phthalates. The following types of procedures may increase the risk of exposure to phthalates when a

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1 Introduction

device containing phthalates is used for treatment of children or treatment of pregnant or nursing women:

• Exchange transfusion in neonates, total parenteral nutrition in neonates, multiple procedures in sick neonates, haemodialysis in peripuberal males, male fetus and male infant of pregnant women, and lactating women; and massive blood infusion into trauma patients. Although these procedures have the potential for increased risk of exposure, conclusive evidence of human health risks has not been established. As a precautionary measure, to reduce the potential for unnecessary exposures to phthalates, the product must be used in accordance with the instructions for use, and practitioners should refrain from using this product beyond the period of time the product is medically necessary or needed.

Follow hospital procedures for the prevention and

•

treatment of malignant hyperthermia for patients sensitive to inhalation anesthetic agents.

Risk of fire. Limit the use of supplemental oxygen

•

concentrations to less than 30 percent when using a heat source or device that may lead to combustion. Consult facility risk management procedures to minimize the risk of fire if an oxygen concentration of more than 30 percent is required for any reason.

This system is not intended for use where the

•

surrounding oxygen concentration is in excess of 25 percent. Increased oxygen concentrations can result in an increased risk of fire.

See "Device standards IEC 60601-1 2005" and "Integral system components" for information regarding monitoring built into this device.

Inspecting the system

Before using the system, make sure that:

• The equipment is not damaged.

• Components are correctly attached.

• The breathing circuit is correctly connected and not damaged.

• The breathing system is correctly assembled and contains

• The Aladin cassette is locked in position and contains sufficient

sufficient absorbent. Refer to the “Cleaning and Sterilization” manual for breathing system assembly instructions.

agent.

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Aisys CS²

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

• Cylinder valves are closed.

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

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

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

• Equipment for airway maintenance, manual ventilation, tracheal intubation, and IV administration is available and in good condition. In the case of system failure, the lack of immediate access to alternative means of ventilation can result in patient injury.

• Applicable anesthetic and emergency drugs are available.

• Check that the brake is set to prevent movement.

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

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

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

Electrical safety

WARNING

Do not connect non-medical electrical equipment directly to the AC outlet at the wall instead of an AC power source which uses a separating transformer. Doing so may increase enclosure leakage current above levels allowed by IEC 60601-1 in normal conditions and under single-fault conditions. This may cause an unsafe electrical shock to the patient or operator.

After connecting anything to these outlets, conduct a complete system leakage current test (according to IEC 60601-1).

The system provides connections for items such as printers, visual displays and hospital information networks (only connect items that are intended to be part of the system). When these items (non-medical equipment) are combined with the system, these precautions must be followed:

• Do not place items not approved to IEC 60601-1 closer than 1.5 m to the patient.

• All items (medical electrical equipment or nonmedical electrical equipment) connected to the system by a signal input/signal output cable must be

1-18 2067226-001

1 Introduction

supplied from an AC power source which uses a separating transformer (in accordance with IEC

60989) or be provided with an additional protective earth conductor.

• If a portable multiple socket outlet assembly is used as an AC power source, it must comply with IEC 60601-1-1. The assembly must not be placed on the floor. Using more than one portable multiple socket outlet assembly is not recommended. Using an extension cord is not recommended.

An operator of the medical electrical system must not

•

touch non-medical electrical equipment and the patient simultaneously. This may cause an unsafe electrical shock to the patient.

•

Use of portable phones or other radio frequency (RF) emitting equipment (that exceed electromagnetic interference levels specified in IEC 60601-1-2) near the system may cause unexpected or adverse operation. Monitor operation when RF emitters are in the vicinity.

•

Use of other electrical equipment on or near this system may cause interference. Verify normal operation of equipment in the system before use on patients.

2067226-001 1-19

1-20 2067226-001

2 System controls and menus

System controls and menus

In this section

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

Advanced breathing system components.............. 2-6

Aladin cassette controls............................2-8

Display controls...................................2-9

Anesthesia system display.........................2-12

Display navigation................................2-15

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System overview

1. Patient monitoring modules 9. Aladin cassette storage bay

2. Dovetail 10. Brake

3. Aladin cassette and active bay 11. O2 flush button

4. Light switch 12. Advanced breathing system

5. Alternate O2 control 13. Auxiliary O2 flow control

6. System switch 14. Anesthesia display

7. Mains indicator 15. Patient monitoring display

8. Integrated suction

2 3

4 5

7 8

AB.75.251

Figure 2-1 • Front view

2-2 2067226-001

2 System controls and menus

11 10

7 8

1. Serial port 7. Mains inlet

2. Collection bottle connection 8. System circuit breaker

3. Cylinder wrench (key) storage 9. Equipotential stud

4. Cylinder yoke 10. Outlet circuit breaker

5. Anesthesia Gas Scavenging System 11. Isolated electrical outlet

6. Pipeline connections

Figure 2-2 • Rear view

5 6

AB.75.255

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AC.22.009

Aisys CS²

Using the brake

The central brake holds the system in place.

WARNING

Do not use the brake while moving the anesthesia system. This could cause the machine to tip over. Only use the brake to keep the system in place.

1. Push down on the brake pedal to lock the system in place.

2. Lift up on the brake pedal to release the brake.

Using the O2 flush button

The O2 flush button supplies a high flow of O2 to the breathing system.

1. Push the O2 flush button to deliver a high flow of O2.

2. Release the O2 flush button to stop the delivery of a high flow of O2.

Positioning the display

The display can be moved for optimal viewing.

1. Unlock the display arm.

2. Raise or lower the display arm to adjust the height of the display.

3. Lock the display arm.

4. Rotate the display arm toward or away from the system to adjust the horizontal position of the display.

5. Tilt the display up or down to adjust the vertical angle of the display.

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2 System controls and menus

6. Tilt the display left or right to adjust the horizontal angle of the display.

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Advanced breathing system components

9 8

1 2

3 4

1. Expiratory check valve 8. Breathing system release

2. Inspiratory check valve 9. Manual bag port

3. Inspiratory flow sensor 10. Adjustable pressure-limiting (APL) valve

4. Expiratory flow sensor 11. Bag/Vent switch

5. Absorber canister 12. Bellows assembly

6. Absorber canister release 13. Airway module

7. Leak test plug

Figure 2-3 • Advanced breathing system

AB.75.252

2-6 2067226-001

1. Bag support arm

2. Auxiliary Common Gas Outlet (ACGO) switch

3. ACGO port

4. EZchange canister module (CO2 bypass)

5. Ezchange canister release

6. Condenser

7. Condenser drain button

2 System controls and menus

2 3

AB.75.254

Figure 2-4 • Breathing system options

Using the bag support arm

Use the optional bag support arm to hold the breathing circuit bag.

AB.82.023

1. To raise the bag support arm, squeeze the button and rotate the arm up the top position.

2. To lower the bag support arm, squeeze the button and rotate the arm down to the lower position.

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Aladin cassette controls

The electronically controlled vaporizer consists of the internal electronic control unit and the Aladin agent cassette. See the "Vaporizer" section for more information.

AB.60.038

1. Handle with release trigger

2. Lock

3. Liquid level indicator

4. Agent filling port

Figure 2-5 • Aladin2 cassette

2-8 2067226-001

Display controls

2 System controls and menus

The system uses touchscreen technology, hard keys, and a ComWheel to access system functions, menus, and settings.

The touchscreen has numerous touch point areas that make accessing menus and settings quick and easy. The buttons on the right side of the screen provide direct access to commonly used functions. The ventilation quick keys enable setup of ventilation modes. The gas control quick keys provide a method to set up the gas used for a case.

Touch only one touch point at a time to ensure the correct selection is made.

WARNING

CAUTION

Liquids on the display may degrade the performance of the touchscreen. If liquids come in contact with the display, lock the touchscreen and clean the display. Unlock the touchscreen once the display has been cleaned to resume use of the touchscreen.

Do not apply excessive force to the touchscreen as damage may occur.

AC.22.001

6 5 4 3

1. ComWheel Selects a menu item or confirms a setting. Turn clockwise or counterclockwise to scroll through menu items or change settings.

2. Home key Removes all menus from the screen.

3. Screen Lock/Unlock

key

4. Start/End Case key Initiates Start or End Case function.

5. Touchscreen Activates functions when touch areas on the screen are selected.

2067226-001 2-9

Locks the touchscreen. Toggles between lock and unlock functions.

Aisys CS²

6. Audio Pause key Stops audio for 120 seconds for any active, eligible high and medium priority alarms. Prevents audio (audio off) for 90 seconds when no medium or high priority alarms are active. Allows the operator to acknowledge any non-active medium or high priority latched alarms.

Figure 2-6 • Display controls

Touch points

1. Wave fields 5. Ventilator quick keys

2. Measured values 6. Gas quick keys

3. Function keys 7. Split screen values

4. Digit fields

Figure 2-7 • Normal/Full screen view with shaded touch point areas

AB.75.256

Measured value touch points

Touching measured values provides access to the Alarm Setup menu and alarm limits.

2-10 2067226-001

1. Touch the measured value to access the Alarm Setup menu.

2. The Alarm Setup menu displays.

3. Select the alarm limit and set it to the correct value. Touch the value on the touchscreen or push the ComWheel to confirm the desired setting.

4. Push the Home key, touch the waveform area of the display, or select Close to close the menu.

Active alarm touch points

When an alarm sounds the alarm message is displayed at the top of the screen and, if applicable, the alarming numeric field and digit field flashes. The Alarm messages at the top of the screen are message alerts only and not active touch points.

1. Touch the flashing numeric field to access the Alarm Setup menu and alarm limits for the active alarm.

2. The Alarm Setup menu displays with the active alarm limit highlighted. For example: If the ‘Ppeak high’ alarm activates, the high alarm limit setting for Ppeak displays with the highlight.

3. Select the active alarm limit and change it to the desired setting.

2 System controls and menus

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Aisys CS²

Anesthesia system display

5 6

8 9

1. Audio pause symbol and countdown clock

2. Alarm message fields Displays the active alarms.

3. Waveform fields Displays the waveforms of measured values. For example: Paw, Flow, and

4. General message fields or lock touchscreen indicator

5. Measured values fields Displays the measured values. For example: Paw, Flow, and CO2.

6. Clock Displays the current time.

7. Function keys Functions available are: Audio Pause, Alarm Setup, Alarms On/Off, Auto

8. Digit fields Contains information for Spirometry, Resp, Agent, and Gases.

9. Ventilation mode Displays the selected ventilation mode. For example: Ventilator On, and

10. Ventilator quick keys Displays Mode, associated ventilation parameters, and More Settings. For

Indicates when alarm audio is paused and the countdown clock until audio is on.

CO2. Displays general messages and the touchscreen lock indicator.

Limits, System Setup, Next Page, Trends, Spirometry, Procedures, Timer, Start, and End Case.

Volume Control.

example: Mode, TV, RR, I:E, PEEP, and More Settings.

AB.75.258

2-12 2067226-001

2 System controls and menus

11. Gas quick keys Displays O2, Total Flow, and Gas Setup.

12. Split screen Contains airway pressure, gas flow values, compliance, trends, and optional

ecoFLOW information.

Figure 2-8 • Typical Normal/Full view

Digit fields

The digit field can be set to show specific information such as gas types, gas supply, flow, agent, respiration, and spirometry loops. If the digit field is set to show agent and no airway module is inserted, the area is blank.

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

See "Screen setup menu" in the "Operation" section for more information.

Waveform fields

Split screen field

Up to three waveforms can be shown on the normal screen view. Each waveform can be set to show specific Paw, agent, flow, or CO2 data. The corresponding numeric information shows in the measured values field to the right of the waveform. If the waveform is set to show the agent and no airway module is inserted, that waveform and numeric area is blank.

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

When in a case, touch the waveform field area to close the menu. See "Screen setup menu" in the "Operation" section for more

information.

The split screen field can be set to show gas metabolics, trends, spirometry loops, Paw gauge, airway compliance, and optional ecoFLOW information. If None is selected, the waveforms expand to fill the split screen area.

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Aisys CS²

Touch the spilt screen field to directly open the Screen Setup menu. See "Screen setup menu" in the "Operation" section for more

information.

2-14 2067226-001

Display navigation

2 System controls and menus

Use the touchscreen and ComWheel to navigate the display.

1. Menu Displays the title of the open menu. For example: Start Case.

2. Instructions or help information This shows any additional instructions or help messages.

3. Menu items Shows Case Defaults, Volume Apnea Alarm, CO2 Alarms, Age, Ideal

Weight, and Start Case Now.

Figure 2-9 • Menu view and menu example

Using menus

Use the function keys to access the corresponding menus. When a menu is selected, the menu field overlays the normal view and the waveform fields start at the right edge of the menu.

1. Select the menu key to access the corresponding menu.

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Aisys CS²

Using the ComWheel

2. Select a menu item to choose the item, or turn the ComWheel left or right to highlight a menu item and then push to confirm.

3. If the menu item selected is an adjustment, turn the ComWheel left or right to make the setting and then push to confirm.

If the menu item has a drop-down list, select the desired value from the list by touching the item.

4. Select Close, touch the waveform area, or push the Home key to exit the menu.

Use the ComWheel to scroll through the quick key settings and function keys, make selections, change settings, and confirm settings.

• Push the ComWheel to make a selection.

• Turn the ComWheel to the right. For menu items, the highlight moves down. For quick keys, the highlight moves to the next key on the right. For settings, the value changes to the next available setting. For pull-down selections, the highlight moves to the next

available selection.

• Turn the ComWheel to the left. For menu items, the highlight moves up. For quick keys, the highlight moves to the next key on the left. For settings, the value changes to the previous available setting. For pull-down selections, the highlight moves to the previous

available selection.

• Push the ComWheel to confirm a setting.

Using quick keys

The gas settings and the main ventilator settings for each ventilation mode can be changed using the quick keys.

1. Select a quick key to open the menu or select a parameter.

2. If Gas Setup, Mode, or More Settings is selected, a menu displays. Select the desired value on the menu by touching the value.

If any other quick key is selected, the value displays with a highlight. Turn the ComWheel left or right to set the desired value.

3. Push the ComWheel or select the quick key to confirm the change.

2-16 2067226-001

3 Operation

Operation

In this section

System operation safety............................3-2

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

Start a case......................................3-4

Turning off the system............................. 3-7

Ventilator setup...................................3-8

Auto limits.......................................3-9

Gas setup......................................3-10

System setup................................... 3-13

Alarm setup.....................................3-17

Alarms On Off...................................3-21

Next page......................................3-22

Trends.........................................3-23

Spirometry......................................3-24

Procedures.....................................3-27

Timer function...................................3-31

ecoFLOW......................................3-32

Alternate O2 control..............................3-34

EZchange canister mode..........................3-36

Condenser......................................3-38

Auxiliary Common Gas Outlet...................... 3-40

2067226-001 3-1

Aisys CS²

System operation safety

WARNING

Do not use antistatic or electrically-conductive breathing tubes or masks. They can cause burns if used near highfrequency surgical equipment.

Explosion Hazard. Do not use this system with flammable

•

anesthetic agents.

Ventilator alarms indicate potential hazard conditions.

•

Investigate all alarms that occur to help ensure adequate patient safety.

If an alarm occurs, safeguard the patient first before

•

performing troubleshooting or doing repair procedures. Failure to safeguard the patient could result in patient injury.

Make sure that the patient breathing circuit is correctly

•

assembled and that the ventilator settings are clinically appropriate before starting ventilation. Incorrect breathing circuit assembly and incorrect ventilator settings can injure the patient.

Make sure that the breathing circuit is correctly

•

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

Maintain sufficient fresh gas flow when using

•

sevoflurane.

Desiccated (dehydrated) absorbent material may

•

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

Do not leave gas cylinder valves open if the pipeline

•

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

Unplug the system power cord to run the system on the

•

battery power if the integrity of the protective earth conductor is in doubt.

The top shelf weight limit is 45 kg (100 lb).

•

Do not subject the system to excessive shock and

•

vibration. Equipment damage could occur.

Do not place excessive weight on flat surfaces or

•

drawers. Equipment damage could occur.

3-2 2067226-001

Turning on the system

1. Plug the power cord into an electrical outlet. Make sure the

3 Operation

system circuit breaker is on.

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

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

CAUTION

Note

AB.91.044

1. System switch

2. Mains indicator

Figure 3-1 • Mains indicator and system switch

2. Check that the breathing system is properly connected.

Do not turn on the system with the right-hand (inspiratory) port plugged.

3. Turn the System switch to On. The display shows the power-up screen. The system does a series of automated self tests.

4. Perform a Full Test before the first case of the day.

5. Perform a preoperative checkout before each case. See the "Preoperative checkout" section.

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

2067226-001 3-3

Aisys CS²

Start a case

Use the Start Case menu to set the case data and to start the gas flow.

A case can be started using default settings or using custom settings. The default settings are configured by the Super User. See the "Super user mode" section for information on the Start Case menu defaults.

Default Settings selection shows the first of five default case types when the Start Case menu is accessed. Four of the default case types are configured by the Super User. The fifth default case is Last Case.

The Ideal Weight, Age, and Volume Apnea Alarm values are set to the pre-selected settings defined by the Super User corresponding to the case type.

WARNING

Make sure that the patient breathing circuit is correctly assembled and that the ventilator settings are clinically appropriate before starting ventilation. Incorrect breathing circuit assembly and incorrect ventilator settings can injure the patient.

Make sure that the preset alarm limits are appropriate for

•

the patient before starting ventilation. Incorrect alarm settings can injure the patient.

Note

Volume Apnea Alarm is not shown on the Start Case menu when the Volume Apnea Selection is set to Disable in the Super User settings.

The TV for Ideal Body Weight menu item from the Patient Demographics menu can only be accessed when the ventilation mode is set to VCV, PCV-VG, SIMV VCV, and SIMV PCV-VG. Use this setting for breath rate and tidal volume calculations based on the set patient weight.

Minimum Alveolar Concentration

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

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

0.0 to 9.9.

3-4 2067226-001

The adjusted MAC value shows on several areas of the screen including in the mini-trend, agent waveform numeric information, agent digit field, and graphical trends page.

Starting a case using default settings

Start a case using the default settings by case type defined by the Super User.

Case Defaults contain five case type selections. Each case type has preset values for Ideal Weight, Age, and Volume Apnea Alarm. The first four default case types are configured and named by the Super User. The fifth default case is Last Case.

1. Set the Bag/Vent switch to Bag.

2. Select Start Case. The Case Defaults selection shows the first preset case type. Ideal Weight, Age, CO2 Alarms, and Volume Apnea Alarm

show the default settings that correspond to the case type shown.

3. Verify or change the Case Defaults selected.

4. Verify the settings are clinically appropriate.

5. Select Start Case Now. Gas flow starts.

3 Operation

Starting a case using custom settings

Ideal Weight, Age, CO2 Alarms, and Volume Apnea Alarm can be custom set on the Start Case menu before starting a case. Additional ventilator settings, ventilation mode, alarm settings, and gas settings can be custom set through the Vent Mode menu and other ventilation quick keys, Alarm Setup menu, Gas Setup menu.

1. Set the Bag/Vent switch to Bag.

2. Select Start Case. The Case Defaults selection shows the first preset case type. Ideal Weight, Age, CO2 Alarms, and Volume Apnea Alarm

show the default settings that correspond to the case type shown.

3. Change Ideal Weight, Age, or Volume Apnea Alarm settings on the menu.

The Case Defaults changes from the case name to Preset. If the CO2 Alarms setting on the menu is changed, the Case

Defaults remains as previously selected.

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Aisys CS²

End a case

4. To change ventilation mode, select Mode. Make the change.To change the ventilation settings, select a ventilator quick key or More Settings. Make the change.

5. To change alarm settings, select Alarm Setup. Make the change.

6. To change the gas settings or the circuit type, select Gas Setup. Make the change.

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

See the "Ventilator setup" section for information on the Vent Mode menu.

See the "Gas setup" section for information on the Gas Setup menu. See the "Alarm setup" section for information on the Alarm Setup

menu.

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

1. Set the Bag/Vent switch to Bag.

2. Select End Case.

3. Select End Case Now on the menu to put the system in standby (stops the gas flow and patient alarms). The End Case menu shows the gas and agent usage for the case.

3-6 2067226-001

Turning off the system

1. Perform the "End a case" procedure, if appropriate.

2. Turn the System switch to Standby.

3. Turn the suction switch (optional) to the off position.

4. Rotate the Auxiliary O2 knob fully clockwise to turn off the flow.

5. Disconnect or turn off any scavenging.

3 Operation

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Ventilator setup

Use the Vent Mode menu to set the ventilation mode. Use ventilator quick keys and More Settings to change ventilator settings.

WARNING

Most anesthetic agents will cause patients to have reduced ventilatory responses to carbon dioxide and to hypoxemia. Therefore, triggered modes of ventilation may not produce adequate ventilation.

The use of neuromuscular blocking agents will reduce

•

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

Important

See the "Specifications and theory of operation" section for more information on ventilation modes.

Changing ventilator mode

1. Select the Mode quick key. The Vent Mode menu shows.

2. Select the desired ventilation mode.

3. Set and confirm the primary ventilation setting to activate the ventilation mode.

Controls that are frequently used in the ventilation mode can be adjusted with the ventilator quick keys and the More Settings quick key.

Changing ventilator settings

Change the ventilator settings for the ventilation mode when a case is running.

1. Select the ventilation setting to be adjusted. Set the desired value.

2. Push the ComWheel to activate the change.

Optional ventilator procedures

See "Procedures" for more information on Vital Capacity and Cycling procedures.

3-8 2067226-001

Auto limits

Setting auto limits

3 Operation

Use the Auto Limits menu to quickly set alarm ranges for ‘MV’, ‘TV’, and ‘EtCO2’ during mechanical ventilation.

1. Select Auto Limits. The menu shows the current measured values and the

proposed low and high alarm limits.

2. Check the proposed parameters.

• Select Confirm to use the proposed low and high alarm

limits.

• Select Cancel to leave the alarm limits unchanged.

• Select Case Default Limits to set the alarm limits to the

case default limits.

Note

The proposed low and high alarm limits are shown in highlighted text. The alarm limits that are not highlighted do not change.

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Gas setup

Changing gas settings

Use the Gas Setup menu to adjust the Agent, O2% and total flow, to change the balance gas, and to change the circuit type.

1. Select the Gas Setup quick key.

2. Select the setting to change from the Gas Setup menu.

3. Change the setting.

4. For Circuit, select the menu item and change using the dropdown menu. Select Confirm.

5. For Other Gas, select the menu item and change using the drop-down menu.

6. For Agent, O2%, and Total Flow, select the setting and make the change using the ComWheel and push to confirm the setting.

Changing balance gas

1. Select the Gas Setup quick key.

2. Select the Other Gas menu item.

3. Select the balance gas to use with O2.

Changing circuit type

1. Select the Gas Setup quick key.

2. Select Circle or Non-Circle

3. Select Confirm.

3-10 2067226-001

3 Operation

Using the circle circuit

Use the circle circuit mode to combine fresh gas with recirculated gas from the CO2 absorber. The combined gas flows out through the inspiratory port. Patient gas is returned to the system through the expiratory port.

Mechanical ventilation and tidal volume monitoring are available when using the circle circuit.

O2 monitoring of fresh gas is available automatically when using the circle circuit if the system has the airway module option or the O2 cell monitoring option. Systems with both an airway module and an O2 cell will display the O2 values obtained from the airway module.

1. Select the Gas Setup quick key.

2. Select Circle. Fresh gas oxygen concentration is displayed on the screen. Fresh gas flow combines with the exhaled gas and exits out

through the inspiratory port.

3. Set the alarm limits to clinically appropriate settings.

WARNING

Using the non-circle circuit

Use the non-circle circuit mode to divert fresh gas around the inspiratory check valve and out through the inspiratory port. This fresh gas source may be used with circuits that do not have CO2 absorbent capability (for example, Mapleson variants). Mechanical ventilation is not available when using the non-circle circuit. Tidal volume monitoring is not available when using the non-circle circuit.

O2 monitoring of fresh gas is available automatically when using the non-circle circuit if the system has the airway module option or the O2 cell monitoring option. Systems with both an airway module and an O2 cell will display the O2 values obtained from the airway module.

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

•

The maximum pressure at the non-circle circuit can be up to 27 kPa (4 psi). Use a breathing circuit with a pressure limiting device to limit the pressure at the patient connection port, during normal and single-fault conditions, to less than 12.5 kPa (125 cmH2O) or to the maximum pressure required by local standards.

1. Select the Gas Setup quick key.

2. Select Non-Circle. Fresh gas oxygen concentration is displayed on the screen. Fresh gas flow is diverted around the inspiratory check valve

and out through the inspiratory port.

2067226-001 3-11

Aisys CS²

3. Set the alarm limits to clinically appropriate settings.

3-12 2067226-001

System setup

3 Operation

Use System Setup to access menus and settings for Patient

Demographics, Screen Setup, Fresh Gas Usage, System Status, Calibration, and Checkout.

Note

System Status shows the status of gas supplies, electrical supplies, and the software version.

See the "User maintenance" section for information on the Calibration menu item.

See the "Preoperative tests" section for information on the Checkout menu item.

Patient demographics

Use the Patient Demographics menu to access menus and settings for Age, Ideal Weight, TV for Ideal Body Weight, and Set Vent by Weight.

Screen setup menu

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

Screen Setup contains the Layout, Scales, Time and Date, and More Settings submenus.

Setting waveform fields

The waveforms can be set to show agent, CO2, flow, Paw, or set to Off. If a waveform is set to the same value as another waveform, the previously set waveform changes to off and is removed from the screen.

1. Select System Setup - Screen Setup.

2. Select the Layout tab.

3. Select the desired waveform button and select the value from the drop-down menu.

4. Select Close.

Setting digit fields

The digit field can be set to show gas supply, flow, spirometry loops, gases, respiration, or agent. If the digit field is set to show agent and no airway module is inserted, the digit field will be blank.

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Aisys CS²

1. Select System Setup - Screen Setup.

2. Select the Layout tab.

3. Select the desired digit field button and select the value from the drop-down menu.

4. Select Close.

Setting the split screen

Use the Split Screen setting to show metabolics, trends, spirometry loops, Paw gauge, airway compliance, and optional ecoFLOW information.

See the "ecoFLOW" for information on the ecoFLOW option.

Note

Resistance (Raw) shows in the airway compliance split screen when the system detects an airway module with spirometry and the module has completed a warm-up phase.

1. Select System Setup - Screen Setup.

2. Select the Layout tab.

3. Select Split Screen and select the desired view from the dropdown menu.

4. Select Close.

Setting time and date

Use the Time and Date menu to set the time and date.

The Time and Date menu cannot be changed when a case is running.

1. Select System Setup - Screen Setup.

2. Select the Time and Date tab.

3. Select the time or date item to change. Make the change. The clock format factory default is 24 hours.

• When the clock format is set to 12 h, the hour selections are

in ‘1a’ format for a.m. and ‘1p’ format for p.m.

• When the clock format is set to 24 h, the hour selections are

0 to 23 in one hour increments.

4. Select Close.

Setting the data source

Use Data Source to specify the source of spirometry data.

1. Select System Setup - Screen Setup - More Settings or Spirometry - Setup Loops.

2. Select Data Source.

3-14 2067226-001

3 Operation

3. Select Patient to have spirometry data sourced from the airway module or Vent to have spirometry data sourced from the ventilator.

4. Select Back to view changes made and access other functions of the Spirometry menu.

Setting sweep speed

Use the Sweep Speed setting to set the waveform draw rate to fast (6.25 mm/s) or slow (0.625 mm/s). When the sweep speed changes, waveforms redraw at the new rate.

1. Select System Setup - Screen Setup.

2. Select More Settings.

3. Select Sweep Speed and then select Fast or Slow.

4. Select Close.

Setting display brightness

Use the brightness setting to adjust the contrast level of the display.

1. Select System Setup - Screen Setup.

2. Select More Settings.

3. Select Display Brightness.

4. Select the desired brightness level with 1 being the dimmest and 5 being the brightest.

5. Select Close.

Setting keypad brightness

Use the brightness setting to adjust the contrast level of the hard keys on the bezel.

1. Select System Setup - Screen Setup.

2. Select More Settings.

3. Select Keypad Brightness.

4. Select the desired brightness level with 1 being the dimmest and 5 being the brightest.

Set to 0 to turn off the keypad brightness.

5. Select Close.

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Aisys CS²

Setting fresh gas controls

Use the Fresh Gas Controls selection to set the gas control style to O2% with Total Flow or to individual gas flow.

Selecting O2% shows O2% as the first quick key and Total Flow l/min as the second quick key.

Selecting Flow shows balance gas l/min as one of the quick keys and O2 l/min as the other quick key.

Note

Fresh gas usage

Both O2% and Flow are available if User is selected by the Super User. If User is not selected by the Super User, either O2% or Flow will be unavailable.

Fresh Gas Controls cannot be accessed during a case.

1. Select System Setup - Screen Setup.

2. Select More Settings.

3. Select Fresh Gas Controls.

4. Select O2% or Flow from the drop-down menu. When set to O2%, balance gas adjusts automatically when

either the O2% or the Total Flow is changed using the gas quick keys.

When set to Flow, balance gas and the O2% are controlled individually using the gas quick keys.

5. Select Close.

Use Fresh Gas Usage to view the volume of O2, Air, N2O, and agents used for the three most recent cases.

• Data only shows for gases available on the system.

• Agent data shows the three most recently used agents.

1. Select System Setup - Fresh Gas Usage.

2. Select Case Start Time to select the patient case to view.

3. Select Close.

3-16 2067226-001

Alarm setup

3 Operation

Use the Alarm Setup menu to set and adjust alarm limits, alarm volume, and other alarm settings and to view alarm history. The

Alarm Setup menu contains the Primary Limits, More Limits, Alarm History, and Configure submenus.

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

Note

Setting CO2 alarms

Selecting Change to Default Limits loads the default settings as set by the Super User or the factory defaults if no Super User settings have been entered.

Use the CO2 Alarms setting to turn off the CO2 ‘Apnea’ alarm, ‘EtCO2 low’, ‘EtCO2 high’, and ‘FiCO2 high. Absorbent OK?’ alarms during manual ventilation.

CO2 information is obtained from the airway module installed in the anesthesia system module bay. The CO2 alarms setting has no effect if there is no airway module in the anesthesia system.

1. Select Alarm Setup.

2. To turn off the CO2 alarms, set CO2 Alarms to Off. The ‘CO2 Alarms Off’ message shows in the general message

field. The CO2 alarm limit waveform numerics shows dashes during a

case. The alarms remain disabled until the Bag/Vent switch is set to

Vent, the case is ended, or the CO2 Alarms is set to On.

3. To turn on the CO2 alarms, set CO2 Alarms to On.

4. Select Close.

Setting volume apnea alarm

Use the Vol Apnea Alarm setting to turn off the volume apnea alarm during manual ventilation. The volume apnea alarm remains off until the Bag/Vent switch is set to Vent or Vol Apnea Alarm is set to On.

Note

2067226-001 3-17

Vol Apnea Alarm does not show on the Alarm Setup menu when the Volume Apnea Selection has been disabled by the Super User. See the "Super user mode" section for more information.

1. Select Alarm Setup.

Aisys CS²

Setting MV TV alarms

2. To turn the volume apnea alarms off, select Vol Apnea Alarm to Off.

‘Volume Apnea Off’ shows in the general message field.

• If mechanical ventilation is started, the volume apnea

alarms are active.

• If manual ventilation is restarted, a pop-up confirmation

window appears to resume the Off setting.

3. To turn the volume apnea alarms on, set Vol Apnea Alarm to On.

4. Select Close.

Use the MV/TV Alarms setting to turn off the MV and TV alarms. Settings made during manual ventilation are not retained when

mechanical ventilation starts. Settings made during mechanical ventilation are retained when manual ventilation starts.

For example, if MV/TV Alarms is set to Off during manual ventilation, the alarms remain off until the Bag/Vent switch is set to Vent or the MV/TV Alarms is set to On.

For example, if the MV/TV Alarms is set to Off during mechanical ventilation, the alarms remain off when manual ventilation starts.

Setting alarm limits

WARNING

1. Select Alarm Setup.

2. To turn the volume alarms off, set MV/TV Alarms to Off. ‘MV/TV Alarms Off’ appears in the general message field. The volume alarm limits waveform numerics shows dashes

during a case.

3. To turn the volume alarms on, set MV/TV Alarms to On.

4. Select Close.

Do not set alarm limits to extreme values. Setting limits to extreme values can render the alarm useless.

1. Select Alarm Setup.

2. From the Primary Limits and More Limits tabs, select the alarm limit and make the change.

3. Push the Home key, touch the waveform area of the display, or select Close to close the menu.

3-18 2067226-001

Viewing alarm history

Use the Alarm History tab to view the list of the 12 most recent high and medium priority alarms that occurred since the start of the case. The alarm history clears at the start of a new case.

1. Select Alarm Setup.

2. Select the Alarm History tab.

3. Select Close.

Setting alarm volume

1. Select Alarm Setup.

2. Select the Configure tab.

3. Set Alarm Volume to the desired value.

4. Select Close.

3 Operation

The list of alarms shows in the window.

The alarm volume range is 1 to 5.

Setting apnea delay

Use the Apnea Delay setting to set the desired apnea time delay. The apnea time delay is the amount of time that can pass without the system detecting a measured breath before the apnea alarm occurs.

1. Select Alarm Setup.

2. Select the Configure tab.

3. Set Apnea Delay to the desired time.

• The apnea time delay range is 10 to 30 seconds.

• The apnea time settings are in 1 second increments.

4. Select Close.

Silencing leak audio alarms

Use the Leak Audio setting to silence audio alarms of small leaks.

1. Select Alarm Setup.

2. Select the Configure tab.

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Aisys CS²

3. Set Leak Audio to Off. The audio alarms for small leaks are silenced.

4. To turn audio alarms back on, set Leak Audio to On.

5. Select Close.

Note

If the Low MV alarm limits are off or MV/TV Alarms is set to Off, Leak Audio is automatically set to On and cannot be changed.

Setting auto MV limits

MV alarm limits can be calculated automatically for mechanical ventilation when in VCV or PCV-VG modes and volume compensation is enabled. Use the Auto MV Limits setting to turn on automatic calculations of the MV alarm limits.

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

1. Select Alarm Setup.

2. Select the Configure tab.

3. Set Auto MV Limits to On.

4. Select Close.

The MV alarm limits are automatically calculated until Auto MV Limits is set to Off or until an MV limit is manually adjusted during mechanical ventilation. The MV alarm limits are automatically calculated based on TV and RR settings.

Setting to default limits

Use Change to Default Limits to set alarm limits to the values set by the Super User.

1. Select Alarm Setup.

2. Select the Configure tab.

3. Select Change to Default Limits.

4. Select Close.

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Alarms On Off

3 Operation

Use the Alarms On/Off menu to turn On or turn Off the CO2 Alarms Limits and MV/TV Alarm Limits during manual ventilation. Alarm limits are enabled at the start of mechanical ventilation.

Note

Disable alarm limits

The CO2 ‘Apnea’ alarm cannot be turned off through the Alarms On/Off menu. Only the ‘EtCO2’ and ‘FiCO2’ alarms are turned off

using this menu.

1. Select Alarms On/Off.

2. View the alarm limit status.

3. Select Confirm to change the alarm limit settings. Select Cancel to leave the alarm limits unchanged.

• If the CO2 Alarms Limits and MV/TV Alarm Limits are

On, the alarm limits change to Off.

• If the CO2 Alarms Limits or MV/TV Alarm Limits are On,

the alarm limits change to Off.

• If the CO2 Alarms Limits and MV/TV Alarm Limits are

Off, the alarm limits change to On.

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Aisys CS²

Select Next Page to change the screen view. A default view and four configurable screen views are available. A general message displays identifying the page number of the screen view.

See the "Super user mode" section for information on setting the preset screen views.

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Trends

Setting trends

3 Operation

Use the Trends menu to view patient trends and set the time scale. There are three views for patient trends: measured (numerical), settings, and graphical. Trend information is saved every 15 seconds for the most recent 24 hours.

1. Select Trends.

2. Select the desired view.

3. Select Scroll to move through the current trend view.

4. Select Time Scale to select the desired scale from the dropdown menu.

5. Select Next Page to view additional parameters.

6. Select Close.

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Aisys CS²

Spirometry

Use the Spirometry menu to:

• Set the loop type.

• Adjust the loop scaling.

• Save a loop to memory.

• Access the Setup Loops menu.

• View a saved loop.

• Delete a saved loop.

There are three types of spirometry loops: Pressure-Volume (Paw- Vol), Flow-Volume (Flow-Vol), and Pressure-Flow (Paw-Flow). The spirometry loops show in the spirometry window and can be set to show alongside the waveforms as the split screen.

Setting loop type

AB.98.039

1. Volume axis

2. Pressure axis

3. Real-time loop

4. Reference loop (appears on display in gray)

Figure 3-2 • Example of a Paw-Vol loop

1. Select Spirometry.

2. Select Loop Type and select the loop from the drop-down list.

3. Select Close.

3-24 2067226-001

Setting loop graph scaling

Use Spirometry Scaling to set the scales of the spirometry loop graph. The available settings for the volume, Paw, and flow graph axes are dependent on the set patient type of adult or pediatric.

• Auto automatically adjusts the volume, Paw, and flow axes of the loop based on the minimum and maximum breath reading shown in the waveform.

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

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

1. Select Spirometry - Setup Loops.

2. Select Spirometry Scaling and set the scale type from the drop-down list.

3. Select Back to view changes made and access other functions of the Spirometry menu.

3 Operation

Setting patient and sensor type

Patient and sensor type refer to the style of airway adapter used with the airway module. If spirometry data is obtained from the airway module, make sure that the sensor type matches the type of airway adapter used. Adult or pediatric patient types are available.

WARNING

Make sure that the set sensor type corresponds to the type of airway adapter in use. If the sensor type is not set correctly, the information displayed may not be accurate.

1. Select Spirometry - Setup Loops.

2. Select Patient and Sensor and then select Adult or Pedi depending on the sensor used.

3. Select Back to view changes made and access other functions of the Spirometry menu.

Setting the data source

Use Data Source to specify the source of spirometry data.

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Aisys CS²

Setting spirometry volume type

1. Select System Setup - Screen Setup - More Settings or Spirometry - Setup Loops.

2. Select Data Source.

3. Select Patient to have spirometry data sourced from the airway module or Vent to have spirometry data sourced from the ventilator.

4. Select Back to view changes made and access other functions of the Spirometry menu.

The volume shown on the spirometry split screen can be set to minute volume or tidal volume.

1. Select Spirometry - Setup Loops.

2. Select Show MV or TV and select MV or TV from the dropdown list.

Set to TV to show TVinsp and TVexp on the spirometry split screen.

Set to MV to show MVexp and TVexp on the spirometry split screen.

3. Select Back to view changes made and access other functions of the Spirometry menu.

Saving, viewing, and deleting spirometry loops

Spirometry loops can be saved, viewed, and deleted through the Spirometry menu.

1. Select Spirometry.

2. To store a loop to memory, select Save Loop. Up to six loops can be saved.

3. To view a saved loop, set Show Ref. Loop to the time at which it was saved.

4. To delete a saved loop, set Delete Ref. Loop to the time at which it was saved.

5. Select Close.

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Procedures

3 Operation

Use the Procedures menu to pause the gas flow, start cardiac bypass, perform or change settings for a vital capacity procedure, or perform or change the settings for a cycling procedure.

Note

Pause gas flow

Vital Capacity shows in the menu if it is set to Yes by the Super User. Vital Capacity is only selectable during mechanical ventilation.

Cycling shows in the menu if it is set to Yes by the Super User. Cycling is only selectable during mechanical ventilation.

Use Pause Gas Flow to temporarily suspend the flow of gas during a case. Using Pause Gas Flow while the breathing circuit is disconnected prevents the flow of gas into the room. Pause Gas Flow is available during both mechanical ventilation and manual ventilation.

1. Select Procedures.

2. Select Pause Gas Flow. The amount of time remaining in the gas flow pause shows in

the window. Gas flow stops for 1 minute and automatically resumes after 1

minute. If mechanical ventilation is on, mechanical ventilation stops for 1

minute and then automatically resumes after 1 minute.

3. Resume the flow of gas at any time during the pause by selecting Restart Gas Flow.

Cardiac bypass

There are two types of cardiac bypass. Manual ventilation cardiac bypass is standard. VCV cardiac bypass is optional.

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

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

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Aisys CS²

WARNING

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

Using manual ventilation cardiac bypass

1. Set the Bag/Vent switch to Bag.

2. Select Procedures.

3. Select Start Cardiac Bypass. The ‘Cardiac Bypass’ message shows in the waveforms and in

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

4. Select Close.

Using VCV cardiac bypass

1. Start mechanical ventilation in VCV mode.

2. Select Procedures.

3. Select Start Cardiac Bypass. PEEP is set to 5 cmH2O. TV settings of less than 170 ml prior to starting cardiac bypass

remain at the set TV. TV settings of more than 170 ml prior to starting cardiac bypass

change to 170 ml. The ‘VCV Cardiac Bypass’ message shows in the waveforms

and in the general message field when VCV cardiac bypass is active.

Note

PEEP and TV settings can be changed after entering cardiac bypass mode.

4. Select Close.

Vital capacity

Use the Vital Capacity procedure to deliver a pressure breath for a set time. The Vital Capacity procedure provides a simple way to deliver one pressure breath during mechanical ventilation without making multiple ventilator setting changes. The PEEP on Exit setting provides a way to change the ventilation PEEP setting automatically at the end of the Vital Capacity procedure.

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3 Operation

The Pressure Hold, Hold Time, and PEEP on Exit settings can be preset by the Super User. These settings can be changed by the user before starting the procedure.

Note

PEEP on Exit shows if it is set to Yes by the Super User.

Using vital capacity

1. Select Procedures.

2. Select Start Vital Capacity. One pressure breath is given at the set pressure. The pressure is held for the set time. PEEP is set to the PEEP on Exit setting.

3. Select Stop Vital Capacity at any time to stop the procedure.

4. Select Close.

If the procedure is stopped before completion, the PEEP on Exit setting is not used.

Changing vital capacity settings

1. Select Procedures.

2. Select the setting to change and make the change.

• Set Pressure Hold to between 20 and 60 cmH2O.

• Set Hold Time to between 10 and 40 seconds.

• Set PEEP on Exit to Off or between 4 and 30 cmH2O.

Cycling

Note

3. Select Start Vital Capacity.

4. Select Close.

Use the Cycling procedure to deliver pressure breaths through a series of ventilation steps. The Cycling procedure provides a flexible way to deliver pressure breaths during ventilation without making multiple ventilator setting changes. Up to seven preset steps with multiple breaths are available.

Each procedure defaults steps and ventilation settings which can be preset by the Super User. The ventilation settings of each step can be changed by the user before starting a procedure.

There is a limited amount of gas in the bellows. No additional gas enters the bellows during the cycling procedure. Increase fresh gas flow to avoid bellows collapse.

Using cycling

1. Select Procedures.

2067226-001 3-29

Aisys CS²

2. Select Cycling.

3. Select a Procedure to perform.

4. Select Start Cycling. The procedure begins. Procedure progress shows in the procedure window.

5. Stop the procedure anytime by selecting Stop Cycling.

6. Select Close.

Changing cycling settings

1. Select Procedures.

2. Select Cycling.

3. Select a Procedure to perform.

4. Select Adjust Settings. The first setting of Step 1 in the procedure window is selected.

5. Push the ComWheel to enter the adjustment window.

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

7. Select Start Cycling.

8. Select Close.

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Timer function

Using the timer

3 Operation

Use Start as a timer function. When selected a clock will display counting up from zero.

1. Select Start to start the clock.

2. Select Stop to pause or stop the clock. If Start is selected, the clock will resume operation. If Start is selected and held for longer than 1 second, the clock

will reset to zero.

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Aisys CS²

ecoFLOW

This feature provides a split screen view that shows the approximate minimum O2 flow to maintain a preset inspired O2 concentration. Also shown is the approximate agent used per hour and the cost.

9 8

-20

AgentTotal Flow

21.91

100

O2 Total

1.30

Fi25 O2 flow

0.60

Iso

041

22.

. C A

1. Agent Shows Agent cost and flow information.

2. Agent cost The cost of the current agent flow. This value is determined by the agent flow multiplied by the agent cost set in Super user mode.

3. Agent flow The measured value of the liquid agent flow from the vaporizer. The agent flow may have a delayed response. For example: Iso.

4. FiO2 flow marker The graphical representation on the flow tube of the FiO2 flow value. This marker can be removed by disabling it in Super user mode.

5. FiO2 flow The minimum O2 flow needed to maintain the set inspired O2 flow. This item can be disabled in Super user mode. For example: Fi25 O2 flow.

6. O2 total (numeric) The numeric representation of the total O2 flow. If N2O is the balance gas, this equals the set O2 flow. If Air is the balance gas, this is the set O2 flow plus 21% of the Air flow. For example: O2 Total.

7. O2 total (graphical) The graphical representation of the total O2 flow. If N2O is the balance gas, this equals the set O2 flow. If Air is the balance gas, this is the set O2 flow plus 21% of the Air flow.

8. Remaining gas flow If N2O is the balance gas, this equals the set N2O flow. If Air is the balance gas, this N2 is 79% of the Air flow.

9. Flow bobbin The height of this represents the total fresh gas flow delivered to the patient.

10. Total flow Shows Total Flow information.

Figure 3-3 • ecoFLOW feature

3-32 2067226-001

Using ecoFLOW

3 Operation

1. Select System Setup - Screen Setup.

2. Select the Layout tab.

3. Select Split Screen and select ecoFLOW from the drop-down menu.

4. Select Close.

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Aisys CS²

Alternate O2 control

WARNING

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

When Alternate O2 control is enabled, flow from the

•

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

•

Agent delivery cannot be activated in the case of certain electronic mixer or agent delivery failures. The Agent quick key will be blank if agent delivery is unavailable.

Use the Alternate O2 control to deliver O2 through an independent pneumatic path to the vaporizer and patient circuit. Alternate O2 is connected to the system O2 supply. Alternate O2 control activates automatically in the case of certain failures or errors. It can also be activated manually.

The Alternate O2 control is available approximately 20 seconds after the system is turned on. The Alternate O2 flow is adjustable to approximately 0.5 l/min to 10 l/min as indicated on the flow tube.

1. ON/OFF button

2. Flow control

3. Flow tube

Figure 3-4 • Alternate O2 control

Using Alternate O2 control

1. Push the Alternate O2 ON/OFF button. The O2 flow is indicated on the flow tube.

AB.91.077

3-34 2067226-001

3 Operation

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

3. Set the agent to the desired concentration.

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

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Aisys CS²

EZchange canister mode

Use the optional EZchange canister mode for continued ventilation of the patient while changing the absorber canister. The EZchange canister mode seals the breathing circuit when the canister holder is down. While the absorber canister is out of the breathing circuit, the patient re-breaths exhaled gases without any gas passing through the absorbent.

Systems with EZchange canister mode have a label on the canister holder. An EZchange canister has side rails that fit in the EZchange canister holder.

Figure 3-5 • EZchange canister holder label

AB.82.042

1. Side rails

Figure 3-6 • EZchange canister

AC.22p.010

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Using EZchange canister mode

3 Operation

Note

Make sure that the absorber canister has side rails. If the canister does not have side rails, it will not work in the EZchange canister holder.

1. Push the absorber canister release to activate the EZchange canister mode.

The canister swings down to the EZchange position. ‘CO2 Absorber Out of Circuit’ shows in the waveform area on

the anesthesia display.

2. Remove the canister from the holder.

3. Install a canister with fresh absorbent into the holder.

4. Push the canister back up and snap it into absorber position. The exhaled gas flows through the absorber, removing CO2.

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Aisys CS²

Condenser

Use the optional condenser to remove water in the system that is produced from the reaction of CO2 gas with the absorbent. The condenser is connected between the outlet of the absorber canister and the inlet of the circuit module. Moisture in the gas is condensed into water droplets, which run into the condenser’s reservoir.

1. Drain button

2. Reservoir

3. Condenser

Figure 3-7 • Condenser

Draining the condenser

AB.82.043

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

2. Place a container under the reservoir.

3-38 2067226-001

3 Operation

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

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Aisys CS²

Auxiliary Common Gas Outlet

Use the optional Auxiliary Common Gas Outlet (ACGO) switch to direct the fresh gas flow through the ACGO port on the front of the system. The ACGO may be used to provide fresh gas to an auxiliary manual breathing circuit.

Mechanical ventilation is not available when using an auxiliary manual breathing circuit with fresh gas from the ACGO. The Bag/ Vent switch, APL valve, and CO2 absorber are not part of the external circuit. Volume and pressure monitoring are not available.

O2 monitoring of fresh gas is available when the ACGO is selected if the system has the airway module option or the O2 cell monitoring option. Systems with both an airway module and an O2 cell will display the circuit O2 value obtained from the airway module.

WARNING

Using the ACGO

The Bag/Vent switch and the APL valve do not control the ACGO or any breathing circuit connected to the AGCO. Do not use these controls when using a breathing circuit with fresh gas from the ACGO. Patient injury may occur.

•

Volume and pressure monitoring are not available through the system when using the ACGO port. Monitor the patient using other methods.

•

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

•

The maximum pressure at the ACGO can be up to 55 kPa (8 psi). Use a breathing circuit with a pressure limiting device to limit the pressure at the patient connection port, during normal and single-fault conditions, to less than 12.5 kPa (125 cmH2O) or to the maximum pressure required by local standards.

1. Set the ACGO switch to the ACGO position. Fresh gas flows through the ACGO port. Fresh gas oxygen concentration is displayed on the screen.

2. Set the alarm limits to clinically appropriate settings.

3. To stop fresh gas flow through the ACGO port, set the ACGO switch to the circle circuit position.

Note

3-40 2067226-001

Displayed fresh gas oxygen concentration may not reflect FiO2 during spontaneous breathing or in rebreathing circuits. Use an external O2 monitor if using a rebreathing circuit on ACGO.

3 Operation

Note

A sample of the fresh gas is diverted to the O2 cell in the breathing system. The sample flow to the O2 cell is dependent on the pressure in the external circuit. The sample flow reduces the fresh gas flow rate to the auxiliary breathing circuit equal to the amount diverted to the O2 cell.

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4 Preoperative checkout

Preoperative checkout

In this section

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

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

2067226-001 4-1

Aisys CS²

Every day before your first patient

Check that necessary emergency equipment is available and

□

in good condition. Check that the equipment is not damaged and that

□

components are correctly attached. Check that the pipeline gas supplies are connected. If

□

equipped with cylinders, check that there is sufficient reserve capacity and that the cylinder valve is closed.

Connect scavenging and verify operation.

□

Check that the amount of liquid agent in the cassette is

□

adequate. Install the agent cassette into the active bay. The cassette is properly inserted when the agent is identified on the display.

Check that the breathing circuit is correctly connected, not

□

damaged, and the breathing system contains sufficient absorbent in the canister.

Turn the System switch On.

□

Perform a Full Test from the Checkout menu.

□

Do an Agent Delivery check in the Checkout menu for each

□

agent cassette that will be used during the day. Check that an adequate reserve O2 supply is available.

□

Check that the ventilator functions correctly:

□

• Connect a test lung to the patient breathing circuit connection.

• Set the ventilator to VCV mode and the settings to TV to 400 ml, RR to 12, I:E to 1:2, Tpause to Off, and Pmax to 40 cmH2O.

• Set the gas flow to the minimum settings.

• Start a case.

• Set the Bag/Vent switch to Vent.

• Fill the bellows using O2 flush.

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

Turn the system circuit breaker off and check that mechanical

□

ventilation continues while the system is running on battery power. After completing the check, turn the system circuit breaker on. The mains indicator is lit when AC power is connected.

Set the appropriate controls and alarm limits for the case.

□

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Before every patient

4 Preoperative checkout

Note

This check does not need to be done before the first case of the day if the "Every day before your first patient" checklist was done.

Check that the necessary emergency equipment is available

□

and in good condition. Select Checkout and perform a Low P Leak test.

□

If the cassette was changed since the last case:

□

• Check that the amount of liquid agent in the cassette is adequate.

• Check that the cassette is properly inserted. The cassette is properly inserted when the agent is identified on the display.

Check that an adequate reserve O2 supply is available.

□

Check that the breathing circuit is correctly connected, not

□

damaged, and the breathing system contains sufficient absorbent in the canister.

Select Checkout and perform a Circuit Leak test.

□

Check that the ventilator functions correctly:

□

• Connect a test lung to the patient breathing circuit connection.

• Set the ventilator to VCV mode and the settings for TV to 400 ml, RR to 12, I:E to 1:2, Tpause to Off, and Pmax to 40 cmH2O.

• Set the gas flow to the minimum settings.

• Start a case.

• Set the Bag/Vent switch to Vent.

• Fill the bellows using O2 flush.

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

• Set the appropriate controls and alarm limits for the case. Make sure that the alarms function. See the "Alarm tests".

Set the appropriate controls and alarm limits for the case.

□

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5 Preoperative tests

Preoperative tests

In this section

Aladin cassette installation..........................5-2

Flow and pressure calibration........................5-3

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

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

Full test.........................................5-6

Individual tests................................... 5-8

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

2067226-001 5-1

Aisys CS²

Aladin cassette installation

1. Using the liquid level indicator, check that the cassette is filled to the appropriate level.

2. If using Aladin2, unlock the cassette handle before installing it into the active bay.

3. Insert the cassette into the active bay until a click is heard. An audible click indicates that the cassette is in position.

4. Turn the lock on the handle to the horizontal position (Aladin2 cassettes only).

5. The cassette is properly inserted when the agent is identified on the display. Make sure that the displayed agent matches the cassette.

Note

Store the cassettes in the cassette storage bay when they are not in use. See the "Vaporizer cassettes" section for additional cassette information.

5-2 2067226-001

Flow and pressure calibration

5 Preoperative tests

Important

Room temperature fluctuations of more than 5°C may affect sensor measurements. Recalibrate the flow sensors if the room temperature changes by more than 5°C.

Calibrate the flow sensors by removing the flow sensor module from the system. On-screen instructions are available through System Setup - Calibration - Flow and Pressure.

1. Set the Bag/Vent switch to Bag.

2. Remove the flow sensor module.

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

4. Reinsert the flow sensor module. Make sure the flow sensors are securely latched when they are reinserted. Wait for alarms to clear.

5. Start mechanical ventilation when ready.

2067226-001 5-3

Aisys CS²

Circuit compliance compensation

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

• The system has an airway module installed.

• The Circuit Compliance is set to On from Super User System Config. - Ventilator Settings.

• The Checkout is completed after the system is turned on.

Circuit compliance is determined during the Checkout - Full Test or when the Vent and Gas check is done as an individual test. Circuit compliance must be set by the Super User for the Circuit Compliance compensation function to be active. See the “Super user mode” section for information on the circuit compliance setting.

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

WARNING

Perform a Vent and Gas test after changing the patient tube type. Changing the patient breathing circuit after completing a Vent and Gas test affects the volume measurements in all modes.

Breathing circuits and breathing circuit components are

•

available in many different configurations from multiple suppliers. Attributes of the breathing circuits such as materials, tube length, tube diameter, and configuration of components within the breathing circuit, may result in hazards to the patient from increased leakage, added resistance, or changed circuit compliance.

5-4 2067226-001

Checkout menu

5 Preoperative tests

The Checkout menu shows on the display after turning on the system. To access the Checkout menu between cases, select Checkout. Step-by-step instructions show in the Checkout menu during the tests. Use the Checkout menu to:

• Perform a Full Test.

• Perform any of the individual tests.

• View the Test Log.

• Start a case.

2067226-001 5-5

Aisys CS²

Full test

The Full Test or the individual tests must be performed at least once within every 24-hour period.

Perform the Full Test at the start of each day. The full test runs automatically and beeps to indicate when it is finished or if interaction is required.

The Full Test does the following tests: Vent and Gas, Circuit Leak, and Circuit O2 Cell (if circuit O2 cell is present). When one of the tests is completed, the next test begins.

1. From the Checkout menu, select Full Test and follow the instructions.

2. If a test fails, follow the instructions to perform a retest or accept the results.

3. When the Full Test is completed, start a case.

Vent and gas

Circuit leak

Note

In case of a patient emergency, the Full Test may be bypassed by selecting Start Case. The general message ‘Please Do Checkout’ is displayed if a Full Test or all of the individual tests are not completed with passing results within 24 hours.

The Vent and Gas test checks the agent delivery, airway module, Bag/Vent switch, proper gas supply pressures, ventilator operation and leak, battery and electrical power, circuit compliance, and flow control operation. This is a two-step test.

To run this test, follow the on-screen instructions. When the test passes, the next test starts.

Any cassette may be used during the test. Use a non-desflurane cassette during the test to check the full functionality of the internal electronic control unit.

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

To run this test, follow the on-screen instructions. When the test passes, the next test starts.

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GE auisys cs2 User's Reference Manual

Specifications and Main Features

Frequently Asked Questions

User Manual