Medtronic PB840_OperatorsAndTechnicalReferenceManual_EN_10067721D00 Voluson E8 Expert Service Manual
Puritan Bennett
800 Series Ventilator
TM
Copyright Information
COVIDIEN, COVIDIEN with logo, and positive results for life are U.S and internationally registered trademarks of COVIDIEN
AG. All other brands are trademarks of a Covidien company or of their respective owners.
© 2011–2016 Covidien.
The information contained in this manual is the sole property of Covidien and may not be duplicated without permission.
This manual may be revised or replaced by Covidien at any time and without notice. Ensure this manual is the most current
applicable version. If in doubt, contact Covidien’s technical support department or visit the Puritan Bennett™ product
manual web page at:
www.medtronic.com/covidien/support/product-manuals
Click Acute Care Ventilation > Puritan Bennett™ 840 Ventilator then follow the prompts to select the desired manual.
While the information set forth herein is believed to be accurate, it is not a substitute for the exercise of professional judgment.
The ventilator should be operated and serviced only by trained professionals.
Covidien’s sole responsibility with respect to the ventilator and software, and its use, is as stated in the limited warranty
provided.
Nothing in this document shall limit or restrict in any way Covidien’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, Covidien has no obligation to furnish any such revisions, changes, or modifications to the owner or user of
the equipment (including its software) described herein.
™* Trademark of its respective owner.
Proportional Assist and PAV are registered trademarks of The University of Manitoba, Canada. Used under license. Other
brands are trademarks of a Covidien company.
Table of Contents
Operator’s Manual
OP 1 Introduction
OP 1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-1
OP 1.2 Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-2
OP 1.3 Technical Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-2
OP 1.3.1 General Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-2
OP 1.3.2 Pressure and Flow Triggering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-3
OP 1.3.3 Breathing Gas Mixture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-4
OP 1.3.4 Inspiratory Pneumatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-4
OP 1.3.5 Patient Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-5
OP 1.3.6 AC Mains and Backup Power System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-5
OP 1.3.7 Ventilator Emergency States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-6
OP 1.4 Graphic User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-6
OP 1.5 User Interface Controls and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
OP 1.5.1 Onscreen Symbols and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-12
OP 1.6 Ventilator System Labeling Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-16
OP 2 How to Set up the Puritan Bennett™ 840 Ventilator
OP 2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-1
OP 2.2 Connecting the Electrical Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-3
OP 2.3 Connecting the Air and Oxygen Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-8
OP 2.4 Connecting the Patient Circuit Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-10
OP 2.4.1 Selecting and Connecting a Patient Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-11
OP 2.4.2 Installing the Expiratory Filter and Collector Vial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-13
OP 2.4.3 Installing the Flex Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-15
OP 2.4.4 Installing the Humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-18
OP 2.4.5 Using the Ventilator Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-19
OP 3 How to Run Short Self Test (SST)
OP 3.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-1
OP 3.2 Introduction to SST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-1
OP 3.3 When to Run SST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-2
OP 3.4 SST Components and Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-2
OP 3.5 SST Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-3
OP 3.6 SST Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-8
OP 3.6.1 Interpreting Individual SST Test Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-9
OP 3.6.2 SST Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-9
i
OP 4 How to use the Puritan Bennett™ 840 Ventilator
OP 4.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-1
OP 4.2 Structure of the User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-2
OP 4.3 Patient Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-3
OP 4.3.1 Ventilating With the Most Recent Control Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-4
OP 4.3.2 Ventilating With New Control Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-4
OP 4.3.3 Patient Data and Current Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-7
OP 4.3.4 Other Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-9
OP 4.4 Changing the Main Ventilator Control Parameters . . . . . . . . . . . . . . . . . . . . . . . . OP 4-11
OP 4.5 Other Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-12
OP 4.6 Constant Timing Variable During Rate Changes . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-13
OP 4.7 Changing Apnea Ventilation Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-14
OP 4.8 Setting Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-14
OP 4.9 Changing Other Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-16
OP 4.10 Expiratory Pause Maneuvers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-17
OP 4.11 Inspiratory Pause Maneuvers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-18
OP 4.12 Interpreting Pause Maneuver Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-19
OP 4.13 Using NIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-20
OP 4.13.1 NIV Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-20
OP 4.13.2 NIV Breathing Interfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-20
OP 4.13.3 NIV Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-21
OP 4.13.4 High Spontaneous Inspiratory Time Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-23
OP 4.13.5 Apnea Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-24
OP 4.13.6 Alarm Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-24
OP 4.13.7 Changing from Invasive to NIV Vent Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-25
OP 4.13.8 Changing from NIV to Invasive Vent Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-25
OP 4.13.9 NIV Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-26
OP 5 How to Handle Alarms
OP 5.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-1
OP 5.2 Ventilator Alarm Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-1
OP 5.3 Alarm Silence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-2
OP 5.4 Alarm Reset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-3
OP 5.5 Alarm Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-4
OP 5.6 Alarm Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-5
OP 5.7 Alarm Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-6
OP 6 How to View Graphics
OP 6.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-1
OP 6.2 Graphics Display Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-1
OP 6.3 How to Set Up a Graphics Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-3
OP 6.4 Graphics Display Details and Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-3
ii
OP 6.5 How to Adjust Displayed Graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-4
OP 6.6 The Graphics Display FREEZE Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-4
OP 6.7 How to Print Patient Data Graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 6-4
OP 6.8 Automatic Display of Graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-5
OP 6.9 When Graphics are not Accessible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 6-5
OP 7 Preventive Maintenance
OP 7.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-1
OP 7.2 How to Dispose of Used Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-1
OP 7.3 How to Clean, Disinfect, and Sterilize Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-1
OP 7.3.1 How to Clean Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-4
OP 7.4 Disinfection and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-4
OP 7.5 Preventive Maintenance Procedures for the Operator . . . . . . . . . . . . . . . . . . . . . .OP 7-6
OP 7.5.1 Total Operational Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6
OP 7.5.2 Inspiratory and Expiratory Bacteria Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-8
OP 7.5.3 Daily or as Required: Collector Vial and Drain Bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-9
OP 7.5.4 Daily or as Required: In-line Water Traps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-10
OP 7.5.5 Every 250 Hours: Compressor Inlet Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-10
OP 7.5.6 Every Year: Ventilator Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-11
OP 7.6 Additional Preventive Maintenance Procedures . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-16
OP 7.7 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-17
OP 7.8 Repacking and Shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-17
OP A Specifications
OP A.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-1
OP A.2 Physical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-1
OP A.3 Environmental Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-2
OP A.4 Pneumatic Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-3
OP A.5 Electrical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-4
OP A.6 Compliance and Approvals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-5
OP A.6.1 Manufacturer’s Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-7
OP A.7 Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-11
OP A.8 Patient Circuit Configurations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-14
OP A.9 Ranges, Resolutions, and Accuracies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-15
OP A.9.1 Recommended Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-15
OP A.9.2 Software Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-15
OP B Part Numbers
OP B.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-1
iii
OP C Pneumatic Schematic
OP C.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP C-1
OP D Alarm and Oxygen Sensor Calibration Testing
OP D.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP D-1
OP D.2 Alarm Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP D-1
OP D.3 Oxygen Sensor Calibration Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP D-6
OP E Remote Alarm and RS-232 Ports
OP E.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-1
OP E.2 Remote Alarm Port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-2
OP E.3 RS-232 Port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-2
OP E.4 How to Configure the RS-232 Ports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3
OP E.5 Printers and Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-4
OP E.5.1 Printers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-4
OP E.5.2 Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-4
OP E.6 RS-232 Port Commands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-5
Technical Reference
TR 1 Introduction to Breath Delivery
TR 1.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 1-1
TR 2 Detecting and Initiating Inspiration
TR 2.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-1
TR 2.2 Internally Triggered Inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-1
TR 2.2.1 Pressure Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 2-2
TR 2.2.2 Flow Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-3
TR 2.2.3 Time-cycled Inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-4
TR 2.3 Operator-triggered Inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-5
TR 3 Detecting and Initiating Exhalation
TR 3.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-1
TR 3.2 Internally Initiated Exhalation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-1
TR 3.2.1 Time-cycled Exhalation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-1
TR 3.2.2 End Inspiratory Flow Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-1
TR 3.2.3 Airway Pressure Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-2
TR 3.3 Backup Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-3
TR 3.3.1 Time Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 3-3
iv
TR 3.3.2 High Circuit Pressure Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 3-3
TR 3.3.3 High Ventilator Pressure Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 3-4
TR 4 Mandatory Breath Delivery
TR 4.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-1
TR 4.2 Comparison of Pressure- and Volume-based Mandatory Breaths . . . . . . . . . . . TR 4-1
TR 4.3 Compliance Compensation for Volume-based Mandatory Breaths . . . . . . . . . . TR 4-3
TR 4.4 BTPS Compensation for Volume-based Mandatory Breaths . . . . . . . . . . . . . . . . TR 4-4
TR 4.5 Manual Inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-4
TR 5 Spontaneous Breath Delivery
TR 5.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 5-1
TR 6 Assist/control (A/C) Mode
TR 6.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-1
TR 6.2 Breath Delivery in A/C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-1
TR 6.3 Rate change During A/C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-2
TR 6.4 Changing to A/C Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-3
TR 7 Synchronized Intermittent Mandatory Ventilation
TR 7.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-1
TR 7.2 Breath Delivery in SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2
TR 7.3 Apnea Ventilation in SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-3
TR 7.4 Changing to SIMV Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-4
TR 7.5 Rate Change During SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-6
TR 8 Spontaneous (SPONT) Mode
TR 8.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 8-1
TR 8.2 Breath Delivery in SPONT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 8-1
TR 8.3 Changing to SPONT Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 8-1
TR 9 Apnea Ventilation
TR 9.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-1
TR 9.2 Apnea Detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-1
TR 9.3 Transition to Apnea Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-3
TR 9.4 Key Entries During Apnea Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-3
TR 9.5 Resetting Apnea Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-3
TR 9.6 Resetting to A/C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4
TR 9.7 Resetting to SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4
v
TR 9.8 Resetting to SPONT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4
TR 9.9 Phasing in New Apnea Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4
TR 10 Detecting Occlusion and Disconnect
TR 10.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-1
TR 10.2 Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-1
TR 10.3 Disconnect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-2
TR 10.4 Occlusions and Disconnect Annunciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-4
TR 11 Phasing in Setting Changes
TR 11.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 11-1
TR 12 Ventilator Settings
TR 12.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-1
TR 12.2 Apnea Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-1
TR 12.3 Circuit Type and IBW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-2
TR 12.4 Disconnect Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-2
TR 12.5 Expiratory Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-3
TR 12.6 Expiratory Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-3
TR 12.7 Flow Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-3
TR 12.8 Flow Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-4
TR 12.9 High Spontaneous Inspiratory Time Limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-4
TR 12.10 Humidification Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-5
TR 12.11 I:E Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-5
TR 12.12 Ideal Body Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-5
TR 12.13 Inspiratory Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-5
TR 12.14 Inspiratory Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-6
TR 12.15 Mode and mandatory Breath Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-6
TR 12.16 O
% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-8
2
TR 12.17 Peak Inspiratory Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-9
TR 12.18 PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-9
TR 12.19 PEEP Restoration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10
TR 12.20 Plateau Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10
TR 12.21 Pressure Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10
TR 12.22 Pressure Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10
TR 12.23 Respiratory Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-11
TR 12.24 Rise Time% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-11
TR 12.25 Safety Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-12
TR 12.26 Spontaneous Breath Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-13
TR 12.27 Tidal Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-13
TR 12.28 Vent Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-14
vi
TR 13 Alarms
TR 13.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-1
TR 13.2 Alarm Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-1
TR 13.2.1 Alarm messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-2
TR 13.2.2 Alarm Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-4
TR 13.3 AC POWER LOSS Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-15
TR 13.4 APNEA Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-15
TR 13.5 CIRCUIT DISCONNECT Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-15
TR 13.6 DEVICE ALERT Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-16
TR 13.7 HIGH CIRCUIT PRESSURE Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-16
TR 13.8 HIGH DELIVERED O
% Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-17
2
TR 13.9 HIGH EXHALED MINUTE VOLUME Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-17
TR 13.10 HIGH EXHALED TIDAL VOLUME Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-17
TR 13.11 HIGH INSPIRED TIDAL VOLUME Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-18
TR 13.12 HIGH RESPIRATORY RATE Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-18
TR 13.13 INSPIRATION TOO LONG Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-18
TR 13.14 LOW CIRCUIT PRESSURE Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-19
TR 13.15 LOW DELIVERED O
% Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-19
2
TR 13.16 LOW EXHALED MANDATORY TIDAL VOLUME Alarm . . . . . . . . . . . . . . . . . . . . .TR 13-20
TR 13.17 LOW EXHALED SPONTANEOUS TIDAL VOLUME Alarm . . . . . . . . . . . . . . . . . . . TR 13-20
TR 13.18 LOW EXHALED TOTAL MINUTE VOLUME Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-21
TR 13.19 PROCEDURE ERROR Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-21
TR 14 Patient Data
TR 14.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-1
TR 14.2 Delivered O
% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-1
2
TR 14.3 End Expiratory Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-1
TR 14.4 End Inspiratory Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-2
TR 14.5 Exhaled Minute Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-2
TR 14.6 Exhaled Tidal Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-3
TR 14.7 I:E Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-4
TR 14.8 Intrinsic (auto) PEEP and Total PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-4
TR 14.9 Mean Circuit Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-4
TR 14.10 Peak Circuit Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-4
TR 14.11 Plateau Pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-5
TR 14.12 Spontaneous Minute Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-5
TR 14.13 Static Compliance and Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-5
TR 14.14 Total Respiratory Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-9
TR 15 Safety Net
TR 15.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-1
TR 15.2 Patient Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-1
vii
TR 15.3 System Faults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-1
TR 15.4 Ongoing Background Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-2
TR 15.5 Hardware Monitoring Circuitry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-3
TR 15.6 Power On Self Test (POST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-4
TR 15.7 Short Self Test (SST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-4
TR 15.8 Extended Self Test (EST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-4
TR 15.9 Oxygen Sensor Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-4
TR 15.10 Exhalation Valve Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
TR 15.11 Ventilator Inoperative Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
TR 15.12 Flow Sensor Offset Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
TR 15.13 Atmospheric Pressure Transducer Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
TR 16 Power on Self Test (POST)
TR 16.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-1
TR 16.2 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-1
TR 16.3 POST Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-1
TR 16.4 POST Following Power Interruptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-3
TR 16.5 POST Fault Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-3
TR 16.6 POST System Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-3
TR 16.7 POST User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-4
TR 17 Short Self Test (SST)
TR 17.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 17-1
TR 17.2 SST Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 17-1
TR 17.3 SST Failure Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 17-2
TR 18 Extended Self Test (EST)
TR 18.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-1
TR 18.2 EST Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-1
TR 18.3 EST Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-1
TR 18.4 EST Failure Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-2
TR 18.5 EST Safety Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-3
TR 19 RS-232 Commands
TR 19.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-1
TR 19.2 SNDA Command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-1
TR 19.3 SNDF Command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-5
Glossary
Index
viii
List of Figures
Operator’s Manual
FigureOP 1-1. Puritan Bennett™ 840 Ventilator System Block Diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-3
FigureOP 1-2. Puritan Bennett™ 840 Ventilator System GUI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-7
FigureOP 2-1. How to Lift the Ventilator Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-2
FigureOP 2-2. How to Connect the Ventilator Power Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-4
FigureOP 2-3. Ventilator Power Switch, AC Indicator, and AC Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-5
FigureOP 2-4. Power Cord Storage on the RTA Cart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-7
FigureOP 2-5. Power Cord Storage on the Newer Compressor Mount Cart and Pole Cart (shown). . . . .OP 2-8
FigureOP 2-6. How to Connect the Air and Oxygen Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-10
FigureOP 2-7. How to Connect the Patient Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-12
FigureOP 2-8. How to Install the Expiratory Filter and Collector Vial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-13
FigureOP 2-9. How to Use the Collector Vial With or Without the Drain Bag. . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-14
FigureOP 2-10.How to Install the Flex Arm on the RTA Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-16
FigureOP 2-11.How to Install the Flex Arm on the Newer Compressor Mount Cart or Pole Cart. . . . . . .OP 2-17
FigureOP 2-12.How to Install the Humidifier (Fisher & Paykel™* version shown) for Ventilators
Mounted on RTA Carts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-19
FigureOP 2-13.Location of Cart Lot Number Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-20
FigureOP 2-14.How to Lock and Unlock the RTA Cart’s Front Wheels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-21
FigureOP 2-15.How to Lock and Unlock the Compressor Mount Cart or Pole Cart Front Wheels. . . . . . OP 2-21
FigureOP 3-1. Test Button Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-4
FigureOP 4-1. Touch Screen User Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-2
FigureOP 4-2. Ventilator Startup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-3
FigureOP 4-3. Touch Screen Appearance During Normal Ventilation (shown with alarm silence
/CAL in progress). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-8
2
FigureOP 4-4. T
and 100% O
(or TH) Selected as the Constant During Rate Change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-13
I
FigureOP 4-5. Alarm Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-15
FigureOP 4-6. New Patient Setup Screen—NIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-21
FigureOP 4-7. NIV Ventilator Settings Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-23
FigureOP 4-8. New Patient Default Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-24
FigureOP 4-9. More Patient Data Screen — NIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-26
FigureOP 5-1. Alarm Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-1
FigureOP 5-2. Alarm Silence in Progress Indicator (lower screen). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-3
FigureOP 5-3. Alarm log. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-4
FigureOP 5-4. Alarm Message Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 5-6
FigureOP 6-1. Pressure-volume Loop. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-2
FigureOP 6-2. Flow-volume Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-2
FigureOP 7-1. How to Empty the Collector Vial and Seal the Drain Bag. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-10
FigureOP 7-2. 806 Compressor with Inlet Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-11
FigureOP 7-3. Dislodge the O
FigureOP 7-4. Open O
FigureOP 7-5. Locate O
Sensor Access Port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-14
2
2
Sensor Access Cover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-13
2
Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-14
FigureOP A-1. Heated Wire Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-14
ix
FigureOP A-2. Non-heated Wire Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-14
FigureOP B-1. Ventilator Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-2
FigureOP B-2. Ventilator Accessories (compressor mount cart shown) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-6
FigureOP B-3. Puritan Bennett™ 840 Ventilator System Shown Mounted on
Puritan Bennett™ 800 Series Ventilator Pole Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-10
FigureOP C-1. Pneumatic Schematic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP C-2
FigureOP E-1. Remote Alarm and RS-232 Ports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP E-1
FigureOP E-2. Remote Alarm Pinout (view from back of GUI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-2
FigureOP E-3. RS-232 Serial Port Pinout. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3
Technical Reference
FigureTR 2-1. Declaring Inspiration Using Pressure Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-2
FigureTR 2-2. Declaring Inspiration Using Flow Sensitivity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-3
FigureTR 2-3. Time-cycled Inspiration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-4
FigureTR 3-1. Initiating Exhalation using the End-inspiratory Flow Method . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-2
FigureTR 3-2. Initiating Exhalation using the Airway Pressure Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-3
FigureTR 6-1. A/C Mode, No Patient Effort Detected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-2
FigureTR 6-2. A/C Mode, Patient Effort Detected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-2
FigureTR 6-3. A/C Mode, VIM and PIM Breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-2
FigureTR 7-1. SIMV Breath Cycle (mandatory and spontaneous intervals) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-1
FigureTR 7-2. SIMV Breath Cycle, PIM Delivered Within Mandatory Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2
FigureTR 7-3. SIMV Breath Cycle, PIM Not Delivered Within Mandatory Interval . . . . . . . . . . . . . . . . . . . . . . . TR 7-2
FigureTR 7-4. Apnea Ventilation in SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-4
FigureTR 9-1. Apnea Interval Equals Breath Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-2
FigureTR 9-2. Apnea Interval Greater than Breath Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-2
FigureTR 9-3. Apnea Interval Less than Breath Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-2
FigureTR 13-1.Alarm messages format (upper GUI screen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-3
x
List of Tables
Operator’s Manual
TableOP 1-1. Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators . . . . . . . . . . . . . . . . . . . OP 1-8
TableOP 1-2. BDU Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-11
TableOP 1-3. Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations . . . . . . . . . . . . . . . . . .OP 1-13
TableOP 1-4. Labeling Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-16
TableOP 2-1. Patient circuit and IBW values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-12
TableOP 3-1. SST Test Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-6
TableOP 3-2. Individual SST Test Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-9
TableOP 3-3. Overall SST Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-10
TableOP 4-1. Ideal Body Weight (IBW) Based on Patient Height . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-9
TableOP 4-2. Soft Bound Ranges for Ideal Body Weight (IBW) and Tube Internal Diameter (ID) . . . . . .OP 4-10
TableOP 4-3. Patient Circuit and IBW Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-11
TableOP 4-4. Monitored Ventilator Control Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-11
TableOP 4-5. Automatic Settings Changes—Invasive to NIV on the Same Patient . . . . . . . . . . . . . . . . . . .OP 4-25
TableOP 4-6. Automatic Settings Changes—NIV to Invasive on the Same Patient . . . . . . . . . . . . . . . . . . .OP 4-25
TableOP 5-1. Alarm Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 5-7
TableOP 7-1. Procedures to Clean, Disinfect, and Sterilize Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-2
TableOP 7-2. Disinfection and Sterilization Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-5
TableOP 7-3. Operator Preventive Maintenance Procedures and Frequency . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6
TableOP 7-4. Service Preventive Maintenance Procedures and Intervals. . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-16
TableOP A-1. Physical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-1
TableOP A-2. Environmental Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-2
TableOP A-3. Pneumatic Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-3
TableOP A-4. Electrical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-4
TableOP A-5. Compliance and Approvals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-6
TableOP A-6. Electromagnetic Emissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-7
TableOP A-7. Electromagnetic Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-8
TableOP A-8. Electromagnetic Immunity—Conducted and Radiated RF . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-9
TableOP A-9. Recommended Separation Distances Between Portable and Mobile RF
Communications Equipment and the Puritan Bennett™ 840 Ventilator System . . . . . . . OP A-10
TableOP A-10.Compliant Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-11
TableOP A-11.Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-11
TableOP A-12.Ventilator Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-16
TableOP A-13.Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-28
TableOP A-14.Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-31
TableOP A-15.Other Screens—Displayed Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-36
TableOP B-1. Ventilator Parts and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-2
TableOP B-2. Ventilator Parts and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-6
TableOP B-3. Ventilator Pole Cart and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-10
TableOP C-1. Pneumatic Components. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP C-3
xi
Technical Reference
TableTR 4-1. Comparison of Pressure- and Volume-based Mandatory Breaths . . . . . . . . . . . . . . . . . . . . . . . TR 4-2
TableTR 4-2. Compliance Volume Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-4
TableTR 5-1. Spontaneous Breath Delivery Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 5-1
TableTR 12-1. Puritan Bennett™ 840 Ventilator Modes and Breath Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-7
TableTR 12-2. Illustrated Modes and Breath Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-8
TableTR 13-1. Alarm Priority Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-2
TableTR 13-2. Alarm Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-4
TableTR 13-3. Loss of GUI Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-14
TableTR 13-4. Applicability of High Inspired Tidal Volume Alarm Symbols. . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-18
TableTR 14-1. Inspiratory Pause Maneuver Displays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-7
TableTR 19-1. MISCA Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-2
TableTR 19-2. MISCF Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-6
xii
Applicability
The information in this manual applies to Puritan Bennett™ 840 Ventilator versions manufactured
or updated after August 2005. Some of this information may not apply to earlier versions. Contact
your Covidien representative if in doubt.
Definitions
This manual uses three special indicators to convey information of a specific nature:
WARNING:
Indicates a condition that can endanger the patient or the ventilator operator.
Caution:
Indicates a condition that can damage the equipment.
Note:
Indicates points of particular emphasis that make operation of the ventilator more efficient or convenient.
Warnings, Cautions, and Notes
Take the time to familiarize yourself with the safety considerations listed in this section, special
handling requirements, and regulations that govern the use of the ventilator system.
WARNING:
The ventilator contains phthalates. When used as indicated, very limited exposure to trace
amounts of phthalates may occur. There is no clear clinical evidence that this degree of exposure
increases clinical risk. However, to minimize risk of phthalate exposure in children and nursing or
pregnant women, this product should only be used as directed.
WARNING:
The user of this product shall have sole responsibility for any ventilator malfunction due to
operation or maintenance performed by anyone not trained by Covidien.
WARNING:
To ensure proper servicing and avoid the possibility of physical injury, only qualified personnel
should attempt to service or make authorized modifications to the ventilator.
WARNING:
To avoid an electrical shock hazard while servicing the ventilator, be sure to remove all power to
the ventilator by disconnecting the power source and turning off all ventilator power switches.
WARNING:
To avoid a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (e.g.,
flammable anesthetics or heaters) away from the ventilator system and oxygen hoses.
Operator's and Technical Reference Manual xiii
WARNING:
Do not use oxygen hoses that are worn, frayed, or contaminated by combustible material such as
grease or oils. Textiles, oils, and other combustibles are easily ignited and burn with great intensity
in oxygen-enriched air.
WARNING:
In case of fire or a burning smell, immediately disconnect the ventilator from the oxygen supply,
the facility power, and the backup power source.
WARNING:
When handling any part of the ventilator system, always follow your hospital guidelines for
handling infectious material.
WARNING:
Covidien recognizes cleaning, sterilization, sanitation, and disinfection practices vary widely
among health care institutions. It is not possible for Covidien to specify or require specific
practices that will meet all needs, or to be responsible for the effectiveness of cleaning,
sterilization, and other practices carried out in the patient care setting. As a manufacturer,
Covidien does not have any guidelines or recommendations regarding specific pathogens as they
relate to the usage of our products. In regards to transmission of any specific pathogen, Covidien
can offer the specifications of our products as well as our recommendations for cleaning and
sterilization. Any further clarification regarding pathogens as they relate to our products should
be brought to the attention of your lab pathologist as well as your infection control personnel or
your risk committee.
WARNING:
Patients on life-support equipment should be appropriately monitored by competent medical
personnel and suitable monitoring devices.
WARNING:
The ventilator system is not intended to be a comprehensive monitoring device and does not
activate alarms for all types of dangerous conditions for patients on life-support equipment.
WARNING:
For a thorough understanding of ventilator operations, be sure to thoroughly read this
manual before attempting to use the system.
WARNING:
Before activating any part of the ventilator, be sure to check the equipment for proper operation
and, if appropriate, run SST as described in this manual.
WARNING:
An alternative source of ventilation should always be available when using the ventilator system.
xiv Operator's and Technical Reference Manual
WARNING:
Check the ventilator periodically according to the Puritan Bennett™ 840 Ventilator System Service
Manual; do not use if defective. Immediately replace parts that are broken, missing, obviously
worn, distorted, or contaminated.
WARNING:
This ventilator offers a choice of breath delivery modes and types. Throughout the patient’s
treatment, the clinician should carefully select the ventilation mode and breath type to use for that
patient. This selection should be based on the clinician’s clinical judgment, considering the
condition and needs of the individual patient, as such condition and needs change from time to
time and considering the benefits, limitations, and operating characteristics of each mode and
breath type.
Caution:
Do not use sharp objects to make selections on the graphical user interface (GUI) display or
keyboard.
Note:
Items shown in bold font are physical hardware features (e.g., to patient port, from patient port).
Note:
U. S. federal law restricts this device to sale by or on the order of a physician.
Operator's and Technical Reference Manual xv
Warranty
The ventilator system is warranted against defects in material and workmanship in accordance
with the Covidien Medical Equipment Warranty supplied with your ventilator. Keep a maintenance record to ensure the validity of the warranty.
Year of Manufacture
The GUI and breath delivery unit (BDU), backup power source (BPS) and compressor contain a
specific year of manufacture applicable for that assembly. The year of manufacture is indicated by
the fifth and sixth digits of the serial number, which is located at the back panel of the GUI, BDU,
and BPS, and the side panel of the compressor.
Manufacturer
Covidien llc
15 Hampshire Street
Mansfield, MA 02408
USA
Electromagnetic Susceptibility
The ventilator system complies with the requirements of IEC 60601-1-2:2004 (EMC Collateral Standard), including the E-field susceptibility requirements at a level of 10 volts per meter, at frequencies from 80 MHz to 2.5 GHZ, and with the ESD requirements of this standard.
However, even at this level of device immunity, certain transmitting devices (cellular phones, twoway radios, cordless phones, paging transmitters, etc.) emit radio frequencies that could interrupt
ventilator operation if operated in a range too close to the ventilator. It is difficult to determine
when the field strength of these devices becomes excessive.
Practitioners should be aware radio frequency emissions are additive, and the ventilator must be
located a sufficient distance from transmitting devices to avoid interruption. Do not operate the
ventilator in a magnetic resonance imaging (MRI) environment.
WARNING:
Accessory equipment connected to the power receptacle, analog, and digital interfaces must be
certified according to IEC 60601-1. Furthermore, all configurations shall comply with the system
standard IEC 60601-1-1. Any person who connects additional equipment to the power receptacle,
signal input part, or signal output part of the ventilator configures a medical system, and is
therefore responsible for ensuring the system complies with the requirements of the system
standard IEC 60601-1-1. If in doubt, consult Covidien Technical Services at 1 800 255 6774 or
contact your local Covidien representative.
This manual describes possible ventilator alarms and what to do if alarms occur. Consult with your
institution’s biomedical engineering department in case of interrupted ventilator operation, and
before relocating any life support equipment.
xvi Operator's and Technical Reference Manual
Customer assistance
For further assistance call Covidien Technical Services at 1 800 255 6774 or contact your local Covidien representative.
For online technical support, visit the SolvItSM Center Knowledge Base at
solvitcenter.puritanbennett.com/ and follow the prompts.
The SolvIT Center provides answers to frequently asked questions about the ventilator system and
other Covidien products 24 hours a day, 7 days a week.
Preface
This manual is divided into two parts: the operator’s manual and the technical reference manual.
The operator’s manual describes how to operate the ventilator system. It also provides product
specifications and accessory order numbers. The technical reference manual includes background information about how the ventilator functions, including details on its operating modes,
self-tests, and other features. In the table of contents, list of figures, list of tables, and index, the
prefix OP- identifies page numbers, figure numbers, and table numbers in the operator’s manual,
and the prefix TR- identifies the same items in the technical reference manual.
Any references to the software options BiLevel, Volume Ventilation Plus (VV+) (which include VC+
and VS breath types), NeoMode, Proportional Assist™* Ventilation (PAV™*+), Tube Compensation
(TC), Respiratory Mechanics (RM), and Trending in this manual assume that the option has been
installed on the ventilator. If these options aren’t installed, then references to their functions do
not apply.
While this manual covers the ventilator configurations currently supported by Covidien, it may
not be all-inclusive and may not be applicable to your ventilator. Within the USA, contact Covidien
at 1 800 255 6774 for questions about the applicability of the information.
Some illustrations and images are shown with a ready-to-assemble (RTA) cart, a Puritan Bennett™
800 Series Ventilator Compressor Mount Cart, or a Puritan Bennett™ 800 Series Ventilator Pole
Cart. Note that these images are for illustrative purposes only, and regardless of which cart you
have, the required information is provided.
The term “RTA cart” refers to the ready-to-assemble cart and any earlier cart versions.
Operator's and Technical Reference Manual xvii
Page Left Intentionally Blank
xviii Operator's and Technical Reference Manual
OP 1 Introduction
OP 1.1 Overview
The intended use of the Puritan Bennett™ 840 Ventilator System is for acute and subacute care
of infant, pediatric, and adult patients. Software options, available from Covidien, provide additional ventilation functions.
The ventilator facilitates work of breathing management, offers selectable modes of breath
delivery, and assists the practitioner in selecting the most appropriate ventilator control parameters for the patient. The user interface is intuitive and easy to operate for those with prior
knowledge of ventilator operation.
The user interface includes DualView touch screens that display monitored patient data for easy
assessment of the patient’s condition. The touch screens also display the current ventilator
control parameters.
The SandBox area on the touch screen allows the practitioner to preview the selected ventilator
control parameters prior to active patient ventilation.
The SmartAlert system intercepts alarms, or events, provides specific information about the
cause, and prompts the user with actions to resolve the reported conditions.
The breath delivery unit (BDU) comprises the pneumatics and the patient circuit.
The ventilator uses two independent central processing units (CPUs):
• Breath delivery (BD) CPU
• Graphic user interface (GUI) CPU
The BD CPU uses the ventilator control parameters, selected by the practitioner, to deliver
breaths to the patient. The BD CPU also runs continuous and extensive operational background
checks to ensure proper operation of the ventilator.
The GUI CPU monitors the ventilator and the ventilator/patient interaction. The GUI CPU also
monitors the operation of the BD CPU and prevents simultaneous failure of control and monitor
functions when a single fault is reported.
The ventilator system supplies mandatory or spontaneous breaths with a preset level of positive
end expiratory pressure (PEEP), trigger sensitivity, and oxygen concentration. A mandatory
breath can either be pressure- or volume-controlled, but it is always pressure-controlled in the
optional BiLevel mode. A spontaneous breath allows patient inspiratory flows of up to 200 L/
min, with or without pressure support.
OP 1-1
Introduction
The optional 806 compressor unit provides compressed air to the BDU, and can be used in place
of wall or bottled air. The compressor unit is powered through and communicates with the BDU.
The 802 backup power source or 803 extended backup power source provides DC power to the
BDU and GUI in the event AC power is lost. A new, fully charged BPS runs the ventilator (without
a compressor or a humidifier) for a minimum of 60 minutes (30 minutes on ventilators built prior
to July 2007), which allows patient and ventilator transport within the healthcare facility. The 803
BPS (available after October 2009) can power the ventilator for a minimum of 4 hours under the
same conditions. The same conditions apply, respectively, to the 1-hour or 4-hour BPS assembly
in the compressor-mount cart and the 1-hour or 4-hour batteries in the pole cart.
This manual tells you how to operate and perform simple maintenance for the ventilator system.
Become familiar with this manual and accompanying labels before attempting to operate or
maintain the ventilator.
To ensure optimum performance of the ventilator system, Covidien strongly recommends certified biomedical engineering technicians, or other personnel with equivalent experience and
training in the service of this type of equipment perform periodic maintenance on the ventilator.
For more information, contact Covidien Technical Services in the U.S. at 1 800 255 6774. Outside
of the U.S., contact your local Covidien representative.
OP 1.2 Indications for Use
The 840 ventilator provides continuous ventilation to patients requiring respiratory support. The
840 Ventilator System is intended for patients with an ideal body weight (IBW) as low as 0.3 kg
(with expanded NeoMode option).
The 840 ventilator (with expanded NeoMode option) is intended for use in hospitals and hospitaltype facilities. It may be used during hospital and hospital-type facility transport provided that
electrical power and compressed gas are supplied.
OP 1.3 Technical Description
OP 1.3.1 General Background
The practitioner uses the GUI touch screens, the off-screen keys, and the GUI knob to select the
ventilator control parameters and enter data (see FigureOP 1-1.). The GUI CPU processes the
information and stores it in ventilator memory. The BDU CPU uses the stored information to
control and monitor the flow of gas to and from the patient.
The two CPUs communicate to transfer and verify any new ventilator control parameters or alarm
limits. Each CPU then performs continuous background verification of operational integrity and
data integrity.
OP 1-2
FigureOP 1-1.Puritan Bennett™ 840 Ventilator System Block Diagram
Technical Description
OP 1.3.2
1 GU) 7 Inspiratory limb
2 Exhalation module: active exhalation valve,
pressure transducer, flow sensor
3 Expiratory filter 9 Inspiratory filter
4 Collector vial 10 Air regulator
5 Expiratory limb 11 Oxygen regulator
6 Patient circuit 12 Inspiratory module: PSOLs, safety valve, oxygen sensor,
8 Humidification device
pressure transducers, flow sensor
Pressure and Flow Triggering
The ventilator uses flow or pressure triggering to recognize patient effort. When pressure triggering is in effect, the ventilator monitors pressure in the patient circuit. As the patient draws gas
from the circuit and airway pressure drops by at least the value selected for pressure sensitivity,
the ventilator delivers a breath.
OP 1-3
Introduction
When flow triggering (Flow-by) is in effect, the ventilator monitors the difference between the
inspiratory and expiratory flow sensor measurements. As the patient inhales, the ventilator measures less exhaled flow while the delivered flow remains constant. The result is an increase in the
difference between the inspiratory and expiratory flows. When the difference equals the operator-selected value for flow sensitivity, the ventilator delivers a breath.
If the patient is not inhaling, any difference between the delivered flow and the exhaled flow is
due to sensor inaccuracy or leaks in the patient system. To compensate for leaks in the patient
system, which can cause autotriggering, the operator can increase the flow sensitivity setting.
As a backup method of triggering inspiration, a pressure sensitivity of 2 cmH
This setting is the most sensitive setting that is still large enough to avoid autotriggering, yet will
trigger with acceptable patient effort.
OP 1.3.3 Breathing Gas Mixture
Air and oxygen from cylinders, wall supplies, or a compressor (air only) enter the ventilator
through hoses and fittings (the fittings are available in several configurations). Once inside the
ventilator, air and oxygen are regulated to pressures appropriate for the ventilator, then mixed
according to the selected O
The ventilator delivers the mixed air and oxygen through the inspiratory module and out to the
patient. The oxygen concentration of the delivered gas is monitored in the inspiratory module,
using a galvanic oxygen sensor. The galvanic sensor generates a voltage proportional to the
oxygen concentration. The ventilator reports an alarm if the O
oxygen concentration is more than seven percent higher or lower than the O2% setting, or lower
than 18% after the concentration stabilizes.
The inspiratory manifold also includes a safety valve to relieve patient pressure if necessary (for
example, if the patient circuit is kinked or occluded). The inspiratory module also corrects for gas
temperature and humidity, based on the practitioner-set humidification type.
O is also in effect.
2
%.
2
sensor is enabled and monitored
2
OP 1.3.4 Inspiratory Pneumatics
Ventilator inspiratory pneumatics consist of two parallel circuits: one for oxygen and one for air.
The primary elements of the inspiratory pneumatics are two proportional solenoid valves (PSOLs)
that control the flow of gas delivered to the patient. Air and oxygen flow sensors, along with pressure signals from the patient circuit, provide feedback that the BD CPU uses to control the PSOLs.
As a result, the ventilator supplies mixed breathing gas to the patient, based on the practitionerset ventilator control parameters. The mixed air and oxygen passes through the patient circuit
external to the ventilator.The system delivers the breathing gas mixture to the patient at the
patient wye, located in the external patient circuit.
OP 1-4
OP 1.3.5 Patient Circuit
The patient circuit comprises the components external to the ventilator that route gas between
the ventilator and the patient. These components include:
• An inspiratory filter that protects against contamination between the patient and ventilator
• A humidification device (optional) in line with the patient circuit
• The inspiratory and expiratory limbs of the patient circuit that conduct the breathing gas to and from
the patient
• A collector vial that protects the expiratory pneumatics from bulk moisture in the exhaled gas
• An expiratory filter that limits the escape of microorganisms and particulates in the patient’s exhaled
gas into the room air or inside the ventilator exhalation pneumatics
The ventilator actively controls the exhalation valve that the software accurately positions
throughout the patient’s inspiration and exhalation.The exhalation valve allows the ventilator to
deliver aggressive breaths while pressure overshoots are minimized, PEEP is controlled, and
excess patient pressures are relieved. The exhalation system monitors the exhaled gas leaving the
patient circuit for spirometry.
Technical Description
Note:
The ventilator system does not have a capability to reduce pressure below the PEEP pressure during the
expiratory phase.
Throughout the respiratory cycle, pressure transducers monitor inspiratory pressure, expiratory
pressure, and atmospheric pressure. The temperature of the exhaled gas is heated to a temperature > its dew point to prevent condensation in the exhalation compartment. Refer to Appendix
OP C for a detailed diagram of the ventilator’s pneumatic system and the patient circuit.
OP 1.3.6 AC Mains and Backup Power System
The ventilator derives its power to operate from the AC mains (wall) power or the BPS. The design
of the BDU integral power supply protects against excessive voltages, temperatures, or current
draws. A power cord retainer prevents accidental disconnection of the BDU from the AC mains. A
power switch cover on the front face of the BDU protects against spills and accidental AC poweroff occurrences.
The ventilator connects to the 802 BPS or 803 BPS, which supplies DC power to the ventilator if
AC power is lost. A fully charged 802 BPS operating under nominal ambient conditions, can power
the ventilator for a minimum of 60 minutes (30 minutes on ventilators built prior to July 2007). The
803 extended BPS can power the ventilator for a minimum of 4 hours under the same conditions.
Neither BPS powers the compressor unit or the humidifier, if present. The 803 BPS must be used
on Covidien 840 ventilators with software version AB or higher (part number
4-0070212-85) or equivalent. The operation and alarms of the 803 BPS are identical to the 802 BPS.
The GUI indicates when the ventilator is operating on the BPS, rather than AC mains.
OP 1-5
Introduction
When AC power is connected, it recharges the BPS. The BPS continues to recharge from the AC
power during normal ventilator operation. If the ventilator is mounted on a compressor-mount
cart and has a 4-hour BPS or if the ventilator is mounted on a pole cart with a 4-hour battery, the
software version, battery life, and operating conditions are the same as described for the 803 BPS.
The battery life and operating conditions for each cart with a 1-hour BPS or 1-hour battery are
equivalent to the description given for the 802 BPS.
OP 1.3.7 Ventilator Emergency States
Emergency states include Ventilator Inoperative (Vent Inop) and Safety Valve Open (SVO). When
a vent inop condition occurs, it always includes the SVO state. An SVO state can also occur independent of a vent inop condition.
The following list describes the two ventilator emergency states:
• Safety valve open (SVO)—The ventilator enters the SVO state if both air and oxygen supplies are lost,
an occlusion is detected, or the ventilator enters the vent inop state.
The safety valve open (SVO) state allows the patient to breathe room air unassisted by the ventilator. The
ventilator remains in the SVO state until the condition that caused the emergency state is corrected.
When the ventilator enters the SVO state, the SVO indicator on the front face of the BDU illuminates, and
a high-priority alarm sounds.
In case of a malfunction that prevents software from opening the safety valve, there is also an analog circuit
that opens the safety valve if system pressure exceeds 100 cmH
• Ventilator Inoperative (Vent Inop): The ventilator declares a ventilator inoperative condition if a hard-
ware failure or critical software error occurs that could compromise safe ventilation of the patient.
When a vent inop condition occurs, the vent inop indicator on the front face of the BDU illuminates and
the ventilator enters the SVO state, which in turns sounds a high-priority alarm.
If a vent inop condition occurs, immediately remove the ventilator from use until qualified service person-
nel evaluate and correct the vent inop condition.
If the ventilator declares a vent inop state, the power on self test (POST) must first verify that power levels
to the ventilator are acceptable and the functions of the major electronics systems are satisfactory
before normal ventilation can resume. Qualified service personnel must repair the ventilator to correct
the problem and execute EST successfully before normal ventilation is allowed.
OP 1.4 Graphic User Interface
O to 120 cmH2O.
2
This section describes the GUI, the GUI keys, the GUI indicators, and the symbols you see on the
GUI.
The ventilator system’s GUI comprises the DualView touch screens, the off-screen keys located
below the touch screens, and a knob. Use the knob to set a given ventilator control parameter to
OP 1-6
Graphic User Interface
its desired value. Press the ACCEPT key—the off-screen key above and right of the knob—to enter
the selected value or parameter into memory.
FigureOP 1-2.identifies the components of the GUI, and the location of information on the
DualView touch screens.
FigureOP 1-2.Puritan Bennett™ 840 Ventilator System GUI
OP 1-7
Introduction
1 Vital patient data 9 Symbol definitions
2 Alarms and ventilator 10 Prompt area
3 Upper screen: monitored information
(alarms, patient data)
4 Assorted patient data, including graphical 12 Knob
5 Active alarm log, if applicable 13 ACCEPT key
6 Primary patient 14 CLEAR key
7 Lower screen: ventilator control parame-
ters
8 Setup of ventilator control parameters,
alarm limits, breath timing parameters,
and other parameters
OP 1.5
User Interface Controls and Indicators
11 Off-screen keys
15 Status
Descriptions of the controls and indicators on the graphic user interface are given in TableOP 1-1.
TableOP 1-1.Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator Function
Screen lock key: When the yellow light on the screen lock key is lit, the
screen and off-screen controls (including the knob and ACCEPT key) have no
effect when touched until you press the screen lock key again. New alarms
automatically unlock the screen and controls.
The screen lock allows you to clean the touch screen and prevents inadvertent changes to settings and displays.
Alarm volume key: Allows you to adjust the alarm volume when you hold
down this key while turning the knob. You cannot turn off the alarm volume.
Alarm silence key: Turns off the audible alarm for 2 minutes. The yellow light
on the alarm silence key illuminates during the silence period. An ALARM
SILENCE IN PROGRESS indicator displays on the lower touch screen, along
with a CANCEL button, if there is not a higher-priority alarm display active. To
exit out of the alarm silence, touch the CANCEL button.
The system automatically exits the alarm silence when the 2-minute interval
times out. High priority alarms such as Device Alerts, Safety Valve Open,
Occlusion, and loss of either gas supply cancel the alarm silence.
Each time you press the alarm silence key, the silence period resets to 2 minutes. Each time you press the alarm silence key (whether or not there is an
active alarm), the keypress is recorded in the alarm log.
OP 1-8
TableOP 1-1.Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator Function
Alarm reset key: Clears active alarms or resets high-priority alarms and
cancels an active alarm silence. Each time you press the reset key, it is recorded in the alarm log, if there is an active alarm. You cannot reset a DEVICE
ALERT alarm.
Information key: Displays basic operating information about the ventilator.
Press the key to display a menu of information topics, then touch the button
corresponding to the desired topic. Browse topical information using
the , , and buttons located in the information header.
User Interface Controls and Indicators
Oxygen sensor calibration key: Older ventilators use the 100% O
min key and newer ventilators use the INCREASE O
2 min key. Delivers 100%
2
/CAL 2
2
oxygen (if available) for 2 minutes and calibrates the oxygen sensor. The
green light on this key illuminates and a message (100% O
on the lower touch screen indicates 100% O
key again, the system restarts the 2-minute delivery interval. Press
the O
2
delivery is active. If you press
2
Cal in Progress)
2
CANCEL to stop the calibration. See page TR 15-4 for information on calibrating the oxygen sensor.
Manual inspiration key: In A/C, SIMV, and SPONT modes, delivers one
manual breath to the patient in accordance with the current mandatory
breath parameters. In BILEVEL mode, transitions from low PEEP (PEEPL) to
high PEEP (PEEP
) (or vice versa). To avoid breath stacking, a manual inspira-
H
tion is not delivered during inspiration or during the restricted phase of exhalation.
You can use the MANUAL INSP key to supplement minute volume or to assist
measurement of a patient data parameter, such as peak inspiratory pressure,
or to run an INSP PAUSE maneuver in SPONT mode.
Expiratory pause key: Causes the ventilator to seal the patient’s breathing
circuit when the expiratory phase of a designated breath, mandatory or spontaneous, is followed by a time-cycled mandatory inspiration. An expiratory
pause is used to estimate PEEP
and PEEPI (autoPEEP).
TOT
The ventilator performs two types of pause maneuver: automatic, which you
initiate by a momentary press of the EXP PAUSE key, and manual, which you
control by a continuous press on the key. An automatic pause performs the
maneuver until the pressure stabilizes, then takes its measurements. The
pause lasts at least 0.5 second and does not exceed 3.0 seconds.
During a manual pause maneuver, the ventilator takes its measurements as
soon as the pressure stabilizes or the pause ends. The ventilator continues the
maneuver until you release the EXP PAUSE key. The pause cannot exceed 20
seconds.Expiratory Pause Maneuvers (OP 4.10) on page OP 4-17 describes, in
detail, how to use the EXP PAUSE key.
OP 1-9
Introduction
TableOP 1-1.Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator Function
Inspiratory pause key: Causes the ventilator to seal the patient’s breathing
circuit at the conclusion of the gas delivery phase of a designated, volume- or
pressure-based mandatory inspiration. This inspiratory pause maneuver provides a means to measure the patient’s static lung-thoracic compliance
(C
), static resistance (R
STAT
), and plateau pressure (PPL). The inspiratory
STAT
pause maneuver maintains the inflated state of the lungs.
The ventilator performs two types of pause maneuver: automatic, which is
initiated by the momentary press of the INSP PAUSE key, and manual, which
you control by a continuous press on the key.
An automatic pause performs the maneuver until the pressure stabilizes,
then the system takes its measurements. The pause event lasts at least 0.5
second but no longer than 2.0 seconds.
In a manual pause, the maneuver continues until you release the INSP PAUSE
key, but cannot exceed 7 seconds. The ventilator computes C
at the end of the plateau and displays the values at the end of the maneuver.
P
is computed and updated continuously during the plateau, and its value
PL
is frozen at the end of the plateau. Section Expiratory Pause Maneuvers (OP
4.10) on page OP 4-17 describes, in detail, how to use the INSP PAUSE key.
Knob: Adjusts the value of a setting. A highlighted button on a touch screen
means the knob is linked to that setting. Where applicable, a clockwise turn
of the knob increases the highlighted value, and a counterclockwise turn of
the knob decreases the highlighted value.
STAT
and R
STAT
Clear: Cancels a proposed ventilator parameter value change.
Accept: Applies and saves new ventilator parameter value(s).
Red high-priority alarm indicator ( ! ! ! ): This alarm indicator blinks rapidly
if active; it is steadily lit if autoreset.
Yellow medium-priority alarm indicator ( ! ! ): This alarm indicator blinks
slowly if active; it turns off if autoreset.
Yellow low-priority alarm indicator ( ! ): This indicator is steadily lit if active;
it turns off if autoreset.
Green normal ventilator operation indicator: When ventilation is active
and no alarm states exist, this indicator is steadily lit. This indicator is off if the
ventilator is not in a ventilation mode, for example, during service mode or
short self test (SST).
OP 1-10
User Interface Controls and Indicators
TableOP 1-1.Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator Function
VENT INOP Red ventilator inoperative (VENT INOP) indicator: The ventilator cannot
support ventilation and requires service. The ventilator enters the safe state
(safety ventilation) and discontinues detection of new patient data or alarm
conditions. Qualified service personnel must repair the ventilator to correct
the problem and execute EST successfully before normal ventilation is
allowed. This indicator is accompanied by an audio signal and cannot be
reset.
SAFETY VALVE OPEN Red safety valve open (SVO) indicator: The ventilator has entered its safe
state and opened its safety valve to allow the patient to breathe unassisted
from room air.
BATTERY READY Green BPS ready indicator: The ventilator senses that the BPS is installed,
operational, and that it has a minimum of 2 minutes of estimated run time.
BATTERY ON Battery on power indicator: When the yellow bar to the right of a lit BPS
ready indicator is lit, the ventilator is operating on BPS, and AC power is insufficient to support ventilator operation. During BPS operation, power to the
compressor unit and the humidifier outlet is off.
COMPRESSOR READY Green compressor ready indicator: The compressor cable and air supply
hose are connected to the ventilator. The compressor is up to operating pressure but not supplying gas to the ventilator. The compressor motor turns on
intermittently to keep the compressor chamber pressurized.
COMPRESSOR ON Green compressor operating indicator: When lit, compressor is supplying
air to the ventilator. This indicator does not light unless the compressor is
actually supplying air to the ventilator.
The indicators on the breath delivery unit are shown in TableOP 1-2.
TableOP 1-2.BDU Indicators
Control or indicator Function
VENT INOP Red ventilator inoperative (VENT INOP) indicator: The ventilator cannot
support ventilation and requires service. The ventilator enters the safe state
(safety ventilation) and discontinues detection of new patient data or alarm
conditions. Qualified service personnel must repair the ventilator to correct
the problem and execute EST successfully before normal ventilation is
allowed. This indicator is accompanied by an audio signal and cannot be
reset.
SAFETY VALVE OPEN Red safety valve open (SVO) indicator: The ventilator has entered its safe
state and opened its safety valve to allow the patient to breathe unassisted
from room air.
DISPLAY
(GUI)
INOP
Red loss of GUI indicator: The ventilator has detected a malfunction that
prevents the GUI from reliably displaying or receiving information. If you
encounter a loss of the GUI display, see TableTR 13-3.on page TR 13-14 for a
list of recommended actions.
OP 1-11
Introduction
OP 1.5.1 Onscreen Symbols and Abbreviations
Touch an onscreen symbol to display its definition in the lower left corner of the lower screen.
summarizes the symbols and abbreviations the ventilator uses. For example, if you touch:
The symbol definition area shows this message:
V
MAX
= Peak flow
OP 1-12
TableOP 1-3.Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations
Symbol, icon, or abbreviation Definition
Blinking icon indicates that additional alarms related to the monitored information are active. The symbol blinks when there is not enough screen area to
display all active alarms.
User Interface Controls and Indicators
2
4
The upper alarm limit.
The lower alarm limit.
Touch to access the alarm log.
Alarm log contains events not yet viewed.
Rise time percent.
Flow pattern.
The value you selected for a ventilator control parameter exceeds its recommended limit (soft bound) and requires acknowledgment to continue
or the value selected exceeds its allowable minimum or maximum limit (hard
bound).
Touch to view more patient data.
Touch to view patient data graphics.
Touch to view additional screens.
X-axis (time or pressure) adjustment of patient data graphics.
Y-axis (pressure, volume, or flow) adjustment of patient data graphics.
OP 1-13
Introduction
TableOP 1-3.Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations (Continued)
Symbol, icon, or abbreviation Definition
Baseline pressure (PEEP) adjustment.
A/C Assist control ventilation mode
AV Apnea ventilation
C
E
STAT
SENS
Static compliance
Spontaneous expiratory sensitivity percentage
EST Extended self test
f Respiratory rate (ventilator control parameter)
f
TOT
1f
TOT
Total respiratory rate (monitored parameter)
High respiratory rate alarm
GUI Graphic user interface
HME Heat-moisture exchanger
I:E Inspiratory to expiratory ratio
1O
3O
O
2
O
2
%
2
%
2
Monitored oxygen percentage (patient data)
Oxygen percentage (ventilator control parameter)
High delivered O
Low delivered O
% alarm
2
% alarm
2
PC Pressure control (mandatory breath type)
P
MEAN
Mean circuit pressure
1P
2P
3P
4P
P
PEAK
PEAK
PEAK
PEAK
PEAK
High circuit pressure alarm
High circuit pressure alarm limit
Low circuit pressure alarm
Low circuit pressure alarm limit
Peak circuit pressure (patient data)
PEEP Positive end-expiratory pressure (ventilator control parameter)
PEEP
PEEP
PEEP
PEEP
H
I
L
TOT
High PEEP (ventilator control parameter, BILEVEL mode only)
Intrinsic PEEP (patient data)
Low PEEP (ventilator control parameter, BILEVEL mode only)
Total PEEP (patient data)
PEEP End expiratory pressure (patient data)
OP 1-14
User Interface Controls and Indicators
TableOP 1-3.Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations (Continued)
Symbol, icon, or abbreviation Definition
P
I END
P
P
I
PL
Inspiratory pressure
End inspiratory pressure (patient data)
Plateau pressure
POST Power on self test
PS Pressure support (spontaneous breath type)
P
P
SENS
SUPP
Pressure sensitivity
Pressure support (ventilator control parameter)
P-TRIG Pressure triggering
1P
R
VENT
STAT
High ventilator pressure alarm
Static resistance
SIMV Synchronized intermittent mandatory ventilation mode
SPONT Spontaneous ventilation mode
SST Short self test
T
A
T
E
Apnea interval
Expiratory time
1T
2T
V
V
E SPONT
1V
3V
T
H
T
I
I SPONT
I SPONT
T
L
T
PL
E SET
E TOT
E TOT
High PEEP time (BILEVEL mode only)
Inspiratory time
High spontaneous inspiration time alarm
High spontaneous inspiration time alarm limit
Low PEEP time (BILEVEL mode only)
Plateau time
Set minute volume (calculated from ventilator control parameters)
Exhaled spontaneous minute volume
High exhaled minute volume alarm
Low exhaled minute volume alarm
VC Volume control (mandatory breath type)
V
V
MAX
SENS
V
T
Peak flow (ventilator control parameter)
Flow sensitivity
Tidal volume (ventilator control parameter)
OP 1-15
Introduction
TableOP 1-3.Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations (Continued)
Symbol, icon, or abbreviation Definition
V
TE
3V
TE MAND
3V
TE SPONT
V
TI
1V
TI
V
TI MAND
1V
TI MAND
V
TI SPONT
1V
TI SPONT
V-TRIG
Refer to HIGH INSPIRED TIDAL VOLUME Alarm (TR 13.11)
*
volume alarms.
OP 1.6
Ventilator System Labeling Symbols
Exhaled tidal volume
Low exhaled mandatory tidal volume alarm
Low exhaled spontaneous tidal volume alarm
Inspired tidal volume
High inspired (mandatory or spontaneous) tidal volume alarm*
Inspired mandatory tidal volume
High inspired mandatory tidal volume alarm*
Inspired spontaneous tidal volume
High inspired spontaneous tidal volume alarm*
Flow triggering
on page TR 13-18 for information regarding inspired tidal
The following symbols appear on the various components of the ventilator system.
Note:
All labels shown are examples, and may not reflect the exact configuration of your ventilator.
TableOP 1-4.Labeling Symbols
Symbol or icon Definition
Power switch positions: ON represents the power on
position and represents the power off position. The
power switch, located on the BDU front panel, turns the
BDU and the GUI on and off. When the power switch is in
the off position, the BPS continues to charge if AC power
is present.
Refer to manual: When this icon appears on the product,
it means refer to documentation for information.
OP 1-16
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
Type B equipment, per IEC 60601-1
Potential equalization point (ground): Provides a
means of connection between the equipment and the
potential equalization busbar of the electrical connection.
A common grounding point for the entire ventilator.
Indicates the degree of protection provided by enclosure
(drip-proof)
CSA certification mark signifies the product has been evaluated to the applicable ANSI/ Underwriters Laboratories
Inc. (UL) and CSA standards for use in the US and Canada.
Ventilator System Labeling Symbols
SN Serial number
802 BPS charging status indicator: When the ventilator
is operating on mains power, the top symbol (green LED
next to gray battery icon) on the front of the BPS indicates
the 802 BPS is charged, and the bottom symbol (yellow
LED next to gray battery icon) on the front of the BPS indicates the BPS is charging.
803 BPS charging status indicator: Indicates the
charging status of the 803 BPS. A yellow LED next to the
partially full battery icon indicates the battery is charging.
A green LED next to the full battery icon indicates the
battery is charged.
Charging status indicator on the compressor-mount
cart: Indicates the charging status of the BPS. A yellow
LED next to the partially full battery icon indicates the
battery is charging. A green LED next to the full battery
icon indicates the battery is charged.
Battery indicator label: Indicates a 1-hour battery is
installed in the compressor-mount cart.
OP 1-17
Introduction
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
Battery indicator label: Indicates a 4-hour battery is
installed in the compressor-mount cart.
Charging status indicator on the pole cart: Indicates
the charging status of the battery. A yellow LED next to
the partially full battery icon indicates the battery is
charging. A green LED next to the full battery icon indicates the battery is charged.
Battery indicator label: Indicates a 1-hour battery is
installed in the pole cart.
Battery indicator label: Indicates a 4-hour battery is
installed in the pole cart.
DATA KEY Data key connection:
CAUTION: Do not remove the data key. The data key
enables software options, and stores ventilator operational hours, compressor unit operational hours,
and the serial numbers for the BDU and GUI. The ventilator will not operate without its factory-installed
data key.
TEST TEST button: After you touch the SST onscreen button
(available only during ventilator startup), you must press
the TEST button within 5 seconds in order to access SST.
PTS 2000 Puritan Bennett™ PTS 2000 Performance Test System con-
nection: For use by qualified service personnel only, to run
performance verification tests.
DISPLAY
(GUI)
Ventilator
circuit breaker
Compressor &
humidifier
circuit breaker
GUI connection.
Circuit breaker for ventilator power supply, located in the
BDU.
Ventilator circuit breaker for compressor and humidifier.
Alternating current (at AC inlet and AC power indicator).
OP 1-18
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
Ventilator System Labeling Symbols
Compressor outlet:
5.6 A max
Maximum allowed output to auxiliary mains socket (compressor electrical connection).
BPS electrical connection.
Exhalation filter latch unlock/lock.
Exhalation filter latch open indicator: This red indicator is located on the surface behind the closed latch, and
is easily visible when the latch is open.
GUI mounting latch unlock/lock.
Remote alarm port.
IOIOI RS-232 port.
Susceptible to electrostatic discharge.
Electric shock hazard.
Explosion hazard.
Fire hazard.
OP 1-19
Introduction
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
802 BPS product information label
803 BPS product information label
GUI product information label
GUI ports label
Remote alarm and RS-232 port (9.4 inch GUI only). Refer to Appendix OP E for GUI remote
alarm and RS-232 port specifications.
OP 1-20 Operator's and Technical Reference Manual
Ventilator System Labeling Symbols
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
Humidifier electrical label
(This label not visible unless the cover plate over the humidifier electrical connection is removed.)
BDU gas inlet label
BDU to patient label
Compressor gas connection label
OP 1-21
Introduction
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
Compressor information label
BDU information label
OP 1-22 Operator's and Technical Reference Manual
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
BDU cooling vent label
BDU I/O disconnect label
Ventilator System Labeling Symbols
BDU exhaust information label
OP 1-23
Introduction
TableOP 1-4.Labeling Symbols (Continued)
Symbol or icon Definition
BPS electrical connection label
Compressor lint filter label
Expiratory limb connector on exhalation filter
OP 1-24
OP 2 How to Set up the Puritan Bennett™ 840
Ventilator
OP 2.1 Overview
Chapter OP 2 describes how to set up the Puritan Bennett™ 840 Ventilator System:
• How to connect the electrical supply
• How to connect the air and oxygen supplies
• How to connect the patient circuit and accessories
A Covidien customer service engineer (CSE) must first install the ventilator and run extended self
test (EST), which calibrates the exhalation valve, flow sensors, and atmospheric pressure transducer, before you connect a patient to the ventilator for the first time.
WARNING:
When you lift the ventilator, use assistance and appropriate safety precautions. FigureOP 2-1.
shows the proper technique to lift each ventilator component.
WARNING:
To avoid interrupted ventilator operation or possible damage to the ventilator, always use the
ventilator on a level surface in its proper orientation.
WARNING:
To avoid the possibility of injury to the patient and ensure proper ventilator operation, do not
attach any device to the port labeled EXHAUST unless the device is specifically authorized by
Covidien.
WARNING:
To minimize the increased risk of fire due to an oxygen enriched environment, do not use the
ventilator in a hyperbaric chamber.
WARNING:
To avoid raising the oxygen concentration of room air, use the ventilator in an adequately
ventilated room.
OP 2-1
How to Set up the Puritan Bennett™ 840 Ventilator
FigureOP 2-1.How to Lift the Ventilator Components
1 Lift the BDU from horizontal surfaces as
shown
2 Use two people to lift the compressor
from the base and the handles
3 Lift the GUI from the base and the handle
Caution:
Do not connect or disconnect the ventilator’s GUI, backup power source (BPS), or compressor
while the power switch is on or the ventilator is connected to AC power.
Caution:
All components must be securely mounted and connected by qualified service personnel
according to the appropriate Covidien installation instructions.
Caution:
Do not obstruct the BDU, GUI, or compressor cooling vents or fan vents.
OP 2-2
Caution:
To avoid possible damage to ventilator components, do not use the horizontal surfaces of the
ventilator to place or stack objects.
Note:
Before you use the ventilator for the first time, wipe the ventilator exterior clean and sterilize its
components according to the instructions in Chapter OP 7. Follow your institution’s protocol for cleaning
and sterilizing the ventilator and its components.
OP 2.2 Connecting the Electrical Supply
WARNING:
To minimize the risk of electrical shock, always connect the ventilator power cord into a grounded
AC power outlet.
Connecting the Electrical Supply
WARNING:
In the US, always connect the ventilator to an AC receptacle marked “Hospital Only” or “Hospital
Grade” to ensure proper grounding of the ventilator.
WARNING:
The 802 or 803 BPS must always be installed if you are using an RTA cart. Without the BPS, the
ventilator is not protected against low or lost AC power. Do not use the ventilator unless a BPS with
at least minimal charge is installed.
WARNING:
If you are using a newer compressor mount cart or pole cart, you must ensure you connect the
battery backup system harness to the ventilator.
WARNING:
Do not disconnect the battery backup system, GUI, or compressor from the ventilator while in use.
WARNING:
When possible, connect the ventilator to an outlet connected to the hospital emergency backup
power system. Refer to section OP A.5 for ventilator electrical specifications.
Normally the ventilator system is mains-powered. The 802 or 803 BPS or battery backup system
in newer compressor mount carts and pole carts operates the ventilator when AC power is lost or
drops below a minimum level.
A new, fully charged 802 BPS can operate the ventilator (without the compressor or a humidifier)
for a minimum of 60 minutes (30 minutes on ventilators built prior to July 2007); allowing the ventilator to be used for transport purposes within the healthcare facility. A new, fully charged 803
OP 2-3
How to Set up the Puritan Bennett™ 840 Ventilator
BPS (available after October 2009) can operate the ventilator (without the compressor or a humidifier) for a minimum of 4 hours. The same conditions apply, respectively, to the 1-hour or 4-hour
BPS assemblies in the compressor mount cart and the pole cart.
WARNING:
The 802 or 803 BPS and the battery backup systems in the compressor mount cart and the pole cart
are intended for short-term use only, and are not intended as primary alternative power sources.
The BPS and battery backup systems are intended to power the BDU and GUI only. In case of AC
power loss, power is not available to run either the compressor or the humidifier.
If you turn on the ventilator after it has been unplugged for an extended period, the LOW
BATTERY alarm may sound. If this occurs, recharge the 802 or 803 BPS or battery backup system
in the compressor mount cart or pole cart by leaving it connected to a ventilator connected to
AC power for up to 8 hours (ventilator does not need to be turned on). Because of the larger
battery capacity, the 803 BPS or 4-hour BPS or battery in the compressor mount cart or pole cart
may take up to 20 hours to recharge. If, after turning the ventilator back on, the LOW BATTERY
alarm is still active or if the INOPERATIVE BATTERY alarm is active, qualified service personnel must
replace the battery. The batteries should be recharged whenever they have been depleted.
Leaving them in a discharged state for longer than 24 hours may reduce their capacity. The same
conditions apply, respectively, to the 1-hour or 4-hour BPS assemblies in the compressor mount
cart and the pole cart.
FigureOP 2-2.shows how to connect the power cord to AC power. Built-in power cord retainer
tabs protect against accidental disconnection. Ensure the power cord is securely fastened into the
AC receptacle prior to operation. to remove the cord, squeeze the tabs on the top and bottom of
the plug and pull outward.
FigureOP 2-2.How to Connect the Ventilator Power Cord
OP 2-4
Connecting the Electrical Supply
1 Power cord from AC power 2 Power cord retainer tabs. Squeeze tabs
and pull outward to disconnect cord.
FigureOP 2-3.shows the power switch and AC indicator. When illuminated, the AC indicator indi-
cates the ventilator is receiving AC power and the 802 and 803 BPS, and battery backup systems
in the compressor mount cart and the pole cart will be recharged as needed. The AC indicator is
independent of the power switch, and the power switch does not turn off AC power to the ventilator power supply. When both the power switch and AC indicator are on, power is available for
the humidifier and compressor.
FigureOP 2-3.Ventilator Power Switch, AC Indicator, and AC Panel
1 AC power connection 5 AC panel
2 Ventilator power supply circuit breaker 6 Humidifier and compressor circuit breaker
3 Ventilator power switch 7 Compressor connection
4 AC power indicator 8 Potential equalization (ground) point
If the ventilator power supply circuit breaker (located on the ventilator's AC panel, FigureOP 2-3.)
opens but AC power is still present and the ventilator is operating on BPS, power is still available
OP 2-5
How to Set up the Puritan Bennett™ 840 Ventilator
to the humidifier and compressor connectors (although ventilator software disables compressor
operation).
When the power cord is not in use, wrap the power cord around the hook on the back of the cart
for convenient storage (FigureOP 2-4.and FigureOP 2-5.). The power cord is stored the same way
on the compressor mount cart and the pole cart.
OP 2-6
FigureOP 2-4.Power Cord Storage on the RTA Cart
Connecting the Electrical Supply
OP 2-7
How to Set up the Puritan Bennett™ 840 Ventilator
FigureOP 2-5.Power Cord Storage on the Newer Compressor Mount Cart and Pole Cart (shown)
Connecting the Air and Oxygen Supplies
OP 2.3
The ventilator system can use air and oxygen from cylinder or wall supplies. Follow these steps to
connect the air and oxygen supplies:
OP 2-8
1. Ensure the supply pressures are 241kPa to 690 kPa (35 psi to 100 psi), and the hospital gas piping
system complies with ISO 7396:1987, Non-flammable Medical Gas Pipeline Systems, or an equivalent
standard. Gas hoses must meet the requirements of EN 739:1998, Low-pressure Hose Assemblies for
use with Medical Gases, and NFPA 99:2002, Standard for Healthcare Facilities.
2. Connect the supply hoses to the inlet connectors at the rear of the ventilator (see FigureOP 2-6.).
WARNING:
Connect only air to the air inlet, and only oxygen to the oxygen inlet. Do not attempt to switch air
and oxygen or connect any other gas.
WARNING:
Always connect at least two gas sources to the ventilator to ensure a constant gas supply is
available to the patient. There are three gas source connections: the compressor, air inlet, and
oxygen inlet.
WARNING:
Do not use anti-static or electrically conductive hoses is the ventilator breathing system.
Connecting the Air and Oxygen Supplies
WARNING:
Use only gas supply hoses recommended by Covidien. Other hoses may be restrictive and may
cause improper ventilator operation.
Caution:
To prevent damage to the ventilator, ensure the connections to the air and oxygen supplies are
clean and unlubricated, and there is no water in the air or oxygen supply gas. If you suspect water
in the air supply gas, use an external wall air water trap to prevent water damage to the ventilator
or its components.
Caution:
The ventilator has not been validated by the manufacturer for use with nitric oxide, helium, or gas
mixtures with helium.
Note:
When you connect a pressurized air or oxygen source, the ventilator air and oxygen regulators have a
maximum bleed rate of 3 L/min, even when the ventilator is not in use. Always take this bleed rate into
account when calculating air and oxygen usage.
When the air and oxygen hoses are not in use, you can wrap them around the hook on the back
of the cart for convenient storage (FigureOP 2-6.).
OP 2-9
How to Set up the Puritan Bennett™ 840 Ventilator
FigureOP 2-6.How to Connect the Air and Oxygen Supplies
1 Air inlet connector 3 Air hose (from air supply)
2 Oxygen inlet connector 4 Oxygen hose (from oxygen supply)
OP 2.4
Connecting the Patient Circuit Components
WARNING:
The use of filters on the inspiratory gas outlet and expiratory gas inlet are intended to protect the
gas pathway from contamination by body fluids or expired gases. To minimize the risk of bacterial
contamination or component damage, inspiratory and expiratory filters must always be handled
with care and connected to the ventilator during use.
WARNING:
To minimize the risk of patient injury, use only patient circuits qualified for use in oxygen-enriched
environments with the ventilator system. Do not use anti-static or electrically conductive tubing
in the ventilator breathing system. To ensure a leak-tight connection, only use connectors and
OP 2-10
tubes with ISO standard cone and socket fittings (or use adapters to connect barbed cuff fittings
to ISO-standard fittings).
WARNING:
If you use an external, pneumatically-powered nebulizer with the ventilator system, it adds flow to
the patient circuit and can adversely affect spirometry, delivered O
and breath triggering. Additionally, aerosolized particulates in the ventilator circuit can lead to an
increase in exhalation filter resistance.
WARNING:
Use one of the patient circuits listed in Appendix OP B to ensure the maximum pressure/flow
values specified by IEC 60601-2-12:2001 are not exceeded (see TableOP A-11. on page OP A-11 for
patient circuit testing specifications). Using a circuit with a higher resistance does not prevent
ventilation, but can cause a short self test (SST) fault or compromise the patient’s ability to breathe
through the circuit.
Note:
Covidien recommends you run short self test (SST) every 15 days, between patients, and when you change
the patient circuit (particularly when you change the circuit type, for example, from adult to pediatric or
neonatal).
Connecting the Patient Circuit Components
%, delivered tidal volumes,
2
Note:
Covidien recognizes the protocol for running SST varies widely among health care institutions. Covidien
does not specify or require specific practices that will meet the needs of all institutions, nor is Covidien
responsible for the effectiveness of institutional practices.
OP 2.4.1 Selecting and Connecting a Patient Circuit
Use low-compliance patient circuits to ensure optimum compliance compensation, and use
pediatric patient circuits when the patient ideal body weight (IBW) is greater than 7 kg (15 lb) but
less than or equal to 24 kg (53 lb). Use the NeoMode software option and neonatal patient circuits
for patients whose IBW is less than or equal to 7 kg.
For patients whose IBW is less than or equal to 24 kg, the compliance compensation volume limit
is four times the set tidal volume, in addition to the set tidal volume. To avoid activating a severe
occlusion alarm, only use neonatal patient circuits with the NeoMode software option.
TableOP 2-1.shows IBW values and patient circuit types. The “Allowed but not recommended”
ranges require an override.
WARNING:
Recommended ranges exist to ensure patient safety. Only those with the expertise to judge the
appropriate circumstances should override the recommended ranges.
OP 2-11
How to Set up the Puritan Bennett™ 840 Ventilator
TableOP 2-1.Patient circuit and IBW values
Recommendation Ideal body weight (IBW) in kg (lb)
Recommended Neonatal: 0.3 kg–7.0 kg (0.66 lb–15 lb)*
Pediatric: 7.0 kg–24 kg (15 lb–53 lb)
Adult: 25 kg–150 kg (55 lb–330 lb)
*Assumes NeoMode 2.0 software option is installed
Allowed but not
recommended
Neonatal: Not applicable
Pediatric: 3.5 kg–6.5 kg (7.7 lb–14.3 lb), and 25 kg–35 kg (55 lb–77 lb)
Adult: 7 kg–24 kg (15 lb–53 lb)
FigureOP 2-7.shows how to connect the patient circuit, including the inspiratory filter, humidifier
(if used), inspiratory limb, patient wye, expiratory limb, collector vial, and expiratory filter.
FigureOP 2-7.How to Connect the Patient Circuit
1 From patient 6 Inspiratory limb of patient circuit
2 Expiratory filter 7 Humidifier
3 Expiratory limb of patient circuit 8 Tubing
4 Patient wye 9 Inspiratory filter
5 Collector vial 10 To patient
OP 2-12
WARNING:
To ensure all patient circuit connections are leak-tight, always perform a circuit leak test by
running SST each time you install the expiratory filter on the ventilator.
WARNING:
Adding accessories to the ventilator can increase system resistance. Ensure any changes to the
recommended ventilator circuit configurations do not exceed the specified values for inspiratory
and expiratory resistance (Appendix OP A). If adding accessories to the patient circuit, always run
SST to measure circuit compliance before beginning patient ventilation.
OP 2.4.2 Installing the Expiratory Filter and Collector Vial
Install the expiratory filter and collector vial as follows:
1. Place the expiratory filter latch in the up position (see FigureOP 2-8.).
2. Slide the expiratory filter into the housing area with the expiratory limb connection facing you.
Connecting the Patient Circuit Components
3. Push the expiratory filter latch down; it will position the filter properly.
4. Attach the expiratory limb of the patient circuit to the filter’s expiratory limb connection.
If you do not use a drain bag, be sure to cap the collector vial drain port on the expiratory filter
(FigureOP 2-9.).
FigureOP 2-8.How to Install the Expiratory Filter and Collector Vial
1 Pull the latch up to install filter, pull down
to hold filter and collector vial in place.
4 Expiratory filter
2 Slide the filter rim onto these tracks 5 Expiratory limb connection (from
patient)
3 Filter housing area 6 Collector vial
If you use a drain bag:
OP 2-13
How to Set up the Puritan Bennett™ 840 Ventilator
1. Install the expiratory filter. (Refer to the instructions above.)
2. Install the clamp on the drain bag tubing, ensuring the clamp is closed.
3. Uncap collector vial drain port at the base of the collector vial.
4. Connect the collector bag tubing to the vial drain port.
5. Connect the other end of tubing to drain bag.
6. If the ventilator is mounted on the cart, place the drain bag in the cart drawer (if you have an older style
ready-to-assemble cart) or hang the drain bag on the button provided on the side of the newer style
ventilator compressor mount cart or pole cart (FigureOP 2-9.).
WARNING:
Do not attempt to clean, reprocess, or reuse the drain bag as this poses the risk of infection to
medical personnel and the patient.
FigureOP 2-9.How to Use the Collector Vial With or Without the Drain Bag
OP 2-14
Connecting the Patient Circuit Components
1 Place the drain bag in the cart drawer of
the RTA cart or hang the drain bag on the
button provided. The collector vial drain
port must be capped if you do not use a
drain bag on the side of the cart
2 Drain bag 5 The collector vial drain port must be
3 Tubing
Note:
Check the inspiratory and expiratory limbs of the patient circuit, the collector vial, and the in-line water
traps regularly for water buildup. Under certain conditions, they can fill quickly. Empty and clean the
collector vial and in-line water traps as necessary.
OP 2.4.3 Installing the Flex Arm
The flex arm supports the patient circuit between the ventilator and the patient. FigureOP 2-
10.and FigureOP 2-11.show how to install the flex arm onto one of the two (in ready-to-assem-
ble carts) or four (in newer compressor mount cart or pole cart) threaded sockets on the ventilator
cart.
4 Clamp
capped if you do not use a drain bag.
OP 2-15
How to Set up the Puritan Bennett™ 840 Ventilator
FigureOP 2-10.How to Install the Flex Arm on the RTA Cart
1 Flex arm 2 Threaded socket (one of two)
OP 2-16
Connecting the Patient Circuit Components
FigureOP 2-11.How to Install the Flex Arm on the Newer Compressor Mount Cart or Pole Cart
1 Flex arm 2 Threaded socket (one of four)
Caution:
Use only the cart handles to move the ventilator. Do not pull or push the ventilator with the flex
arm.
OP 2-17
How to Set up the Puritan Bennett™ 840 Ventilator
Flex arm replacement parts can be found in the Puritan Bennett™ 840 Ventilator System Service
Manual.
OP 2.4.4 Installing the Humidifier
An electrical outlet for a humidifier is located on the front of the BDU. FigureOP 2-12.shows how
to install a Fisher & Paykel™* humidifier onto the ventilator for ventilators mounted on RTA carts.
Separate humidifier installation instructions are shipped with humidifier mounting kits listed in
TableOP B-2.and TableOP B-3.of appendix OP B for humidifiers mounted on compressor mount
carts and pole carts, respectively.
WARNING:
When using a Fisher & Paykel™* humidifier with the Puritan Bennett™ 840 ventilator, use the
appropriate Fisher & Paykel™* humidifier chambers for adult, pediatric, and neonatal patients.
WARNING:
Take proper precautions to prevent water/condensate from splashing into the patient circuit
during circuit disconnects and high peak flow rate conditions.
WARNING:
To avoid possible patient injury or damage to the ventilator system, follow your institution’s
protocol for proper patient circuit condensate management.
Caution:
Qualified service personnel must first install the humidifier mounting hardware.
Caution:
To avoid equipment damage to the ventilator due to liquid ingress:
• Install the plug cover when the humidifier is plugged into the ventilator.
• Install the flat cover plate over the humidifier electrical outlet on the front of the BDU when the
humidifier is not plugged into the ventilator.
Note:
To ensure uninterrupted ventilator operation, do not install a humidifier whose maximum current
capabilities exceed 2.3 A, with a maximum power consumption of 270 VA.
Note:
When you install a Fisher & Paykel™* humidifier, make sure the humidifier has a right-angle electrical plug.
A short power cord is preferable.
OP 2-18
Note:
To ensure ventilator occlusion detection operates properly, do not use Puritan Bennett™ Cascade
humidifiers with the Puritan Bennett™ 840 Ventilator System.
Note:
If you have further questions about humidifiers qualified for use with the ventilator system, contact
Technical Services or your local Covidien representative.
Connecting the Patient Circuit Components
FigureOP 2-12.How to Install the Humidifier (Fisher & Paykel™* version shown) for Ventilators Mounted on RTA Carts
1 BDU 3 Humidifier
2 Plug cover 4 Mounting bracket on front of ventilator
OP 2.4.5
OP 2-19
Using the Ventilator Cart
Three optional carts are available for use with the Puritan Bennett™ 840 ventilator: the RTA (readyto-assemble) cart, the Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart, and the
Puritan Bennett™ 800 Series Ventilator Pole Cart. The RTA cart can be used with the 802 or 803 BPS,
and newer compressor mount carts can be used with a BPS having a 1-hour battery or an optional
How to Set up the Puritan Bennett™ 840 Ventilator
4-hour battery. The pole cart also has a 1-hour or optional 4-hour battery as part of its battery
backup system.
WARNING:
Install only ventilator BDUs with serial numbers starting with 3512 onto the newer compressor
mount cart and pole cart. Other ventilator serial numbers are not compatible with the newer carts.
The compressor mount cart and pole cart may not be available in all regions. Contact your local
Covidien representative for more information.
To locate the cart’s lot number, a label is applied underneath the cart handle on the cart’s spine
weldment (FigureOP 2-13.).
FigureOP 2-13.Location of Cart Lot Number Label
1 Cart lot number label
WARNING:
Lock the cart’s wheels prior to installing or removing ventilator components.
FigureOP 2-14.and FigureOP 2-15.show how to lock and unlock the cart’s front wheels.
WARNING:
To avoid interrupted ventilator operation or damage to ventilator components, use the cart to
move the ventilator. Do not use the cables, the power cord, GUI, or patient circuit components to
push or pull the ventilator.
OP 2-20
Connecting the Patient Circuit Components
FigureOP 2-14.How to Lock and Unlock the RTA Cart’s Front Wheels
1 Locked position: Press small tab down to
unlock.
FigureOP 2-15.How to
1 Unlocked position: Lift up to unlock 2 Locked position: Press down to lock
Lock and Unlock the Compressor Mount Cart or Pole Cart Front Wheels
2 Unlocked position: Press large tab down
to lock
OP 2-21
How to Set up the Puritan Bennett™ 840 Ventilator
Page Left Intentionally Blank
OP 2-22
OP 3 How to Run Short Self Test (SST)
OP 3.1 Overview
Chapter OP 3 tells you:
• When to run SST
• Required equipment for SST
• SST tests and their functions
• How to set up and run SST
• How to understand the results of SST
OP 3.2 Introduction to SST
SST uses an internal, programmed sequence of tests to:
• Verify proper function of the flow and pressure sensors
• Check the patient circuit for gas leaks
• Measure the expiratory filter resistance
• Measure patient circuit resistance
• Measure patient circuit compliance
SST requires approximately 3 minutes to complete.
WARNING:
Always disconnect the ventilator from the patient before you run SST. If you run SST while the
ventilator is connected to the patient, physical injury to the patient may occur.
WARNING:
An ALERT reported by SST indicates the ventilator or a related component has a defect. Repair
the ventilator or related component before you use the ventilator on a patient, unless you can
determine with certainty the defect cannot create a hazard for the patient, or add to the risks
that may occur from other hazards.
OP 3-1
How to Run Short Self Test (SST)
WARNING:
When you run SST, configure the patient circuit exactly as it will be used on the patient (for
example, with same accessories). If you add accessories to the patient circuit after you run SST, you
must rerun SST with the new accessories before you begin to ventilate the patient.
OP 3.3 When to Run SST
Note:
Covidien recognizes health care institutions may have their own ventilator protocols. However, Covidien
is not responsible for the effectiveness of any institution’s protocols. Nor can Covidien specify, or require,
specific practices to meet the internal needs of every health care institution.
Covidien recommends running SST when one or more of the listed events occurs:
• When you replace the patient circuit and the exhalation filter after 15 days of use
• When you are ready to connect a new patient to the ventilator
• When you connect a different patient circuit to the ventilator
• When you install a new or sterilized expiratory filter
• When you change the patient circuit type
• When you change the humidification device type
• When you remove or add accessories to the patient circuit, such as a humidifier, water trap, or drain
bag
Use SST at any time, provided a patient is not attached to the ventilator to:
• Check the patient circuit for gas leaks
• Calculate patient circuit compliance and resistance
• Calculate expiratory filter resistance
After SST begins, the system prompts you to prepare the ventilator to conduct certain tests. The
system waits indefinitely at a prompt until you take action and respond appropriately.
OP 3.4 SST Components and Requirements
When you conduct SST, you must have available the components and equipment you will use on
the patient:
• Patient tubing
• Expiratory filter and collector vial
OP 3-2
Inspiratory filter
•
• Humidifier, as applicable
• Other accessories (e.g., water traps, drain bag), as applicable
Additional requirements include:
• A number 1 rubber stopper to block the airway at the patient wye
• Two gas sources (air and oxygen) connected to the ventilator
• Each gas source pressure must be between 241 kPa to 690 kPa (35 psi to 100 psi)
Caution:
To prevent SST failures due to leaks, ensure any circuit components such as collector vial drain port
cap (if not using a drain bag), the seal between the expiratory filter and collector vial, and water
trap (if used) seals are properly installed.
Caution:
If you are using a drain bag, ensure the tubing is properly installed on the collector vial drain port
and the tubing is clamped. If the drain bag tubing is not clamped during SST, large leaks and large
compliance values are possible which may cause SST to report ALERTs or FAILUREs.
SST Procedure
Wait at least 10 minutes after you turn on the ventilator before you run SST. The warm up time of
10 minutes will stabilize the ventilator and ensure the accuracy of the SST tests.
OP 3.5 SST Procedure
WARNING:
Always disconnect the ventilator from the patient before you run SST. If you run SST while the
ventilator is connected to the patient, physical injury to the patient may occur.
To run SST
1. Turn the power switch (located on the front of the BDU). The system conducts the POST (power-on
self test) and displays the ventilator startup screen.
2. Allow the ventilator to stabilize for ten10 minutes with the power on.
3. Install the patient circuit, and the expiratory and inspiratory filters you will use to ventilate the patient.
Caution:
The patient circuit must be unobstructed and properly connected to the ventilator to ensure
accurate circuit resistance measurement.
OP 3-3
How to Run Short Self Test (SST)
4. At the ventilator startup screen, touch the SST button (lower touch screen), then press the TEST button
(on the left side of the BDU) within five5 seconds. (Refer to FigureOP 3-1.for location of the TEST button.) The system displays the SST Setup screen (lower touch screen).
Note:
You must press the TEST button within five5 seconds of touching the SST button or SST will not start.
FigureOP 3-1.Test Button Location
Caution:
Do not press the test button when powering up the ventilator. This may cause the ventilator
to enter Service Mmode. If you enter Service Mmode, do not attempt to run Eextended Sself
Ttest (EST) with a patient circuit. Doing so will cause EST to fail. If EST fails, the ventilator will
remain in a Vvent Iinop state until EST successfully passes.
If you accidentally enter Service Mmode, exit Service Mmode by touching the EXIT button on
the lower GUI screen and then pressing the ACCEPT key.
5. Touch the PATIENT CIRCUIT key in the lower touch screen, then use the knob to select either Adult,
Pediatric, or Neonatal (if NeoMode software option is installed) patient circuit.
6. Touch the HUMIDIFICATION TYPE key in the lower touch screen, then use the knob to select the
humidification type you will use for patient ventilation. If you will not use a humidifier, set the humidification type to HME.
7. Press ACCEPT to complete your selection of the patient circuit and humidification types.
WARNING:
Incorrectly specifying the patient circuit type or changing the patient circuit type after you
have run SST can affect the accuracy of the compliance calculation, the measured exhaled tidal
volume, and delivered/measured inspired tidal volumes. You must rerun SST when you
change the circuit type. Compliance calculation and tidal volume accuracy may also be
OP 3-4
affected by incorrectly specifying or changing the humidifier after running SST. If you change
humidifiers, ensure you change the humidification type as described in Section 4.8 Setting
Alarms, page OP 4-14. For optimum accuracy, rerun SST using the new humidifier.
8. The ventilator automatically starts the test sequence. Refer to TableOP 3-1.for details regarding each
SST test step. The SST flow sensor, expiratory filter, circuit resistance, and compliance calibration tests
require your intervention. The system will wait indefinitely for your response. Otherwise you don’t
need to do anything unless a test result is ALERT or FAILURE, or SST is complete.
9. As each test is performed, the SST Status screen shows test results (see TableOP 3-2.).
WARNING:
To ensure reliable SST results, do not repeat an individual test with a different patient circuit if
the test result is FAILURE or ALERT. If you suspect a defective patient circuit, replace the patient
circuit and restart SST from the beginning.
10. You can touch EXIT SST during SST to halt testing. You can touch EXIT SST again to resume testing, or
press ACCEPT to restart the ventilator (if SST has not detected an ALERT or FAILURE).
SST Procedure
WARNING:
To ensure correct compensation for circuit resistance and compliance, do not exit SST until the
entire SST is successfully completed. Do not begin normal ventilation until the entire SST is
successfully completed with the correct patient circuit installed.
11. When all of the tests in SST are complete, the SST Status screen displays all individual test results and
SST outcome. TableOP 3-3.summarizes overall SST outcomes and how to proceed in each case.
12. To begin normal ventilation (if SST has not detected an ALERT or FAILURE), touch EXIT SST, then press
ACCEPT.
13. The ventilator reruns POST.
14. The ventilator displays the ventilator startup screen. Proceed with ventilator startup to configure the
system for the patient.
OP 3-5
How to Run Short Self Test (SST)
TableOP 3-1.SST Test Sequence
Test step Function Comments
SST Setup The system prompts you to
specify the patient circuit type
and humidification type you will
use for patient ventilation.
NOTE:
The HUMIDIFIER VOLUME button is not visible on the touch screen if you select HME.
SST
Flow Sensor Test
The system prompts you to
connect the patient circuit to the
inspiratory filter.
Use FigureOP 2-7.on page OP 2-
12 to connect the patient circuit.
1. Specify the patient circuit type.
2. Specify the humidification type.
You can select one of three
humidification types:
• Heated expiratory tube
• Non-heated expiratory tube
• HME (heat-moisture exchanger)
3. For non-HME humidifiers,
specify the dry humidifier volume.
Use the specified volume, not the
compressible volume, of the
humidifier.
4. Press the ACCEPT key.
WARNING: Select the correct
patient circuit type and humidification type. Otherwise,
faulty occlusion detection and
erroneous expiratory spirometry can result.
1. Connect the patient circuit to
the inspiratory filter— but
without the humidifier.
2. Press ACCEPT to begin the test.
NOTE:
Do not run the Flow Sensor Test with a humidifier installed, even if you
will use a humidifier when you begin patient ventilation.
The system prompts you to block
the patient wye.
The system checks the accuracy
of the inspiratory and expiratory
flow sensors.
After the test completes, the
system prompts you to connect
the humidifier.
NOTE:
If you will use a humidifier during patient ventilation, connect the humidifier to the patient circuit after the
system passes the SST Flow Sensor Test. Refer to FigureOP 2-7.on page OP 2-12 for connection information.
Circuit Pressure Test The system verifies proper func-
tion of the BDU pressure sensors.
3. Block the wye with a number 1
stopper.
4. Press ACCEPT.
If the status of the SST Flow
Sensor Test is FAILURE, you
cannot use the OVERRIDE function.
If the status of the Circuit Pressure
Test is FAILURE, you cannot use
the OVERRIDE function.
OP 3-6
TableOP 3-1.SST Test Sequence (Continued)
Test step Function Comments
SST Procedure
Circuit Leak Test The system determines the ability
of the circuit to hold pressure.
The system displays the drop in
circuit pressure over a 10-second
interval.
Expiratory Filter Resistance Test The system prompts you to
detach circuit tubing from the
expiratory filter.
At the conclusion of the Expiratory Filter Resistance Test, the
system displays the pressure drop
across the expiratory filter.
If the system reports ALERT and
you choose to override the alert
status, the result can be improper
compliance compensation, inaccurate tidal volume delivery, or
autotriggering during patient
ventilation. If the test detects
excessive leaks, the system
reports a FAILURE.
1. Detach the patient circuit from
the expiratory filter.
2. Press ACCEPT to begin the test.
If the system reports an ALERT for
the Expiratory Filter Resistance
Test and you override the ALERT,
an inaccurate patient pressure
estimation can result.
The system will report a FAILURE if
the test detects an exhalation
compartment occlusion or an
expiratory filter occlusion.
If you do not correctly follow the
prompts to disconnect and
connect the patient circuit, the
system will report a FAILURE.
The system prompts you to reattach the patient circuit.
Circuit Resistance The system prompts you to
unblock the patient wye.
The system displays the pressure
drop across the inspiratory and
expiratory limbs.
The reported pressure drop
includes the effect of all devices
installed on each limb, such as filters, water traps, or a humidifier.
3. Reattach the patient circuit to
the expiratory filter.
4. Press ACCEPT to begin the next
test.
1. Remove the stopper from the
wye.
2. Press ACCEPT to begin the test.
If the system reports an ALERT for
the pressure drop across the two
limbs and you override the ALERT,
an inaccurate patient pressure
estimation can result.
The system reports a FAILURE if
the test detects excessive high or
low limb resistance, or if you do
not follow the prompt to unblock
the wye.
OP 3-7
How to Run Short Self Test (SST)
TableOP 3-1.SST Test Sequence (Continued)
Test step Function Comments
OP 3.6
SST Results
Compliance Calibration The system prompts you to block
the patient wye.
If you selected a humidification
type of either Heated exp tube or
Non-heated exp tube, the ventilator prompts you to indicate if
there is water in the humidifier.
The system displays the compliance of the patient circuit.
The system prompts you to
unblock the patient wye.
1. Block the wye with a number 1
stopper.
2. Press ACCEPT to begin the
patient circuit compliance test.
3. Press ACCEPT to indicate YES or
CLEAR to indicate NO, as appropriate, to indicate whether or not
there is water in the humidifier.
If the system reports an ALERT for
the patient circuit compliance
and you override the ALERT,
improper compliance compensation or inaccurate tidal volume
delivery can result.
The system reports a FAILURE if
the test detects an out-of-range
compliance condition.
4. Remove the stopper from the
patient wye.
5. Press ACCEPT to complete the
SST test sequence.
The Puritan Bennett™ 840 Ventilator System uses four status categories to characterize the individual SST test results, and the overall SST outcome.
ALERT
You can override an ALERT reported for an individual test if you can determine with certainty the
defect in the ventilator or related component cannot create a hazard for the patient, or add to the
risks arising from other hazards.
Note:
If an ALERT is reported and you exit SST without overriding the ALERT, the ventilator will enter the safety
valve open (SVO) state and cannot be used for normal ventilation until SST passes or the ALERT is
overridden.
FAILURE
When the system declares a FAILURE for an individual test in the SST sequence, the ventilator
enters the SVO state. When a ventilator experiences a FAILURE, immediately remove the equipment from clinical use until qualified service personnel have completed and verified the necessary repairs.
OVERRIDDEN
OP 3-8
OVERRIDDEN is a final status of the overall SST outcome and indicates you used the override
feature when the system reported an ALERT condition. (The ventilator must have ended the test
with an ALERT condition.)
PASS
Pass is the final status of the overall SST outcome in which no alerts or failures were detected.
Refer to TableOP 3-2.and TableOP 3-3.to learn how to interpret and respond to each of these SST
status categories.
OP 3.6.1 Interpreting Individual SST Test Results
SST reports a test result status for each of the individual tests. Use TableOP 3-2.to interpret SST
test results and to determine how to respond.
TableOP 3-2.Individual SST Test Results
If the test status is: it means: Do this:
SST Results
PASSED The system did not detect a fault
for the individual test.
ALERT The test result is not ideal, but is
not critical.
If SST is in progress, it halts further
testing and prompts you to make
a decision.
FAILURE A critical problem has been
detected, and SST cannot complete until the ventilator passes
the failed test.
You do not need to do anything,
unless you are prompted by the
ventilator.
When the system prompts you,
touch one of these buttons, then
press ACCEPT:
EXIT SST Discontinue SST
RESTART SST Repeat SST from
the beginning
NEXT Proceed to the
next test
REPEAT Repeat the test
Touch one of these buttons, then
press ACCEPT:
EXIT SST Discontinue SST
RESTART SST Repeat SST from the
beginning
REPEAT Repeat the test
OP 3.6.2 SST Outcomes
When SST has completed all of the tests, use TableOP 3-3.to determine how to proceed.
OP 3-9
How to Run Short Self Test (SST)
If the SST outcome is: It means: Do this:
PASSED All tests passed. Touch one of these buttons, then
TableOP 3-3.Overall SST Outcomes
press ACCEPT:
EXIT SST Exit SST and begin
normal ventilation
RESTART SST Repeat SST from
the beginning
ALERT One or more faults were detect-
ed. If you can determine with certainty this cannot create a hazard
for the patient, or add to the risks
which may arise from other hazards, you can choose to override
the ALERT status and authorize
ventilation.
FAILURE One or more critical faults were
detected. The ventilator enters
the SVO state and cannot be used
for normal ventilation until SST
passes. Service is required.
Touch one of these buttons, then
press ACCEPT:
EXIT SST Discontinue SST
RESTART SST Repeat SST from
the beginning
OVERRIDE Press ACCEPT to override the ALERT, as allowed by your
institution’s protocol. Touch EXIT
SST, then press ACCEPT to begin
normal ventilation.
Restart SST with a different
patient circuit. Touch one of these
buttons, then press ACCEPT:
EXIT SST Discontinue SST
RESTART SST Press ACCEPT to
repeat SST from the beginning. If
the failure persists, contact qualified service personnel.
OP 3-10
OP 4 How to use the
Puritan Bennett™ 840 Ventilator
OP 4.1 Overview
Chapter OP 4 provides the listed information:
• How the Puritan Bennett™ 840 Ventilator System user interface is structured
• How to start up the ventilator for a new or previous patient
• How to change main settings
• How to change other settings
• How to set the humidification type, expiratory sensitivity, and disconnect sensitivity
• How to enable or disable the oxygen sensor
• How to select and set the variable that remains constant when the breath rate setting is changed
• How to set the alarm limits
• How to perform inspiratory and expiratory pause maneuvers
• How to interpret inspiratory pause maneuver displays
• How to use non-invasive ventilation (NIV)
Note:
The DualView touch screens use light beams to detect where you touch the screen. To avoid a DEVICE
ALERT alarm, do not place any foreign substances or objects on the screen.
OP 4-1
How to use the Puritan Bennett™ 840 Ventilator
Structure of the User Interface
OP 4.2
The following buttons are available on the upper and lower touch screens. These buttons appear
across the bottom portion of each of the two screens.
FigureOP 4-1.Touch Screen User Interface
Upper screen
Display graphics
Diagnostic
code log
(system diagnostic, system
information,
EST/SST diagnostic logs)
Current/proposed
setup (vent type,
mode, breath
types, trigger type,
settings
More patient
data (e.g., O
P
I END
Operational
log (compressor, ventilator
hours)
2
)
Alarm log
(time, event,
%,
priority, alarm,
analysis)
SST result log Ventilator con-
Lower screen
Current/proposed
apnea setup
Active alarms Other screens Trending (if
figuration, revisions, serial
numbers, part
numbers,
installed
options)
Current/proposed
alarm settings
option is
installed)
Test summary
(time, date,
outcome of
SST, EST)
Other screens
Communication
setup (printer/DCI,
baud rate, data bits,
parity mode)
OP 4-2
Time/date change More settings
(humidification
type, O
sensor
2
enable/disable,
disconnect sensitivity, humidifier
volume, and
access to additional options)
Patient Setup
OP 4.3
WARNING:
Always complete the patient setup before you attach a patient to the ventilator. If you attach a
patient before the setup procedure is complete, the ventilator issues a procedure error and
initiates the safety ventilation mode.
When you turn on the ventilator, the ventilator automatically runs POST (power on self test). After
POST passes, the system displays the ventilator startup screen (FigureOP 4-2.) on the lower
screen. The prompt area, located in the lower right corner of the lower screen, contains setup
instructions.
Patient Setup
FigureOP 4-2.Ventilator Startup Screen
OP 4-3
How to use the Puritan Bennett™ 840 Ventilator
OP 4.3.1 Ventilating With the Most Recent Control Parameters
To continue ventilation with the most recent ventilator control parameters, touch Same Patient
and press ACCEPT. Ventilation does not begin until a patient is connected. A flashing reminder
arrow prompts you to consider the previous tube ID and tube type if the prior Spontaneous Type
used these parameters.
OP 4.3.2 Ventilating With New Control Parameters
Refer to TableOP A-12.for the descriptions, ranges, resolutions, accuracies, and new patient
values of the available ventilator control parameters.
1. Touch the New Patient button to select new ventilator control parameters for patient ventilation. If you
want to return to the ventilator startup screen, touch the RESTART button.
2. The system displays the new patient settings screen with the following buttons, and uses the rotary
knob or drop-down menus to display the available selections.
IBW: Ideal body weight. Turn the knob to adjust the IBW. The proposed value is highlighted.
WARNING:
Always enter the IBW appropriate for the patient. The system uses the patient’s IBW to
automatically set certain values, alarm limits, and parameter boundary limits for several initial
parameters. (The IBW values correlated with patient height are listed in TableOP 4-1.) If you
are changing IBW to a new value, all settings not currently applicable shall be automatically
adjusted, if necessary, to their new patient value or to the minimum or maximum allowable
value for the new IBW.
Vent Type: Determines the ventilation type
• INVASIVE — conventional ventilation using either endotracheal (ET) or tracheostomy (trach) tubes
• NIV (non-invasive) — ventilation using full-face masks, nasal masks, infant nasal prongs, or uncuffed
ET tubes (see Using NIV (OP 4.13) on page OP 4-20 for specific information on how to use NIV)
Mode: Determines the type and sequence of breath delivery
• A/C (Assist Control)
• SIMV (synchronized intermittent mandatory ventilation)
• SPONT (spontaneous)
• CPAP (continuous positive airway pressure, available only with the NeoMode software option
when vent type is NIV)
• BILEVEL (available only with the BiLevel software option when vent type is invasive)
OP 4-4
Patient Setup
Mandatory Type: Determines the type of mandatory breath control
• PC (Pressure Control)
• VC (Volume Control)
• VC+ (Volume Control Plus available only with the Volume Ventilation Plus (VV+) software option
when vent type is invasive)
(If the selected mode is SPONT, the mandatory type applies to manual inspirations only.)
Spontaneous Type: Determines type of support for spontaneous breaths
• PS (Pressure Support)
• TC (Tube Compensation Tube Compensation available only with the TC software option when
Vent Type is INVASIVE)
• VS (Volume Support Volume Support available only with the VV+ software option when vent type
is invasive)
• PA (Proportional Assist™
1
available only with the PAV™*+ software option when vent type is inva-
sive)
• NONE
(If the selected mode is A/C, the Spontaneous Type button does not appear.)
Trigger Type: Determines the method used to detect patient inspiratory effort
• P-TRIG (Pressure) (not available when vent type is NIV or when using the NeoMode option)
• V-TRIG (Flow)
3. Touch the button and turn the knob to adjust the desired settings. When you complete your settings
changes, touch CONTINUE. (You must touch the IBW button first before the CONTINUE button
appears.)
Touch the button and turn the knob to adjust the desired settings. When you complete your settings
changes, touch CONTINUE.
4. The final new patient settings screen appears. Touch the button of each parameter you want to
change, then turn the knob to select its value. To cancel this change, press the CLEAR key. To cancel
all changes and start over, touch the RESTART button.
1. Proportional Assist and PAV are registered trademarks of The University of Manitoba, Canada. Used under license.
OP 4-5
How to use the Puritan Bennett™ 840 Ventilator
Note:
The ventilator control parameter you are setting may be dependent upon other ventilator settings
that determine its boundaries. Refer to the prompt area on the lower GUI screen (FigureOP 1-1.) for
more information.
5. Press ACCEPT to put all of your ventilation control settings into effect. Normal ventilation begins once
a patient is connected.
6. The Apnea Setup screen appears. Apnea settings are automatically determined based on IBW, circuit
type, and mandatory breath type, but you can change them. If you change any apnea settings, press
ACCEPT to apply.
Although you are not required to change or confirm apnea settings, you should verify they are appropriate for the patient prior to ventilation.
WARNING:
Set the apnea interval (TA) to a value less than the expected or current breath period interval
as a way of allowing the patient to initiate breaths while protecting the patient from the
consequences of apnea.
7. Press the ALARM SETUP button to review the current alarm limit settings on the alarm settings screen.
Ensure they are appropriate for the patient. To change any limit, touch the button and turn the knob.
To cancel, touch PROPOSED ALARM. To apply the settings, press the ACCEPT key.
You may choose to calibrate the ventilator’s oxygen sensor at this point. Press the 100% O
or INCREASE O
information on calibrating the oxygen sensor.
During the oxygen sensor calibration, the ventilator delivers 100% oxygen (if available) for
and calibrates the oxygen sensor in the BDU.
The ventilator always monitors the delivery of oxygen to the patient unless you disable the oxygen
sensor. Touch the MORE SETTINGS button to access oxygen sensor disable or enable functions.
8. After you accept the ventilation control parameters, you can attach a patient to the ventilator. Ventila-
tion only begins when the ventilator senses that a patient is attached.
If you attach a patient before completing setup, the ventilator initiates safety ventilation mode and
annunciates a PROCEDURE ERROR alarm that is reset once you complete the patient setup.
WARNING:
Each patient circuit type is appropriate for a specified range of IBW values. This information is
summarized in TableOP 4-3.The recommended ranges exist to ensure patient safety. Only
those with expertise to judge the appropriate circumstances should override the
recommended ranges.
/ CAL 2 min
2
2 min key located on the keyboard below the touch screens. See page TR 15-4 for more
2
2 minutes
OP 4-6
OP 4.3.3 Patient Data and Current Settings
The top of the upper screen shows vital patient data. (Out-of-range data flashes to alert you.) The
current breath type is indicated in the upper left corner:
• C = Control
• S = Spontaneous
• A = Assist
You can access additional patient data when you touch the MOREPATIENT DATA button.
You can display the definitions for any symbol used in the patient data, alarm log, or settings areas
by touching the symbol. The symbol definitions appear at the bottom of the lower touch screen.
Current ventilator control settings are displayed across the top of the lower touch screen (Fig-
ureOP 4-3.). If you press the 100% O
/CAL 2 min key or the INCREASE O2 2 min key, the lower
2
touch screen automatically displays the IN PROGRESS indicator. If you touch the Alarm Silence
key, the IN PROGRESS indicator will appear if there is no other higher-priority display active. Press
the CANCEL button for either indicator to cancel the alarm silence or oxygen sensor calibration in
progress.
Patient Setup
OP 4-7
How to use the Puritan Bennett™ 840 Ventilator
FigureOP 4-3.Touch Screen Appearance During Normal Ventilation (shown with alarm silence and 100% O2/CAL in progress)
1 Vital patient data area 5 Subscreen area
2 Breath type (C= Control) 6 Main ventilator control settings
3 Alarm area 7 Ventilator settings (lower screen)
4 Patient data (upper screen) 8 Subscreen area
OP 4-8
OP 4.3.4 Other Changes
The system initially sets most upper and lower alarm limits based on the patient’s IBW. After entering the IBW, review and change these alarm settings as needed. TableOP 4-1.provides the information needed to determine the patient’s IBW using the patient’s height.
Patient Setup
TableOP 4-1.Ideal Body Weight (IBW) Based on Patient Height
Patient height
IBW (lb)
ft in ft in
5 5 121 6 10 212
5 6 126 6 11 217
5 7 130 7 0 225
5 8 134 7 1 231
5 9 141 7 2 238
5 10 146 7 3 245
5 11 150 7 4 251
6 0 154 7 5 258
6 1 161 7 7 269
6 2 165 7 8 278
6 3 172 7 9 287
6 4 176 7 10 293
6 5 183 7 11 300
6 6 187 8 0 309
Patient height
IBW (lb)
6 7 194 8 1 317
6 8 201 8 2 324
6 9 207 8 3 331
The new patient tube ID value is the high value tube ID for the chosen IBW in TableOP 4-2.
OP 4-9
How to use the Puritan Bennett™ 840 Ventilator
TableOP 4-2.Soft Bound Ranges for Ideal Body Weight (IBW) and Tube Internal Diameter (ID)
IBW (kg) Low value tube ID in mm High value tube ID in mm
<7.0 At this IBW, tube ID is not an
allowable setting
7–10 NONE 4.5
11–13 NONE 5.0
14–16 NONE 5.5
17–18 NONE 6.0
19–22 5.0 6.0
23–24 5.0 6.5
25–27 5.5 6.5
28–31 5.5 7.0
32–35 6.0 7.0
36 6.0 7.5
37–42 6.5 7.5
43–49 6.5 7.5
50 7.0 8.0
55 7.0 8.5
At this IBW, tube ID is not an
allowable setting
60 7.0 9.0
65 7.5 9.0
70 7.5 9.5
75 8.0 9.5
80–100 8.0 NONE
110–130 8.5 NONE
140–150 9.0 NONE
The patient circuit type you specify during SST determines several default settings and the ranges
available for ventilator operation (TableOP 4-3.).
OP 4-10
Changing the Main Ventilator Control Parameters
TableOP 4-3.Patient Circuit and IBW Values
Recommendation Ideal body weight (IBW) in kg (lb)
Recommended
Allowed but not
recommended
(operator override
required)
1. To use a neonatal patient circuit, the ventilator must have both the NeoMode software option
and the NeoMode hardware installed.
OP 4.4
Changing the Main Ventilator Control Parameters
Neonatal patient circuit: 0.3–7.0 kg (0.66–15 lb)
Pediatric patient circuit: 7.0–24 kg (15–53 lb)
Adult patient circuit: 25 kg–150 kg (55–330 lb)
*IBW range assumes NeoMode 2.0 software option
is installed
Neonatal patient circuit: Not applicable
Pediatric patient circuit: 3.5 kg–6.5 kg (7.7 lb–14.3 lb)
and 25 kg–35 kg (55 lb–77 lb)
Adult patient circuit: 7.0 kg–24 kg (15 lb–53 lb)
1
*
The main ventilator control parameters are the buttons displayed at the top of the lower screen.
Follow these steps to change main parameters:
1. Touch button of the parameter you want to change.
2. Turn the knob to the set the desired value. To cancel this change, press the CLEAR key to go back to
the previous value.
3. Repeat steps 1 and 2 for each parameter you want to change.
4. To cancel your changes, press the CANCEL ALL button, or press ACCEPT to apply the new ventilator
control parameters.
The lower screen displays monitored control parameters TableOP 4-4.if you select or change
other control parameters that affect them.
TableOP 4-4.Monitored Ventilator Control Parameters
Set minute volume
(V
)
E SET
Volume per weight ratio
(V
/IBW)
T
V
/IBW Volume per weight ratio: displayed when you select
T SUPP
Displayed along with the breath timing bar whenever
you select or change the respiratory rate (f) or volume
control parameters.
Displayed when you select or change the tidal
volume (V
(V
T
or change the target support volume (V
breath type is VS) control parameter.
, when breath type is VC) or target volume
T
, when breath type is VC+).
T SUPP
, when
OP 4-11
How to use the Puritan Bennett™ 840 Ventilator
Other Changes
OP 4.5
1. Touch the VENT SETUP button on the lower screen. The current vent setup screen appears.
2. To change ventilation setup (IBW, vent type, mode, mandatory breath type, spontaneous type, or
trigger type), touch its button then turn the knob to set the value. Proposed changes are highlighted.
To cancel the change just made, press the CLEAR key to go back to the previous setting. Press PROPOSED SETUP to cancel all changes and start over.
3. Once you change IBW, you cannot change the mode, vent type, mandatory type, or spontaneous type,
but you can, however, change the trigger type. If you change the IBW back to its original value, you
can change any of the main control settings again. Similarly, if you change any of the main control settings, the GUI will prevent you from changing the IBW until you change the main control settings back
to their original values. Also, if you are ventilating with TC or PA as the spontaneous type, you must
ensure the tube ID specified is appropriate for the new IBW.
Note:
• The intent of allowing IBW to be changed was ventilator settings would not be automatically
changed. An exception is when tube ID <6 mm.
4. After making any necessary changes, touch CONTINUE. Appropriate settings for the ventilation setup
5. For each ventilator setting you want to change, touch its button, then turn the knob to set its value.
6. After making all necessary changes, review the control parameters, then press ACCEPT to apply all the
Note:
Once the changes are in effect, the PREVIOUS SETUP button appears at the bottom of the lower screen
when you press VENT SETUP. This allows you to restore the entire previous setup (including alarm and
apnea settings) in effect immediately before you made settings changes using the ventilator setup screen.
To restore the previous setup, touch PREVIOUS SETUP, then press ACCEPT.
• Given the current ventilator settings, if PAV™* would otherwise be an allowable spontaneous type
(except that tube ID <6 mm), then PAV™* becomes selectable.
• If PAV™* is selected when tube ID <6 mm, tube ID shall be automatically set to its new patient
value, based on the new IBW (see TableOP 4-2.for tube ID ranges corresponding with IBW).
An attention icon for tube ID (whether new or unchanged) displays whenever PAV™* is selected.
selected appear on the lower screen.
To cancel this value, press the CLEAR key. Press PROPOSED SETUP to cancel all changes and start over.
new control parameters at the same time.
OP 4-12
Constant Timing Variable During Rate Changes
Constant Timing Variable During Rate Changes
OP 4.6
If pressure control (PC or VC+ is the mandatory breath type in the ventilator setup, or if you have
selected BILEVEL mode, you can select one of three available timing variables to be held constant
when the respiratory rate setting changes. The selected timing variable is the one held constant
during rate changes, and also the only one of the three timing variables you can adjust directly.
The three available timing variables for PC or VC+ mandatory breaths are defined as follows:
• T
represents the inspiratory time. This timing variable determines the inspiratory interval for PC man-
I
datory breaths.
• I:E represents the inspiratory to expiratory ratio. This timing variable determines the ratio of inspiratory
time to expiratory time for PC mandatory breaths.
• T
represents the expiratory time. This timing variable determines the duration of expiration for PC
E
mandatory breaths.
The three available timing variables for BILEVEL mode are defined as follows:
• T
represents the time interval for the high PEEP level (PEEPH).
H
• T
determines the ratio of the high PEEP time interval to the low PEEP time interval for BiLevel
H:TL
breaths.
• T
represents the time interval for the low PEEP level (PEEPL).
L
Follow these steps to view or change the timing variable held constant during respiratory rate
changes:
1. Touch VENT SETUP.
2. Touch CONTINUE. A graphic of the breath timing bar appears in the lower screen, with a lock icon
above each of the three timing variables (FigureOP 4-4.).
FigureOP 4-4.TI (or TH) Selected as the Constant During Rate Change
1T
2 I:E or TH:T
OP 4-13
or T
I
H
L
3T
or T
E
L
How to use the Puritan Bennett™ 840 Ventilator
3. Touch the lock icon of the timing variable you want to remain constant when the respiratory rate
setting changes. The lock icon of your selection should now be a closed lock, as it appears above the
T
timing variable in FigureOP 4-4.
I/TH
In addition, the current value of your selected timing variable is highlighted within the breath timing
graphic, and both this variable name and its current value are displayed in a highlighted box under the
ventilator control parameter PC.
4. Turn the knob to set the value of your constant timing variable.
5. Review the selected timing variable and its value. Make changes if necessary, then press ACCEPT.
Note:
You can change the value of the constant timing variable at any time, but the value does not change as a
result of changing the respiratory rate setting. For example, if you select T
change, you can still change the value of T
I:E and T
variables T
do change) when you change the respiratory rate setting. This also holds true for the BiLevel
E
, TH:TL, and TL.
H
to remain constant during rate
I
. Otherwise, the value of TI does not change (and the values of
I
OP 4.7 Changing Apnea Ventilation Settings
1. Touch the APNEA SETUP button on the lower screen. The current Apnea Setup screen appears.
2. If you select the apnea mandatory type setting (CHANGE VC/PC button), a button appears indicating
the current mandatory type setting. Touch the button to reveal a drop-down menu of the available
selections with the current selection highlighted. If desired, turn the knob to select a new mandatory
type, then press CONTINUE to review the settings applicable to the chosen apnea mandatory type.
3. For each setting you want to change, touch its button, then turn the knob to set its value. Proposed
changes are highlighted. Press PROPOSED APNEA to cancel changes and start over.
Note:
The CHANGE VC/PC button disappears when you change other apnea settings until you press the
ACCEPT key to apply the changes.
4. Once you’ve made any changes you want, review the settings, then press ACCEPT to apply all the new
settings at the same time.
OP 4.8 Setting Alarms
The system initially sets most alarm settings based on the patient’s IBW. You should review all
alarm settings, but you are not required to confirm or change them at startup.
1. Touch the ALARM SETUP button (lower screen) to view the current alarm setup (see FigureOP 4-5.).
The pointer to the left of each bar shows the current patient data value for each parameter, and high-
OP 4-14
lighted blocks represent the recent range of corresponding patient data. The buttons to the right of
each bar show the alarm limit(s) for each parameter.
2. Touch the button for each alarm limit you want to change.
3. Turn the knob to set the value you want (the active alarm limit button moves up or down with the
selected value). Proposed values are highlighted. You can change more than one alarm setting before
applying the changes. To cancel the last change made, press the CLEAR key to go back to the previous
setting. Press PROPOSED ALARM to cancel all changes and start over.
Note:
• You cannot set the upper and lower limits of an alarm to conflict with each other.
• The upper limits for the spontaneous exhaled tidal volume and mandatory exhaled tidal volume
Setting Alarms
alarms are always the same value. Changing the upper limit of one alarm automatically changes
the upper limit of the other.
FigureOP 4-5.Alarm Setup
4. Once you have made all of the desired changes and have reviewed the settings, press ACCEPT to
apply.
OP 4-15
How to use the Puritan Bennett™ 840 Ventilator
You can touch the ALARM SETUP button at any time during ventilation to show the current limits
and the monitored patient value (shown inside the white arrows in FigureOP 4-5.) for each alarm
limit.
OP 4.9 Changing Other Settings
The Other Screens button allows you to configure the communications (RS-232) ports, set or
change the time and date, and access settings for the humidifier, oxygen (O
nect sensitivity.
To configure the communications ports, refer to Appendix OP E.
The Time/Date Change button allows you to set the current time of day and calendar date. The
date format is selectable and includes a check for correct number of days in a month. For example,
you cannot enter February 30.
Available date formats are:
DD MMM ‘YY (DD.MM) (default)
) sensor, and discon-
2
‘YY MMM DD (MM-DD)
‘YY/MM/DD (MM-DD)
MM/DD/’YY (MM-DD)
MM/DD/’YY (MM/DD)
DD/MM/’YY (DD.MM)
The time is shown in hours and minutes in a 24-hour clock format.
To set or change the time and date
1. Touch the Other Screens button, then touch the Time/Date Change button.
2. Touch the Date Format button and turn the knob to select your desired date format.
3. Touch the corresponding button and turn the knob to change the values for day, month, year, hour,
and minute. To cancel your changes, touch the Other Screens button again.
4. Press ACCEPT to apply the new settings.
The More Settings button leads to settings that usually change infrequently. Three settings, listed
below, are available:
• Humidification type
• Oxygen (O
• D
SENS
OP 4-16
) sensor
2
(disconnect sensitivity)
To change humidification type, humidifier volume (for non-HME humidifiers), or disconnect sensitivity (D
), or to enable or disable the O2 sensor, and to change tube type or tube ID when
SENS
using the TC option, follow these steps:
1. Touch the Other Screens button, then touch the More Settings button.
2. Touch the button of a parameter you want to change, then turn the knob to set the parameter value.
(You can change multiple parameters and then apply the changes all at once.)
For non-HME humidifiers, touch the Humidifier Volume button, then turn the knob to select the dry
humidifier volume. (The Humidifier Volume button is not visible when HME is selected.) To leave settings unchanged, touch the Other Screens button again.
3. Review the proposed parameters.
4. Press ACCEPT to apply the new settings.
OP 4.10 Expiratory Pause Maneuvers
Pressing the EXP PAUSE key seals the breathing circuit during the expiratory phase of a designated breath. The designated breath can be mandatory or spontaneous, and must be followed by a
mandatory inspiration. The expiratory pause maneuver allows pressure in the patient’s lungs to
equilibrate with the pressure in the ventilator breathing circuit, and results in elevated circuit pressure if intrinsic PEEP (PEEP
) is present. An expiratory pause maneuver is used to estimate PEEP
I
and PEEPI.
Expiratory Pause Maneuvers
TOT
There are two types of expiratory pause maneuvers:
• An automatic expiratory pause maneuver begins when you press the EXP PAUSE key momentarily. An
automatic pause maneuver continues until the pressure stabilizes. An automatic expiratory pause
maneuver lasts at least 0.5 second, but no longer than 3.0 seconds.
An automatic expiratory pause maneuver is most appropriate for patients whose airways remain open
throughout exhalation. To cancel an automatic expiratory pause maneuver, press the CANCEL button
on the lower screen.
• A manual expiratory pause maneuver begins when you press and hold the EXP PAUSE key down. The
manual expiratory pause maneuver continues until you release the key, up to a maximum of 20 seconds.
A manual expiratory pause maneuver is most appropriate for patients whose near end-expiratory flow
shows signs of obstruction.
The most recently selected graphics are displayed and frozen when an expiratory pause maneuver begins, so you can see when the expiratory pressure stabilizes. At the end of the maneuver,
the system displays the values for PEEP
and PEEP
I
TOT
.
OP 4-17
How to use the Puritan Bennett™ 840 Ventilator
Note:
• If the patient triggers breaths during the waiting period prior to the start of the expiratory pause
maneuver, the ventilator will wait approximately 1 minute while it detects the appropriate conditions
to start the maneuver. If the conditions are not met during the wait period, the ventilator cancels the
maneuver.
• If the patient initiates a breath or an alarm occurs during the expiratory pause maneuver, the ventilator
cancels the maneuver, and returns to normal ventilation. A message appears in the graphics display
indicating the maneuver has been canceled.
• The high pressure alarm condition and the action taken by the ventilator as a result of the high pres-
sure alarm violation are active during expiratory pause maneuvers.
OP 4.11 Inspiratory Pause Maneuvers
When you press the INSP PAUSE key, the breathing circuit seals after the end of the gas delivery
phase of a designated, volume- or pressure-based mandatory inspiration. This allows pressure in
the lungs to equilibrate with the pressure in the breathing circuit, which results in a pressure plateau. An inspiratory pause maneuver begins at the end of gas delivery (VC breath) or when the set
inspiratory time (T
ery phase of the current or the next breath.
) elapses (PC or VC+ breath). The maneuver begins at the end of the gas deliv-
I
This maneuver allows you to measure the patient’s static lung thoracic compliance (C
resistance (R
), and plateau pressure (PPL), or to maintain the inflated state of the lungs.
STAT
STAT
), static
There are two types of inspiratory pause maneuver:
• An automatic inspiratory pause maneuver begins when you press the INSP PAUSE key momentarily.
An automatic inspiratory pause maneuver continues until the pressure stabilizes, and lasts at least 0.5
second but no longer than 2.0 seconds.
Use an automatic inspiratory pause maneuver to measure C
breaths), and P
the lower screen.
• A manual inspiratory pause maneuver begins when you press and hold the INSP PAUSE key down, and
continues until the INSP PAUSE key is released, up to a maximum of 7 seconds.
Use a manual pause to maintain lung inflation; for example, during an X-ray.
. To cancel an automatic inspiratory pause maneuver, press the CANCEL button on
PL
STAT
, R
(only on square wave, VC
STAT
If you select a plateau time (TPL), you can extend the inspiratory pause maneuver or TPL. For example, during an automatic inspiratory pause maneuver, TPL can be extended to up to 2.0 seconds.
If TPL exceeds 2.0 seconds and the inspiratory pause maneuver ends before TPL elapses, the
plateau lasts the full TPL interval. During a manual inspiratory pause maneuver, the maneuver lasts
the TPL setting or the manual interval, but never longer than 7 seconds.
OP 4-18
Interpreting Pause Maneuver Results
It is possible to compute C
STAT
and R
with invalid data. For example, a leak can prevent the
STAT
achievement of a plateau, or the lungs may not be empty when an inspiration begins. While the
inspiratory pause maneuver is in progress, software checks the quality of the data, and indicates
when estimates for C
STAT
and R
are questionable.
STAT
The most recently selected graphics are displayed and frozen when an inspiratory pause maneuver begins, so you can assess the inspiratory pressure. P
during the inspiratory pause. C
phase. The value of R
is computed and displayed only if the mandatory breath type is VC with
STAT
STAT
and R
are displayed at the start of the next inspiratory
STAT
is continuously updated and displayed
PL
a square flow waveform.
Note:
The high pressure alarm condition and the action taken by the ventilator as a result of the high pressure
alarm violation are active during inspiratory pause maneuvers.
OP 4.12 Interpreting Pause Maneuver Results
Compliance (C
mL/cmH2O. Resistance (R
respiratory system. It is an estimate of how restrictive the patient’s airway is, based on the pressure
drop at a given flow. It is expressed in cmH
operator-initiated inspiratory pause maneuver, in which the inspiratory valves and exhalation
valve are closed. C
mandatory breath with a square waveform.
) is an estimate of the elasticity of the patient’s lungs; it is expressed in
STAT
) is the total inspiratory resistance across the artificial airway and
STAT
O/L/second. These values are computed during an
2
is computed during a mandatory breath. R
STAT
is computed during a VC
STAT
During the pause maneuver, the most recently selected graphics are displayed and frozen, so you
can see when inspiratory pressure stabilizes. C
STAT
and R
are displayed at the start of the next
STAT
inspiration following the inspiratory pause maneuver. They take this format:
xxx
C
STAT
or
yyy
R
STAT
If the software determines variables in the equations or the resulting C
of bounds, it identifies the questionable C
STAT
and R
values with special formatting and text
STAT
STAT
or R
values are out
STAT
messages:
• Parentheses ( ) signify questionable C
• Flashing C
• Asterisks (******) mean variables fall below noise-level bounds.
• R
(------) means resistance could not be computed, because the breath was not of a mandatory, VC
STAT
type with a square flow waveform.
STAT
or R
values are out of bounds.
STAT
STAT
or R
values, derived from questionable variables.
STAT
OP 4-19
How to use the Puritan Bennett™ 840 Ventilator
Refer to End Expiratory Pressure (TR 14.3) for detailed information on static compliance and resistance. TableTR 14-1.summarizes the significance and possible corrective actions for the C
and R
OP 4.13 Using NIV
When setting up or changing ventilation control parameters, you must select NIV (non-invasive
ventilation) using the VENT TYPE button that appears on the new patient setup or current setup
screens.
Choosing NIV allows ventilation with various non-invasive interfaces and with uncuffed endotracheal tubes in NeoMode.
OP 4.13.1 NIV Intended Use
NIV is intended for use by neonatal, pediatric, and adult patients possessing adequate neural-ventilatory coupling and stable, sustainable, respiratory drive.
STAT
displays.
STAT
OP 4.13.2 NIV Breathing Interfaces
Covidien has successfully tested the following non-vented interfaces with NIV:
Full-face Mask: Puritan Bennett™ Benefit Full Face Mask (large, part number 4-005253-00),
ResMed Mirage™* Non-Vented Full Face Mask (medium)
Nasal Mask: ResMed Ultra Mirage™* Non-vented Mask (medium)
Infant Nasal Prongs: Sherwood Davis & Geck Argyle™* CPAP Nasal Cannula (small), Hudson
RCI™* Infant Nasal CPAP System (Number 3)
Uncuffed neonatal ET tube: Mallinckrodt™ Uncuffed Tracheal Tube, Murphy (3.0 mm)
WARNING:
Use only non-vented patient interfaces with NIV.
WARNING:
Full-faced masks used for non-invasive ventilation should provide visibility of the patient's nose
and mouth to reduce the risk of emesis aspiration.
WARNING:
Do not ventilate patients intubated with cuffed endotracheal or tracheostomy tubes using NIV
Vent Type.
OP 4-20
OP 4.13.3 NIV Setup
NIV can be initiated from either the new patient setup screen during vent start-up or while the
patient is being ventilated invasively. FigureOP 4-6.shows the new patient setup screen when NIV
is the selected vent type.
Using NIV
FigureOP 4-6.New Patient Setup Screen—NIV
1 IBW button: button used to set the
patient’s ideal body weight
2 Vent type button: button used to select
between INVASIVE or NIV
3 Breath mode: Only A/C, SIMV, and SPONT
modes are allowed with NIV.
4 Mandatory Type: Only VC and PC are avail-
able with NIV.
5 Spontaneous Type: Only PS or NONE are
available with NIV when SIMV or SPONT
breath mode is selected.
6 Trigger Type: Only flow triggering is avail-
able with NIV.
Refer to the sections Changing from Invasive to NIV Vent Type, page OP 4-25 and Changing from
NIV to Invasive Vent Type, page OP 4-25 for information on automatic settings changes that occur
when switching between vent types.
Follow these steps to set up the ventilator for NIV:
OP 4-21
How to use the Puritan Bennett™ 840 Ventilator
To set up a new patient: To set up a patient currently being
1. Turn the ventilator on. 1. Touch the VENT SETUP button. Proceed to step 3.
Select NEW PATIENT
3. Enter the patient’s Ideal
Body Weight (IBW).
4. Touch the VENT TYPE button and turn the rotary knob to change to NIV.
5. Touch the MODE button and turn the rotary knob to select A/C, SIMV, or SPONT. (BILEVEL mode is not
available with NIV.).
6. Touch the MANDATORY TYPE button and turn the knob to choose pressure control (PC) or volume
control (VC). (VC+ is not available with NIV.)
7. If either SIMV or SPONT was selected in step 5, touch the SPONTANEOUS TYPE button and turn the knob
to select PS or NONE. (TC, PA, and VS are not available with NIV.)
NOTE:
With NIV selected as Vent Type, the only allowable trigger type is flow triggering (
ventilated:
V-TRIG).
Note:
During NIV, the exhaled volume of the patient can differ from the measured exhaled volume due to leaks
around the patient interface.
It is recommended that CO2 monitoring equipment is provided for the measurement of expiratory carbon dioxide concentration.
For CO
monitoring equipment manufacturers' instructions for use.
8. Touch CONTINUE and adjust settings as needed. See High Spontaneous Inspiratory Time Limit, page OP
4-23, for information on the high spontaneous inspiratory time limit ventilator setting.
NOTE:
With NIV selected as Vent Type, the DISCONNECT SENSITIVITY (D
screen set to OFF. If desired, touch the button and turn the knob to set a value. To change the disconnect
sensitivity after you have applied the ventilator settings, touch the OTHER SCREENS button, then the
MORE SETTINGS button and make your changes. FigureOP 4-7.shows the NIV settings screen.
9. Press ACCEPT to apply the settings. Review the apnea and alarm settings as described below.
monitoring equipment setup and connection to the ventilator, please refer to the CO2
2
) button appears on the Settings
SENS
OP 4-22
FigureOP 4-7.NIV Ventilator Settings Screen
Using NIV
OP 4.13.4
High Spontaneous Inspiratory Time Limit
NIV includes a setting in SIMV or SPONT modes for high spontaneous inspiratory time limit (2T
). When a patient’s inspiratory time reaches or exceeds the set limit, the ventilator transitions
SPONT
from inspiration to exhalation, and the 2T
cating the ventilator has truncated the breath (see FigureOP 4-9.). The 2T
restrict changes to IBW; if the IBW is decreased, 2T
remain within its allowable limits.
WARNING:
No audible alarm sounds in conjunction with the visual
appear in any alarm log or alarm message.
It is possible the target inspiratory pressure may not be reached if the 2T
enough, or if system leaks are so large as to cause the ventilator to truncate the breath at the
maximum allowable
1 “N” in header indicates NIV Vent Type 3 Note D
2
2T
I SPONT
2T
setting button
I SPONT
setting.
I SPONT
symbol appears on the upper GUI screen, indi-
I SPONT
may be decreased automatically to
2T
I SPONT
defaults to OFF
SENS
I SPONT
indicator, nor does the indicator
I SPONT
setting does not
setting is not long
I
Note:
To reduce the potential for not reaching the target pressure, minimize the leaks in the system and increase
the rise time% or decrease the E
OP 4-23
setting, or both, if appropriate.
SENS
How to use the Puritan Bennett™ 840 Ventilator
OP 4.13.5 Apnea Setup
Set the patient’s apnea parameters as described in Changing Apnea Ventilation Settings (OP 4.7) on
page OP 4-14. NIV does not change the way apnea parameters are set.
OP 4.13.6 Alarm Setup
Touch the ALARM SETUP button to display the current alarm settings and change the alarm settings as needed. A low circuit pressure (
circuit disconnects or large system leaks based upon pressure measurements in the patient circuit. Refer to TableOP 5-1., TableOP A-13., and TableTR 13-2.for more information regarding the
3P
alarm. The 3P
PEAK
alarm may be turned OFF, if desired. FigureOP 4-8.shows the NIV alarm
PEAK
screen with new patient default settings.
3P
FigureOP 4-8.New Patient Default Alarm Settings
) alarm is available during NIV to detect potential
PEAK
1 Yellow background with black letters on
lower GUI screens indicates NIV vent type
and current breath mode
2
4P
alarm limit
PEAK
WARNING:
With NIV selected as the Vent Type, the new patient value for each of the following alarm limits is
OFF:
2f
4V
TOT
Additionally, the 4P
PEAK
Ensure you have set these alarms appropriately before connecting the patient to the ventilator.
OP 4-24
E TOT
4V
TE MAND
4V
alarm can be set to OFF.
TE SPONT
Loading...