NORTH AMERICAN DRÄGER Drager Narkomed 2C User manual
North
A
merican
Dräger
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Operator’s Instruction Manual
Part Number: 4112258-018
Rev: C
Date: 30 September 1999
© 1999 N.A.D., Inc.
Narkomed 2C
Anesthesia System
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Narkomed 2C
Operator’s Instruction Manual
Table of Contents
Section 1: Introduction
Operator’s Responsibility for Patient Safety ................................... 1-1
Limitation of Liability ................................................... 1-2
Restriction .......................................................... 1-2
Symbol Definition ..................................................... 1-2
How This Manual Is Organized ........................................... 1-3
Conventions Used in This Manual ......................................... 1-3
General Warnings and Cautions ........................................... 1-3
Section 2: General Description
Overview ........................................................... 2-1
Gas Delivery System ................................................... 2-1
Vaporizers ......................................................... 2-11
Absorber .......................................................... 2-12
Bain Circuit Adapters .................................................. 2-15
Scavenger Systems ................................................... 2-17
AV2+ Ventilator ...................................................... 2-19
Main Switch Panel .................................................... 2-20
Power Supply System ................................................. 2-22
Breathing System Sensor Interface Panel ................................... 2-24
Adjustable Display Arm ................................................ 2-25
Monitoring System .................................................... 2-25
Display Screen ...................................................... 2-26
Control Key Panel .................................................... 2-26
Datagrip ........................................................... 2-27
Datascan Display .................................................... 2-28
Central Alarm Display and Audio Alarm Annunciation .......................... 2-30
Manual Sphygmomanometer ............................................ 2-33
O.R. Data Manager ................................................... 2-33
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Section 3: Daily Checkout
Daily Checkout Procedure ............................................... 3-1
Section 4: Preuse Checkout
Preuse Checkout Procedure ............................................. 4-1
Section 5: Operation
Gas Delivery System
Overview .................................................... 5-1-1
Connecting the Pipeline Gas Supply ................................. 5-1-1
Connecting the Gas Cylinders .....................................5-1-2
Connecting the Fresh Gas Hose .................................... 5-1-4
Adjusting the Gas Flow .......................................... 5-1-4
Using the Oxygen Flush .......................................... 5-1-4
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Narkomed 2C
Operator’s Instruction Manual
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Vaporizer
Overview .................................................... 5-2-1
Filling Systems ................................................ 5-2-1
North American Dräger Exclusion System ............................. 5-2-2
Operating the Vaporizers ......................................... 5-2-3
Filling the Vaporizer ............................................. 5-2-4
Filling the Vaporizer During a Case .................................. 5-2-5
Draining the Vaporizer .......................................... 5-2-11
Absorber System
(Refer to separate manual) ....................................... 5-3-1
Bain Circuit Adapter
(Refer to separate manual) ....................................... 5-4-1
Open Reservoir Scavenger
Overview .................................................... 5-5-1
Connecting the Open Reservoir Scavenger System ...................... 5-5-2
Operating the Open Reservoir Scavenger System ....................... 5-5-3
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Scavenger Interface for Passive Systems
Overview .................................................... 5-6-1
Operating the Scavenger Interface for Passive Systems ................... 5-6-2
Main Switch Panel
Overview .................................................... 5-7-1
System Power Switch ........................................... 5-7-1
Testing the Battery .............................................5-7-2
AV2+ Anesthesia Ventilator
Overview .................................................... 5-8-1
Activating the Ventilator .......................................... 5-8-2
Adjusting the Tidal Volume ........................................ 5-8-4
Setting the Respiratory Frequency .................................. 5-8-4
Setting the Inspiratory/Expiratory (I:E) Phase
Time Ratio ...................................................5-8-5
Setting the Inspiratory Flow Rate ................................... 5-8-5
Setting the Inspiratory Pressure Limit ................................ 5-8-5
Problem Resolution ............................................. 5-8-6
Monitoring System
Overview .................................................... 5-9-1
Power-On Screen .............................................. 5-9-4
Using the Screen Selection Menu ................................... 5-9-5
Invoking the Machine Monitor Screen ................................ 5-9-6
Invoking a System Monitor Screen .................................. 5-9-8
Invoking the CO2System Monitor Screen ............................ 5-9-10
Invoking the NIBP System Monitor Screen ........................... 5-9-11
Invoking the Breathing Pressure System Monitor Screen ................. 5-9-11
Invoking the Respiratory Volume System Monitor Screen ................. 5-9-12
Invoking the Agent System Monitor Screen ........................... 5-9-13
Invoking the Pulse Oximetry System Monitor Screen .................... 5-9-14
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Narkomed 2C
Operator’s Instruction Manual
Table of Contents
Setting Up the Monitoring System .................................. 5-9-14
Invoking the Templates Subscreen ................................. 5-9-17
Configuring the Monitoring System ................................. 5-9-21
Invoking the System Configure Screen .............................. 5-9-22
Invoking the Auto Log Screen .................................... 5-9-27
Invoking the Serial Ports Screen ................................... 5-9-29
Invoking the Datascan Configure Screen ............................. 5-9-34
Invoking the Preuse Checkout Screen ............................... 5-9-36
Invoking the Data Log Screen .................................... 5-9-38
Invoking the Data Management Screen .............................. 5-9-41
Oxygen Monitoring
Overview ................................................... 5-10-1
Monitor Display ............................................... 5-10-1
Setting Alarm Limits ............................................ 5-10-2
Calibrating the Oxygen Sensor .................................... 5-10-3
Oxygen Alarm Messages ........................................ 5-10-6
Low Oxygen Supply Whistle ...................................... 5-10-7
Problem Resolution ............................................ 5-10-8
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Respiratory Volume Monitoring
Overview ................................................... 5-11-1
Monitor Display ............................................... 5-11-2
Setting Minute Volume Low Limit .................................. 5-11-3
Setting Volume Alarms On/Off .................................... 5-11-4
Setting Minute Volume Trend Scale ................................ 5-11-4
Respiratory Volume Alarm Messages ............................... 5-11-5
Problem Resolution ............................................ 5-11-7
Breathing Pressure Monitoring
Overview ................................................... 5-12-1
Installing the Breathing Pressure Pilot Line ........................... 5-12-1
Choice of Breathing Pressure Monitoring Location ...................... 5-12-2
Monitor Display ............................................... 5-12-4
Setting Pressure High and Threshold Pressure Alarm Limits .............. 5-12-5
Setting Apnea Alarm On/Off ...................................... 5-12-7
Setting Auto-Threshold ......................................... 5-12-7
Setting Pressure Trend Scale ..................................... 5-12-7
Breathing Pressure Alarm Messages ............................... 5-12-8
Problem Resolution ........................................... 5-12-10
Manual Sphygmomanometer
Overview ................................................... 5-13-1
Selecting a Blood Pressure Cuff ................................... 5-13-2
Connecting the Cuff ............................................ 5-13-2
Placing the Cuff ............................................... 5-13-3
O.R. Data Manager
Overview ................................................... 5-14-1
Central Processing Unit with Floppy Disk Drive and Network Interface ....... 5-14-3
Keyboard ................................................... 5-14-3
Display Screen ............................................... 5-14-5
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Narkomed 2C
Operator’s Instruction Manual
Table of Contents
Handling Floppy Disks .......................................... 5-14-6
General Operation ............................................. 5-14-8
Pop-up Menus ............................................... 5-14-12
Using the O.R. Data Manager ................................... 5-14-17
Starting a Case with a Floppy Disk-Based O.R. Data Manager ............ 5-14-17
Disk Error Messages .......................................... 5-14-27
Starting a case with a Network-Based O.R. Data Manager ............... 5-14-28
Data Recording During the Case ................................. 5-14-34
Ending a Case with the O.R. Data Manager ......................... 5-14-35
Patient Data Screen .......................................... 5-14-38
Pre-Anesthesia Evaluation Screen ................................ 5-14-52
Drug Administration Screen ..................................... 5-14-55
O.R. Event Record Screen ...................................... 5-14-65
QA Indicators ............................................... 5-14-78
Numeric Data Screen ......................................... 5-14-84
Graphic History Screen ....................................... 5-14-101
Printing Anesthesia Records ................................... 5-14-106
System Configuration Screen ................................... 5-14-109
Set Current Templates Sub-screen ............................... 5-14-110
Configuration Options Sub-screen ................................ 5-14-112
Import Site Lists Sub-screen ................................... 5-14-121
Transfer Case Sub-screen ..................................... 5-14-123
Configure Numeric Screen Sub-screen ............................ 5-14-130
Install Default Templates Sub-screen ............................. 5-14-134
Screen Menu Sub-screen ...................................... 5-14-136
Service Functions Sub-screen .................................. 5-14-136
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Section 6: Cleaning and Routine Maintenance
Overview ........................................................... 6-1
Routine Maintenance ................................................... 6-1
Removing Parts for Cleaning and Disinfection ................................ 6-10
Disassembling Parts for Cleaning and Disinfection ............................. 6-13
General Guidelines for Cleaning and Disinfection ............................. 6-15
Reassembly Instructions ............................................... 6-22
Section 7: Specifications
General ............................................................ 7-1
Environmental ........................................................ 7-1
Electrical ........................................................... 7-1
Gas Delivery System ................................................... 7-1
Vaporizers .......................................................... 7-2
Ventilator ........................................................... 7-3
Absorber System ...................................................... 7-3
Oxygen Monitoring .................................................... 7-3
Breathing Pressure Monitoring ............................................ 7-4
Respiratory Volume Monitoring ............................................ 7-4
Serial Interface ....................................................... 7-5
Appendix - Spare and Replacement Parts ........................................ A-1
Index ..................................................................... I-1
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Section 1
Introduction
Operator’s
Responsibility for
Patient Safety
North American Dräger anesthesia products are designed to provide the
greatest degree of patient safety that is practically and technologically
feasible. The design of the equipment, the accompanying literature, and
the labeling on the equipment take into consideration that the purchase
and use of the equipment are restricted to trained professionals, and
that certain inherent characteristics of the equipment are known to the
trained operator. Instructions, warnings, and caution statements are
limited, therefore, to the specifics of the North American Dräger design.
This publication excludes references to hazards which are obvious to a
medical professional, to the consequences of product misuse, and to
potentially adverse effects in patients with abnormal conditions. Product
modification or misuse can be dangerous. North American Dräger
disclaims all liability for the consequences of product alterations or
modifications, as well as for the consequences which might result from
the combination of North American Dräger products with products
supplied by other manufacturers if such a combination is not endorsed
by North American Dräger.
The operator of the anesthesia system must recognize that the means of
monitoring and discovering hazardous conditions are specific to the
composition of the system and the various components of the system. It
is the operator, and not the various manufacturers or suppliers of
components, who has control over the final composition and
arrangement of the anesthesia system used in the operating room.
Therefore, the responsibility for choosing the appropriate safety
monitoring devices rests with the operator and user of the equipment.
Patient safety may be achieved through a variety of different means
depending on the institutional procedures, the preference of the
operator, and the application of the system. These means range from
electronic surveillance of equipment performance and patient condition
to simple, direct contact between operator and patient (direct
observation of clinical signs). The responsibility for the selection of the
best level of patient monitoring belongs solely to the equipment operator.
To this extent, the manufacturer, North American Dräger, disclaims
responsibility for the adequacy of the monitoring package selected for
use with the anesthesia system. However, North American Dräger is
available for consultation to discuss monitoring options for different
applications.
1-1
Section 1
Introduction
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Limitation of
Liability
North American Dräger’s liability, whether arising from or related to the
manufacture and sale of the products, their installation, demonstration,
sales representation, use, performance, or otherwise, including any
liability based upon North American Dräger’s product warranty, is
subject to and limited to the exclusive terms of North American Dräger’s
limited warranty, whether based upon breach of warranty or any other
cause of action whatsoever, regardless of any fault attributable to North
American Dräger and regardless of the form of action (including, without
limitation, breach of warranty, negligence, strict liability, or otherwise).
North American Dräger shall in no event be liable for any
special, incidental, or consequential damages (including loss of
profits) whether or not foreseeable and even if North American
Dräger has been advised of the possibility of such loss or
damage. North American Dräger disclaims any liability arising
from a combination of its product with products from another
manufacturer if the combination has not been endorsed by North
American Dräger. Buyer understands that the remedies noted in
North American Dräger’s limited warranty are its sole and
exclusive remedies.
Furthermore, buyer acknowledges that the consideration for the
products, equipment, and parts sold reflects the allocation of
risk and the limitations of liability referenced herein.
Restriction
Symbol Definition
Federal law restricts this device to sale by, or on the order of, a
physician.
The following symbols appear on the label on the back of the Narkomed
2C and are defined below.
CAUTION: Refer to accompanying documents before
operating equipment.
ATTENTION: Consulter les documents ci-joints avant de
faire fonctionner l’apparail.
CAUTION: Risk of electric shock, do not remove cover.
Refer servicing to a North American Dräger
qualified technical service representative.
ATTENTION: Risque de choc electrique, ne pas enlever le
couvercle. Ne faire reparer que par un
representant technique autorise de North
American Dräger.
Degree of protection against electric shock: Type B.
Protection contre le risque de choc electrique: Type B.
1-2
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Section 1
Introduction
These additional symbols are used on other locations of the Narkomed
2C to provide quick and easy recognition of product functions.
Oxygen Concentration
Breathing Pressure
Breathing Volume
Audible Alarm Disable
How This Manual Is
Organized
Conventions Used
in This Manual
All users of the Narkomed 2C must read this manual completely before
using the machine. In order to make this document more convenient for
future reference, it has been divided into several independent sections.
Section 2 - General Description provides a summary of Narkomed 2C
features and functions.
Section 3 - Daily Checkout contains the checkout procedures that must
done on a daily basis.
Section 4 - Preuse Checkout contains the checkout procedures to be
performed between successive cases.
Section 5 - Operation has detailed instructions on the use and operation
of each functional component of the system.
Section 6 - Routine Maintenance provides cleaning, maintenance, and
replacement procedures.
Section 7 - Specifications contains the specifications for all system
components.
This manual has been set up with several conventions to help organize
the information contained in it. Please read about these conventions
carefully so that you understand their significance in the manual.
Typefaces
Different typefaces are used throughout the manual to differentiate
between narrative information and machine messages and labels.
1-3
Section 1
Introduction
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Warnings and
Cautions
General Warnings
and Cautions
All parts of this manual contain warning and caution statements about
the Narkomed 2C.
• Warning statements give important information that, if ignored,
could lead directly to a patient’s injury.
• Caution statements give important information that, if ignored, could
lead directly to equipment damage and, indirectly, to a patient’s
injury.
The following list of warnings and cautions apply to general operation
and maintenance of the Narkomed 2C. Warnings and cautions about
installing and operating specific parts appear with those topics.
WARNING: Any person involved with the setup, operation, or
maintenance of the Narkomed 2C anesthesia system must
be thoroughly familiar with this instruction manual.
WARNING: This anesthesia system will not respond automatically to
certain changes in patient condition, operator error, or
failure of components. The system is designed to be
operated under the constant surveillance and control of a
qualified operator.
WARNING: No third-party components shall be attached to the
anesthesia machine, ventilator, or breathing system
(except for certain approved exceptions). Contact the North
American Dräger technical service department for further
information.
WARNING: When moving the anesthesia machine, remove all monitors
and equipment from the top shelf, remove the absorber
system, and use only the machine handles or push/pull
bars. The anesthesia machine should only be moved by
people who are physically capable of handling its weight.
North American Dräger recommends that two people move
the anesthesia machine to aid in maneuverability. Exercise
special care so that the machine does not tip when moving
up or down inclines, around corners, and across thresholds
(for example, in door frames and elevators). Do not
attempt to pull the machine over any hoses, cords, or other
obstacles on the floor.
1-4
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Section 1
Introduction
CAUTION: Although the Narkomed 2C is designed to minimize the
effects of ambient radio-frequency interference, machine
functions may be adversely affected by the operation of
electrosurgical equipment or short wave or microwave
diathermy equipment in the vicinity.
CAUTION: Communications with external equipment may be
temporarily affected by electromagnetic interference due to
the use of electrosurgical equipment.
CAUTION: Do not place sensitive electronic equipment on or adjacent
to the display screen.
CAUTION: Do not place more than 100 pounds on top of the
Narkomed 2C monitor housing.
Recommendations
In the interest of patient safety, North American Dräger strongly
advocates the use of an oxygen analyzer, pressure monitor, and
either a volume monitor or an end-tidal CO
monitor in the breathing
2
circuit at all times.
Because of the sophisticated nature of North American Dräger
anesthesia equipment and its critical importance in the operating
room setting, it is highly recommended that only appropriately
trained and experienced professionals be permitted to service and
maintain this equipment. Please contact North American Dräger’s
Technical Service Department at (800) 543-5047 for service of this
equipment.
North American Dräger also recommends that its anesthesia
equipment be serviced at three-month intervals. Periodic
Manufacturer’s Service Agreements are available for equipment
manufactured by North American Dräger. For further information
concerning these agreements, contact the North American Dräger
Technical Service Department at (800) 543-5047.
1-5
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A
S
V
S
S
A
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Section 2
General Description
Overview
The Narkomed
®
2C is a continuous flow anesthesia system. All
Narkomed 2C machines are equipped with a monitoring system and
pneumatic circuitry for delivering gases and anesthetic vapor. A front
view of the Narkomed 2C is shown in the figure below.
UXILIARY OXYGEN
FLOWMETER (OPTIONAL)
DISPLAY
RM
DISPLAY
CREEN
DATAGRIP
ENTILATOR
BELLOWS
BREATHING
YSTEM SENSOR
INTERFACE PANEL
OPEN RESERVOIR
CAVENGER
CIRCUIT BREAKERS
VENTILATOR
O.R. DATA
MANAGER
(OPTIONAL)
VAPORIZERS
(OPTIONAL)
FLOWMETER
BANK
FRESH GAS
OUTLET
MAIN
SWITCH
PANEL
OP20999
Gas Delivery
System
The pneumatic system can simultaneously deliver up to four gases and
one anesthetic agent (from a selection of up to three). Oxygen and
nitrous oxide are standard on all Narkomed 2C machines. Optional
gases are air and carbon dioxide. Gas is supplied to the system through
pipelines and cylinders. Connections for oxygen and nitrous oxide are
standard on all machines, and a pipeline connection for air is also
available. Gas cylinder yokes are available for up to two oxygen
cylinders and two nitrous oxide cylinders, plus one additional cylinder
for a third gas.
2-1
Section 2
General Description
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Color Coding
Gas Entry Through a
Pipeline
Each connection, valve, gauge, and flowmeter is labeled and color-coded
for the appropriate gas, as shown in the table below.
GAS SYSTEM COLOR CODING
GAS MARKING USA GERMANY ISO
Air AIR Yellow Yellow Black/White
Checkered
Carbon Dioxide CO
Nitrous Oxide N2O Blue Gray Blue
Oxygen O
2
2
Gray Black Gray
Green Blue White
Gas from the hospital pipelines enters the Narkomed 2C through hoses
connected to indexed pipeline inlets located on the side of the flowmeter
housing. The indexed connector system reduces the risk of delivering the
wrong gas to a patient by preventing incorrect connection of gas pipes.
The inlets include check valves, which prevent backflow leakage into the
atmosphere (when supply hoses are not connected) or into the attached
supply hoses (when reserve cylinders are in use). Each pipeline
connection is equipped with a filter to prevent foreign material from
entering the internal gas piping of the Narkomed 2C. Pipeline gases
should be supplied at 50–55 psi.
Pipeline Pressure
Gauges
Pipeline pressure gauges for oxygen and nitrous oxide are standard. If
the anesthesia machine is equipped with air, a pipeline pressure gauge
for air is also included. These gauges are located directly below their
corresponding flowmeters and flow control valves. They are labeled and
color-coded for their respective gases on the flowmeter shield. Concentric
scales in psi and kPa indicate the pipeline supply pressure. A typical
pressure gauge and flowmeter arrangement is shown in the following
figure.
2-2
10
9
8
7
6
5
4
3
2
1
10
9
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
9
10
1000
1000
900
800
700
600
500
400
300
200
100
900
800
700
600
500
400
300
200
100
100
200
300
400
500
600
700
800
900
1000
COARSE FLOW
TUBE (l/min)
FINE FLOW
TUBE (ml/min)
INDICATOR
FLOATS
FLOWMETER
GUARD KNOB
FLOW CONTROL
VALVE
PIPELINE
PRESSURE
GAUGE
CYLINDER
PRESSURE
GAUGE
OP10006
THREE-GAS FLOWMETER
AND PRESSURE GAUGE ASSEMBLY
PIPELINE
CYLINDER
PIPELINE
CYLINDER
AIR O
2
N2O
PIPELINE
CYLINDER
N2O
AIR
O
2
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Section 2
General Description
When the machine is connected to an active pipeline supply, each gauge
should indicate 50–55 psi. A deviation from within this range indicates
that the pipeline gas supply system is improperly adjusted and may
adversely affect the operation of the Narkomed 2C. For example, a
fluctuating pipeline supply pressure would cause a corresponding
fluctuation of the gas flow delivered from that pipeline. An excessively
low pipeline pressure may activate the corresponding reserve cylinder
and deplete its contents (if the reserve cylinder valve was left in the
open position).
CAUTION: To ensure that gas supplies are at adequate pressure,
pipeline pressure gauges should indicate steady pressures
of 50–55 psi.
2-3
Section 2
General Description
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Gas Entry Through
Cylinder Yokes
The Narkomed 2C can be equipped with a maximum of two oxygen and
two nitrous oxide cylinder hanger yokes. An additional yoke for an
optional third gas is also available. To prevent a cylinder from being
improperly connected, the yokes are labeled, color-coded, and keyed for
gas-specific cylinders using the pin-indexed safety system.
A filter within each yoke prevents foreign material from entering the
internal gas piping. A check valve in each yoke prevents leakage into the
atmosphere if the cylinder is not mounted on the yoke. When the
machine is configured with two yokes for the same gas, the check valve
prevents movement of gas from one cylinder to the other. If a cylinder is
not mounted to a yoke, the attached yoke plug should be placed between
the yoke handle’s threaded bolt and the yoke’s gas inlet.
When attaching a cylinder, make sure that only one washer is installed
between the cylinder and the yoke gas inlet. Using multiple washers
may compromise the pin-indexed safety system. Be sure to verify the
integrity of both index pins whenever you install a new cylinder.
WARNING: Check cylinder yokes for the presence of two index pins
each time you attach a cylinder to the machine. Use only
one cylinder gasket per yoke. Using more than one gasket
could cause leakage of the cylinder gas and compromise
the pin-indexed safety system.
Cylinders attached to the hanger yokes must contain gas at the
recommended pressures outlined in the following table. Replace any
cylinders with less than the recommended pressure (psi-min) with full
cylinders.
GAS PSI - FULL* PSI - MIN*
Air 1900 1000
Carbon Dioxide 838 600
Nitrous Oxide 745 600
Oxygen 1900 1000
*Indicated pressures are for E-size cylinders at 70° F (21° C).
2-4
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Section 2
General Description
Cylinder Pressure
Gauges
Oxygen Supply
Pressure Failure
Protection Device
(OFPD)
Each cylinder gas circuit has a cylinder pressure gauge, located at the
bottom of the flowmeter panel on the front of the machine (see the
Flowmeter and Pressure Gauge Assembly figure earlier in this section.)
Each gauge is labeled and color-coded on the flowmeter housing for its
respective gas. When a cylinder’s valve is open, its pressure gauge
indicates the gas pressure in the cylinder. The dial is marked with
concentric scales for psi and kPa. If two reserve cylinders of the same
gas are open at the same time, the gauge indicates the pressure in the
cylinder having the higher pressure.
For nonliquefied gases (oxygen, air), the indicated pressure is
proportional to the gas content of the cylinder. For liquefied gases
(nitrous oxide, carbon dioxide), the gauge indicates the vapor pressure of
the liquefied gas in the cylinder. This pressure remains constant until
all of the liquid in the cylinder has vaporized. When the liquid has
vaporized, the cylinder pressure decreases proportionally as gas is
removed from the cylinder.
The oxygen failure protection device (OFPD) is a pneumatically operated
valve that protects the patient in the event of partial or complete oxygen
pressure loss. All gas circuits, except the oxygen circuit, are controlled by
these valves. OFPD-controlled valves respond to the gas pressure in the
oxygen supply line. When oxygen pressure is adequate, the valves open
for unrestricted gas flow. When oxygen pressure is reduced or lost, the
valves to close proportionally to the loss. Controlled gases are restricted
or shut down without affecting the oxygen flow.
Gas flow reductions are indicated on the flowmeters. When oxygen
supply pressure drops below about 37 psi, an oxygen supply pressure
alarm is activated, resulting in the following:
• The Caution message O2 SUPPLY LOW appears on the central
alarm display.
• The red O
SUPPLY PRESSURE indicator on the main switch
2
panel lights.
• An intermittent audible alarm sounds.
• A 7-second whistle may sound, depending on the machine’s
configuration.
NOTE: When one source of oxygen pressure (either pipeline or
reserve cylinders) fails, but the other source maintains proper
supply pressure in the oxygen supply lines, the oxygen supply
pressure alarms are not activated.
2-5
Section 2
General Description
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Flowmeters
Low-Flow Flowmeters
(Optional)
Minimum Oxygen
Flow
Flow Control Valves
Flowmeters, located directly above their corresponding flow control
valves, indicate the delivered flow rate of each gas in the fresh gas
mixture. Dual flowmeter tubes (fine and coarse) are used in tandem for
oxygen, nitrous oxide, and air (if provided). When other gases are
supplied, single flowmeter tubes are used. All flowmeters are color-coded
and labeled at the lower end of the flowtube. A typical flowmeter
arrangement is shown in the Flowmeter and Pressure Gauge Assembly
figure earlier in this section.
Each flowmeter has a float indicator. To determine the flow rate, read
the flowmeter scale at the center of the float.
For low-flow anesthesia, the Narkomed 2C can be configured with lowflow, dual-tube flowmeters for oxygen and nitrous oxide. These
flowmeters function the same way as the standard dual-tube flowmeters,
but they are calibrated to provide greater resolution for low-flow
anesthesia.
The oxygen dispensing system incorporates a calibrated bypass flow of
150 ±50 ml/min (at 50 psi pipeline pressure), which delivers this volume
of oxygen even if the oxygen flow control valve is fully closed.
A needle valve is located below the fine flowmeter tube for each gas.
This valve is used to adjust the flow of gas. Turning the valve knob
counterclockwise increases flow. Turning the knob clockwise decreases
flow. A zero-stop prevents damage to the flow control valve seats. If
necessary, a North American Dräger qualified technical service
representative can readjust the stop.
2-6
Each flow control knob is identified by its color code and chemical
symbol. The oxygen flow control valve is also touch-coded with a deeply
fluted knob.
CAUTION: The flow of oxygen cannot be completely shut off (see
“Minimum Oxygen Flow” earlier in this section). Do not
force the oxygen flow control knob in an effort to shut off
the minimum flow. Forcing the knob can damage the valve
seat.
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Section 2
General Description
Oxygen Flush
Oxygen Ratio
Controller (ORC)
A manually operated, self-closing oxygen flush valve is located on the
front of the machine. A bezel is mounted around the pushbutton to
prevent accidental engagement. When the valve is actuated, it delivers
an unmetered oxygen flow of approximately 55 l/min directly to the
Narkomed 2C’s fresh gas common outlet. The SYSTEM POWER switch
does not have to be in the ON position to use the oxygen flush.
The ORC is a pneumatic oxygen/nitrous oxide interlock system designed
to maintain a fresh gas oxygen concentration of 25 ±4% and independent
control of the oxygen and nitrous oxide flows.
The ORC works by proportionally limiting the nitrous oxide flow
whenever the selected oxygen and nitrous oxide flow control valve
settings would otherwise result in a hypoxic fresh gas mixture. For
example, if you open the nitrous oxide flow control valve excessively
without making a corresponding increase in the oxygen flow control
valve setting, the flow of nitrous oxide will not increase even though its
flow control valve setting has been greatly increased. Similarly, if you
decrease the oxygen flow without also decreasing the nitrous oxide flow,
the nitrous oxide flow will automatically drop in proportion to the
oxygen flow.
WARNING: In circle systems, the gas mixture in the patient circuit is
not necessarily the same as that in the fresh gas flow. This
is particularly true at low fresh gas flow rates when the
patient rebreathes a significant portion of previously
exhaled gases. It is important that the gas mixture in the
patient circuit be monitored and that the fresh gas flow is
adjusted to meet the requirements of the patient as well as
to compensate for patient uptake, any system leakage, or
any gas withdrawn through sample lines and not returned.
WARNING: The ORC interlocks only the flows of oxygen and nitrous
oxide. Hypoxic fresh gas concentrations are possible if
carbon dioxide is used as an additional gas.
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Section 2
(
)
General Description
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Fresh Gas Outlet
The fresh gas outlet delivers the fresh gas mixture (consisting of oxygen,
nitrous oxide, optional gases, and vapors of a liquid anesthetic) to the
patient breathing system. It is located on the front of the anesthesia
machine.
The outlet’s 15 mm cylindrical female fitting is designed to accept a
15 mm male fitting on the absorber fresh gas hose. The male fitting
slides into a retaining slot in the spring-loaded safety locking bar to
prevent inadvertent disconnection of the fresh gas hose. The 15 mm
male fitting on the fresh gas hose is unique to North American Dräger
design, and should not be replaced by a hose from any other
manufacturer.
TABLETOP
FRESH GAS
OUTLET
O2 FLUSH
CONTROL
FRESH
GAS
HOSE
OP10011
RELEASE TO
L
K
HANDLE
FRESH GAS
LOCKING BAR
EXTENDED POSITION
2-8
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Section 2
General Description
Fresh Gas Outlet
(Canada)
The fresh gas outlet delivers the fresh gas mixture (consisting of oxygen,
nitrous oxide, optional gases, and vapors of a liquid anesthetic) to the
patient breathing system. It is located on the front of the anesthesia
machine.
The outlet has a dual fitting for using gas hoses with these fittings:
• a 15 mm male fresh gas hose fitting, such as those supplied with
North American Dräger absorbers and Bain circuit adapters.
When using a 15 mm fitting, place the spring-loaded locking bar
over the male fitting to secure it to the female fitting.
• a 22 mm female fitting with a load-bearing threaded mount, such
as the ones for Magill circuits or ISO-type nonrebreathing
adapters. When using an ISO-type nonrebreathing adapter,
swing the spring-loaded locking bar to the side to gain access to
the threaded load-bearing fitting.
TABLETOP
O2 FLUSH CONTROL
FRESH GAS
HOSE
RELEASE TO
LOCK
HANDLE
FRESH GAS
LOCKING BAR
OP10012
2-9
Section 2
General Description
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Fresh Gas Oxygen
Sensor Adapter
The optional fresh gas adapter allows the Narkomed 2C to monitor the
fresh gas oxygen concentration when using a nonrebreathing circuit
(other than a Bain circuit). The fresh gas adapter fits securely into the
fresh gas outlet of the anesthesia machine. It has a port for an oxygen
analyzer sensor and a fitting for a nonrebreathing circuit.
FRESH GAS
OUTLET
OXYGEN
SENSOR
FRESH GAS
LOCKING BAR
(EXTENDED POSITION)
15MM MALE
FITTING
ADAPTER
STEM
OXYGEN
SENSOR PLUG
OP20997
FRESH G A S HOSE
BARBED FITTING FOR
NON-REBREATHING
GAS CIRCUIT
OXYGEN SENSOR PORT
WARNING: The fresh gas oxygen sensor adapter measures the fresh
gas oxygen concentration, not the inspiratory oxygen
concentration. Depending on the fresh gas flow and the
respiratory minute volume, the inspiratory oxygen
concentration may be lower than fresh gas oxygen
concentration due to rebreathing of previously exhaled
gases.
2-10
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Section 2
General Description
Auxiliary Oxygen
Flowmeter (Optional)
Vaporizers
Exclusion System
Filling Systems
For the delivery of a metered flow of pure oxygen (for example, delivery
of oxygen through a nasal cannula), an optional auxiliary oxygen
flowmeter can be mounted on the left side of the flowmeter bank. This
flowmeter can be used when the machine is turned off. A zero-stop
prevents damage to the flow control valve seat.
The Narkomed 2C can be equipped with up to three Vapor 19.1
vaporizers for administering liquid anesthetics.
A cam and lever interlock system, incorporated into the vaporizer bank,
prevents more than one vaporizer from being activated at a time. The
interlock system requires all unused vaporizers to be locked in their
zero-volume percent positions.
WARNING: Only one vaporizer can be activated at a time. If the
exclusion system permits simultaneous activation of more
than one vaporizer, do not use the anesthesia machine.
Contact a North American Dräger qualified technical
service representative for adjustment.
Two filling systems are available for the Vapor 19.1 vaporizer the open
funnel system and the key-indexed safety system.
OPEN FUNNEL FILLER
OP10603
KEY INDEXED
SAFETY SYSTEM
2-11
Section 2
General Description
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Absorber
The absorber is a dual-canister system for absorbing exhaled carbon
dioxide in the rebreathing circuit of the anesthesia machine. It has an
adjustable pressure limiter (APL) valve, a breathing system pressure
gauge, a fresh gas line, and connections for sensing breathing pressure,
respiratory volume, frequency, and oxygen concentration.
OXYG EN SENSO R
INSPIRATORY
VALVE
RESPIRATORY VOLUM E SENSOR
(ULTRASONIC FLOW SENSO R)
EXPIRATORY VALVE
PEEP BYPASS
CONTROL
APL VALVE
PEEP VALVE
(O P T IO N A L )
ABSORBENT
CANISTER
FRESH G AS
HOSE
DUST CUP
O P 98103A
MANUAL/
AUTOM ATIC
SELECTOR
VALVE
BREATHING
SYSTEM
PRESSURE
GAUGE
BREATHING
BAG M OUNT
CANISTER RELEASE LEVER
2-12
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Section 2
General Description
The absorber system permits spontaneous, manually assisted, or
automatic ventilation of the patient. The absorber incorporates a
manual/automatic selector valve, which allows you to select either
manual or automatic ventilation. An absorber with a positive endexpiratory pressure (PEEP) valve is also available.
WARNING: Waste gas scavenging systems used with North American
Dräger absorber systems must have safety features to
ensure that excessive subatmospheric pressure (lower than
-0.5 cmH
+0.5 cmH
O) and excessive positive pressure (higher than
2
O) are not possible at the connection point.
2
Inspiratory and
Expiratory Valves
The inspiratory and expiratory valves control the direction of gas flow in
the absorber system. The inspiratory valve is labeled INSPIRATION and
the expiratory valve is labeled EXPIRATION.
The valves are unidirectional, permitting gas flow in one direction only:
• The inspiratory valve allows gas to flow toward the patient only,
with no backflow to the absorber.
• The expiratory valve allows gas to flow into the absorber only,
with no backflow to the patient.
The valves are not interchangeable. They must be connected to the
correct mounts for proper flow direction through the absorber system.
Different size mounting threads on each valve prevent connecting a
valve to the wrong mount.
WARNING: Do not use the inspiratory or expiratory valves if:
• the pins in the plastic valve domes or in the valve
bodies are bent, damaged, or missing,
• valve disks are missing or damaged,
• valve seat is damaged.
2-13
Section 2
General Description
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Canisters
Dust Cup
Breathing System
Pressure Gauge
Each absorber unit has two transparent plastic canisters that house the
absorbent. The absorbent soda lime or barium hydroxide lime can be
purchased in either loose granular or prepacked cartridge form. The
canisters are interchangeable.
A removable, transparent plastic cup below the bottom assembly collects
absorbent dust and excess moisture that could cause increased flow
resistance in the system.
The absorber system is equipped with a pressure gauge for quick visual
checks of breathing circuit pressure. The gauge is marked for
measurements from -20 to +80 cmH
O in increments of 2 cmH2O.
2
WARNING: You must frequently observe the breathing system
pressure gauge to ensure adequate pressure buildup and
relief, regardless of the mode of operation.
2-14
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Section 2
General Description
Bain Circuit
Adapters
Absorber Mount
Two types of Bain circuit adapters are available. One mounts to the
absorber. The other mounts to the absorber pole.
The absorber-mounted Bain circuit adapter mounts on the
manual/automatic selector valve of the absorber system. The adapter has
an adjustable pressure limiter (APL) valve, a breathing pressure gauge,
a quick-connect fitting for the breathing pressure pilot line, a port for
the oxygen sensor, a 15/22 mm port for nonrebreathing circuits, and a
connector for the breathing bag.
APL VALVE
CONTROL KNOB
OXYG EN
SENSO R
22M M
M/15MM F
EXPIRATIO N
TER M IN A L
BREATHING PRESSURE
PILO T LIN E
Q U IC K -C O N N E C T F IT T IN G
BAIN
CIRCUIT
BAIN CIRCUIT
HO SE BARB FOR
FRESH G AS HO SE
BREATHING
BAG
FRESH G AS
HOSE
O P 21036
BREATHING
PRESSURE G AUG E
MANUAL/AUTOM ATIC
SELECTOR VALVE
OXYG EN SENSO R
PORT CAP
2-15
Section 2
General Description
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Pole Mount
The pole-mounted Bain circuit adapter mounts on the absorber pole. A
positive end-expiratory pressure (PEEP) valve is optional.
OXYG EN
SENSO R
BREATHING
PRESSURE
PILO T LIN E
BAIN
CIRCUIT
BAIN
CIRCUIT HOSE
BARB FOR FRESH
GAS HO SE
PEEP CO NTROL
KNO B (OPTIONAL)
PEEP BYPASS CO NTRO L
(O P T IO N A L )
BREATHING SYSTEM
PRESSURE G AUG E
19 MM SCAVENG ER
HOSE
22M M VENTILATO R
HO SE
MANUAL/AUTOMATIC
SELECTOR VALVE
APL VALVE
SET SCREW
MOUNTING
STUD
O-RING
ABSORBER POLE
FRESH G AS HOSE
BREATHING
BAG M OUNT
O P 00200
2-16
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Section 2
General Description
Scavenger Systems
Open Reservoir
Scavenger
The Narkomed 2C can be equipped with two kinds of scavenger systems,
for the best match with the hospital’s waste gas disposal system.
The open reservoir scavenger is used with suction (vacuum) waste gas
disposal systems. This scavenger is an “open” system with continually
open ports for positive and negative pressure control.
LOCK NUT
VACUUM
DISS HOSE
TERMINAL
NEEDLE
VALVE KNOB
19MM
SCAVENGER
HOSE TERMINAL
THREADED
INPUT
PORT CAP
19MM
SCAVENGER
HOSE TERMINAL
RELIEF
PORT
OP75121
FLOWMETER
RESERVOIR
CANISTER
2-17
Section 2
General Description
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Scavenger Interface
for Passive Systems
The scavenger interface for passive systems is used with
nonrecirculating HVAC systems (also called exhaust systems). This
scavenger is a “closed” system with a spring-loaded valve for positive
pressure relief.
WARNING: Do not use this device with a waste gas disposal system
capable of applying a negative pressure to the scavenger
interface (a suction or vacuum waste gas disposal system).
SAFETY RELIEF
VALVE, SHOWN
CLOSED
WASTE GAS
INPUT PORT,
19MM HOSE
TERMINAL
WASTE GAS
INPUT PORT,
19MM HOSE
TERMINAL
2-18
INPUT
PORT CAP
OP76131
WASTE GAS EXHAUST PORT,
19MM HOSE TERMINAL
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