Hamilton G5 Operator's Manual

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Operator‘s manual

624074/07

Software version 2.2X

624074/07

© 2012 HAMILTON MEDICAL AG. All rights reserved. Printed in Switzerland. No part of this publication may be reproduced or stored in a database or retrieval system, nor transmitted, in any form or by any means, electronic, mechanical, by photocopying, recording, or otherwise, without the prior written permission of HAMILTON MEDICAL.

This manual may be revised or replaced by HAMILTON MEDICAL at any time and without notice. Ensure that you have the most current applicable version of this manual; if in doubt, contact HAMILTON MEDICAL AG Marketing Department. While the information set forth is believed to be accurate, it is not a substitute for the exercise of professional judgment.

Nothing in this manual shall limit or restrict in any way HAMILTON MEDICAL’s right to revise or otherwise change or modify the equipment (including its software) described herein, without notice. In the absence of an express, written agreement to the contrary, HAMILTON MEDICAL has no obligation to furnish any such revisions, changes, or modifications to the owner or user of the equipment (including software) described herein.

The equipment must be operated and serviced by trained professionals only. HAMILTON MEDICAL’s sole responsibility with respect to the equipment and its use is as stated in the Limited Warranty provided in this manual.

Product and company names mentioned herein may be the trademarks of their respective owners.

HAMILTON MEDICAL will make available on request circuit diagrams, component parts lists, descriptions, calibration instructions, or other information that will assist the user’s authorized trained personnel to repair those parts of the equipment deemed by HAMILTON MEDICAL to be repairable.

624074/07 iii

Manufacturer Distributor in USA

HAMILTON MEDICAL AG Via Crusch 8 CH-7402 Bonaduz Switzerland Phone: (+41) 81 660 60 10 Fax: (+41) 81 660 60 20 info@hamilton-medical.com www.hamilton-medical.com

HAMILTON MEDICAL, Inc. 4990 Energy Way P.O. Box 30008 Reno, NV 89520, USA Phone: (775) 858-3200 Toll-free: (800) 426-6331 Fax: (775) 856-5621 marketing@hamilton-medical.net

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Safety warnings, cautions, notes

The software version for the HAMILTON-G5 is visible in the

System -> Info window

(ventilator unit processor) (that is, the digit to the left of the decimal point for VUP) should match the version on the title page of this manual. See section 4.3.1 for details.

WARNING

A WARNING alerts the user to the possibility of

injury, death, or other serious adverse reactions associated with the use or misuse of the device. It

also describes potential serious adverse reactions and safety hazards.

CAUTION

A CAUTION alerts the user to the possibility of a problem with the device associated with its use of misuse, such as device malfunction, device failure, damage to the device, or damage to other property. It also alerts against unsafe practices. This

includes the special care necessary for the safe and effective use of the device.

. The software version for the VUP

NOTE:

A NOTE emphasizes information of particular importance.

624074/07 v

Displayed only when the P/V Tool maneuver option is installed

Displayed only when the adaptive support ventilation (ASV) option is installed.

Displayed when the heliox option is installed

Displayed only when the CO

sensor option is

installed

Displayed only when the SpO2 sensor option is installed

Displayed only when neonatal option is installed

vi 624074/07

Displayed when the INTELLiVENT-ASV option is installed

Displayed when the intelliCuff option is installed

This manual shows screenshots and hardware with several options installed.

General warnings, cautions, and notes

Intended use

CAUTION

Federal (USA) law restricts this device to sale by or on the order of a physician.

NOTE:

• Not all options are available in all markets.

•ASV

and INTELLiVENT®-ASV for adult and pediatric

use only.

The HAMILTON-G5 ventilator is designed for intensive care ventilation of adult and pediatric patients, and optionally infant and neonatal patients. The device is intended for use in the hospital and institutional environment where health care professionals provide patient care. The HAMILTON-G5 ventilator is intended for use by properly trained personnel under the direct supervision of a licensed physician. The HAMILTON-G5 ventilator may be used for transport within a hospital or hospital type

624074/07 vii

facility provided compressed gas is supplied. The device is not to be used in the presence of flammable anesthetic agents or other ignition sources. The ventilator is not to be used in an environment with magnetic resonance imaging (MRI) equipment. The device is not intended for transportation outside the hospital or for use in the home environment.

General notes for operators

• Operators must familiarize themselves with this manual before using the ventilator on a patient. For training options of the HAMILTON-G5, please contact the HAMILTON MEDICAL representatives.

• The displays shown in this manual may not exactly match what you see on your own ventilator. Your ventilator may not include all the modes and features described in this manual.

Monitoring and alarms

• The HAMILTON-G5 is not intended to be a comprehensive vital sign monitor for patients on life-support equipment. Patients on life-support equipment must be appropriately monitored by qualified medical personnel and suitable monitoring devices. The use of an alarm monitoring system does not give absolute assurance of warning for every form of malfunction that may occur with the ventilator. Alarm messages may not exactly pinpoint a problem; the exercise of clinical judgment is necessary.

• An alternative means of ventilation shall be available whenever the ventilator is in use. If a fault is detected in the ventilator or its life-support functions are in doubt, disconnect the HAMILTON-G5 from the patient and immediately start ventilation with such a device (for example, a resuscitation bag), using PEEP and/or increased oxygen concentration when appropriate. The ventilator must be removed from clinical use and serviced by HAMILTON MEDICAL authorized service personnel.

• It is recommended that additional independent monitoring devices be used during mechanical ventilation. The opera-

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tor of the ventilator must still maintain full responsibility for proper ventilation and patient safety in all situations.

• Do not silence the audible alarm when leaving the patient

unattended.

• Do not use the exhaust port of the expiratory valve for

spirometry. Due to the HAMILTON-G5’s base flow, the exhaust gas output is larger than the patient’s actual exhaled volume.

• Heliox gas is not compatible with INTELLiVENT

• The Masimo Rainbow SpHb sensor is valid for a total of 66

hours of operation. Once this time expires, you must connect a new SpHb sensor. For details, see Appendix F, Pulse oximetry.

Fire and other hazards

• To reduce the risk of fire or explosion, do not place the

HAMILTON-G5 in a combustible or explosive environment (for example, around flammable anesthetics or other ignition sources). Do not use it with any equipment contaminated with oil or grease.

• To minimize the risk of fire, do not use high-pressure gas

hoses that are worn or contaminated with combustible materials like grease or oil.

• To reduce the risk of fire, use only breathing circuits

intended for use in oxygen-enriched environments. Do not use antistatic or electrically conductive tubing.

• In case of fire, immediately secure the patient’s ventilatory

needs, switch off the HAMILTON-G5, and disconnect it from its gas and electrical sources.

• Do not put a vessel filled with a liquid on the ventilator.

If a liquid enters the product, a fire and/or electric shock may occur.

-ASV use.

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Service and testing

• To ensure proper servicing and to prevent possible physical injury, only qualified personnel should attempt to service the ventilator.

• To reduce the risk of electrical shock, do not remove the ventilator housing. Refer the ventilator for servicing by qualified personnel.

• To reduce the risk of electrical shock, disconnect electrical power from the ventilator before servicing. Be aware that

battery power remains even after the mains is disconnected. Be aware that if the power switch is off, some parts still carry high voltage.

• Do not attempt service procedures other than those specified in the service manual.

• Use replacement parts supplied by HAMILTON MEDICAL only.

• Any attempt to modify the ventilator hardware or software without the express written approval of HAMILTON MEDICAL automatically voids all warranties and liabilities.

• The preventive maintenance program requires a general service every 5000 hours or yearly, whichever comes first.

• To ensure the ventilator’s safe operation, always run the tests and calibrations prescribed in Chapter 4, Tests, calibrations, and utilities, before using the ventilator on a patient. If the ventilator fails any tests, remove it from clinical use immediately. Do not use the ventilator until necessary repairs are completed and all tests have passed.

Electromagnetic susceptibility

For further information see Appendix A.

Electromagnetic emissions

For further information see Appendix A.

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Units of measure

Air and oxygen pressures are indicated on the HAMILTON-G5 in cmH2O or mbar. Hectopascals (hPa) are used by some institutions instead. Since 1 mbar equals 1 hPa, which equals

1.016 cmH2O, the units may be used interchangeably.

measurements are indicated in mmHg, Torr, and kPa.

These units are user configurable.

SpO

measurements are indicated in %.

Disposal

Dispose of all parts removed from the device according to your institution’s protocol. Follow all local, state, and federal regulations with respect to environmental protection, especially when disposing an electronic device or parts of it (for example, oxygen cell, batteries).

Year of manufacture

The year of manufacture is shown on the serial number label on the HAMILTON-G5 ventilation unit.

624074/07 xi

xii 624074/07

Safety warnings, cautions, notes . . . . . . . . . . . . . . .v

General warnings, cautions, and notes . . . . . . . . . . . . . . . vii

Intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

General notes for operators . . . . . . . . . . . . . . . . . . . . . . . viii

Monitoring and alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Fire and other hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Service and testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x

Electromagnetic susceptibility . . . . . . . . . . . . . . . . . . . . . . . x

Electromagnetic emissions . . . . . . . . . . . . . . . . . . . . . . . . . . x

Units of measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

Year of manufacture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxvii

List of Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxxv

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

1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

1.2 Functional description . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

1.2.1 System overview . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

1.2.2 Gas supply and delivery . . . . . . . . . . . . . . . . . . . 1-10

1.2.3 Gas monitoring with the flow sensor . . . . . . . . . 1-12

1.3 Physical description . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

1.3.1 Breathing circuits and accessories . . . . . . . . . . . 1-13

1.3.2 Ventilation cockpit . . . . . . . . . . . . . . . . . . . . . . . 1-17

1.3.3 Ventilation unit . . . . . . . . . . . . . . . . . . . . . . . . . 1-23

1.4 Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-26

2 Preparing for ventilation . . . . . . . . . . . . . . . . . . . . 2-1

2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

2.2 Installing and positioning the Ventilation Cockpit. . . . . . . 2-4

2.2.1 Mounting the Ventilation Cockpit . . . . . . . . . . . . 2-4

2.2.2 Adjusting the Ventilation Cockpit (tilt and swivel) 2-6

2.3 Installing the patient tubing support arm . . . . . . . . . . . . . 2-7

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Table of Contents

2.4 Installing the humidifier. . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8

2.4.1 Connecting and attaching the humidifier . . . . . . .2-9

2.5 Installing the modules (CO

, SpO2, Aeroneb,

HAMILTON-H900 humidifier) . . . . . . . . . . . . . . . . . . . . .2-12

2.6 Verifying the oxygen cell installation . . . . . . . . . . . . . . . . 2-13

2.7 Installing the patient breathing circuit . . . . . . . . . . . . . . . 2-14

2.8 Using the auxiliary pressure (Paux) measurement. . . . . . . 2-22

2.9 Using an expiratory filter . . . . . . . . . . . . . . . . . . . . . . . . . 2-23

2.10 Connecting to AC power . . . . . . . . . . . . . . . . . . . . . . . . 2-24

2.11 Using the optional power strip . . . . . . . . . . . . . . . . . . . . 2-25

2.12 Using the backup batteries . . . . . . . . . . . . . . . . . . . . . . . 2-25

2.12.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-26

2.12.2 Replacing the optional extended battery pack. . .2-28

2.13 Connecting gas supplies . . . . . . . . . . . . . . . . . . . . . . . . .2-29

2.14 Connecting to an external patient monitor or other

device . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-32

2.15 Starting up the ventilator . . . . . . . . . . . . . . . . . . . . . . . . 2-33

2.16 Shutting down the ventilator. . . . . . . . . . . . . . . . . . . . . .2-34

2.17 Ventilation cockpit navigation guidelines . . . . . . . . . . . . . 2-35

3 Hardware options. . . . . . . . . . . . . . . . . . . . . . . . . . 3-1

3.1 Set up CO2 sensor monitoring. . . . . . . . . . . . . . . . . . . . . . 3-3

3.1.1 Enabling CO

3.1.2 CO

mainstream measurement . . . . . . . . . . . . . . .3-5

3.1.2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . 3-5

3.1.2.2 Connecting the CO

3.1.3 CO

sidestream measurement. . . . . . . . . . . . . . . . 3-9

3.1.3.1 Using the LoFlo™ CO

3.1.3.2 Module mounting . . . . . . . . . . . . . . . . . 3-9

3.1.3.3 Module exhaust . . . . . . . . . . . . . . . . . .3-10

3.1.3.4 Connecting the CO

3.1.3.5 Sidestream sample kit . . . . . . . . . . . . . . 3-13

3.2 SpO

monitoring options . . . . . . . . . . . . . . . . . . . . . . . . 3-14

3.3 Installing the pneumatic nebulizer . . . . . . . . . . . . . . . . . .3-15

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

mainstream sensor .3-6

Module . . . . . . . . 3-9

sidestream sensor . 3-10

3.4 Integrated Aeroneb® system . . . . . . . . . . . . . . . . . . . . . 3-17

3.4.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17

3.4.2 Indications for use . . . . . . . . . . . . . . . . . . . . . . . 3-18

3.4.3 System description . . . . . . . . . . . . . . . . . . . . . . . 3-18

3.4.4 Enabling the Aeroneb option . . . . . . . . . . . . . . . 3-20

3.4.5 Connecting the nebulizer. . . . . . . . . . . . . . . . . . 3-20

3.4.6 Continuous nebulization . . . . . . . . . . . . . . . . . . 3-22

3.4.6.1 Setting the flow-rate for continuous

nebulization . . . . . . . . . . . . . . . . . . . . 3-23

3.4.7 Installation in breathing circuit . . . . . . . . . . . . . . 3-24

3.4.8 Adding medication . . . . . . . . . . . . . . . . . . . . . . 3-26

3.4.9 Configuring nebulization . . . . . . . . . . . . . . . . . . 3-27

3.4.9.1 Configuring nebulization for intermittent doses less than or equal

to 6 ml . . . . . . . . . . . . . . . . . . . . . . . . 3-27

3.4.9.2 Configuring nebulization for

continuous doses . . . . . . . . . . . . . . . . . 3-28

3.4.10 Functional test . . . . . . . . . . . . . . . . . . . . . . . . . . 3-29

3.4.11 Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-30

3.5 IntelliCuff

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-30

3.5.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-30

3.5.2 Indications for use . . . . . . . . . . . . . . . . . . . . . . . 3-30

3.5.3 System description . . . . . . . . . . . . . . . . . . . . . . . 3-30

3.5.4 Enabling the integrated cuff pressure controller

option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-33

3.5.5 Operation of the automatic cuff pressure

controller. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-34

3.5.6 Operating modes . . . . . . . . . . . . . . . . . . . . . . . . 3-35

3.5.6.1 Cuff pressure control OFF . . . . . . . . . . 3-35

3.5.6.2 Setting constant cuff pressure

(MANUAL) . . . . . . . . . . . . . . . . . . . . . . 3-36

3.5.6.3 Setting cuff pressure relative to

airway pressure (AUTO) . . . . . . . . . . . . 3-37

3.5.6.4 Full deflation of the cuff . . . . . . . . . . . 3-38

3.5.7 Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-39

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Table of Contents

3.6 Working with the integrated HAMILTON-H900

humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-39

3.6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-40

3.6.2 Humidifier overview . . . . . . . . . . . . . . . . . . . . . .3-40

3.6.3 Setting up the humidifier . . . . . . . . . . . . . . . . . . 3-42

3.6.4 Humidifier display on the ventilator. . . . . . . . . . . 3-42

3.6.5 Controlling humidifier options . . . . . . . . . . . . . .3-44

3.6.6 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-45

4 Tests, calibrations and utilities . . . . . . . . . . . . . . . 4-1

4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2

4.2 Pre-operational checks . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

4.2.1 Pre-operational check with heliox . . . . . . . . . . . . . 4-6

4.3 System functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8

4.3.1 Info: Viewing ventilator operating hours,

options, and versions . . . . . . . . . . . . . . . . . . . . . . 4-8

4.3.2 Tests & calib: Running sensor calibrations and the

tightness test . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10

4.3.2.1 Flow sensor calibration . . . . . . . . . . . . . 4-10

4.3.2.2 Tightness test . . . . . . . . . . . . . . . . . . . . 4-13

4.3.2.3 Oxygen cell calibration . . . . . . . . . . . . . 4-14

4.3.2.4 CO

4.3.2.5 SpO

4.3.3 Sensors on/off: Enabling/disabling SpO

and CO

4.3.3.1 Gas source: Assigning air or heliox . . . . 4-18

4.3.4 Setting day and night . . . . . . . . . . . . . . . . . . . . . 4-19

4.3.5 Setting date and time . . . . . . . . . . . . . . . . . . . . .4-20

4.4 Alarm tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-20

4.4.1 High pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-21

4.4.2 Low minute volume . . . . . . . . . . . . . . . . . . . . . . 4-21

4.4.3 Oxygen supply failed and low oxygen alarms . . . 4-21

4.4.4 Disconnection . . . . . . . . . . . . . . . . . . . . . . . . . . .4-22

4.4.5 Loss of mains power . . . . . . . . . . . . . . . . . . . . . . 4-22

4.4.6 Exhalation obstructed . . . . . . . . . . . . . . . . . . . . .4-22

4.4.7 Apnea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-22

sensor/adapter zero calibration . . .4-15

sensor/adapter test . . . . . . . . . . .4-16

, O2,

monitoring . . . . . . . . . . . . . . . . . . . . . .4-17

xvi 624074/07

5 Ventilator settings . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2

5.2 Setting up the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

5.3 Patient window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

5.3.1 Patient window: Changing patient gender

and height. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

5.3.2 Patient window: Ventilation timer . . . . . . . . . . . . 5-6

5.4 Modes window: Setting the ventilation mode . . . . . . . . . 5-7

5.5 Controls window: Settings including apnea backup

ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10

5.5.1 Adjusting and confirming control settings

without mode change . . . . . . . . . . . . . . . . . . . . 5-10

5.5.2 Adjusting and confirming control settings

after mode change . . . . . . . . . . . . . . . . . . . . . . 5-12

5.5.3 About apnea backup ventilation . . . . . . . . . . . . 5-14

5.6 Additions window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15

5.6.1 Sigh: Enabling/disabling the sigh function . . . . . 5-16

5.6.2 TRC: Setting tube resistance compensation . . . . 5-17

5.6.3 Table of control settings, additions, and ranges . 5-19

5.7 Alarms window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-27

5.7.1 Limits: Setting alarm limits . . . . . . . . . . . . . . . . . 5-28

5.7.2 Loudness: Adjusting alarm loudness. . . . . . . . . . 5-30

5.7.3 Buffer: Viewing active alarms . . . . . . . . . . . . . . . 5-31

5.7.4 Table of alarm limit settings and ranges . . . . . . . 5-31

6 Neonatal ventilation . . . . . . . . . . . . . . . . . . . . . . . 6-1

6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2

6.2 Breathing circuit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3

6.3 Flow sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3

6.4 Test and calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4

6.5 Ventilation modes and mode additions . . . . . . . . . . . . . . 6-4

6.6 Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

6.6.1 Ti max . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

6.6.2 Flowtrigger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

6.6.3 P-ramp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

6.7 Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

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Table of Contents

7 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

7.2 Monitoring window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

7.2.1 Monitored parameter windows and sensor

data window: Viewing numeric patient data . . . . . 7-4

7.2.2 Paw/Paux: Assigning Paw or Paux as pressure

input for numeric patient data . . . . . . . . . . . . . . . 7-5

7.3 Graphics window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7

7.3.1 Graphics window: Set up for the ventilation

cockpit (layout and setting trend timing). . . . . . . .7-7

7.3.2 Setting up individual panels . . . . . . . . . . . . . . . . .7-8

7.3.3 About graphic types . . . . . . . . . . . . . . . . . . . . . . . 7-9

7.3.3.1 Waveforms . . . . . . . . . . . . . . . . . . . . . . 7-10

7.3.4 Loops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10

7.3.4.1 Trends . . . . . . . . . . . . . . . . . . . . . . . . . 7-12

7.3.4.2 Dynamic lung . . . . . . . . . . . . . . . . . . . . 7-13

7.3.4.3 Vent status . . . . . . . . . . . . . . . . . . . . . . 7-13

7.3.4.4 INTELLiVENT

7.3.4.5 ASV graphics window . . . . . . . . . . . . . .7-14

7.3.4.6 ASV data window . . . . . . . . . . . . . . . . .7-14

7.3.5 Freeze and cursor measurement . . . . . . . . . . . . . 7-14

7.4 Tools window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15

7.4.1 Hold: Performing inspiratory/expiratory hold

maneuvers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-15

7.4.2 Performing a static P/V maneuver . . . . . . . . . . . . 7-18

7.5 Monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . . 7-18

-specific intelligent panels 7-13

8 Intelligent panels . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1

8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2

8.2 Dynamic lung panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2

8.2.1 Tidal volume (Vt). . . . . . . . . . . . . . . . . . . . . . . . . . 8-3

8.2.2 Compliance (Cstat) . . . . . . . . . . . . . . . . . . . . . . . .8-3

8.2.3 Patient triggering: Muscle . . . . . . . . . . . . . . . . . . . 8-4

8.2.4 Resistance: Bronchial tree . . . . . . . . . . . . . . . . . . . 8-4

8.2.5 Heart circulation . . . . . . . . . . . . . . . . . . . . . . . . . .8-5

xviii 624074/07

8.3 Heart-Lung Interaction . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6

8.3.1 Graphic Display . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6

8.4 Vent status. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7

8.5 ASV monitored data window . . . . . . . . . . . . . . . . . . . . . . 8-9

8.6 ASV target graphics window . . . . . . . . . . . . . . . . . . . . . 8-10

8.7 INTELLiVENT®-specific intelligent panels . . . . . . . . . . . . 8-10

8.8 Quick Wean-specific intelligent panels . . . . . . . . . . . . . . 8-10

9 P/V tool maneuver option . . . . . . . . . . . . . . . . . . . 9-1

9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2

9.1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2

9.1.2 Required conditions for use . . . . . . . . . . . . . . . . . 9-3

9.1.3 Indication for use . . . . . . . . . . . . . . . . . . . . . . . . 9-3

9.1.4 Contraindications for use . . . . . . . . . . . . . . . . . . . 9-4

9.1.5 How the P/V Tool works . . . . . . . . . . . . . . . . . . . 9-4

9.2 Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5

9.2.1 Performing the maneuver . . . . . . . . . . . . . . . . . . 9-6

9.2.2 Using the cursor feature to graphically analyze

the plot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-12

9.2.3 Analyzing the curve . . . . . . . . . . . . . . . . . . . . . . 9-14

9.2.4 Selecting plot type . . . . . . . . . . . . . . . . . . . . . . . 9-17

9.2.5 Using the Reference feature to review stored

curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-18

9.2.6 Flow sensor and breathing circuit check. . . . . . . 9-19

9.2.7 P/V Tool against P/V Tool Pro . . . . . . . . . . . . . . . 9-23

9.3 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-23

10 Responding to alarms . . . . . . . . . . . . . . . . . . . . . 10-1

10.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2

10.2 How to respond to an alarm . . . . . . . . . . . . . . . . . . . . . 10-5

10.3 Active alarm buffer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6

10.4 Event logs: Reviewing events . . . . . . . . . . . . . . . . . . . . . 10-7

10.5 Alarm troubleshooting table. . . . . . . . . . . . . . . . . . . . . . 10-8

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11 Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1

11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2

11.2 Cleaning, disinfection, and sterilization . . . . . . . . . . . . . .11-2

11.2.1 General guidelines for cleaning . . . . . . . . . . . . . 11-10

11.2.2 General guidelines for chemical disinfection . . .11-10

11.2.3 General guidelines for autoclave sterilization. . .11-11

11.3 Preventive maintenance . . . . . . . . . . . . . . . . . . . . . . . .11-11

11.3.1 Cleaning or replacing the fan filter . . . . . . . . . . 11-14

11.3.2 Removing a gas supply filter housing . . . . . . . . 11-14

11.3.3 Replacing the oxygen cell . . . . . . . . . . . . . . . . .11-14

11.4 Calibration of the extended battery . . . . . . . . . . . . . . . . 11-15

11.5 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-15

11.6 Repacking and shipping . . . . . . . . . . . . . . . . . . . . . . . . 11-15

12 Special functions. . . . . . . . . . . . . . . . . . . . . . . . . . 12-1

12.1 Standby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2

12.2 O

12.3 Suctioning tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-5

12.4 Manual breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-6

12.5 Pneumatic and Aeroneb

12.6 Print screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7

12.7 Screen Lock/Unlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8

enrichment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4

nebulizer. . . . . . . . . . . . . . . . .12-6

A Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-1

A.1 Physical characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

A.2 Environmental requirements . . . . . . . . . . . . . . . . . . . . . . A-3

A.3 Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . A-3

A.4 Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

A.5 Control settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-6

A.6 Monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . A-20

A.7 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-26

A.8 Configuration specifications . . . . . . . . . . . . . . . . . . . . . A-33

A.9 Breathing circuit specifications . . . . . . . . . . . . . . . . . . . A-37

A.10 Other technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . A-38

A.11 Standards and approvals . . . . . . . . . . . . . . . . . . . . . . . . A-41

xx 624074/07

A.12 EMC declarations (IEC 60601-1-2) . . . . . . . . . . . . . . . . . A-42

A.13 Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-47

A.14 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-48

B Modes of ventilation . . . . . . . . . . . . . . . . . . . . . . . B-1

B.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-2

B.2 Mandatory modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-5

B.2.1 Synchronised controlled mandatory ventilation

((S)CMV) mode . . . . . . . . . . . . . . . . . . . . . . . . . . B-5

B.2.2 Pressure-controlled CMV (P-CMV) mode . . . . . . . B-6

B.3 SIMV (synchronized intermittent mandatory ventilation)

modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7

B.3.1 SIMV mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-8

B.3.2 P-SIMV mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . B-9

B.4 Pressure support mode (SPONT) . . . . . . . . . . . . . . . . . . . B-10

B.5 Advanced ventilation modes . . . . . . . . . . . . . . . . . . . . . B-11

B.5.1 Adaptive pressure ventilation (APV) . . . . . . . . . . B-11

B.5.1.1 Advantages . . . . . . . . . . . . . . . . . . . . . B-13

B.5.1.2 Principles of operation . . . . . . . . . . . . . B-14

B.5.2 Adaptive support ventilation (ASV). . . . . . . . . . . B-15

B.5.3 DuoPAP (Duo positive airway pressure) and

APRV (Airway pressure release ventilation) . . . . . B-15

B.5.3.1 Introduction . . . . . . . . . . . . . . . . . . . . B-15

B.5.3.2 Differences between DuoPAP and APRV B-18 B.5.3.3 The many faces of DuoPAP and APRV . B-18 B.5.3.4 Pressure support in DuoPAP/APRV

breaths . . . . . . . . . . . . . . . . . . . . . . . . B-19

B.5.3.5 Synchronization . . . . . . . . . . . . . . . . . . B-20

B.5.3.6 References . . . . . . . . . . . . . . . . . . . . . . B-21

B.5.4 Noninvasive ventilation (NIV and NIV-ST) . . . . . . B-21

B.5.5 nCPAP-PS mode . . . . . . . . . . . . . . . . . . . . . . . . B-23

B.5.5.1 Introduction . . . . . . . . . . . . . . . . . . . . B-23

B.5.5.2 Controls of nCPAP-PS . . . . . . . . . . . . . B-24

B.6 Leak compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-25

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CASV® (Adaptive Support Ventilation). . . . . . . . . . C-1

C.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-2

C.2 ASV use in clinical practice . . . . . . . . . . . . . . . . . . . . . . . C-3

C.3 Detailed functional description of ASV . . . . . . . . . . . . . C-15

C.3.1 Normal minute ventilation. . . . . . . . . . . . . . . . . C-15

C.3.2 Targeted minute ventilation . . . . . . . . . . . . . . . C-15

C.3.3 Lung-protective rules strategy . . . . . . . . . . . . . C-17

C.3.4 Optimal breath pattern . . . . . . . . . . . . . . . . . . . C-20

C.3.4.1 Initial breaths: How ASV starts . . . . . . C-21

C.3.4.2 Approaching the target . . . . . . . . . . . C-22

C.3.5 Dynamic adjustment of lung protection . . . . . . C-24

C.3.6 Dynamic adjustment of optimal breath pattern . C-25

C.4 Minimum work of breathing (Otis’ equation). . . . . . . . . C-26

C.5 ASV technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-28

C.6 ASV Start up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-31

C.7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-32

D NIV (Noninvasive ventilation) . . . . . . . . . . . . . . . .D-1

D.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

D.2 Benefits of noninvasive ventilation, . . . . . . . . . . . . . . . . . D-3

D.3 Required conditions for use . . . . . . . . . . . . . . . . . . . . . . . D-4

D.4 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-5

D.5 Potential adverse reactions . . . . . . . . . . . . . . . . . . . . . . . D-5

D.6 Selecting a patient interface . . . . . . . . . . . . . . . . . . . . . . D-5

D.7 Control settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7

D.8 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-8

D.9 Monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . . D-8

D.10 Additional notes about using noninvasive ventilation. . . . D-9

D.11 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11

ECO2 sensor option: Volumetric Capnography . . . E-1

E.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-2

E.2 CO E.3 End-tidal CO

E.4 Airway dead space (VDaw) . . . . . . . . . . . . . . . . . . . . . . . . E-5

E.5 Alveolar minute ventilation (V’alv) . . . . . . . . . . . . . . . . . . . E-6

xxii 624074/07

elimination (V’CO2) . . . . . . . . . . . . . . . . . . . . . . . . . . E-3

(PetCO2 and FetCO2) . . . . . . . . . . . . . . . . . E-5

E.6 Capnogram shape (slope of the alveolar plateau,

slopeCO

) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-7

E.7 Formulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9

E.8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-10

F Pulse oximetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-1

F.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-3

F.2 SpO2 monitoring options . . . . . . . . . . . . . . . . . . . . . . . . F-13

F.2.1 About Masimo SET and Masimo Rainbow SET . F-14

F.2.1.1 Masimo SpHb sensor modes of

operation . . . . . . . . . . . . . . . . . . . . . . F-15

F.2.2 About Nihon-Kohden . . . . . . . . . . . . . . . . . . . . F-17

F.3 Monitored parameters and settings . . . . . . . . . . . . . . . . F-17

F.3.1 About the Masimo SpO

measurements F-19

F.4 SpO

pulse oximeter data display . . . . . . . . . . . . . . . . . . F-19

F.4.1 SpO

parameters in the Monitoring window . . . F-20

F.4.2 Quality index indicators . . . . . . . . . . . . . . . . . . . F-21

F.5 Working in SpHb Spot Check mode . . . . . . . . . . . . . . . . F-23

F.5.1 Performing an SpHb spot check . . . . . . . . . . . . . F-25

F.6 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-26

F.6.1 Masimo SpO F.6.2 SpO

Alarm Limits window . . . . . . . . . . . . . . . . F-27

alarm delay . . . . . . . . . . . . . . . . . F-26

F.6.3 Table of pulse oximeter-related alarm settings . . F-27

F.7 Masimo information codes and troubleshooting. . . . . . . F-29

F.7.1 About the pulse oximeter information codes . . . F-30

F.8 Configuring the oximeters . . . . . . . . . . . . . . . . . . . . . . . F-32

F.8.1 Configuring the Masimo options . . . . . . . . . . . . F-32

F.8.1.1 Configuring Masimo data acquisition

options . . . . . . . . . . . . . . . . . . . . . . . . F-33

F.8.1.2 Table of Masimo data acquisition

settings . . . . . . . . . . . . . . . . . . . . . . . . F-34

F.8.1.3 Enabling and configuring monitoring

settings . . . . . . . . . . . . . . . . . . . . . . . . F-35

F.8.1.4 Table of Masimo monitoring options . . F-36 F.8.1.5 Enabling and configuring Masimo

alarms . . . . . . . . . . . . . . . . . . . . . . . . . F-37

Raw parameter

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Table of Contents

F.8.2 Configuring the Nihon-Kohden options . . . . . . . F-38

F.9 Connecting the equipment . . . . . . . . . . . . . . . . . . . . . . . F-38

F.9.1 Connecting the Masimo oximeter . . . . . . . . . . . . F-39

F.9.1.1 Attaching the adapter to a rail . . . . . . . F-40

F.9.1.2 Attaching the adapter cable . . . . . . . . . F-42

F.9.1.3 Attaching the patient cable to the

adapter . . . . . . . . . . . . . . . . . . . . F-43

SpO

F.9.1.4 Attaching the sensor to the patient

cable . . . . . . . . . . . . . . . . . . . . . . . . . . F-43

F.9.2 Connecting the Nihon-Kohden oximeter . . . . . . . F-44

F.9.3 Confirming measurements . . . . . . . . . . . . . . . . . F-45

F.9.4 Disconnecting the SpO

F.10 Troubleshooting Masimo issues . . . . . . . . . . . . . . . . . . . . F-45

F.11 Masimo specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . F-49

F.12 Basics of pulse oximetry . . . . . . . . . . . . . . . . . . . . . . . . . F-54

F.13 SpO

F.14 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-57

/FiO2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-56

sensor . . . . . . . . . . . . . . F-45

G Pneumatic diagram. . . . . . . . . . . . . . . . . . . . . . . . .G-1

H Parts and accessories . . . . . . . . . . . . . . . . . . . . . . .H-1

I Communication interface. . . . . . . . . . . . . . . . . . . . I-1

I.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-2

I.2 RS-232 interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-3

I.3 Patient monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-4

I.4 PDMS or other computer system . . . . . . . . . . . . . . . . . . . . I-7

I.5 Inspiratory:Expiratory (I:E) timing outlet . . . . . . . . . . . . . . . I-8

I.6 Remote alarm outlet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-9

I.7 Connector pin assignments . . . . . . . . . . . . . . . . . . . . . . . I-10

J Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-1

J.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2

J.2 Begin configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2

J.3 Language: Choosing the default language . . . . . . . . . . . . J-3

J.4 Customize: Choosing the ventilation philosophy and

alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-4

xxiv 624074/07

J.4.1 Breath timing philosophies (adult patients). . . . . . .J-5

J.5 Quick Wean: Choosing the default weaning activity

criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J-7

J.6 MMP selection: Choosing the default main monitoring

parameter display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-10

J.7 Vent Status: Configuring the Vent Status intelligent

panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J-11

J.8 Options: Activating software and hardware options . . . . .J-13

J.9 Interface: Configuring the I:E timing outlet. . . . . . . . . . . . J-14

J.10 Nebulizer: Configuring the nebulizer type . . . . . . . . . . . .J-15

J.11 SpO

: Configuring pulse oximeter settings . . . . . . . . . . . .J-16

J.12 Defaults: configuring default settings . . . . . . . . . . . . . . . .J-18

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary-1

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1

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xxvi 624074/07

List of Figures

1-1 Closed-loop ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

1-2 Controller conceptual design . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

1-3 HAMILTON-G5 system overview . . . . . . . . . . . . . . . . . . . . . . . . 1-9

1-4 Gas delivery in the device . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11

1-5 Flow sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

1-6 Ventilator with accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14

1-7 Ventilation Cockpit front view . . . . . . . . . . . . . . . . . . . . . . . . 1-17

1-8 Ventilation Cockpit rear view . . . . . . . . . . . . . . . . . . . . . . . . . 1-19

1-9 Default screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-21

1-10 Front of ventilation unit (patient breathing circuit

connections). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-23

1-11 Rear of ventilation unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-25

2-1 Ventilation Cockpit mounting positions . . . . . . . . . . . . . . . . . . 2-5

2-2 Disconnecting the Ventilation Cockpit . . . . . . . . . . . . . . . . . . . 2-5

2-3 Mounting the Ventilation Cockpit . . . . . . . . . . . . . . . . . . . . . . . 2-6

2-4 Tilting the Ventilation Cockpit. . . . . . . . . . . . . . . . . . . . . . . . . . 2-6

2-5 Swiveling the Ventilation Cockpit . . . . . . . . . . . . . . . . . . . . . . . 2-7

2-6 Installing the patient tubing support arm . . . . . . . . . . . . . . . . . 2-8

2-7 Back of humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-10

2-8 Power, communication connections (bottom) . . . . . . . . . . . . . 2-11

2-9 HAMILTON-900 communications cable connected to RS-232

port on ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12

2-10 CO

2-11 Check for the oxygen cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14

2-12 Patient breathing circuit for use with heater wire

2-13 Patient breathing circuit for use with heater wire (neonatal) . . 2-18

2-14 Patient breathing circuit for use with HME . . . . . . . . . . . . . . . 2-19

2-15 Installing the expiratory valve membrane . . . . . . . . . . . . . . . . 2-20

2-16 Installing the expiratory valve cover. . . . . . . . . . . . . . . . . . . . . 2-21

2-17 Installing the flow sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-22

2-18 Electrical power symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-27

2-19 To open the front cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-28

2-20 To remove the extended battery pack . . . . . . . . . . . . . . . . . . . 2-29

2-21 HAMILTON-G5 inlet fittings . . . . . . . . . . . . . . . . . . . . . . . . . . 2-32

, SpO2, Aeroneb modules. . . . . . . . . . . . . . . . . . . . . . . . . 2-13

(pediatric/adult) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17

624074/07 xxvii

List of Figures

2-22 Power switch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-34

3-1 Selecting CO 3-2 Connecting the CO 3-3 Attaching the CO 3-4 Connecting the CO

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

sensor cable . . . . . . . . . . . . . . . . . . . . . . . 3-6

sensor to the airway adapter . . . . . . . . . . . . 3-7

sensor/airway adapter to the patient

circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

3-5 Mounting bracket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

3-6 Connecting the CO

sensor cable . . . . . . . . . . . . . . . . . . . . . . 3-11

3-7 Inserting the sample cell into the receptacle. . . . . . . . . . . . . . . 3-11

3-8 Attaching the CO

sensor to the airway adapter . . . . . . . . . . . 3-12

3-9 Installing a pneumatic nebulizer. . . . . . . . . . . . . . . . . . . . . . . . 3-16

3-10 System components. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19

3-11 Selecting Aeroneb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-20

3-12 Connecting nebulizer to T-adapter. . . . . . . . . . . . . . . . . . . . . . 3-21

3-13 Connecting HAMILTON-G5 Aeroneb module. . . . . . . . . . . . . . 3-21

3-14 Aeroneb solo nebulizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23

3-15 Nebulizer for adult breathing circuit. . . . . . . . . . . . . . . . . . . . . 3-24

3-16 Nebulizer for pediatric breathing circuit . . . . . . . . . . . . . . . . . . 3-24

3-17 Nebulizer for neonatal breathing circuit . . . . . . . . . . . . . . . . . . 3-25

3-18 Add medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-27

3-19 Intermittent nebulization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28

3-20 Continuous nebulization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28

3-21 Connecting cuff tubing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-32

3-22 Cuff tubing connected to cuff inflating tube . . . . . . . . . . . . . . 3-32

3-23 Selecting the cuff pressure controller . . . . . . . . . . . . . . . . . . . . 3-34

3-24 User Interface for automatic cuff pressure control (manual

or no automatic adjustment activated) . . . . . . . . . . . . . . . . . . 3-35

3-25 User Interface for cuff controller, showing cuff pressure

kept constant at manually set level. . . . . . . . . . . . . . . . . . . . . . 3-36

3-26 User Interface for cuff controller, cuff pressure automatically

adapted to actual airway pressure . . . . . . . . . . . . . . . . . . . . . . 3-37

3-27 Concept of automatically set Pcuff based on patient’s

airway pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-38

3-28 User Interface for cuff controller, showing full deflation of

cuff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-39

3-29 HAMILTON-900 humidifier, front view . . . . . . . . . . . . . . . . . . . 3-41

3-30 Humidifier window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-43

4-1 Info window, screen 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8

xxviii 624074/07

4-2 Info window, screen 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9

4-3 Tests & calib window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10

4-4 CO

sensor/adapter calibration setup . . . . . . . . . . . . . . . . . . . 4-16

4-5 Sensors on/off window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-18

4-6 Gas Source window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-19

4-7 Day/Night window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-20

5-1 Patient setup window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

5-2 Patient window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5

5-3 Modes window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-8

5-4 Controls window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11

5-5 Controls window after mode change . . . . . . . . . . . . . . . . . . . 5-13

5-6 INTELLiVENT®-ASV mode window . . . . . . . . . . . . . . . . . . . . . 5-13

5-7 Sigh window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-16

5-8 TRC window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-18

5-9 Ptrach and Paw waveforms (with TRC active) . . . . . . . . . . . . . 5-19

5-10 Alarm Limits 1 window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-29

5-11 Alarm Limits 2 window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-30

5-12 Alarm Loudness window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-31

7-1 Basic display with monitoring windows . . . . . . . . . . . . . . . . . . . 7-3

7-2 Monitored parameter window 1 . . . . . . . . . . . . . . . . . . . . . . . . 7-4

7-3 Monitored window 2, with sensor data . . . . . . . . . . . . . . . . . . 7-5

7-4 Paw/Paux window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6

7-5 Graphics window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7

7-6 Panel setup window (waveform window shown) . . . . . . . . . . . 7-9

7-7 Pressure waveform display . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10

7-8 Dynamic pressure/volume loop display . . . . . . . . . . . . . . . . . . 7-11

7-9 Trend display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13

7-10 Freeze and cursor function . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15

7-11 Hold window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-16

8-1 Dynamic Heart/Lung panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2

8-2 Compliance shown by the dynamic lung. . . . . . . . . . . . . . . . . . 8-3

8-3 Patient triggering shown by the dynamic lung muscle. . . . . . . . 8-4

8-4 Rinsp shown by the bronchial tree of the dynamic lung . . . . . . 8-4

8-5 Heart circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5

8-6 Dynamic Heart-Lung Interaction panel . . . . . . . . . . . . . . . . . . . 8-6

8-7 Vent status panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8

9-1 How the P/V Tool works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5

624074/07 xxix

List of Figures

9-2 P/V Tool information window . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7

9-3 P/V Tool window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8

9-4 P/V Tool Pro window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-10

9-5 Using the cursor function in the P/V Tool window: Creating

the linear compliance curve . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-13

9-6 Using the cursor function in the P/V Tool Pro window:

Creating the linear compliance curve . . . . . . . . . . . . . . . . . . . . 9-14

9-7 Interpreting the P/V curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-15

9-8 P/V Tool plot window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-17

9-9 Paw/Flow plot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-18

9-10 Demonstration lung assembly . . . . . . . . . . . . . . . . . . . . . . . . . 9-19

9-11 Checking for a gas leak between the Flow Sensor and

the demonstration lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-22

9-12 Checking flow sensor performance . . . . . . . . . . . . . . . . . . . . . 9-22

10-1 Visual alarm indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4

10-2 Active alarm buffer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7

10-3 Events window (all events shown) . . . . . . . . . . . . . . . . . . . . . . 10-8

12-1 Special function keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3

12-2 Activate standby window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3

12-3 Standby activated window . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4

A-1 HAMILTON-G5 dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-2

B-1 (S)CMV control window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-6

B-2 P-CMV control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7

B-3 Breath delivery in SIMV modes . . . . . . . . . . . . . . . . . . . . . . . . . . B-8

B-4 SIMV control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-9

B-5 PSIMV+ control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-10

B-6 SPONT control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-11

B-7 APVcmv control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-12

B-8 APVsimv control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-13

B-9 DuoPAP control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-16

B-10 APRV control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-17

B-11 DuoPAP pressure curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-18

B-12 APRV pressure curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-18

B-13 Pressure support in DuoPAP/APRV . . . . . . . . . . . . . . . . . . . . . . B-20

B-14 NIV control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-22

B-15 NIV-ST control window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-22

B-16 Breath timing in nCPAP-PS. . . . . . . . . . . . . . . . . . . . . . . . . . . . B-23

B-17 nCPAP-PS basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-24

xxx 624074/07

C-1 Clinical use of ASV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-4

C-2 ASV control window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-5

C-3 Hypothetical example of high %MinVol setting incompatible

with the lung-protective rules strategy . . . . . . . . . . . . . . . . . . C-10

C-4 ASV target graphics window. . . . . . . . . . . . . . . . . . . . . . . . . . C-11

C-5 ASV monitored data window . . . . . . . . . . . . . . . . . . . . . . . . . C-12

C-6 Normal minute ventilation as a function of ideal body

weight (IBW) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-15

C-7 MinVol = 7 l/min. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-16

C-8 Lung-protective rules strategy . . . . . . . . . . . . . . . . . . . . . . . . . C-17

C-9 Anatomy of the ASV target graphics window . . . . . . . . . . . . . C-21

C-10 Example of a situation after the three initial breaths . . . . . . . . C-23

C-11 Lung-protective limits are changed dynamically and

according to the respiratory system mechanics . . . . . . . . . . . . C-24

C-12 Changes of target values in broncho-constriction . . . . . . . . . . C-26

C-13 Three different relationships between rate and WOB . . . . . . . C-27

E-1 Typical capnogram of patient on pressure-controlled ventilation,

showing fractional concentration of CO

plotted against time . E-3

E-2 Typical spirogram of a patient on pressure-controlled ventilation

(same breath as shown in Figure E-1) . . . . . . . . . . . . . . . . . . . . E-4

E-3 Combination of capnogram and spirogram. . . . . . . . . . . . . . . . E-4

E-4 Interpretation of volumetric capnogram . . . . . . . . . . . . . . . . . . E-6

F-1 Masimo SpO

pulse oximeter components . . . . . . . . . . . . . . . .F-12

F-2 Monitoring window, SpO2raw . . . . . . . . . . . . . . . . . . . . . . . . .F-19

F-3 Monitoring window, Window 2 tab . . . . . . . . . . . . . . . . . . . . .F-21

F-4 Tools -> Spot Check window . . . . . . . . . . . . . . . . . . . . . . . . . .F-24

F-5 SpO

Alarm Limits 2 window . . . . . . . . . . . . . . . . . . . . . . . . . .F-27

F-6 System Info 2 window, pulse oximeter information . . . . . . . . . .F-30

F-7 Masimo data acquisition parameters. . . . . . . . . . . . . . . . . . . . .F-33

F-8 Selecting sensor options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-35

F-9 Configuring Masimo monitoring settings . . . . . . . . . . . . . . . . .F-35

F-10 Configuration SpO

alarms, using the Customize window . . . .F-38

F-11 Fully connected oximeter (Masimo) . . . . . . . . . . . . . . . . . . . . . .F-39

F-12 Adapter on rail, fully assembled (Masimo). . . . . . . . . . . . . . . . .F-40

F-13 Adapter, open and closed views . . . . . . . . . . . . . . . . . . . . . . . .F-40

F-14 Fit adapter over rail. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-41

F-15 Masimo adapter and patient cables, connection ports on

adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-41

624074/07 xxxi

List of Figures

F-16 Connecting the ventilator SpO2 cable to the ventilator (Masimo)F-42 F-17 Connecting the patient cable to the SpO

adapter (Masimo) . . F-43

F-18 Connecting the patient cable to the sensor (Masimo). . . . . . . . F-43

F-19 Locking cover between patient cable and sensor (Masimo). . . . F-44

F-20 Connecting the patient cable to the ventilator . . . . . . . . . . . . . F-44

F-21 Connecting sensor to the patient cable (Nihon-Kohden) . . . . . F-45

F-22 Light absorption spectrum of oxy- (HbO

) and

deoxyhaemoglobin (Hb) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-55

F-23 Scheme of a pulse oximeter . . . . . . . . . . . . . . . . . . . . . . . . . . . F-55

F-24 Simultaneous pulse oximeter plethysmogram and airway

pressure recording with POPmax and POPmin indicated on

the plethysmogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-56

F-25 Oxygen-haemoglobin dissociation curve . . . . . . . . . . . . . . . . . F-57

G-1 Pneumatic diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-1

H-1 Ventilator parts and accessories . . . . . . . . . . . . . . . . . . . . . . . . .H-1

I-1 HAMILTON-G5 connected to a patient monitor . . . . . . . . . . . . . I-5

I-2 HAMILTON-G5 connected to a computer system . . . . . . . . . . . . I-7

I-3 HAMILTON-G5 connected to an external device through the

Special Interface connector . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-8

I-4 Remote alarm relay positions . . . . . . . . . . . . . . . . . . . . . . . . . . I-10

I-5 Interface connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-11

J-1 Configuration window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-3

J-2 Language window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-3

J-3 Customize window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-4

J-4 Relationships between breath timing settings . . . . . . . . . . . . . . J-6

J-5 Quick Wean To start settings . . . . . . . . . . . . . . . . . . . . . . . . . . . J-8

J-6 Quick Wean SBT settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-8

J-7 Quick Wean To abort settings . . . . . . . . . . . . . . . . . . . . . . . . . . J-9

J-8 Main Monitoring Parameter selection drop-down list . . . . . . . . J-10

J-9 Vent status window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-11

J-10 Vent status intelligent panel. . . . . . . . . . . . . . . . . . . . . . . . . . . J-12

J-11 Options window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-13

J-12 Interface window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-14

J-13 I:E outlet timing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-15

J-14 Nebulizer window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-16

J-15 SpO

Parameter selection window . . . . . . . . . . . . . . . . . . . . . . J-17

J-16 Masimo Data Acquisition settings . . . . . . . . . . . . . . . . . . . . . . J-17

J-17 Defaults window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-18

xxxii 624074/07

List of Tables

1-1 Compatible parts and accessories . . . . . . . . . . . . . . . . . . . . . . 1-15

1-2 Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-26

2-1 Breathing circuit parts and patient types . . . . . . . . . . . . . . . . . 2-16

3-1 Airway adapter kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-14

3-2 Controlling humidifier options on the ventilator . . . . . . . . . . . 3-44

3-3 Humidifier-related alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-45

4-1 When to perform tests and calibrations . . . . . . . . . . . . . . . . . . 4-2

5-1 Ventilation modes and patient types. . . . . . . . . . . . . . . . . . . . . 5-8

5-2 Control settings, mode additions, and ranges . . . . . . . . . . . . . 5-19

5-3 Alarm limit settings and ranges . . . . . . . . . . . . . . . . . . . . . . . 5-32

7-1 Monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-19

8-1 Dynamic lung normal values. . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5

8-2 Vent status parameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-8

9-1 P/V Tool against P/V Tool pro . . . . . . . . . . . . . . . . . . . . . . . . . 9-23

10-1 Alarm indications in HAMILTON-G5 . . . . . . . . . . . . . . . . . . . . 10-3

10-2 Alarms and other messages . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9

11-1 Decontamination methods for HAMILTON-G5 parts . . . . . . . . 11-4

11-2 Preventive maintenance schedule . . . . . . . . . . . . . . . . . . . . . 11-12

A-1 Physical characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

A-2 Environmental requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

A-3 Pneumatic specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

A-4 Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

A-5 Control setting ranges and resolutions . . . . . . . . . . . . . . . . . . . A-6

A-6 Control settings applicable to HAMILTON-G5 ventilation modesA-15

A-7 P/V Tool setting ranges and resolutions . . . . . . . . . . . . . . . . . A-19

A-8 Monitored parameter ranges and resolutions . . . . . . . . . . . . . A-21

A-9 Real-time curves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-26

A-10 Adjustable alarms with automatic and standard settings. . . . . A-26

A-11 Configuration specifications . . . . . . . . . . . . . . . . . . . . . . . . . . A-33

A-12 Breathing circuit specifications . . . . . . . . . . . . . . . . . . . . . . . . A-37

A-13 Other technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-38

A-14 Guidance and manufacturer's declaration – electromagnetic

emissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-42

A-15 Guidance and manufacturer's declaration – electromagnetic

immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-43

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List of Tables

A-16 Recommended separation distances between portable and

mobile RF communications equipment and the HAMILTON-G5

ventilator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-46

B-1 Ventilation mode summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3

B-2 Controls active in HAMILTON-G5 ventilation modes . . . . . . . . . B-4

C-1 Blood gas and patient conditions and possible adjustments

for ASV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-9

C-2 Interpretation of breathing pattern at 100% MinVol setting . .C-12 C-3 Interpretation of breathing pattern at much higher than

100% MinVol setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-13

C-4 Interpretation of breathing pattern at much lower than

100% MinVol setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-13

C-5 ASV technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-28

C-6 Initial breath pattern for Adult settings . . . . . . . . . . . . . . . . . .C-31

C-7 Initial breath pattern for Pediatric settings . . . . . . . . . . . . . . . .C-31

D-1 Patient interfaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-6

E-1 Examples of “normal” or expected values in mechanically

ventilated patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-8

F-1 SpO2 pulse oximeter options. . . . . . . . . . . . . . . . . . . . . . . . . . F-13

F-2 Masimo SpHb sensor modes . . . . . . . . . . . . . . . . . . . . . . . . . . F-16

F-3 SpO2 parameters and settings. . . . . . . . . . . . . . . . . . . . . . . . . F-17

F-4 SpO2 parameters in the Monitoring window . . . . . . . . . . . . . . F-20

F-5 SpO2 parameter quality index indicators . . . . . . . . . . . . . . . . . F-22

F-6 Spot Check window Status area options . . . . . . . . . . . . . . . . . F-25

F-7 Adjustable alarms with automatic and standard settings . . . . . F-27

F-8 Masimo sensor information . . . . . . . . . . . . . . . . . . . . . . . . . . . F-30

F-9 Masimo option settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-32

F-10 Masimo data acquisition settings. . . . . . . . . . . . . . . . . . . . . . . F-34

F-11 Masimo monitoring parameters. . . . . . . . . . . . . . . . . . . . . . . . F-36

F-12 Troubleshooting Masimo issues . . . . . . . . . . . . . . . . . . . . . . . . F-46

F-13 Masimo pulse oximeter specifications . . . . . . . . . . . . . . . . . . . F-49

H-1 Ventilator parts and accessories. . . . . . . . . . . . . . . . . . . . . . . . .H-2

I-1 Interfacing hardware for patient monitors . . . . . . . . . . . . . . . . . I-6

I-2 Requirements for interfacing PDMS’s. . . . . . . . . . . . . . . . . . . . . I-8

I-3 Interface connector pin assignments . . . . . . . . . . . . . . . . . . . . I-11

J-1 Timing controls applicable to breath timing

control philosophies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-7

xxxvi 624074/07

General information

1.1 Introduction 1-2

1.2 Functional description 1-9

1.2.1 System overview 1-9

1.2.2 Gas supply and delivery 1-10

1.2.3 Gas monitoring with the flow sensor 1-12

1.3 Physical description 1-13

1.3.1 Breathing circuits and accessories 1-13

1.3.2 Ventilation cockpit 1-17

1.3.3 Ventilation unit 1-23

1.4 Symbols 1-26

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1 General information

1.1 Introduction

The HAMILTON-G5 (hereafter referred to as the “device”) provides for intensive care ventilation of adult, pediatric and neonatal patients. This device must be operated only by trained personnel under the supervision of a licensed physician.

Fully closed-loop control. Optional. On the HAMILTON-G5, you can install the world’s first and unique “fully closed-loop control” option. The device is intended only for adult and pediatric patients. With the HAMILTON-G5 this feature is referred to as INTELLiVENT

The physiological inputs come from the patient. The physician establishes targets and a strategy that are matched with the patient inputs, or what the INTELLiVENT automatically established. Then the ventilator automatically adjusts the ventilator settings (output) to get the patient within the target ranges. This automatic input and output continues, each influencing the other, resulting in a “closed-loop” system.

This feature is an improvement on older conventional devices that needed frequent manual intervention to maintain satisfactory ventilation. With this device, when you enter specific patient conditions (with INTELLiVENT the data received from sensors (CO suitable automatic adjustments.

In closed-loop ventilation, information from the patient is collected and analyzed by the device in a continuous manner, adjusting the ventilator without frequent human intervention (see Figure 1-1).

-ASV.

-ASV feature has

-ASV), the device uses

, flow, and SpO2) to make

1-2 624074/07

Figure 1-1. Closed-loop ventilation

The device incorporates three main closed-loop control inputs:

• Automatic minute volume

• PEEP

• Automatic oxygen adjustment

As the situation requires, the operator can control them manually or automatically. This means the operator can let the adjustment controllers in the device determine oxygenation and ventilation for the patient solely on the basis of input from the sensors, or can intervene and determine treatment parameters derived from a clinical judgment.

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1 General information

Figure 1-2. Controller conceptual design

Ventilation modes. This device offers a fully featured inten-

sive care ventilator and uses conventional volume- and pressure-controlled and spontaneous modes, plus other advanced modes. The three conventional modes include:

• (S)CMV+ and SIMV+, delivered by an adaptive volume controller, combine the attributes of pressure-controlled with volume-targeted ventilation.

• P-CMV and P-SIMV are conventional pressure-controlled modes.

• SPONT is a conventional pressure-controlled mode.

The advanced modes include:

•ASV

(adaptive support ventilation) ensures the patient receives selected minute ventilation with the optimal breath pattern (lowest pressure and volume, optimal rate to minimize work of breathing and intrinsic PEEP).

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• Optional. INTELLiVENT®-ASV is a complete fully closed-loop

ventilation solution for oxygenation and ventilation. It relies on ASV® to perform the first step to a fully closed loop solution. It covers all applications from intubation until extubation with simplicity for an early weaning.

•DuoPAP

and APRV are two related pressure-controlled modes where the operator sets two pressure levels and the patient can breathe spontaneously at either level. This is similar to having an upper and lower level of continuous positive airway pressure (CPAP). Both modes provide a combination of controlled and spontaneous breaths at either level, while letting the patient breathe freely throughout the entire breath cycle.

• NIV (noninvasive ventilation) and NIV-ST (spontaneous/ timed noninvasive ventilation) provide pressure support ventilation through a mask or other noninvasive interface.

• APVcmv and APVsimv are dual-control adaptive pressure ventilation modes that combine the attributes of pressureand volume-controlled ventilation.

• nCPAP-PS provides pressure support ventilation through nasal interface for infants and neonates.

Patient triggered breaths may be flow triggered or pressure triggered. To reduce the patient’s work of breathing while on this device, the ventilator’s tube resistance compensation (TRC) feature offsets the resistance imposed by the tracheal (ET) or tracheostomy tube.

Monitor window. The Monitoring window on the Cockpit offers the operator a clear view of the various displays showing the patient’s status during ventilation. The device offers a variety of monitoring capabilities. This window displays monitored parameters as numbers. To display individual data elements the Monitoring window displays data in various forms. These include:

• Graphics (as a combination of real-time waveforms (curves))

• Dynamic loops

• Trend waveforms

• Intelligent Panels

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1 General information

The Intelligent Panels allow the operator to select various elements for display, to include:

• Global Dynamic Lung/Haemodynamics with haemodynamics-lung interactions (refer to section 8.2 and the INTELLiVENT the lung and the activity and interaction of the patient's lungs and haemodynamics

• Vent status

The Vent Status displays the patient’s level of ventilator dependency. The Ventilation Horizon, Map and Guide allow the operators to view and keep track of the patient’s situation and the controllers’ actions. The data window provides this information in a numeric form. The device’s trending function lets you view up to 96 hours of previously collected data. You can freeze trend waveforms, real-time waveforms, or loops and use the cursor measurement function to determine a value at a selected point.

The Ventilation Map provides additional trending to get an overview in time of changes of physiological input and ventilator actions (modifications of setting) while in automatic ventilation. Additionally you can use the optional P/V Tool Pro The P/V Tool Pro display the inflation and deflation pressure-volume curves of the lungs for determination of the lower and upper inflection points and the deflation limb derecruitment point.

The device’s monitored data is based on pressure and flow measurements collected by the HAMILTON MEDICAL proximal flow sensor, placed between the Y-piece and the patient and shows:

• Oxygen measurements by integrated oxygen monitor

•Proximal CO stream CO

• Measurement of arterial O pulse oximeters

Optionally the pressure measurements can come from an auxiliary pressure sensing site (Paux) or from an esophageal pressure measurement.

-ASV manual) and show the current status of

is an automated function to measure and

measurement by the mainstream and side-

sensor

saturation (SpO2) by one or two

1-6 624074/07

Alarms. The operator can adjust the device alarms; they can be set individually or automatically using the Auto button shown in the Alarms window (refer to Chapter 10, Responding to alarms). You can switch OFF some alarms. Other alarms are considered critical and you cannot switch these alarms OFF. This restriction helps ensures the patient’s safety.

User interface. The device uses a combination of a 15 inch (38 cm) touch screen display with a separate press-and-turn knob and key buttons. The key buttons (referred to as ‘keys’), when activated are a momentary backlit push buttons. Each element of the user interface is designed for ease of operation and offers ergonomic benefits.

Configuration. The language, ventilation philosophy, alarms, default patient group, default mode and settings (for each patient group individually) and options and default graphics layout (for each patient group individually) can be preselected in the configuration mode.

Power. The device is normally powered from AC mains, offering a voltage range of 100 to 240 Volt AC, 50/60 Hz. In the event of an AC power failure, the ventilator power source automatically switches to backup battery. A single optional, hot-swappable extended battery pack can power the device for a minimum of 1 hour, so multiple packs permit operation for a longer period. If the extended battery pack is not installed or is depleted, the internal battery provides power for a minimum of 1 hour.

Mounting. Variations for mounting the device include:

• Trolley-mount version with space for a VENTILAIR II

medical air compressor

• Version suitable for shelf or pendant

The Ventilation Cockpit is detachable and can be attached to the top, front, or side of the ventilation unit, or the device can be installed on a hospital rail system.

Nebulization function. The ventilator offers pneumatic and micropump nebulization (using Aerogen® technology). The nebulization function allows the device to power an Aeroneb® nebulizer or a pneumatic nebulizer connected to the pneumatic nebulizer outlet.

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1 General information

The P/V Tool Pro® feature is an automated process that lets you measure and display the inflation and deflation pressurevolume curves of the lungs for determination of inflection points. This option is preinstalled on the device.

The Minute Volume Adjustment feature enables automatic control of %MinVol (Ventilation adjustment).

The PEEP Adjustment feature enables automatic control of PEEP (as part of the Oxygenation Adjustment).

The Oxygen Adjustment feature enables automatic control of Oxygen.

The CO

sensor with an associated MinVol controller feature

continuously monitors airway carbon dioxide and reports

and inhaled/exhaled CO2 for display and alarm pur-

EtCO

poses.

The SpO

sensor is a sensor attached to the patient which

continuously monitors the oxygen saturation of the blood.

The neonatal feature lets you ventilate neonates.

Added features. These additional features are available for the device:

•The communications interface lets you monitor the patient from a remote workstation, transmits alarms through a nurse call relay system, and transmits I:E timing signals. This feature is preinstalled on the device.

•The power strip (multiple-socket outlet, MSO) provides AC power to the VENTILAIR II medical air compressor, and a humidifier.

• Integrated humidifier. With the use of the HAMILTON- H900 humidifier, you can monitor and control humidifier settings directly from the ventilator screen. The HAMILTONH900 also provides a breathing circuit with integrated heater wires and temperature probe, improving ease of use. In addition, all humidifier data can be transmitted to any connected PDMS. You can still use other humidifiers, without full system integration.

1-8 624074/07

• nCPAP-PS. This feature applies nasal continuous positive

airway pressure with additional pressure support to neonates.

•The heliox feature provides for heliox delivery, with adjust-

ments of inspired and exhaled volumes.

1.2 Functional description

The following paragraphs describe the operation of the device hardware.

1.2.1 System overview

In Figure 1-3 the conceptual overview of the HAMILTON-G5 device is shown. The principle functions are to ventilate the patient and implement the physician’s ventilation strategy for a particular patient.

Figure 1-3. HAMILTON-G5 system overview

The important element in the system operations is the exchange of information between the device and the patient and the operator and the device. This interaction provides for both the patient’s needs and permits the operator to control the system. As the device works, the operator has the tools to execute the orders of the physician. The following list describes in general terms the basic elements and features of the device.

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1 General information

• The device acts as an electronically controlled pneumatic ventilation system. Power comes from an AC source with internal battery backup. There is an optional extended battery backup available to order which protects against power failure or unstable power and aids in intra-hospital transport.

• The device’s pneumatic system delivers gas, while its electrical systems control the pneumatics, monitor alarms, and distribute power.

• When you input instructions or settings you use the device’s microprocessor system accessing features by way of a touch screen, push button keys, and a press-and-turn knob. Your inputs become instructions for the device’s pneumatics to deliver precisely controlled gas mixtures to a patient. The device receives inputs originating from several sources such as sensors within the ventilator. As the device receives this monitored data, it adjusts gas delivery to the patient. The graphic user interface (GUI) displays this data via the touch screen display using various windows.

• The device’s microprocessor system controls gas delivery and monitors the patient. The gas delivery and monitoring functions are cross-checked by an alarm controller. This cross-check feature helps prevent simultaneous failure of these two main functions and minimizes the possible hazards of software failure.

1.2.2 Gas supply and delivery

The device uses high-pressure oxygen, air and heliox from wall supplies, cylinders, or the VENTILAIR II medical air compressor (Figure 1-4). These gases enter though water traps with integrated high-efficiency particle filters at the gas inlets.

1-10 624074/07

Figure 1-4. Gas delivery in the device

Within the ventilator, the gas enters the device’s pneumatic system. An electronic mixer combines oxygen and air/heliox according to the user-set concentration. This mixture fills a reservoir, which is maintained within a prescribed pressure range. As the gas mixture is delivered to the patient, the pressure drops, and the reservoir is refilled.

Gas in the reservoir supplies the inspiratory valve. The microprocessor controls the size of the inspiratory valve opening and the length of time it is open to meet the user settings. The opening of the valve is then adjusted based on feedback in the form of monitored data.

The device delivers gas to the patient through the inspiratory limb breathing circuit parts, including possibly the inspiratory filter, flex tubes, the humidification system, a water trap, the Y-piece, the CO

sensor and the flow sensor. An internal high

pressure valve supplies the nebulizer flow (oxygen).

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1 General information

Gas exhaled by the patient passes through the expiratory limb breathing circuit parts, including flex tubes, the flow sensor, the Y-piece, a humidifier or HME, and an expiratory valve cover and membrane. Gas is vented through the expiratory valve cover such that no exhaled gas comes into contact with any internal components of the device. Measurements taken at the flow sensor are used in the pressure, flow, and volume measurements.

An oxygen cell (sensor) monitors the oxygen concentration of the gas to be delivered to the patient, which is the same as the reservoir concentration. This galvanic cell generates a voltage proportional to the partial pressure of oxygen in the delivered gas. Neither the pressure nor the humidity of the inspired gas affects the oxygen measurement. The ventilator alarms if the monitored oxygen concentration is more than 5% above or below the oxygen setting, less than 18%, or more than 105%.

The mainstream/ sidestream CO carbon dioxide and reports EtCO

The SpO

sensor attached to the patient continuously monitors

the saturation of hemoglobin with oxygen in the blood and a plethysmographic curve which is used to assess heart-lung interaction. A second sensor may be used to secure the SpO information.

The operations of the inspiratory and expiratory valves are coordinated to maintain system pressure levels.

sensor continuously monitors

and inhaled/exhaled CO2.

1.2.3 Gas monitoring with the flow sensor

The device accurately measures flow, volume, and pressure in the patient’s airway with the HAMILTON MEDICAL flow sensor. This proximal flow sensor lets the device sense even weak patient breathing efforts. Between its highly sensitive flow trigger and fast response time, the device helps minimize the patient’s work of breathing.

The flow sensor contains a thin, diamond-shaped membrane within the outer housing and has a pressure port on either side. The membrane allows bidirectional flow through its variable orifice (Figure 1-5).

1-12 624074/07

Figure 1-5. Flow sensor

The area of the orifice changes depending on the flow rate. It opens progressively as the flow increases, creating a pressure drop across the orifice. The pressure difference is measured by a high-precision differential pressure sensor inside the ventilator. The pressure difference varies with flow (relationship determined during flow sensor calibration), so the patient’s flow is determined from the pressure drop. The device calculates volume from the flow measurements.

The flow sensor is highly accurate even in the presence of secretions, moisture, and nebulized medications. The device continuously flushes the sensing tubes with mixed gases (rinse flow) to prevent blockage.

1.3 Physical description

1.3.1 Breathing circuits and accessories

NOTE:

To ensure proper ventilation operation, use parts and accessories specified in Table 1-1 only.

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1 General information

Figure 1-6 shows the device with its breathing circuit and accessories. See Appendix H, Parts and accessories, for details on breathing circuits and accessories supplied by HAMILTON MEDICAL. See Table 1-1 for information on other compatible breathing circuits and accessories.

Figure 1-6. Ventilator with accessories

1 Ventilation Cockpit

2 Breathing circuit connections

3 Trolley (option)

4 Breathing circuit

5 Support arm

1-14 624074/07

Table 1-1. Compatible parts and accessories

Part Use only

Patient tubing circuit

• HAMILTON MEDICAL reusable patient tubing circuits

• Other circuits that meet the ventilator breathing system specifications in Appendix A, Specifications.

Inspiratory filter • HAMILTON MEDICAL reusable inspiratory bacteria

filter

• Other filters that have a 22 mm female conical inlet connector, a 22 mm male conical outlet connector, and that meet the ventilator breathing system specifications in Appendix A, Specifications.

Humidification device

• HAMILTON-H900 humidifier, which offers full integration with the ventilator (see Chapter 2, Preparing for ventilation, and Chapter 3, Hardware options)

• HAMILTON-HC 180, 200 humidifier

• Any active humidifier with a flow capability of up to 120 l/min

• Heat and moisture exchanger

Flow sensor

CAUTION

Use HAMILTON MEDICAL parts only.

Expiratory valve membrane and

Use HAMILTON MEDICAL parts only. See Appendix H, Parts and accessories.

cover

Compressor HAMILTON MEDICAL VENTILAIR II medical air compressor

624074/07 1-15

1 General information

Table 1-1. Compatible parts and accessories

Part Use only

Nebulizer • Internal nebulizer: Pneumatic nebulizer specified for

approximately 6 to 7 l/min

• Integrated Aeroneb® nebulizer: The integrated Aeroneb® nebulizer system consists of the Aeroneb® nebulizer and the Aeroneb® module. It is used during the mechanical ventilation of patients to nebulize physician-prescribed medications which are approved for use with a general purpose nebulizer. For the Aeroneb®, reusable as well disposable consumables are available.

sensor • HAMILTON MEDICAL CAPNOSTAT 5™ mainstream

sensor

• HAMILTON MEDICAL LoFlo™ sidestream sensor

SpO2 pulse oximeters

• Masimo SpO2 pulse oximeter with accessories

• Masimo Rainbow SET options for use with Masimo

pulse oximeter (offers additional monitoring

SpO

parameters)

• Nihon Kohden SpO

For details on SpO

pulse oximeter with accessories

pulse oximeters, see Appendix F,

Pulse oximetry.

CO2 airway adapter

Compact-

• Philips CAPNOSTAT 5 mainstream airway adapter

• Philips CO

sidestream airway adapter/sampling kits

HAMILTON MEDICAL parts recommended Flash® and USB storage device

1-16 624074/07

1.3.2 Ventilation cockpit

The screen of the Ventilation Cockpit (interaction panel), shown in Figure 1-7 and Figure 1-8, provides information about the status of the patient and ventilator. The basic screen (Figure 1-9) is the default screen. You can directly access all the windows for mode, controls, alarms, and monitoring from the basic screen, even during normal ventilation. The special function keys at the bottom of the Cockpit are typically backlit in white. When the key is pressed and the selected function is active, the color of the backlight changes. For example, during the 2-minute alarm silence, the alarm silence key turns red.

Figure 1-7. Ventilation Cockpit front view

1Touch screen

2 Alarm lamp. Lights when an alarm is active. Red = high-prior-

ity alarm. Yellow = medium- or low-priority alarm. Blue = heliox application.

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1 General information

3 Press-and-turn (P&T) knob. Selects and adjusts ventilator

settings and selects monitored data.

4 Print screen key. Saves a JPG file of the current ventilator

screen to a CompactFlash or USB storage device.

5 Standby key. Activates the standby (waiting) mode. When the

mode is activated, the standby activated screen is displayed. For details, see Section 12.1.

6 Nebulizer on/off key. Activates nebulization during the

breath phases and for the duration selected during configuration. You can switch nebulization off earlier by pressing the key again.

7 Screen lock/unlock key. Prevents inadvertent touch screen

entries. By touching the locked screen an acoustic BEEP sounds and a notice “screenlock active” appears.

8 Alarm silence key. Silences the ventilator audible alarm for

2 min. Pushing a second time cancels the alarm silence.

9 O2 enrichment key/suctioning tool.

Adults and Pediatric: Delivers 100% oxygen for 2 min. The backlighting changes color to green and the actually applied oxygen concentration is displayed on the oxygen control (green). Pushing the key a second time or manually changing the oxygen concentration ends the 100% oxygen enrichment period.

Neonatal option: 2 min. The backlit color changes to green and the currently applied oxygen concentration is displayed on the oxygen knob (green). Pushing the key a second time or manually changing the oxygen concentration ends the oxygen enrichment period. For further information on the suctioning tool, see Section 12.3.

Delivers 125% of the last oxygen setting for

10 Manual breath key. Triggers a mandatory breath when

pressed and released during exhalation. The mandatory breath is delivered using the currently active settings.

1. In Japan, 100% oxygen is also applied for the neonatal option

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Figure 1-8. Ventilation Cockpit rear view

1 CompactFlash connector. Used to save a JPG file of the current

ventilator screen to CompactFlash storage device and for software updates.

NOTE:

The CompactFlash connector is for data export and program update only! HAMILTON MEDICAL CompactFlash is recommended.

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1 General information

2 USB device. Used to save a JPG file of the current ventilator

screen to USB storage device and for software updates.

NOTE:

The USB device is for data export and program update only! HAMILTON MEDICAL USB memory is recommended.

3 DVI-I connector. Outputs video signals to digital display devices

such as flat panel LCD computer displays and digital projectors.

CAUTION

The DVI-I connector for an external XGA monitor is for training purposes. It is not intended for use on the patient side.

4 Ventilation Cockpit tilt assembly

5 Ventilation Cockpit cable assembly

6 Ventilation Cockpit swivel assembly

7 Storage for Ventilation Cockpit cable assembly

1-20 624074/07

Figure 1-9. Default screen

1 Alarm silence countdown. Shows when alarm silence has

been activated. Displays the remaining silence time.

2 Message bar. Displays alarm and other messages for user

guidance and status report. See Chapter 10, Responding to alarms, for further information.

3 Graphic display. Real-time waveforms (curves), loops, trend

waveforms, or Intelligent Panel, depending on user selection.

4I-icon. Displayed when alarms have been activated, but not

reviewed. Click the icon to display the Alarm buffer.

5 Date and time. Current date and time.

6 INTELLiVENT tab. Opens the INTELLiVENT window. (Available

as an option.)

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1 General information

7 Access to Patient, Additions, and Mode windows. Patient

window allows you to view/update patient data, and view the ventilator timer; Additions window gives access to sigh and tube resistance compensation (TRC); Mode window allows you to update the ventilation mode.

8 Active mode, patient type, weaning, recruitment and

apnea backup status (if active).

9 Freeze button. Lets you freeze or unfreeze graphics.

10 Trend button. Additional option to display trends in

INTELLiVENT

-ASV. (Available as an option.)

11 View cursor. Changes between oxygenation and ventilation

horizons, maps and guides.

12 IntelliCuff button. Access to automatic cuff pressure control-

ler settings. (Available as an option.)

13 Heliox icon. Indicates the heliox option is active.

14 Controller buttons for ventilation (%MinVol) and oxygen-

ation (PEEP/CPAP and oxygen). When these are functioning automatically they pulse with a blue circle.

15 Input power. Shows all available power sources. The framed

symbol indicates the current source (AC = mains, INT = internal battery, EXT = extended battery pack). The green part of the battery symbols shows the level of battery charge, while the red shows the level of discharge. The AC mains symbol and the internal battery symbol are always displayed, but are crossed out if that source is not available. The extended battery symbol is shown only if the external battery is installed.

16 Humidifier button. Provides quick access to the Humidifier

visualization window (same as touching

). (Available as an option.)

fier

System > Humidi-

17 Window tabs. Open the associated windows.

18 Secondary monitoring parameters (SMP). A group of

numeric patient data. You can display other groups using the group scrolling arrows. The data is divided into groups for display purposes.

1-22 624074/07

19 Main monitoring parameters (MMP). Five numeric parame-

ters set during configuration.

20 Alarm limits. Upper and lower alarm limits, where applicable,

for each MMP.

1.3.3 Ventilation unit

Figure 1-10 and Figure 1-11 show the patient breathing circuit connections and other important parts of the ventilation unit.

Figure 1-10. Front of ventilation unit (patient breathing

circuit connections)

1 Paux connector. Connects to an auxiliary pressure

sensing site, for use as the pressure input in addition to the proximal flow sensor measurement. By default there is no rinse flow through the Paux connector.

2 Pneumatic NEBULIZER connector

3 FLOW SENSOR connection. Always attach the blue

tube to the blue connector and the clear tube to the silver connector. The blue tube should always be toward the patient.

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1 General information

4 Cuff pressure controller with luer connection

5 Expiratory valve cover and membrane

6 From patient port. The expiratory limb of the patient

breathing circuit and the expiratory valve are connected here.

7 Exhaust port. Expiratory valve cover opening to

ambient air.

8 Ventilation unit LED panel. Redundant display of

ventilator status. It is intended to provide status information when the Ventilation Cockpit is disconnected, as follows:

An emergency situation exists (red LED) The ventilator is connected to AC mains power

(blue LED)

Power switch is on (green LED)

9 Sensor or Aeroneb option module with connector

10 Inspiratory filter

11 To patient port (inspiratory outlet). The inspiratory

filter and the inspiratory limb of the patient breathing circuit are connected here.

1. Not available in all markets.

1-24 624074/07

Figure 1-11. Rear of ventilation unit

1 Fan filter

2 Serial number label

3 Power switch

4 High-pressure air inlet, DISS or NIST fitting

5 High-pressure oxygen inlet DISS or NIST fitting (for heliox

option, see section 2.13)

6 High-pressure gas water trap with filter

7 Reservoir pressure relief valve exhaust

8 Communications interface connectors (COM1, COM2)

9 Power cord with retaining clip

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1 General information

10 Potential equalization terminal

11 Oxygen cell with cover

12 Fuse drawer; holds two mains fuses

13 Ventilation Cockpit cable connector

14 Power receptacle

1.4 Symbols

Table 1-2 describes the symbols used on the back panel.

Symbol Definition

Fuse

Table 1-2. Symbols

Power switch on position

Terminal for the connection of a potential equalization

conductor

Manufacturer

1-26 624074/07

Symbol Definition

Table 1-2. Symbols

Date of manufacture

Classification of Medical Electrical Equipment, type B, as specified by IEC 60601-1.

Classification of Medical Electrical Equipment, type BF, as specified by IEC 60601-1.

Refer to the operator’s manual for complete information.

CE Marking of Conformity, seal of approval guaranteeing that the device is in conformance with the Council Directive 93/42/EEC concerning medical devices.

The CSA marks with the indicators “C“and “US“ mean that the product complies with Canadian requirements and the requirements of US authorities for safety.

Dispose according to Council Directive 2002/96/EC or WEEE (Waste Electrical and Electronic Equipment.

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1 General information

Symbol Definition

Serial number

This way up

Fragile, handle with care

Keep dry

Table 1-2. Symbols

Temperature limitations

Humidity limitations for transport and storage

Atmospheric limitations for transport and storage

1-28 624074/07

Symbol Definition

Table 1-2. Symbols

Stacking limitations for transport and storage

Temperature limitations for transport and storage

Recyclable materials

Consult accompanying documents

To patient

From patient

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1 General information

1-30 624074/07

Preparing for ventilation

2.1 Introduction 2-2

2.2 Installing and positioning the Ventilation Cockpit 2-4

2.2.1 Mounting the Ventilation Cockpit 2-4

2.2.2 Adjusting the Ventilation Cockpit

(tilt and swivel) 2-6

2.3 Installing the patient tubing support arm 2-7

2.4 Installing the humidifier 2-8

2.4.1 Connecting and attaching the

humidifier 2-9

2.5 Installing the modules (CO HAMILTON-H900 humidifier) 2-12

2.6 Verifying the oxygen cell installation 2-13

2.7 Installing the patient breathing circuit 2-14

2.8 Using the auxiliary pressure (Paux) measurement 2-22

2.9 Using an expiratory filter 2-23

2.10 Connecting to AC power 2-24

2.11 Using the optional power strip 2-25

2.12 Using the backup batteries 2-25

2.12.1 Introduction 2-26

2.12.2 Replacing the optional extended

battery pack 2-28

2.13 Connecting gas supplies 2-29

2.14 Connecting to an external patient monitor or other device 2-32

2.15 Starting up the ventilator 2-33

2.16 Shutting down the ventilator 2-34

2.17 Ventilation cockpit navigation guidelines 2-35

, SpO2, Aeroneb,

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2 Preparing for ventilation

2.1 Introduction

WARNING

• Additional equipment connected to medical

electrical equipment must comply with the respective IEC or ISO standards. Furthermore, all configurations must comply with the requirements for medical electrical systems (see IEC 60601-1-1 or clause 16 of the 3Ed. of IEC 60601-1, respectively). Anybody connecting additional equipment to medical electrical equipment configures a medical system and is therefore responsible that the system complies with the requirements for medical electrical systems. Also be aware that local laws take priority over the above mentioned requirements. If in doubt, consult your local representative or Technical Support. To prevent possible patient injury, do not block the holes between the HAMILTON-G5’s To patient and From patient ports. These holes are vents for the overpressure and ambient valves.

• To prevent back pressure and possible patient

injury, do not attach parts not expressly recommended by HAMILTON MEDICAL to the exhaust port of the exhalation valve housing (for example, spirometer, tube, or other device).

• To prevent interrupted operation of the HAMIL-

TON-G5 or any accessories, use only accessories or cables that are expressly stated in this manual and supplied by HAMILTON MEDICAL.

• To prevent interrupted operation of the

HAMILTON-G5 due to electromagnetic interference, avoid using it adjacent to or stacking other devices on it. If adjacent or stacked use is necessary, verify the HAMILTONG5’s normal operation in the configuration in which it will be used.

2-2 624074/07

• To prevent possible personal injury and equipment damage use two persons to lift when crossing thresholds and ensure the device is attached securely to the trolley or shelf with screws.

CAUTION

• To prevent ventilator components from over-

heating, do not obstruct the cooling fan vents.

• To prevent possible equipment damage, avoid overloading the HAMILTON-G5’s basket and tray or placing objects on the HAMILTON-G5 that might compromise its stability.

• To prevent possible equipment damage, lock the trolley’s wheels when parking the ventilator

NOTE:

• Before using the ventilation for the first time, HAMILTON MEDICAL recommends that you clean its exterior and sterilize its components as described in Chapter 11, Maintenance.

• To electrically isolate the HAMILTON-G5 circuits from all poles of the supply mains simultaneously, disconnect the mains plug.

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2 Preparing for ventilation

2.2 Installing and positioning the Ventilation Cockpit

2.2.1 Mounting the Ventilation Cockpit

CAUTION

Handle the touchscreen with care. Do not pull on or place stress on the cable.

With the correct mounting rails you can mount the Ventilation Cockpit to the top, front, or side of the ventilation unit or to a hospital rail system (Figure 2-1). Dismount and reinstall the cockpit as follows:

1. If necessary, disconnect the Cockpit from the ventilation unit by pushing on the cable release tab with a small screwdriver or similar utensil to disengage cable (Figure 2-2).

2. Dismount the Cockpit by loosening the knob in the clamp assembly (Figure 2-3).

3. Reinstall the Cockpit by positioning it over the rail or top mounting assembly and tightening the knob. Reconnect the cable as necessary.

2-4 624074/07

Figure 2-1. Ventilation Cockpit mounting positions

1 Front mounting on rail

2 Top mounting

3 Hospital rail mounting

4 Side mounting for use on shelf or pendant installation

Figure 2-2. Disconnecting the Ventilation Cockpit

1 Ventilation Cockpit cable

2 Cable release tab

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2 Preparing for ventilation

Figure 2-3. Mounting the Ventilation Cockpit

2.2.2 Adjusting the Ventilation Cockpit (tilt and swivel)

Adjust the position of the Ventilation Cockpit by releasing either the tilt or swivel handle, positioning the Cockpit as desired, then locking the handle (Figure 2-4 and Figure 2-5).

Figure 2-4. Tilting the Ventilation Cockpit

1 Tilt assembly locking handle

2-6 624074/07

Figure 2-5. Swiveling the Ventilation Cockpit

1 Swivel assembly locking handle

2.3 Installing the patient tubing support arm

Install the patient tubing support arm on either side of the HAMILTON-G5 (Figure 2-6). Attach the patient tubing support arm only on the straight parts of the rail.

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2 Preparing for ventilation

Figure 2-6. Installing the patient tubing support arm

1 Support arm

2 Support arm bracket

2.4 Installing the humidifier

CAUTION

To prevent possible patient injury and possible water damage to the HAMILTON-G5, make sure the humidifier is set to appropriate temperature and humidification settings.

2-8 624074/07

NOTE:

• Once installed, you can configure and monitor the HAMILTON-H900 humidifier data and main settings directly on the ventilator screen, in the

Humidifier

window. You can also access the

System

Humidifier window using the Quick Access button on the main screen. For details, see Section 3.6.

• The integrated humidifier is not available in all markets. Check with your distributor to determine availability.

• Before proceeding with installation, be sure to read the HAMILTON-H900 Operating Instructions, and the installation/configuration information in this section and in Chapter 3, Hardware Options.

Installation involves the following steps:

1. Connecting the power cord, and the communication cable between the humidifier and the ventilator. See Section

2.4.1.

2. Installing the humidifier onto a mounting bracket. See Section 2.4.1.

3. Configuring the humidifier. See the HAMILTON-H900 Operating Instructions.

For details on the integration between the HAMILTON-H900 humidifier and the ventilator, see Section 3.6.

2.4.1 Connecting and attaching the humidifier

NOTE:

When connecting the HAMILTON-H900 humidifier to the optional internal power socket on the ventilator, be sure to connect the grounding cable to the potential equalization terminal on the back of the ventilator and to a grounding connection in the ICU.

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2 Preparing for ventilation

The power and communication cable sockets are located on the bottom of the humidifier. The mounting bracket is on the back.

Two options are available for mounting the humidifier to the trolley:

• A fixed mount on the front of the trolley

• An adjustable-height mount on the side of the trolley

Figure 2-7. Back of humidifier

1 Mounting bracket

2 AC mains power socket

3 COM port and communications cable (see detail in

Figure 2-8)

4 Potential equalization terminal

2-10 624074/07

Figure 2-8. Power, communication connections (bottom)

1 AC mains power socket

2 COM port and communications cable

1. Attach the power cord to the power socket on the bottom of the humidifier. For details on AC power requirements, refer to the HAMILTON-H900 Operating Instructions. See Figure 2-8.

2. Attach the communication cable to the COM port on the bottom of the humidifier. See Figure 2-8.

3. Attach the humidifier to the trolley or other designated location by sliding the bracket on the rear of the humidifier onto the mounting bracket from the top down.

For details on attaching the adjustable-height mount to the trolley, see the Adjustable Humidifier Kit Installation Guide.

4. Connect the humidifier power cable to AC mains power. For details on AC power requirements, refer to the HAMILTON-H900 Operating Instructions.

5. Connect the communications cable to the RS-232 port on the ventilator. See Figure 2-9.

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2 Preparing for ventilation

Figure 2-9. HAMILTON-900 communications cable

connected to RS-232 port on ventilator

For details on setting up the water chamber and connecting the rest of the humidifier tubes to the ventilator, see the HAMILTON-H900 Operating Instructions.

For details on the integration between the HAMILTON-H900 humidifier and the ventilator, see Section 3.6.

2.5 Installing the modules (CO2, SpO2, Aeroneb, HAMILTON-H900 humidifier)

Install a module (Figure 2-10) by pushing it into its slot until the connector engages and is locked.

Remove a module by pressing the release handle, then pulling the module out by its handle until the module disengages from the connector.

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Figure 2-10. CO2, SpO2, Aeroneb modules

1 CO

or SpO2 connector

2 Aeroneb connector (Aeroneb/HAMILTON-H900 humidifier

module not shown)

2.6 Verifying the oxygen cell installation

This device uses an integrated oxygen cell to monitor the delivered oxygen concentration. Before operating the ventilator, verify the cell is present and properly connected (Figure 2-11). If a cell is not present, install one according to the instructions found in section 11.3.3.

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2 Preparing for ventilation

Figure 2-11. Check for the oxygen cell

1 Oxygen cell

2.7 Installing the patient breathing circuit

WARNING

• To minimize the risk of bacterial contamination

or physical damage, handle bacteria filters with care.

• To prevent patient or ventilator contamination, always use a bacteria filter between the ventilator and the inspiratory limb of the patient breathing circuit.

• To reduce the risk of fire, use only breathing circuits intended for use in oxygen-enriched environments. Do not use antistatic or electrically conductive tubing.

2-14 624074/07

NOTE:

• For optimal ventilator operation, use HAMILTON

MEDICAL breathing circuits or other circuits that meet the specifications given in Appendix A, Specifications. When altering the HAMILTON MEDICAL breathing circuit configurations (for example, when adding accessories or components), make sure not to exceed these inspiratory and expiratory resistance values of the ventilator breathing system, as required by EN 794-1/IEC 60601-2-12: adult, 6 cmH2O at 60 l/min; pediatric, 6 cmH2O at 30 l/min; and infant, 6 cmH2O at 5 l/min).

• Any bacteria filter, HME, or additional accessories in

the expiratory limb may substantially increase flow resistance and impair ventilation and lead to alarms.

• To ensure that all breathing circuit connections are

leak-tight, perform the tightness test every time you install a circuit or change a circuit part.

• Regularly check the water traps and the breathing

circuit hoses for water accumulation. Empty as required.

• For neonatal patients with body weights > 7 kg, you

may want to select the pediatric patient type. This prevents the need to change circuits and calibrate the flow sensor should you later decide that your patient requires more support.

• Do not combine the Infant CO

airway adapter and

the adult flow sensor. Artifacts during the measurement are possible.

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2 Preparing for ventilation

Install the breathing circuit as follows:

1. Determine the patient type (adult, pediatric or neonatal) from Table 2-1. Select the correct breathing circuit parts for your patient. Note that the type of CO depends on tracheal tube size.

Table 2-1. Breathing circuit parts and patient types

airway adapter

Patient height

< 50 cm (19 in.)

30 to 150 cm (11 to 59 in.)

> 130 cm (51 in.)

IBW (kg)

≤

3 to 423 to 7 15 Pediat-

> 30

Tracheal tube ID (mm)

≤

5 10 Infant Infant Neona-

≥

522 Adult

Breathing circuit tube OD (mm)

Flow sensor

ric/ adult

air-

way adapter

Pediatric/ adult

Patient type

tal

Pediatric

2. Assemble the patient breathing circuit. Figure 2-12 through Figure 2-14 show four typical circuit configurations; for ordering information, contact your HAMILTON MEDICAL representative. Follow the specific guidelines for the different parts.

3. Properly position the breathing circuit after assembly. Make sure the hoses will not be pushed, pulled, or kinked during the patient’s movement, nebulization, or other procedures.

2-16 624074/07

Figure 2-12. Patient breathing circuit for use with heater

wire (pediatric/adult)

1 Paux connector

2 Nebulizer outlet

3 Flow sensor connectors

4 From patient

5 Expiratory valve membrane/ valve cover

6 Expiratory limb

7 CO

sensor

8 Flow sensor

9 CO

airway adapter

10 Y-piece

11 Heater wire

12 Humidifier

13 Inspiratory limb

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2 Preparing for ventilation

14 Water trap/heater wire

15 Inspiratory filter

16 To patient

Figure 2-13. Patient breathing circuit for use with heater

wire (neonatal)

1 Paux connector

2 Nebulizer outlet

3 Flow sensor connectors

4 From patient

5 Expiratory valve membrane/ valve cover

6 Expiratory limb

7 CO

sensor

8 Flow sensor

9 15M x 15F adapter

10 CO

airway adapter

2-18 624074/07

11 Y-piece

12 Heater wire

13 Humidifier

14 Inspiratory limb

15 Water trap/heater wire

16 Inspiratory filter

17 To patient

Figure 2-14. Patient breathing circuit for use with HME

1 Paux connector

2 Nebulizer outlet

3 Flow sensor connectors

4 From patient

5 Expiratory valve membrane/ valve cover

6 Expiratory limb

7 CO

sensor

8 Flow sensor

9 HME

10 CO

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airway adapter

2 Preparing for ventilation

11 Y-piece

12 Inspiratory limb

13 Inspiratory filter

14 To patient

Expiratory valve membrane:

NOTE:

Place the silicone membrane into the valve cover with the metal plate upward (Figure 2-15). The side that is marked DOWN must be placed downward.

Figure 2-15. Installing the expiratory valve membrane

1 Expiratory valve membrane

2 Expiratory valve cover

Position the cover and twist clockwise into place (Figure 2-16).

2-20 624074/07

Figure 2-16. Installing the expiratory valve cover

WARNING

To prevent inaccurate flow sensor readings, make sure the flow sensor is correctly installed:

• The flow sensor tubings must not be bent.

• The flow sensor tubings must be secured with clamp (included with flow sensor).

• Use HAMILTON MEDICAL flow sensors only.

Flow sensor: Insert a flow sensor for the proper patient type

between the Y-piece of the breathing circuit and the patient connection (Figure 2-17). Connect the blue and colorless tubes to the flow sensor connectors in the front panel. The blue tube goes to the blue connector. The colorless tube goes to the silver connector.

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2 Preparing for ventilation

Figure 2-17. Installing the flow sensor

sensor and airway adapter (optional): Refer to Chapter 3.

2.8 Using the auxiliary pressure (Paux) measurement

WARNING

• To use the pressure at the end of the tracheal tube as the Paux pressure input, you must have the rinse flow enabled (disabled by default). This must be done by an authorized HAMILTON MEDICAL service person. When the rinse flow is enabled, the device generates a weak flow of about 9 ml/min in the patient’s direction to help keep the lumen of the carina clear of mucus.

• When the rinse flow is enabled, an esophageal balloon CANNOT be used to provide the Paux pressure input. If the rinse flow is enabled, the esophageal balloon can overinflate, resulting in possible patient injury.

The device uses the airway pressure (Paw) as it’s standard pressure input. You can reassign the device’s pressure input, so monitored numeric parameters are based on a pressure from a different site, such as the esophageal balloon catheter end

2-22 624074/07

of the tracheal tube. (This auxiliary pressure input can be particularly useful when conducting scientific studies.) For ARDS patients use the esophageal balloon catheter to determine the trans-pulmonary pressure. PEEP can be adjusted to maintain oxygenation and this action prevents damage to the lungs. You must connect the site to the ventilator through the Paux connector to use the auxiliary pressure input. To make the connection, use at minimum of 1 m (of 3 mm ID) tubing (flow sensor tubing works) for the connection. You must also set up the device’s monitoring functions to recognize the Paux input; otherwise, the ventilator will continue to use the standard Paw input.

2.9 Using an expiratory filter

WARNING

• The use of an expiratory filter can lead to a

significant increase in expiratory circuit resistance. Excessive expiratory circuit resistance can compromise ventilation and increased patient work of breathing or AutoPEEP or both.

• Nebulization of drugs can cause an occlusion

and an increased resistance of the filter.

NOTE:

Monitored parameters for increased expiratory resistance are not specific to the breathing circuit and may indicate increased patient airway resistance and/or increased resistance of the artificial airway (if used). Always check the patient and confirm adequate ventilation.

An expiratory filter is not required on the HAMILTON-G5, but you may use one according to your institution’s protocol. An expiratory filter is not required, because the expiratory valve design prevents internal ventilator components from contact with the patient’s exhaled gas.

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2 Preparing for ventilation

If you do use an expiratory filter:

1. Place it on the patient side of the expiratory valve cover.

2. Remove any expiratory filter or HME during nebulization. See the Warnings and Notes in this section for guidance.

3. You must monitor closely for increased expiratory circuit resistance.

Exhalation obstructed

excessive expiratory circuit resistance. If the

obstructed

expiratory filter immediately. If you suspect increased expiratory circuit resistance, remove the expiratory filter or install a new filter to eliminate it as a potential cause.

alarm happens repeatedly, then remove the

2.10 Connecting to AC power

WARNING

• To minimize the risk of electrical shock, plug the

ventilator power cord into a grounded AC power receptacle. It is the hospital’s responsi-

bility to ensure that the receptacle is properly grounded (earth).

• To ensure grounding reliability, use a special

hospital-grade receptacle (USA only).

alarm can also indicate

Exhalation

NOTE:

To prevent unintentional disconnection of the power cord, make sure it is well seated into the ventilator’s socket and secured with the power cord retaining clip.

Connect the device to a grounded AC outlet using power of 100 to 240 Volt, 50/60 Hz. Always verify the reliability of the AC outlet. The AC power symbol in the bottom right-hand corner of the screen is displayed with a frame around it. The AC power LED on the ventilation unit will also be lit.

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2.11 Using the optional power strip

WARNING

• Connect only these devices to the power strip:

– HAMILTON MEDICAL VENTILAIRII medical air

compressor

– HAMILTON-HC 180/200

– HAMILTON-H900 humidifier

– Fisher & Paykel MR 850 humidifier

– Aeroneb-Pro

• Connection of other electrical equipment to the power strip is responsibility of the operator to ensure that the power system complies with the requirements for medical electrical systems (for details, see Section 2.1) as well as local regulations.

• Do not connect additional auxiliary mains socket outlets or an extension cord to the system.

The device is optionally equipped with a power strip containing auxiliary mains socket outlets. These outlets can power up to three devices comprising the ventilator system.

2.12 Using the backup batteries

NOTE:

• The backup batteries are not intended to be a primary power source. They are intended for shortterm use only.

• HAMILTON MEDICAL recommends the ventilator’s batteries be fully charged before you begin to ventilate a patient. If the batteries are not fully charged you must pay close attention to the battery charge levels in the event the AC power fails.

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2 Preparing for ventilation

2.12.1 Introduction

Backup batteries, both the internal battery and the optional extended battery pack, protect the device from low or failure of AC power. When AC mains fail to provide power during ventilation, the ventilator power supply automatically switches to backup battery without an interruption in ventilation. An alarm sounds to signal the switchover. The alarm will continue sound until you silence the alarm. Silencing the alarm confirms operator notification of the power system change and resets the alarm.

When the device AC power supply is interrupted the ventilator shifts to the optional extended battery pack. If this is not available or adequately charged, the ventilator power supply will choose to switch to internal battery.

Important: The batteries power the ventilator until AC power is again adequate or until the batteries are depleted.

As a further safeguard, the device provides a “low-battery” alarm. The low-battery alarm is operated by a capacitor-driven buzzer that sounds for at least 2 minutes when either type of battery power is completely lost.

Both the internal and extended batteries power the ventilator for a minimum of 1 hour each (for new, fully charged batteries with the device at default settings and a 2 liter demonstration lung).

When the ventilator is connected to the AC mains power, the batteries are charged, with or without the ventilator power being switched ON.

The power source symbols are displayed in the bottom righthand corner of the screen (Figure 2-18) indicating the available power sources. A frame around a symbol indicates the current ventilator power source (AC mains, internal battery, or extended battery).

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Figure 2-18. Electrical power symbols

1 Frame indicates current power source

2 AC mains symbol

3 Internal battery symbol

4 Extended battery symbol

Observe the battery charge level before the ventilator is used on a patient, and before unplugging the ventilator for transport or other purposes.

• A green symbol indicates a fully charged battery.

• A red and green symbol indicates a partially charged battery.

• If a battery symbol is crossed out with a red X, the battery is discharged or defective.

If the batteries are not fully charged, recharge them by plugging in the ventilator for a minimum of 15 hours (for the internal battery) or 7 hours (for an extended battery pack), or until the battery charge level is 80 to 100%. If the internal battery is not fully charged at this time, have the ventilator serviced by authorized service personnel.

The extended battery pack requires a periodic recalibration. Use the designated battery calibrator for the extended battery.

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2 Preparing for ventilation

2.12.2 Replacing the optional extended battery pack

CAUTION

Use HAMILTON MEDICAL batteries only.

Replace the extended battery pack as described below:

1. Open the ventilator’s front cover by grasping the indent on your right-hand side and swinging the front cover door open (Figure 2-19).

2. Press on the tab, and slide the extended battery pack out of the housing. When removed, replace with a freshly charged battery pack (Figure 2-20).

Figure 2-19. To open the front cover

1 Indent for opening cover

2-28 624074/07

Figure 2-20. To remove the extended battery pack

1 Battery housing

2 Extended battery pack

3 Tab

2.13 Connecting gas supplies

WARNING

• Always check the status of the gas cylinders before using the HAMILTON-G5 during transport.

• Ensure the gas cylinders are equipped with pressure-reducing valves.

• To minimize the risk of fire, DO NOT use highpressure gas hoses that are worn or contaminated with combustible materials like grease or oil.

• To prevent possible hypoxia or death, connect the heliox gas supply containing at minimum of 20% oxygen.

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2 Preparing for ventilation

CAUTION

• To prevent damage to the ventilator, connect

only clean, dry medical-grade gases. Inspect for water and particle build-up in the gas supply water traps before each use.

• To prevent heliox entering the wall supply, connect compressed air with a minimum pressure of 2.8 bar.

NOTE:

• When using a compressor with the device ventilator, connect a HAMILTON MEDICAL VENTILAIRII medical air compressor only.

• Use heliox blend of 78% (He)/ 22% (O mixture is preferred, as it allows the maximum amount of helium to be used yet consumes less gas when used in conjunction with mechanical ventilation (80/20 and 79/21 mixtures are also permitted).

• Only use the HAMILTON MEDICAL mixer block with inlet fittings for oxygen, air and heliox.

• Select the appropriate gas source in the

Gas source

actual source gas can result in inaccurate gas delivery and volume monitoring.

• After switching between air and heliox, it is recommended that you calibrate the flow sensor.

• After significant changes in oxygen concentration during heliox ventilation, it is recommended that you recalibrate the flow sensor.

• During heliox administration, O enabled and CANNOT be disabled.

)! The 78/22

System

window. A mismatch of selected and

monitoring is

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• Inspect heliox cylinder pressure, and keep the cylin-

der at a level sufficient for ventilation (> 2.8 bar (280 kPa/41 psi)).

• To prevent under- or overheating during heliox ther-

apy, use a patient circuit with heater wire and carefully monitor heated humidifier performance. Heliox’s thermal conductivity, which is greater than that of nitrogen/oxygen mixtures, can affect the humidification device output. A febrile patient may transfer heat via the gas column to a proximal temperature sensor, leading to decreased humidifier output and desiccated airway secretions. In a heater wire breathing circuit, heat transfer from the patient can affect the heater wire output and result in increased condensation in the breathing circuit. In some humidifiers, you possibly need to reduce humidifier settings to prevent overheating of the breathing gas.

• Disconnect all gases if the device is not in use.

The device uses compressed air and oxygen (Table A-3). The gas fittings available are DISS, NIST or NF. Alternatively, you can select the heliox option in standby. The compressed gases can come from central gas supplies, from gas cylinders, or from the VENTILAIRII medical air compressor. The device’s universal trolley provides space for the compressor or two cylinders (if you have the optional VENTILAIR II medical air compressor mounting kit or cylinder holder installed).

If you are using gases from cylinders, secure the cylinders to the trolley with the accompanying straps. Connect the gas hoses to the device’s inlet fittings, shown in Figure 2-21.

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2 Preparing for ventilation

Figure 2-21. HAMILTON-G5 inlet fittings

1 Oxygen inlet fitting

2 Heliox inlet fitting

3 Air inlet fitting

If you intend to use heliox, select the appropriate gas source in the

System-> Gas source

switch choices between air and heliox without exchanging the gas hoses.

window. In standby, you can

2.14 Connecting to an external patient monitor or other device

NOTE:

All devices connected to the HAMILTON-G5 must be for medical use and meet the requirements of standard IEC 60601-1.

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With the communications interface, you can connect your device to a patient monitor, to a PDMS or computer (via an RS-232 port), or to a nurse call device. See Appendix I for details on the communications interface. Before connecting any other device, ensure your device is properly configured (see Appendix J).

2.15 Starting up the ventilator

WARNING

To ensure the ventilator’s safe operation, always run the prescribed tests and calibrations before using the ventilator on a patient. If the ventilator fails any tests, remove it from clinical use immediately. DO NOT use the defective ventilator until necessary repairs are completed and all tests passed.

NOTE:

• To shut down the device in an orderly manner, avoid switching the power quickly OFF and ON. If the ventilator buzzer sounds continuously upon power ON, switch the power OFF, then wait for several seconds before switching the power ON again.

• If your device is new, be sure it has been properly configured for default language, ventilation philosophy, alarms, and others factors (see Appendix J).

• The Ventilation Cockpit must be connected to the ventilator unit.

1. Turn the ventilator power switch ON (Figure 2-22). The ventilator will run a self-test. You will hear the emergency buzzer alarm momentarily activated.

The patient setup window load for a few moments (Figure 5-1).

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2 Preparing for ventilation

1 Power switch

2. Run the required tests and calibrations listed in Table 4-1, as described in Chapter 5, Setting up the ventilator.

Figure 2-22. Power switch

3. Set up the ventilator as described in Section 5.2.

2.16 Shutting down the ventilator

NOTE:

When you turn OFF the device, wait at least 2 seconds to permit an orderly shutdown before turning the ventilator back ON.

To shut down of the device, turn the power switch OFF.

Battery charging continues even when power is switched OFF, as long as the ventilator remains connected to AC mains.

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2.17 Ventilation cockpit navigation guidelines

Use the touch screen and the press-and-turn knob (referred to as the P&T knob) to access the device ventilation parameters and monitored data. You can use a combination of touching the screen attributes, rotating the knob, and pressing the knob to activate your configuration choices. The knob can be rotated in either direction (clockwise CW, or counter-clockwise CCW), allowing you to scroll through choices displayed in the Cockpit windows.

To open a window (other than a pop-up window), touch a window tab to select and

activate your selection; or scroll to it by rotating the P&T knob and then press the P&T knob to activate your selection. The selected item is framed in yellow.

To close a window (other than a pop-up window), touch the window tab or the X

(close) in the upper left-hand corner; or scroll to the X by rotating the P&T knob and then press the P&T knob to activate your selection. The selected item is framed in yellow.

To adjust a control, touch the control to select and activate it; or rotate the P&T knob to select the control, then press it to activate your selection. The selected control is framed in yellow. The activated control turns red. Rotate the P&T knob to increment or decrement the value. Press the P&T knob, or touch the control, activating the adjustment.

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2 Preparing for ventilation

Pulsing circle. When in automatic control, the circles turn blue and rotates using a pulsing motion. The speed with which the pulses move indicates a rapid or steady change in rate.

When the circle rotates to the right, the controlled value is increasing toward the target range. When the circle moves to the left, the controlled value is decreasing toward the target range.

When the circle turns red and stops moving, the patient parameters cannot be identified or are invalid. The adjusted parameters remain as set. The remaining time is also shown: for oxygen, 60 seconds, for PEEP, 360 seconds.

During O

enrichment, the oxygen control

displays the currently applied oxygen concentration (value displayed in green) and the elapsed time.

To make a selection in a pop-up window, turn the P&T knob to scroll to and select the desired parameter, then press the P&T knob or touch the panel to activate your selection. The window closes automatically.

To scroll through a log using the scroll bar or arrows, touch the scroll bar to select and

activate it; or turn the P&T knob to select the scroll bar and then press it to activate your selection. Your selection is framed in yellow, and it becomes red when activated. Now turn the P&T knob to scroll through the log. Touch the scroll bar or turn the P&T knob to deactivate.

Alternatively, touch a scroll arrow repeatedly to scroll up or down, or turn the P&T knob to select one of the scroll directional arrows and then press it repeatedly to scroll up or down.

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Hamilton G5 Operator's Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Safety warnings, cautions, notes

Table of Contents

List of Figures

List of Tables

General information

1.1 Introduction

1.2 Functional description

1.2.1 System overview

1.2.2 Gas supply and delivery

1.2.3 Gas monitoring with the flow sensor

1.3 Physical description

1.3.1 Breathing circuits and accessories

1.3.2 Ventilation cockpit

1.3.3 Ventilation unit

1.4 Symbols

Preparing for ventilation

2.1 Introduction

2.2.1 Mounting the Ventilation Cockpit

2.2.2 Adjusting the Ventilation Cockpit (tilt and swivel)

2.3 Installing the patient tubing support arm

2.4 Installing the humidifier

2.4.1 Connecting and attaching the humidifier

2.5 Installing the modules (CO2, SpO2, Aeroneb, HAMILTON-H900 humidifier)

2.6 Verifying the oxygen cell installation

2.7 Installing the patient breathing circuit

2.9 Using an expiratory filter

2.10 Connecting to AC power

2.11 Using the optional power strip

2.12 Using the backup batteries

2.12.1 Introduction

2.12.2 Replacing the optional extended battery pack

2.13 Connecting gas supplies

2.14 Connecting to an external patient monitor or other device

2.15 Starting up the ventilator

2.16 Shutting down the ventilator

2.17 Ventilation cockpit navigation guidelines