NORTH AMERICAN DRÄGER Cicero User manual
Cicero EM
Integrated Anaesthetic Workstation
Instructions for Use
Software-Versionen:
Ventilator: ................. 6.n/7.n
Monitor:.................... 4.n
23529278
Working with these Instructions for Use
Each page is organized according to the following
principles:
At the top – the subject ...
of the main chapter as listed in the Overall Contents
on page 3.
It is always contained in a headline and printed in
bold type at the beginning of the chapter.
Xxxxxxx Yxxxxxxxxx
Xxxxxxxxx
● Xxxxxxxxxxxxxxxxxxxxxxxxxxxx:
Xxxxxxxxxx: Vxxxxxxxxx?
Xxxxxxxxxxxxx: Hxxxxxxx ?, Fxxxxxxx ?, Dxxxxxx ?
Xxxxxxxxx: Sxxxxxxxxxxxxx ?
Xxxxxxxxxx Xxxxxxx xxxxxxxxxxxxxxx
1 Xxxxxxxxxxx Xxxxxxxxxx xxxxx -
● Xxxxxxxxxxxxx XXXXXXXXXX cccxxxxxxxxxxxxx xxxxx x
2 Xxxxxxxxxxxxxxxxxx xxxxxxxxx (X xxxxxxxxx).
1
2
Left-hand column – the text ...
contains explanations, prompts the user to do
something and describes the machine's response.
The dots and numbers refer to actions, while the
numbers also draw attention to details in the
illustrations supplementing the text.
The numbering starts anew on each page.
Xxxxxxxxxxxxxxxxxxx
● Xxxxxxxxxxxxxxx xxx Xxxxxxxxxxx xxxxxxxxx xxxxxxxx -
● Xxxxxxxxxx - xxxxxx xxxxxxxxxxxx ! - xxx xxx Xxxxxxxxxx
xxxxxxxxxxxx xxxxx !
● Xxxxxxxxxx xxxxxxxx xxxxxx xxx xxxxxxxxx Xxxxxxxxxx xxxxxx
xxx xxx Xxxxxxxxxxxxx:
– xxxx. –
(xxxxxxxx X xxxxxxxx Xxxxxxxxxxx)
● Xxxxxx xxxxxxxxx xxxx xxxxxx Xxxxxxx xxxx Xxxxxxxxx.
● Xxxxxx xxx Xxxxxxx xxx Xxxxxxxx xxxxxxxxxx.
O2-Xxxxxxx
● Xxxxxxxxxxxxx xxx Xxxxxx xxxxxx xxxxxcxxx !
Xxxxxxxx xxx xxx Xxxxxxxxxxxxxxx xxx Xxxxxxxx xxxxxxxx -
● xxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxx
Xxxxxxxxx xxxxxxxxx
● Xxxxxxxxxxxx xxxxxxxx
3 Xxxx xx Xxxxx xxx xx Xxxxx xxxxxxxxxx xcxxxxxxxx - xxx xxx
Xxxxxxxcxx -
xxxxxx Xxxxxx Xxxxxxxxxxxxxxx xxxxx xxxxxxxxxxxxxx !
● Xxxxxxxxxxxxx xx Xxxxxxxx xxxxx xxx xxxxxxxxxxxxx
4 Xxxxxxxx xxx xxx Xxxxxxxxxxx xcxx xxxxxxx xxxxxxxxx
(xxxxxxxxxxxx) -
XYZ
Gasversorgung Flow O
Funktion Umschalter Air/N
ORC Flow N
O2-Flush Strömungsgeräusch, Beutel füllt sich
11:59
06.12.98
00:00
Pleth
Checkliste Cicero EM
Vor jeder Benutzung vom Anwender zu prüfen
Vapor Nullstellung
Füllung
Zeit seit letzter Inspektion 6<Monate
Sicherheitsfüllvorrichtung Verschlußschieber
eingeschoben und festgezogen
Stecksystem Adapter liegt gleichmäßig auf
Verriegelt
Narkosegasfortleitung Schauzeichen grün
Atemsystem Fester Sitz und vollständig
Atemkalk Kalk erneuert, kein Farbumschlag
Notbeatmungsbeutel Funktion gewährleistet
Zentralversorgung (ZV) Druck O
, Air, N2O > 2,7 bar
2
Reservegasflaschen Druck O
, Air > 50 bar
2
Sekretabsaugung Unterdruck vorhanden
, Air, N2O vorhanden
2
O gewährleistet
2
2O sinkt proportional mit Flow O2
Cicero nach Checkliste o.k ? Bitte bestätigen
3
4
Test-
Abbruch
Right-hand column - the illustrations ...
make it easier to locate the various parts of the
equipment.
Details mentioned in the text are highlighted in
bold type or coloured black.
Overall contents
For your safety and that of your patients 4
Intended use 5
Emergency Quick-Start 6
Operating concepts 9
Preparing for use 15
Anaesthesia ventilation 31
System screen functions 45
Parameter Box 85
Notes
Power failure
Gas failure
Master switch
Ventilator operating concept
Monitor operating concept
Power supply
Compressed gas supply
Connecting external equipment
Checking workstation with checklist
Spontaneous breathing/manual ventilation
IPPV mode
SIMV mode
PCV mode
Paediatric use
Changing patients
After use
Basic screen configuring
Monitoring functions in operation
Alarm concept
Function keys and indicators
Measurement functions
Messages - Cause - Remedy 99
Care 117
Checking readiness for operation 131
Location of valves and subsystems
Warning, caution and advisory messages
Stripping down machine
Disinfection, cleaning and sterilization
Disposing of throw-away articles
Re-assembling machine
Checking machine functions
Maintenance intervals
What's what 139
Technical data 151
Descriptions 163
Machine functions
Operation of the ceiling version
Abbreviations and symbols 189
Index 191
3
For your safety and that of your patients
For your safety and that of your
patients
Strictly follow the Instructions for Use
Any use of the apparatus requires full understanding and
strict observation of these instructions. The apparatus is
only to be used for purposes specified here.
Maintenance
The apparatus must be inspected and serviced regularly
by trained service personnel at six monthly intervals (and
a record kept).
Repair and general overhaul of the apparatus may only be
carried out by trained service personnel.
We recommend that a service contract be obtained with
DrägerService and that all repairs also be carried out by
them. Only authentic Dräger spare parts may be used for
maintenance.
Observe chapter "Maintenance Intervals".
Accessories
Do not use accessory parts other than those in the order
list.
Liability for proper function or damage
The liability for the proper function of the apparatus is
irrevocably transferred to the owner or operator to the
extent that the apparatus is serviced or repaired by
personnel not employed or authorized by DrägerService
or if the apparatus is used in a manner not conforming to
its intended use.
Dräger cannot be held responsible for damage caused by
non-compliance with the recommendations given above.
The warranty and liability provisions of the terms of sale
and delivery of Dräger are likewise not modified by the
recommendations given above.
Dräger Medizintechnik GmbH
Not for use in areas of explosion hazard
This apparatus is neither approved nor certified for use in
areas where combustible or explosive gas mixtures are
likely to occur.
Safe connection with other electrical equipment
Electrical connections to equipment which is not listed in
these Instructions for Use should only be made following
consultations with the respective manufacturers or an
expert.
4
Intended Use
Intended use
Integrated anaesthetic workstation
»Cicero EM« with system monitor
Universally applicable, integrated anaesthetic workstation
for
– Inhalation anaesthesia for adults, children and
neonates.
– Inhalation anaesthesia in semi-closed to virtually
closed systems with »low flow« and »minimal flow«
techniques (for minimum gas and anaesthetic
consumption).
– Automatic ventilation (IPPV).
– Synchronized intermittent mandatory ventilation
(SIMV).
– Pressure-controlled breathing (PCV) in the PCV
ventilator.
– Manual ventilation (MAN).
– Spontaneous breathing (SPONT).
– Automatic anaesthetic agent recognition.
The following information is displayed in colour on the
system monitor:
– Airway pressure and temperature
– Inspiratory O2 concentration
– Expiratory tidal volume
– Patient compliance
–CO2 and anaesthetic concentration at the Y-piece
– Fresh gas balance
together with the main haemodynamic parameters
monitored with the parameter box:
– ECG curve with heart rate and ST segment analysis.
– The real-time curve of the invasive blood pressure
(iBP) in two channels, with the systolic, diastolic and
mean pressure values.
– The values of the non-invasive blood pressure (NiBP)
with the systolic, diastolic and mean pressure values.
– The body temperature in two channels.
– The functional O2 saturation (SpO2) with the pulse
rate.
– The plethysmogram.
Other accessories (optional)
Vapor*)
Anaesthetic vaporizer for enflurane, isoflurane, halothane
and sevoflurane.
Connection for two Vapor vaporisers*)
Devapor*)
Anaesthetic vaporizer for desflurane.
Anaesthetic gas scavenging system*)
Uninterruptible power supply*)
Passive air conditioning*)
Heated breathing hoses.
pEEG*)
Notes on operation
Only non-flammable anaesthetic agents conforming to
EN 740 may be used. Risk of fire!
Since this apparatus is not approved for use with
inflammable anaesthetics (ether, cyclopropane, etc.),
it is not necessary to use antistatic (conductive) breathing
hoses or face masks.
Conductive breathing hoses and face masks may cause
burns during high-frequency surgery and are therefore
not recommended for this apparatus.
Any additional electrical equipment which is latched
onto the top of the workstation must also be connected to the base unit by means of an equipotential
bonding conductor!
Electromagnetic fields exceeding the limits specified
in EN 60601-1-2 may interfere with the operation of
the device and therefore put patients at risk.
Mobile radio telephones must not be used within
10 metres of the workstation!
Cicero EM must not be used with magnetic resonance
tomography (MRT, NMR, NMI).
The workstation should only be moved by the handles!
Always operate the device under the supervision of
qualified medical personnel in order to obtain prompt
assistance in the event of malfunction.
Retrofitting in different devices
The software described in these Instructions for Use, in
combination with the »Cicero EM«, has passed a conformity
evaluation procedure conforming to 93/42/EEC (medical
appliances); the corresponding conversion kits therefore
bear the C mark of conformity.
The conversion kit can also be installed in the »Cicero EM
color« even if the unit itself does not bear the C symbol,
because the conformity evaluation procedure has confirmed
the suitability of the product for this type of device.
*) Refer to the separate Instructions for Use for this equipment.
5
Emergency Quick-Start
Emergency Quick-Start
Press the master switch (1)
– The pressure gauges (2) are in the green zone.
– All lamps on the ventilator light up.
Press a function key on the ventilator
Recommendation: Press and hold down
longer than 1 second.
– The message »Test interrupted« is displayed.
For devices without PCV mode (software 6.n):
M
key for
D
I
O
MAN
SPONT
IPPV
SIMV
PCV VT
2
Gas/Power
ON / I
Press
1
001292780022927800329278
TEST
Pmax
PPCV
fIPPV TI:TE
TIP:TI
fIMV
PEEP
Flow
O
Deliver fresh gas
– With the delivery valve buttons (3) under the
measuring tubes
– If necessary fill the system rapidly with the O2
flush (4).
– The manual ventilation bag should fill.
Set the APL pressure limiting valve (5) to »MAN«
Set maximum pressure
– Turn the valve head (6) until the disc is at the
desired maximum pressure.
6
5
6
MAN
SPONT
IPPV
max
P
SIMV PCV VT
PPCV
O2
4
3
fIPPV TI:TE
AIR
Lecktest ?
TIP:TI
Flow
PEEP
TEST
fIMV
Notes on Quick Start
The Quick Start procedure is permitted a maximum of
10 times in succession, and only if the previous (full) selftest was completed without error.
Emergency Quick-Start
Otherwise, the display on the ventilator and the system
screen instruct the user to run through the complete selftest.
Manual ventilation remains possible under all conditions!
● Quick Start can also be triggered by the »Cancel
Test« softkey.
● Quick Start can be triggered at any time, even during
a self-test.
If there is a power failure (manual ventilation is
possible)
Make sure that the master switch is pressed down
– The acoustic power failure warning is muted after
30 seconds.
Deliver fresh gas - set APL valve
– If required, press the O2 flush button (»O2 +«).
Note: If there is a power failure, the piston of the
ventilator is pushed to its end position by the
airway pressure. This increases the system volume
by a maximum of 1.4 litres.
06-12-98
16:47
00:00
Self-test
Self-test cancelled
cancel
test
00429278
If there is a gas failure
In case of AIR failure (medical air)
– The system automatically switches over to O2
supply.
In case of O2 failure
– The system automatically switches over to the
AIR supply. An acoustic alarm is sounded (O2
shortage signal). The supply of N2O is disabled.
If both O2 and air fail
The patient must immediately be ventilated with the
separate emergency ventilation bag!
7
8
Operating concepts
Page
Master switch.......................................................... 10
Ventilator operating concept .................................. 10
Monitor operating concept ..................................... 12
9
A
Operating concepts
Ventilator operating concept
Ventilator operating concept
Master switch for power and gas
1 Press to switch on. The switch clicks into position.
2 Turn clockwise to switch off.
Hardkeys –
for setting the operating modes
»MAN / SPONT« key
for manual ventilation or spontaneous breathing.
»IPPV« key
for IPPV mode.
»SIMV« key
for SIMV mode (see illustrations for the specific
ventilator versions)
»PCV« key
for PCV mode (for PCV ventilator).
»TEST« key
for leakage test and compliance measurement.
D
I
O
D
Gas/Power
ON / I
Press
1
2
005292780062927800729278
Standby key.
for setting ventilation parameters
Below the display window:
»Pmax / PPCV« key
for setting the maximum pressure for IPPV and
SIMV ventilation.
The same key is used in PCV mode to set the
plateau pressure.
»VT« key for setting the tidal volume.
»IPPV« key
for setting the ventilation frequency in IPPV
mode.
»TI : TE« key
for setting the time ratio between inspiration
and expiration.
»TIP : TI / Flow« key
for setting the relative inspiratory pause for
IPPV and SIMV ventilation.
Ventilator with PCV
MAN
SPONT
IPPV
P
max
SIMV PCV VT
PPCV
fIPPV TI:TE
TIP:TI
Flow
Ventilator without PCV
MAN
SPONT
IPPV
Pmax VT
fIPPV TI:TE
TIP:TI PEEP
TEST
fIMV
PEEP
fIMV
O
TEST
SIMV
O
00729278
The same key is used in PCV mode to set the
inspiratory flow.
»PEEP« key
for setting the PEEP pressure for IPPV mode.
»fIMV« key
for setting the ventilation frequency in SIMV
mode.
10
Display window with dialogue function
(in combination with the rotary control)
Example: adjusting the maximum pressure
In the black field, beside the rotary control:
Operating concepts
Operating concept of ventilator
1 The set value appears on the right and left-hand sides
of the field when a parameter key (Pmax, VT, fIPPV) is
pressed. Here: »23«.
2 The value on the right-hand side is changed by
turning the rotary control. Here: »28«.
The old and new values are consequently always
displayed together.
3 The value on the right (»28«) is confirmed as the
definitive value by pressing the control.
If the rotary control is not pressed and not turned again,
the machine is reset after 10 seconds without changing
the setting.
● This dialogue window also displays advisory
messages (see page 100) –
Example »Infant hoses«:
1
23 Pmax / mbar 28
2
3
MAN
SPONT
IPPV
PCV VT
SIMV
fIPPV TI:TE
Kinderschlaeuche
TIP:TI
PEEP
Flow
fIMV
Pmax
PPCV
TEST
O
Infant hoses
0082927800929278010292780112927801229278
Display window without dialogue function
Top left:
Continuous indication of the relative piston movement
(in % referred to the set stroke volume VT).
The set operating parameters correspond with the keys
below:
– Indication of the maximum pressure Pmax in mbar.
– Indication of the tidal volume VT in mL or L.
– Indication of the ventilation frequency fIPPV in
breaths per minute.
0% 100%
23
600
12
mbar ml/L 1/min
Pmax
PPCV
VT
fIPPV
11
Operating concepts
Monitor operating concept
Monitor operating concept
Hardkeys
The right-hand side is reserved for operating elements,
the left-hand side for displays.
E
This key switches the system screen from standby
to measuring mode and vice versa.
The system screen mode depends on the
ventilator mode:
Standby can only be selected on the system
screen if the ventilator is also in standby.
The system screen starts up when the ventilator is
started.
G
This key is used to deactivate the alarm tone for
two minutes. It is reactivated by pressing the key
again. The yellow LED in the key lights up while
alarms are suppressed (see page 79).
During this period, any new advisory and caution
messages will not be audibly signalled but will
appear as text in the alarm fields. Only new
warnings will be signalled once by the appropriate
tone sequence.
Inside the dark area, there are four keys acting directly on
the screen contents:
S
This key is used to call up a menu of the available
display options on the system screen. Selection is
made by turning and pressing the rotary control
(see page 68).
Q
This key always calls up the last standard screen
used (see page 68).
s
This key is used to »freeze« the curves on the
display so that they can be viewed in more detail.
0132927801429278
U
This key is used to generate a manual entry in the
list screen (see page 70).
Indicators
Above the G key are two bar-shaped indicators that
indicate the alarm status even when the acoustic alarm
has been switched off.
Red (upper) flashing lamp Warning !!!
Yellow (lower) flashing lamp Caution !!
Yellow lamp constantly lit Advisory !
12
Softkeys
Operating concepts
Monitor operating concept
1 Beside the screen, on the right-hand side, there is
an unmarked touch-sensitive keypad.
2 The function of these keys depends on the software
and is indicated on the screen itself.
Only those keys which can be activated are actually
shown.
Pressing some of the softkeys or the screen selector
key S will open a menu.
The area where selections can now be made is
turquoise, and the cursor is a yellow rectangle.
● To select: Turn rotary control.
The cursor moves within the turquoise
area.
● To confirm: Press rotary control.
The selected function appears.
All menu levels are displayed in staggered arrangement.
Inactivated menus are grey. The selected menu item is
highlighted in black and white.
Standby / Configuration
iBP 1 function OFF ON
location ART
sensitivity 42.5 50
iBP 2 function OFF ON
location CVP
sensitivity 42.5 50
ECG
NiBP
iBP locations
iBP channels
SpO
/ Pleth
2
CO
/ O
2
2
pEEG
12
3
015292780162927801729278
alarms inactive !
Settings
mode adult neon.
alarm limits
parameter
screen
acoustic
list entry
transport
RS 232 (Medibus)
record (printer)
basic config.
Configuring the colours
3 Press the »Config« softkey.
4 Under »Settings«, select the option »Colours«.
● Select the desired parameter in the colour menu and
confirm.
● Turn the rotary control until the desired colour is
displayed and then confirm
Select a menu position. Please confirm !
11:59
Change the settings. Please confirm again !
00:00
IPPV alarm limits
Anesth. Agent Alarms Calibration Settings
mode adult neon.
alarm sound 1 2 3 4 5 6 7 8 9
pulse tone 0 1 2 3 4 5 6 7 8 9
pulse tone
source ECG Pleth.
colours
curve speed 12,5 25 50
mm/s
call standard
06-12-98
ART
AORTA
A.Pulm
ZVD
ICP
iBP ?
NiBP
EKG
SpO
/Pleth
2
Temp.
pEEG
CO
2
Flow
Paw
Hintergrund hell dunkel
Module
farbig ja nein
Wählen Sie mit dem Drehknopf einen Parameter aus. Bestätigen !
11:59
Wählen Sie die gewünschte Farbe. Bestätigen !
00:00
4
13
14
Preparing for use
Page
Electrical power supply........................................... 16
Equipotential bonding............................................. 16
Uninterruptible Power Supply................................. 17
Compressed gas supply ......................................... 17
Anaesthetic gas scavenging system ...................... 18
Anaesthetic vaporizer ............................................. 19
Connecting external equipment ............................ 19
Parameter box ........................................................ 20
Checking workstation with checklist...................... 21
Manual tests............................................................. 21
Check Vapor....................................................... 22
Check anaesthetic gas scavenging...................... 22
Check breathing system...................................... 23
Check soda lime ................................................. 23
Check emergency ventilation bag ........................ 23
Check piped medical gas supply ......................... 24
Check reserve cylinders (optional)....................... 24
Checking the secretion aspiration system ............ 24
Check gas delivery.............................................. 25
Check Oxygen Ratio Control (ORC).................... 25
Check O
2 flush ................................................... 25
End of manual test according to checklist ................. 25
Self-test................................................................... 26
Semi-automatic part of the self-test........................... 26
Automatic self test.................................................... 27
Fresh gas outlet (option).......................................... 29
15
Preparing for use
Electrical power supply
Equipotential bonding
Preparing for use
The device must be correctly prepared and checked
before every use!
Connecting the electrical power supply
The mains voltage must be within the voltage range
specified on the nameplate on the back panel.
1 Plug the power plug into the wall socket.
Auxiliary mains sockets:
2 Sockets for additional devices that are switched on
and off with the master switch.
(3 sockets. Maximum current per socket: 2 A)
The sum of the derived current in the mains line must not
exceed 500 µA (IEC 601/1).
Equipotential bonding
(e.g. for intracardial or intracranial operations)
3 Connect one end of the earthing cable to the terminal
stud on the back panel.
● Connect the other end to the equipotential bonding
stud, e.g. on the operating table or ceiling lamps.
P
3
2
1
01829278
16
Uninterruptible Power Supply (optional, see
1
Instructions for Use of the UPS)
When the machine is powered by the UPS battery
during a mains power failure, no power is supplied to
the auxiliary sockets!
The Desflurane Vapor unit is powered by the side
connector for non-heating apparatus (No. 9 on page 140)
and will therefore continue to run as normal.
1 Plug the Cicero power plug into the socket of the
UPS.
2 Plug the UPS mains plug into the mains socket.
Preparing for use
UPS
Compressed gas supply
The UPS can supply the Cicero EM with electrical energy
for about 45 minutes. It is activated automatically in the
event of a power failure.
In the case of a ceiling unit, the auxiliary sockets are
not fitted.
Connecting the compressed gas supply
3 Screw hoses for O2, AIR and N2O into the rear of the
apparatus and plug connectors into the wall sockets.
Switch-on lock:
If the machine is switched on without pressure on the
O2 line, it is impossible to meter the other gases for
safety reasons!
S 3 S 4
F2 F2 F3 F4
g
S 5
S 6
USV - Ein / On
I
0
manuell
2
0192927802029278
3
4
»Pressure supply« appears on the ventilator.
● Connect O2 supply and confirm.
● Check that the supply pressure is adequate on the
pressure gauges on the front (pointers must be in the
green area).
4 Holder for anaesthetic gas scavenging. See next page
and separate Instructions for Use.
● If the machine is equipped with a vacuum bronchial
aspirator (option), a vacuum supply system must be
connected.
17
Preparing for use
AGS-system
Bronchial aspirator
Installing the anaesthetic gas scavenging
system:
● Hook the collecting system to the mount on the back
of the Cicero:
Place the slots of the receiving system over the
holders and slide the receiving system down.
See also "What's what" on page 146, No. 14.
Connecting the transfer hoses
1 Pass transfer hose from behind through the hole in
the Cicero EM and
2 connect the hose to the scavenging connector of the
breathing system (only on first installation - the hose
then remains on the connector).
3 Connect the transfer hose to the connector on the
receiving system.
● Make sure the connection is secure!
D
Detailed view
from below after
removing soda
lime container.
2
D
1
021292780222927802329278
4
4 Make sure that the connector for the second transfer
hose is sealed with a screw plug.
Do not plug the openings of the receiving system, otherwise the breathing system could be drained.
5 Connect the scavenging hose to the output connector
of the scavenging system.
6 Plug the connector of the scavenging hose into the
wall socket. The visual indicator shows »green«.
5
3
1
6
18
Preparing for use
Anaesthetic vaporizer
External equipment
Anaesthetic vaporizer:
– Only use the Vapors listed in the list of accessories!
– Note the separate Instructions for Use of the Vapor.
– Only use the Vapor intended for each anaesthetic
agent!
1 The fill plug must always be inserted and securely
tightened!
2 The thumbwheel must always be set to zero when
there is no fresh gas flow.
3 Vapor must always be secured by means of the
locking lever (set to the left-hand limit).
Connecting external equipment
Connection via the printer interface:
4 with a data cable for printers with serial interface,
such as:
3
2
0
Vol. %
1
0242927802529278
Deskjet (made by Hewlett-Packard)
This connector may also be used as an
RS 232 MEDIBUS interface.
● Equipment plugs must be secured with screws!
For interface configuration, see page 64.
Connection via the Dräger RS 232 MEDIBUS interface:
5 with data cable for standard PCs or other monitors.
● Equipment plugs must be secured with screws!
For interface configuration, see page 63.
After removing the outer back panel, the following
connections are accessible:
External screen
6 Any S-VGA-compatible screen can be connected.
External O2 sensor for inspiratory measurement:
7 Connect to the socket marked »O2«.
5
RS 232 C
RS 232 C
Vent.
4
Paw
CAN P-Box VGA extern VGA intern O2 Temp. / Spiro
6 7 8
P
m
*
Airway temperature sensor
8 Connect to the socket marked »Temp«.
19
Preparing for use
Parameter box
Fitting the parameter box
The parameter box can be operated either in the blue
holder or in the slot-in housing. The slot-in housing can
be mounted by Dräger Service on the left-hand side of
the Cicero EM.
The blue holder can be mounted by the user in any
position on a standard rail (10 x 25 mm).
In the blue holder, the parameter box can be tilted up and
down. In the slot-in housing its position is rigidly fixed.
In both cases, the synchronising output for an
external defibrillator is accessible from the rear.
Slot-in housing:
1 Push the parameter box straight into the slot-in
housing. The parameter box locks into position, and
the electrical connections are made.
To remove the parameter box, pull the blue handle on
the box to release the locking lever. The parameter
box can then be simply pulled out of the housing.
1
Cicero EM
D
0262927802729278025290940262909402729094
3
2
Blue holder:
2 Fix the blue holder in a suitable position.
3 Connect the cable of the mounting base to the
connector on the side of the Cicero EM.
4 Hang the parameter box onto the mount from above.
The plug connector must engage.
5 To remove, pull the blue handle on the parameter box.
The parameter box is released and can be taken out
of the blue holder.
6 Defibrillator connection.
Tilting the parameter box:
7 The parameter box can be swivelled up and down.
The parameter box is the central component of the
Dräger transport function. See the separate section in
these Instructions for Use, page 86.
6
4
5
7
20
Checking workstation with checklist
Manual tests:
After switching on, the apparatus runs through a self-test.
Preparing for use
Checking workstation with checklist
D
Prerequisites:
Machine is fully equipped -
Instructions for Use are familiar -
User has been instructed on using the machine -
Duration: approx. 5 minutes
Switching on:
1 Press the master switch.
(Combined master switch for gas and power)
The self-test starts
The user must first check:
On the ventilator:
– Indication of software version, all indicator lamps light
up for approx. 2 seconds. A single tone sounds.
– The message
»Self-test«
appears briefly in the display window.
The Ventilator display goes dark. No operations on the
ventilator are required during the self test.
On the screen:
– The internal program memories are tested. All LEDs
and display elements light up for approx. 2 seconds.
The LED in the standby key
E
remains lit.
I
O
D
Technology for Life
Cicero EM
Version 4.0
06-12-98
Self-Test
Gas/Power
ON / I
Press
1
00129278029292780302927803129278
– Two warning tones sound.
– A clock symbol uappears on the screen = duration
of self-test.
– The keys are still inactive.
Please wait!
Shortly afterwards:
– The checklist appears.
● Indication in user advisory field:
Is the Cicero EM o.k. according to checklist?
Please confirm!
● The user is consequently prompted to check the
points listed.
The equipment must be checked every time,
immediately before being used!
06-12-98
Self-test
In case of emergency: press any ventilator function key for quick startup
Check-list Cicero EM
To be verified by the user prior to each use
Vapor handwheel set to zero
fill - level ok
less than 6 months since last inspection
correctly seated and locked
Safety-fill plug secured in place
Gas scavenger operational
Breathing system complete, locked in place
Soda lime no colour change
Emergency breathing bag present, functional
Central gas supply all pressures greater than 2.7 bar
Backup cylinders all pressures greater than 50 bar
Suction functional
Gas delivery O
ORC N
O2-flush audible flow, breathing bag fills
11:59
00:00
2, Air, N2O present
2O flow changes proportionally to O2
Is the Cicero EM o.k. according to check-list ? Please confirm !
cancel
test
21
Preparing for use
Safety f
pug secu ed n p ace
Checking workstation with checklist
Check Vapor:
– Set the handwheel to »O«.
– Filling level OK?
– Last inspection less than six months ago?
Safety filler:
– The plug is inserted and secured.
Vaporiser mount:
– Vaporiser is correctly seated.
Locking mechanism:
– Plug-in system is locked (lever to the left as far as
possible).
Check-list Cicero EM
To be verified by the user prior to each use
Vapor handwheel set to zero
fill - level ok
less than 6 months since last inspection
correctly seated and locked
Safety-fill plug secured in place
0
Vol. %
0312927802429278031292780222927803229278
Check anaesthetic gas scavenging:
– Is indicator in wall socket green? (Only when using
Dräger systems; note sounds of gas flow in other
cases.)
– Hose connected to breathing system?
– Is the anaesthetic gas scavenging system correctly
installed?
– Are the two hoses fitted correctly?
– Are the vents open?
– Are all hoses free of kinks?
1 Is the transfer hose of the anaesthetic gas scavenging
system free of condensate? Drain if necessary.
Gas scavenger operational
Breathing system complete, locked in place
Soda lime no colour change
Emergency breathing bag present, functional
llll
D
1
22
Check breathing system:
Lift table top:
1 Lever set to the position shown in black.
Preparing for use
Checking workstation with checklist
Check completeness:
2 Valve discs inserted.
– Pressure limiting valve (APL) present.
– Inspiratory microbial filter (optional). Symbol:
– Expiratory microbial filter (optional). Symbol:
3 Pressure measuring hose with filter connected.
4 Measured gas return hose Symbol:
connected.
5 Hose with manual ventilation bag
present. (Connected from below;
not shown) Symbol:
– Correct breathing hoses connected.
(Adult or infant hoses)
6 Fresh gas hose connected.
(Connected from below; not shown)
Water trap (option)
7 Water traps are recommended in both the inspiratory
and the expiratory lines during prolonged anaesthesia,
low-flow anaesthesia and when using a humidifier.
1
03329278034292780352927803629278
3
2
4
APL
– Water traps must be fitted at the lowest point in the
hose and hang downwards.
– Check regularly and drain if necessary.
Observe hygiene regulations –
risk of infection !
The hose system remains sealed. The container must
be replaced securely!
Check soda lime:
8 Soda lime has not noticeably changed colour (purple).
– Filling level adequate (up to the mark).
– The absorber vessel must be screwed in (counter-
clockwise) as far as it will go.
Emergency ventilation bag:
(not shown)
– Bag is complete and hung from the side of the
Cicero EM.
– Bag functions correctly.
7
7
8
5
6
23
Preparing for use
2
Soda i
Checking workstation with checklist
Central medical gas supply
me no co our change
Emergency breathing bag present, functional
– The connectors have been pressed right into the wall
sockets for O2, AIR and N2O (not in holding
position!).
1 Pointers of all three pressure gauges are in the green
range.
Reserve cylinders (option)
2 Open cylinder valves.
Pressure indicator on O2 and AIR cylinders exceeds
50 bar?
Replace cylinders if not!
● Close cylinder valves (to prevent gas leaks).
Central gas supply all pressures greater than 2.7 bar
Backup cylinders all pressures greater than 50 bar
Suction functional
li
r
D
ir
r
1
0312927803729278
Checking the secretion aspirating system:
3 Negative pressure switch to »I«.
4 Set negative pressure to required intensity by means
of rotary control.
Seal the aspiration holes (or fold over the hose) and
5 Check negative pressure on pressure gauge.
3 Negative pressure switch to »O«.
If the negative pressure generated is insufficient,
● replace microbial filter in ejector system
(see »Maintenance intervals«, page 137 and
»What's what«, page 140, No. 11).
● Check adequate supply of compressed gas.
D
3 4
I
O
ON / I
Press
5
03829278
24
Check gas delivery
Preparing for use
Checking workstation with checklist
1 Switch over to »AIR«.
2 Open O2 and AIR delivery valves until the floats in the
measuring tubes indicate more than 9 L/min.
Open N2O delivery valve completely.
– Does N2O measuring tube indicate »O«?
1 Switch over to »N2O«.
– Does N2O measuring tube indicate more than
9 L/min?
Does AIR measuring tube indicate »O«?
Check Sensitive Oxygen Ratio Control (S-ORC)
2 Slowly close O2 delivery valve -
– check:
N2O indication decreases to »O« proportionally
with O2.
1 Switch over to »AIR«.
● Close N2O delivery valve.
Gas delivery O2, Air, N2O present
ORC N
O2-flush audible flow, breathing bag fills
2O flow changes proportionally to O2
31
O2
AIR N2O
031292780392927803129278
Check O2 flush
3 Press button »O2 +« –
– Is there a distinctly audible flow noise?
– Does the manual ventilation bag inflate?
End of manual test according to checklist:
– Confirm if all points are OK:
● Press rotary control on system screen.
Now the interactive part of the self-test begins (see
following page)
The following symbols are used:
? = Enquires whether an action has been performed
or a setting made.
06-12-98
Check-list Cicero EM
To be verified by the user prior to each use
Vapor handwheel set to zero
fill - level ok
less than 6 months since last inspection
correctly seated and locked
Safety-fill plug secured in place
Gas scavenger operational
Breathing system complete, locked in place
Soda lime no colour change
Emergency breathing bag present, functional
Central gas supply all pressures greater than 2.7 bar
Backup cylinders all pressures greater than 50 bar
Suction functional
Gas delivery O
ORC N
O2-flush audible flow, breathing bag fills
11:59
00:00
2, Air, N2O present
2O flow changes proportionally to O2
Is the Cicero EM o.k. according to check-list ? Please confirm !
2
cancel
test
u
= Waiting period. The selected test step is being
performed by the machine.
✔ = The action has been completed successfully.
25
Preparing for use
Self-test
As a basic rule, the general task to be performed is
specified in the centre field, and detailed operating
instructions to the user are given at the bottom of the
screen. The test begins with the question:
Fresh gas occluded?
● Close all delivery valves on the measuring block.
● Press rotary control to confirm.
Fresh gas occluded ?
Self-test
cancel
test
APL (Automatic Pressure Limitation) valve =
30 mbar?
● Flip the APL pressure limiting valve to »MAN«
and turn the valve head to set it to 30 mbar.
● Press rotary control to confirm.
Y-piece open?
● The Y-piece should be attached to the breathing
hoses and the patient connection should be open.
(For instance, it may be lying on the table.)
● Press rotary control to confirm.
● Wait a few seconds.
06-12-98
06-12-98
16:47
Occlude the fresh gas. Please confirm !
00:00
Self-test
automatic part
Hardware
Position of piston
16:47
Adjust pressure limitation valve (APL) to MAN position. Pressure setting 30 mbar.
00:00
Please confirm !
Self-test
automatic part
Fresh gas occluded ✓
APL (Automatic Pressure Limitation) valve = 30 mbar ✓
Y-piece open ?
040292780412927804229278
✓
cancel
test
26
06-12-98
16:47
Open the Y-piece. Please confirm !
00:00
cancel
test
Y-piece occluded?
1 Fit the patient connection of the Y-piece onto the
cone provided.
● Press rotary control to confirm.
– Additional internal tests requiring an occluded
Y-piece are then conducted by the ventilator.
The leakage test includes the measured gas sampling
and return lines. These lines must therefore be correctly
connected and not open-ended.
An open T-piece or open Luer lock will result in major
leakages!
Preparing for use
Self-test
1
0432927804429278 04529278
The automatic part of the self-test follows
immediately.
A list in the middle of the system screen shows, with
symbols, which points have already been completed,
with results if applicable, and which have still to be
carried out.
06-12-98
Self-test
automatic part
Hardware
Position of piston
16:47
Adjust pressure limitation valve (APL) to MAN position. Pressure setting 30 mbar.
00:00
Please confirm !
Self-test
automatic part
Fresh gas occluded ✓
APL (Automatic Pressure Limitation) valve = 30 mbar ✓
Y-piece open ✓
Y-piece occluded ?
✓
cancel
test
cancel
test
config.
06-12-98
16:47
Occlude the Y-piece. Please confirm !
00:00
27
Preparing for use
Self-test
Any faults found are immediately reported in the error
field and a brief note on action to remedy the fault
appears in the user advisory field.
The system stops until the user presses the rotary control
to confirm that the fault has been corrected.
DrägerService must be contacted in the case of faults
which cannot be remedied by the user (e.g. repeated
display of the same fault message or of a three-digit
service number).
Test result:
At the end of the test, all successfully tested items are
marked with a tick ( ✔ ). The measured values for IPPV
leakage and hose compliance are displayed.
Also, the entire sensor system is automatically selfcalibrated. No user intervention is needed.
During the leakage test, the expiration valve is tested for
leaks. If a leak is found, the corresponding fault message
is generated after the leakage test.
The fault must be remedied. The self-test must then be
restarted by pressing the rotary control!
The system switches to »Standby« when the self-test
has been completed successfully.
It is now ready for operation and the illumination of the
flow measuring tubes go out.
Self-test
automatic part
Hardware ✓
Position of piston ✓
Operating pressure ✓
Valve and rolling diaphragm ✓
Leakage IPPV ?
Hose-compliance ?
Self-test
automatic part
Hardware
Position of piston
Operating pressure
Valve and rolling diaphragm
Leakage IPPV 12 ml/min
Hose-compliance 2.5 ml/mbar
✓
✓
✓
✓
Breathing system valves
Standby
Cicero EM
Ventilator
SW-Version 7.n
06-12-98
Leak found in expiratory valve.
Remedy the fault indicated and restart self-test by pressing the rotary control.
Data Manager
SW-Version 4.n
06-12-98
Parameterbox
SW-Version 2.n
06-12-98
cancel
test
04629278047292780482927804929278
✓
cancel
test
leakage
test
delete
trend
config.
»Standby« means that:
– The system can immediately be switched to any
operating mode.
– Gas consumption is zero.
– Power consumption is marginal.
– The piston pump is in withdrawal position.
Manual ventilation is not possible in standby mode!
Any attempt to undertake manual ventilation in standby
mode is immediately detected and causes the system
to start operation in MAN/SPONT mode.
(»Auto-WakeUp« function).
The system should be switched off completely and not
left in »Standby« if it is not required for several hours.
In »Standby«, the screen is switched to screen-saver
mode after one minute if there are no further user inputs.
It is reactivated automatically whenever a key is pressed
or the rotary control turned.
Standby
Cicero-EM
Ventilator
SW-Version 7.n
06-12-98
Select ventilation mode at the ventilator or switch on screen by
Data Manager
SW-Version 4.n
06-12-98
Parameterbox
SW-Version 2.n
15-12-98
1
leakage
test
delete
trend
config.
28
Fresh gas outlet (option)
Preparing
1 Fit the hose of the semi-open system (e.g. Mapleson
system) to the external fresh gas outlet, and connect
the anaesthetic gas scavenging hose.
● Perform self-test in conformity with the Cicero EM
Instructions for Use.
2 Set the desired O2 and N2O flows at the flowmeter
block.
3 Press »MAN SPONT« on ventilator for at least
1 second (or press the key and confirm with the rotary
control. Setting by Dräger Service).
4 The lamp in the »FRESH GAS OUTLET« key does not
light up.
● Check that pressure is building up in the circle system.
4 Switch on the fresh gas outlet –
Press »FRESH GAS OUTLET« key.
The lamp in the key lights up.
● Check that pressure builds up in the semi-open
system.
D
Preparing for use
Fresh gas outlet
2
fIPPV TI:TE
Cicero EM
TIP:TI
fIMV
PEEP
Flow
TEST
O
4
3
MAN
SPONT
IPPV
Pmax
SIMV
PCV VT
PPCV
1
0502927805129278
Operation
Only available in »MAN/SPONT« mode
3 Press »MAN SPONT« on ventilator for at least
1 second (or press the key and confirm with the rotary
control. Setting by Dräger Service).
4 Switch on the external fresh gas outlet –
Press »FRESH GAS OUTLET«
The lamp in the key lights up.
The circle system is switched off.
● Perform anaesthesia ventilation using the external
fresh gas outlet.
● When switching over to another mode, e.g. IPPV, the
circle system is automatically switched on again. The
external fresh gas outlet is then closed.
5 Monitoring the breathing gas (O2 and anaesthetic
gases) in semi-open mode with the sample
measurement at the mask manifold of the semi-open
system in HLM screen mode.
Pressure and flow are not monitored.
When switching on and in the event of a power
failure lasting longer than 2 minutes, Cicero EM
switches automatically to the circle system.
5
29
30
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