NORTH AMERICAN DRÄGER Drager Narkomed 2C User manual

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Operator’s Instruction Manual

Part Number: 4112258-018

Rev: C

Date: 30 September 1999

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

Narkomed 2C Operator’s Instruction Manual

Table of Contents

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

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

iii

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.

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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.

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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.

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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.

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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

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.

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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

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.

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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

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.

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1000

900

800

700

600

500

400

300

200

100

900

800

700

600

500

400

300

200

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

AIR O

N2O

PIPELINE CYLINDER

N2O

AIR

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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.

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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).

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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

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.

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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.

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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

HANDLE

FRESH GAS

LOCKING BAR

EXTENDED POSITION

2-8

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Section 2

General Description

Fresh Gas Outlet (Canada)

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

O) are not possible at the connection point.

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.

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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Section 2

General Description

AV2+ Ventilator

The AV2+ anesthesia ventilator is a volume-preset, time-cycled, pressure-limited ventilator with electronic timing, pneumatic circuitry and independent controls for frequency, inspiratory to expiratory (I:E) ratio, inspiratory flow rate, tidal volume, and inspiratory pressure limit.

Pneumatic power (bellows drive gas) to the ventilator is supplied through the hospital pipeline supply or through reserve cylinders on the anesthesia machine. The pressure of the supply gas must be between 40 and 60 psi. The ventilator will not function properly if this pressure drops below 32 psi. Electrical power is supplied by the AC power source. In event of AC power failure, the backup battery supplies power. A fully charged battery can power the ventilator for about 30 minutes.

The anesthesia ventilator is designed for use with a North American Dräger absorber system that has a manual/automatic selector valve. Use this valve to select the breathing bag and adjustable pressure limiter (APL) valve for manual ventilation or the ventilator bellows for automatic ventilation.

During automatic ventilation, the manual/automatic selector valve isolates the absorber’s APL valve from the breathing system. The ventilator has a relief valve mounted behind the bellows chamber to compensate for the continuous introduction of fresh gas into the breathing system.

When the bellows is completely filled, any excess gas in the system is released to the scavenging system through the ventilator relief valve. As in any ascending bellows, the force needed to overcome gravity acting on the bellows causes a positive end-expiratory pressure (PEEP) within the breathing system. The PEEP is about 2 cmH

The pressure-limit control is used to set the peak inspiratory pressure produced by the ventilator to prevent barotrauma. The pressure-limit control can also improve ventilation for patients with reduced lung compliance (neonatal/pediatric patients and patients with adult respiratory distress syndrome), because it limits the peak inspiratory pressure during the inspiratory phase of ventilation.

The AV2+ ventilator is shown in the following drawing.

2-19

Section 2 General Description

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I:E RATIO CONTROL

EXTENDED RANGE ACCESS

I:E RATIO DISPLAY

FREQUENCY CONTROL

FREQUENCY DISPLAY

FREQUENCY

/min

AV2+

INSPIRATORY PRESSURE LIMIT

cmH2O

1:2.5

I:E RATIO

EXTENDED

RANGE

TIDAL VOLUME

PUSH TO TURN

PRESET TIDAL VOLUME (ml)

1400 1200 1000

800 600 400 200

INSPIRATORY FLOW GAUGE

INSPIRATORY

FLOW CONTROL

VENTILATOR

ON-OFF

CONTROL

INSPIRATORY

FLOW

VENTILATOR

FAULT

TIDAL VOLUME

CONTROL

PRESSURE

LIMIT CONTROL

Main Switch Panel

System Power Switch

AC Power Failure Indicator

TIDAL

BELLOWS CANISTER

VOLUME SETTING INDICATOR

OP91018c

BREATHING CIRCUIT

CONNECTOR

The main switch panel is located between the ventilator bellows and flowmeter bank.

The SYSTEM POWER switch has two positions ON and STANDBY.In the ON position, the gas (pneumatic) and electric power circuits are on. The green indicator next to the switch lights. In the STANDBY position, the switch shuts down the gas supplies, the monitoring system, and all electrical power to the machine except the convenience receptacles and battery charging circuit.

The yellow AC POWER FAIL indicator signals an AC power disruption. The indicator lights whenever the battery supplies power to the monitoring system and the electronic ventilator. A three-pulse tone also sounds every 30 seconds. If the backup battery is completely discharged, the AC power failure indicator does not have power and will not function.

2-20

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Section 2

General Description

O SUPPLY PRE SSURE

RED O2 SUPPLY PRESSURE LOW INDICATOR

YELLOW AC POWER FAIL INDICATOR

YELLOW BATTERY LOW INDICATOR

GREEN BATTERY TEST INDICATOR

POWER FAILAC

LOWBATTERY

BATTERY TEST

STAND BY

SYSTEM POWER

BATTERY

TEST PUSH

BUTTON

SYSTEM

POWER

SWITCH

OP20050

Oxygen Supply Pressure Alarm

The oxygen supply pressure alarm activates if the oxygen supply pressure in the system decreases below about 37 psi. When the alarm is actuated, the red O

SUPPLY PRESSURE indicator lights continuously,

the Caution message O2SUPPLY LOW appears on the central alarm display, and an intermittent audible alarm sounds. Depending on the configuration, a 7-second whistle may also sound.

NOTE: The oxygen supply pressure alarm will not activate if only one

source of oxygen supply pressure (either the cylinder or the pipeline) fails and the other maintains proper pressure in the oxygen supply lines.

2-21

Section 2

General Description

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Power Supply System

Convenience Receptacles

The Narkomed 2C has a central power supply for the ventilator, alarm system, and monitoring system. When in use, the Narkomed 2C must be plugged into an AC outlet.

The Narkomed 2C has four convenience receptacles located on the upper back area of the anesthesia machine. (This option is not available for the 240 VAC power supply option). The receptacles are active whenever the Narkomed 2C is plugged into an outlet, whether or not the machine is turned on.

The total current for devices plugged into the receptacles must not exceed 7 amps. A 7-amp circuit breaker protects the convenience receptacle circuit. This circuit also has an EMI filter to minimize interference from devices plugged into the convenience receptacles.

CAUTION: Devices plugged into the convenience receptacles

contribute to the anesthesia system’s total leakage current. The total leakage current must not exceed 100 microamps.

CIRCUIT BREAKER

Circuit Breakers

2-22

CONVENIENC RECEPTACLES

OP21050

The electrical system has four magnetic circuit breakers to protect machine functions primary AC power input, convenience receptacles, and backup battery power.

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Section 2

General Description

The three circuit breakers located on the lower (absorber) side of the machine are for 117 volt input power, 240 volt input power and backup battery power. The fourth circuit breaker is for the convenience receptacles and is located next to the convenience receptacles.

When the plunger is flush with the surface of its base, the circuit breaker is in its normal, closed position. A circuit breaker is open (tripped) when its plunger extends beyond its base. If a breaker is tripped, the cause must be found and corrected before using the anesthesia system.

Backup Battery System

Machine Functions on Backup Battery Power

The backup battery system consists of a rechargeable battery and a built-in battery charging system.

Although most hospitals have emergency generators that provide AC power when line power fails, a delay may occur before generator power comes on. The backup battery system automatically provides power during the period between line power failure and activation of the hospital’s emergency generator. The backup battery also provides power if the anesthesia machine’s power cord is accidentally unplugged during a case.

When the hospital’s emergency generator comes online (or when a disconnected power cord is reconnected), the Narkomed 2C automatically switches back to AC power and recharges its battery. The battery charging system charges the battery any time the power cord is connected to an active AC power source. The charger can recharge a fully discharged battery in about 12 hours.

If the machine is receiving AC power, but the battery voltage level is low due to a problem with the battery charging circuit or similar hardware malfunction, the Advisory message RESERVE BATT LOW appears on the central alarm display.

If the hospital’s primary AC power fails, the backup battery system is activated. If this happens, the following events occur:

• The yellow AC POWER FAIL indicator on the alarm panel comes on.

• The Caution message AC POWER FAIL appears on the central alarm display.

• A three-pulse pattern tone sounds every 30 seconds.

These alarms signify that about 30 minutes of backup battery power remains from the time the alarm is activated if the battery is fully charged. All monitoring functions continue to operate, using the battery for power.

2-23

Section 2 General Description

When the battery reserve approaches depletion after an AC power loss:

• The yellow BATTERY LOW indicator lights.

• The Caution message AC BATTERY FAIL appears on the central

These alarms signify that about 10 minutes of backup battery power remain from the time the alarm was activated.

The gas supply system remains operative. Because the ventilator is inoperative when battery power is cut off, you must perform manual ventilation by bag. The machine cannot provide monitoring or alarm functions until AC power is restored.

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NOTE: The BATTERY LOW indicator only lights during an AC

power loss when battery reserves are low.

display.

System Interface Panel

NOTE: If the power cord is not plugged into an active AC outlet for a

period of 30 days or more, the backup battery can be depleted. Plugging the power cord into an active AC outlet for about 12 hours recharges the battery.

The system interface panel is located on the absorber side of the Narkomed 2C. The interface panel has receptacles for the oxygen sensor cord, the breathing pressure pilot line, the respiratory volume sensor cord, and the manual/automatic selector valve interface cable.

IN T E R F A C E PANEL

RESPIRATORY VOLUM E MONITOR IN T E R F A C E

MANUAL/ AUTOM ATIC SELECTOR VALVE IN T E R F A C E

OXYGEN SEN SO R

VOLUM E SEN SO R

BREATHING PRESSURE

OXYG EN

ANALYZER

IN T E R F A C E

BREATHING

PRESSURE

MONITOR

IN T E R F A C E

SELECT OR

2-24

O P 21042

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Section 2

General Description

Adjustable Display Arm

Monitoring System

Narkomed 2C Screens

The adjustable display arm, mounted on the absorber side of the machine, supports the remote display and Datagrip. It is also used to route patient sensor lines from the patient to the anesthesia machine. The arm can be adjusted up and down, side-to-side, and front-to-back, to place the display and sensor lines in the most convenient position. To adjust the arm front-to-back, pull and hold the release knob forward, then move the arm to the preferred position and release the knob.

The monitoring system integrates the electronic monitors and organizes information from these monitors on the screen. The screen is mounted on the adjustable display arm.

The Narkomed 2C monitors:

• oxygen concentration measurements

• breathing pressure measurements

• respiratory volume measurements

It also monitors key anesthesia system functions such as oxygen supply pressure and backup battery status.

The Narkomed 2C has several screens for viewing monitoring information, adjusting alarms, and customizing the monitoring system. The screens include:

• Machine Monitor

• System Monitor

• Set Up

• System Configuration

• Data Log

• Data Management

The screens are accessed from a Screen Selection menu. They are described in detail in the Section 5 Operation - Monitoring System “Using the Screen Selection Menu.”

2-25

Section 2 General Description

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Display Screen

All numerical data, waveforms, trends and alarms appear on the display screen that is mounted on the display arm. The screen can be tilted up, down, and sideways for optimal viewing.

DISPLAY ARM

PEAK

MEAN

PEEP

MIN VOL

7.50

TID VOL

0.75

8:30 9:30

WARNING

VENT PRES HI

CAUTION

O2 SUPPLY LOW

MINUTE VOLUME LOW

ADVISORY

NIBP STAT MODE

THRESHOLD LOW RESERVE BATT LOW

8:43

VENT

SET UP

SCROLL TREND

CLEAR TREND

CAL O

THRES

ORDM

VENT

NIBP PRES FLOW

AGT SPO

SET

VENTILATION

ALARMS OFF

AUTOSET

LOG

OP10757

THUMBWHEEL

DATAGRIP

Control Key Panel

DISPLAY SCREEN

CONTROL

KEY PANEL

Each of the Control Key Panel keys, located on the right side of the screen, performs a system function:

Silences the continuous audible alarm for 120 seconds. A message indicating the number of seconds remaining in the silence period is displayed in the Advisories window on the central alarm display. If a new alarm occurs during the 120 seconds, a single tone pattern sounds according to the alarm priority. After 120 seconds, the audible alarm reverts to normal operation if no alarm conditions are active at that time.

If any Warning or Caution alarms are active at 120 seconds, the Narkomed 2C enters an extended silence period and a single tone pattern sounds according to the alarm priority. If a new alarm condition occurs during the extended silence period, a single tone pattern sounds. Also, at each one-minute interval of the extended silence period, the highest-priority alarm tone pattern sounds.

2-26

VENTILATION

ALARMS OFF

AUTOSET

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Section 2

General Description

The silence period can last up to three minutes. The silence period ends if the Narkomed 2C is clear of Warnings and Cautions for 10 seconds. When the extended silence period ends, audio alarms revert to normal operation.

Turns off volume and pressure-apnea alarms. If the ventilator is on, the volume alarms are turned off, but the pressure-apnea alarm remains on.

Function depends on the Datascan Display setting in the System Configure screen.

If the Bar Graph Datascan is selected, pressing the AUTOSET key sets the current measurements at the center line of the Datascan display and resets the endpoints. (See “Bar Graph Datascan Display” presented later in this section.

Datagrip

If the Numeric Datascan is selected, pressing the

AUTOSET key resets the alarm limits according to the O2 ALARM AUTOSET value (WIDE, NARROW,orOFF) set in

the System Configure screen. If the Narkomed 2C is connected to a Vitalert monitor with Alarm Autoset capability, pressing the AUTOSET key also resets the alarm limits on the Vitalert monitor.

For complete information on selecting the Datascan display and setting the O2 ALARM AUTOSET value, see Section 5 Operation - Monitoring System “Invoking the System Configure Screen.”

The Datagrip is the user input device. The Datagrip is composed of a trigger and thumbwheel attached to the display arm, next to the screen. It can be tilted up and down for convenience and comfort.

Rotate the Datagrip thumbwheel to move the cursor around in screens, change variables, and scroll through menus, lists, and trends. Rotating the thumbwheel upward moves the cursor forward in a screen or list and increases numbers. Rotating the thumbwheel downward moves the cursor backward in a screen or list and decreases numbers.

Press the Datagrip trigger to invoke screens, choose parameters, enter new values, and select soft keys that appear on the display screen.

2-27

Section 2 General Description

An instructional dialog box, located in the lower right corner of certain screens, guides you through the functions performed by Datagrip’s trigger and thumbwheel for that specific screen. In the dialog box, the icon indicates the function performed by rotating the thumbwheel. The icon indicates the function performed by pressing the Datagrip trigger.

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Datascan Display

Bar Graph Datascan Display

The Datascan display is located at the top of the Data Log and System Monitor screens. Information is presented in one of two display formats the Bar Graph display or the Numeric display. The display format is selected in the System Configure screen. (See Section 5 Operation - Monitoring System “Invoking the System Configure Screen.”)

The Bar Graph Datascan display shows of six bar graphs that appear at the top of the System Monitor screens. Use the Bar Graph Datascan to see measurement deviations from a baseline. If information for one or more bar graphs is not supplied, the corresponding display area is blank.

The six bar graphs include:

• end-tidal carbon dioxide

• inspiratory/expiratory anesthetic agent

• inspiratory oxygen concentration

• oxygen saturation

• pulse rate

• systolic/diastolic blood pressure

NOTE: The inspiratory agent and the systolic pressure measurements

are the larger numbers located below their respective bar graphs.

2-28

A baseline measurement setpoint appears at the midpoint of each bar graph, represented by a center line common to all six bar graphs. Pointers along the left side of each bar graph mark the high and low alarm limits. The current value for the measurement appears in numerical form under each bar graph.

Any increase in a patient measurement causes the corresponding bar to rise from the center line. If any patient measurement decreases, its bar descends below the center line. Any deviation from the baseline whether positive or negative is immediately apparent.

OP27113

CO2 O2 SPO2 PLS NIBPISO

124

703943

1.5

1.0

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Section 2

General Description

Numeric Datascan Display

To normalize the current measurements of the Narkomed 2C, press the AUTOSET key on the control key panel. This sets the current measurements at the center line (baseline) and resets the endpoints.

The endpoints of the bar graph boundaries represent values above and below the baseline determined by the scaling factor set in the Datascan Configure screen.

The Numeric Datascan displays current values for all patient measurements and shows where those values are in relationship to the current alarm limits. The Numeric Datascan consists of six rectangular display areas for:

• end-tidal carbon dioxide

• inspiratory and expiratory anesthetic agent

• inspiratory oxygen concentration

• oxygen saturation

• pulse rate

• systolic and diastolic blood pressure

If information for one or more measurements is not supplied, the corresponding display area is blank.

The current values for the measurement are the large numbers located in the middle of each display area. The numbers at the top and bottom are the current alarm limits. The arrow on the left side of each display area shows where the current value lies within the boundaries of the alarm limits. This arrow moves move up or down as the values change.

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Section 2 General Description

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Central Alarm Display and Audible Alarms

ISO SPO2PLS

3.0

100

2.3

NOTE: The inspiratory agent and the systolic pressure measurements

also appear in the display areas.

To automatically adjust the alarm limits around the current values, press the AUTOSET key on the control key panel. This sets the oxygen alarm limits according to the O2 ALARM AUTOSET value specified in the System Configure screen. For complete information, see Section 5 Operation - Monitoring System “Invoking the System Configure Screen”. If the Narkomed 2C is connected to a Vitalert monitor with Alarm Autoset capability, pressing the AUTOSET key also resets the alarm limits for the monitoring functions provided by the Vitalert monitor.

The Narkomed 2C presents active alarms on the central alarm display located at the top of the display screen. Alarms are indicated with keyword phrases and are organized into three categories, depending on their urgency. Alarms are displayed either in a single window or in three separate windows corresponding to each alarm category.

1.7

1.0

100

NIBP

150

124

100

OP21010

2-30

A central speaker produces all audible alarm signals, using three different sound patterns to indicate the three levels of alarm urgency. The Narkomed 2C annunciates only the highest-priority, currently active alarm. Lower-priority alarms are temporarily suppressed to minimize the confusion caused by simultaneous alarms. If the primary speaker on the Narkomed 2C fails, the Advisory message SERVICE SPEAKER appears on the central alarm display and a single tone sounds.

If the number of alarms in any of the three categories exceeds the space provided on the display screen for that category, additional alarm messages are retained in memory until displayed alarm conditions are resolved.

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Section 2

General Description

Warnings

Warnings are the highest priority alarms and require an immediate response.

If the Bar Graph Datascan is selected, Warnings appear in a drop-down window in the upper left portion of the System Monitor screens, overlaying the Datascan bar graphs. If no Warning alarm conditions exist, the display is suppressed until an alarm condition occurs. Up to seven Warnings can appear in this window.

If the Numeric Datascan is selected, Warnings appear in the single alarm window in top right corner of the Machine Monitor screen and the System Monitor screens, along with any Caution or Advisory messages. The Warning messages are displayed under a flashing heading labeled WARNING, which is removed from the screen if no Warning alarm conditions exist. The last space at the bottom of the alarm window is reserved for the SILENCE message that indicates the time remaining in the Audio Silence period.

Warnings are announced with a continuously repeating sound pattern consisting of three audio tones. After an initial sound pattern at full volume, there is a 6-second pause. This pause is followed by a pattern at one-third volume, a 5-second pause, a pattern at two-thirds volume, a 4second pause, and another pattern at full volume. After the second full volume pattern, a 3-second pause occurs, followed by a full volume pattern until the alarm condition is removed.

Cautions

Cautions are second-priority alarms and require a prompt response. If the Bar Graph Datascan is selected, Cautions appear in a drop-down

window in the upper middle portion of the System Monitor screens, overlaying the Datascan bar graphs. If no Caution alarm conditions exist, the display is suppressed until an alarm condition occurs. Up to seven Cautions can appear in this window.

If the Numeric Datascan is selected, Cautions appear in the single alarm window in top right corner of the Machine Monitor screen and the System Monitor screens, along with any Warning or Advisory messages. The Caution messages are displayed under a heading labeled CAUTION, which is removed from the screen if no Caution alarm conditions exist or if all space in the alarm window is needed by the higher-priority Warning messages.

2-31

Section 2 General Description

The last space at the bottom of the alarm window is reserved for the SILENCE message that indicates the time remaining in the Audio Silence period.

Cautions are accompanied by a three-pulse sound pattern that is repeated every 30 seconds until the alarm condition is cleared.

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Advisories

Silencing Alarms

Advisories are the lowest priority alarms that do not require immediate attention.

If the Bar Graph display is selected, Advisories appear in a display window in the upper right portion of the screen. Up to nine Advisories can appear in this window, in addition to the SILENCE message that indicates the time remaining in the Audio Silence period. The SILENCE message occupies the last place at the bottom of the Advisory window.

If the Numeric Datascan is selected, Advisories appear in a single window in top right corner of the Machine Monitor screen and the System Monitor screens, along with any Warning or Caution messages. The Advisory messages appear under a heading labeled ADVISORY, which is removed from the screen if all space in the alarm window is needed by the higher-priority Warning or Caution messages. The last space at the bottom of the alarm window is reserved for the SILENCE message that indicates the time remaining in the Audio Silence period.

Depending on the urgency, advisories are accompanied by a single tone sounds or no audible alarm is given.

To temporarily silence audible alarms, use the alarm silence key on the control key panel (labeled with a crossed-out speaker).

Ventilation Alarms

2-32

When the system power switch is turned from STANDBY to ON, the volume and pressure apnea alarms default to Standby to allow machine setup without nuisance alarms. An interlock with the ventilator ensures that when the ventilator is turned on, the alarms are enabled. The alarms can also be enabled individually in the Set Up screen.

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General Description

When the ventilator is turned off, the following events occur:

Section 2

Manual Sphygmomanometer (optional)

O.R. Data Manager (optional)

• If the pressure apnea threshold was greater than 15 cmH the ventilator was turned off, the threshold setting is changed to 15 cmH

O. (If the pressure apnea threshold was less than 15 cmH2O

when the ventilator was turned off, the threshold retains its setting.)

• The Cautions and Warnings associated with apnea alarms change from activation after 15 and 30 seconds of apnea to 30 and 60 seconds, respectively.

When the ventilator is turned back on, the pressure apnea threshold is restored to its previous set value and the apnea alarms revert to activation after 15 seconds (caution) and 30 seconds (warning) of apnea.

Noninvasive blood pressure can be measured with the manual sphygmomanometer. Several cuff sizes are available.

The O.R. Data Manager is an electronic data management system for acquiring, storing, and retrieving information. It consists of a central processing unit with disk drive and a keyboard for entering and editing data. The O.R. Data Manager creates an electronic anesthesia record from information automatically recorded by the monitoring system and from input from the keyboard (such as patient data, events, drugs, and other case-related information), and interfaced monitors such as the

Vitalert

3000.

O when

In addition to creating anesthesia records, the O.R. Data Manager can graphically display case information and send anesthesia records to a disk or laser printer.

2-33

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Section 3

Daily Checkout

Daily Checkout Procedure

Initial Setup and Verification

Before operating the Narkomed 2C, the following checkout procedure must be performed to make sure the machine is ready for use. This is a recommended procedure. Follow your institution’s policies for specific checkout procedures. If the anesthesia system fails any procedures identified by an asterisk (*), do not use the machine. Contact a North American Dräger qualified technical service representative for inspection of the unit.

NOTE: Do not insert any additional components into, or modify,

the anesthesia system after the checkout procedure is started.

1. Enter the serial number located on the right rear leg into the anesthesia record.

2. Make sure there is a valid inspection sticker on the back of the machine indicating that the anesthesia machine was serviced and inspected by a North American Dräger qualified technical service representative.

3. Verify that a cylinder wrench is tethered to the back of the machine next to one of the cylinders.

System Software Diagnostics

Battery Power Verification

4. If the anesthesia machine is not already plugged in, connect the electrical power cable to an active AC outlet that accepts and properly grounds the power cable. Do not use “cheater” plugs. The term “cheater” plug implies any and all electrical plugs or other devices that can inhibit or prohibit the proper grounding of the anesthesia machine.

*5. Turn the SYSTEM POWER switch to the ON position. Wait for

the machine to complete its diagnostic checks. Make sure the system is functional.

*6. Check the reserve battery power. Remove the power plug from

the outlet. Press the BATTERY TEST button on the main switch panel. The green indicator to the left of the test button must light. The yellow BATTERY LOW indicator must remain unlit. Plug the power cable back into the electrical outlet.

NOTE: This test assumes that the anesthesia machine has been

plugged in for 12 hours. The battery charging system works only when the machine is connected to an active AC power source. The charging system takes about 12 hours to charge a fully discharged battery.

3-1

Section 3 Daily Checkout

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Emergency Ventilation Equipment Verification

High Pressure System Verification

*7. Verify that backup ventilation equipment is available and

functional.

*8. Check the oxygen cylinder supplies.

A. Disconnect all pipeline gas supply hoses and drain the

system.

B. Close the oxygen cylinder valve and remove the cylinder

from the yoke. Verify that there is one cylinder gasket and there are two index pins. Verify that the cylinder matches the yoke label. Place the cylinder back in its yoke.

C. Open an oxygen cylinder and check the cylinder pressure

gauge. A full oxygen cylinder registers about 1900 psi. Replace any cylinder with pressure less than 1000 psi. To check for a high pressure leak, close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure.

D. If the machine is equipped with dual oxygen yokes, repeat

these procedures for the other cylinder yoke.

*9. Check the nitrous oxide cylinder supplies.

A. Close the nitrous oxide cylinder valve and remove the

cylinder from the yoke. Verify that there is one cylinder gasket and there are two index pins. Verify that the cylinder matches the yoke label. Place the cylinder back in its yoke.

B. Open the nitrous oxide flow control valve until the nitrous

oxide pipeline and cylinder pressure gauges indicate zero pressure. Open a nitrous oxide cylinder and check the cylinder pressure gauge. A full nitrous oxide cylinder registers about 745 psi. Replace any cylinder with a pressure less than 600 psi. To check for a high pressure leak, close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure.

C. If the machine is equipped with dual nitrous oxide cylinder

yokes, repeat these procedures for the other cylinder yoke.

3-2

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Daily Checkout

*10. Check additional (optional) gas cylinder supplies.

A. With the cylinder closed, open the flow control valve of the

associated gas until the cylinder and pipeline pressure gauges (air only) indicate zero pressure.

B. Close the cylinder valve and remove the cylinder from the

yoke. Verify that there is one cylinder gasket and there are two index pins. Verify that the cylinder matches the associated yoke label. Place the cylinder back in its yoke.

C. Open the associated flow control valve until the cylinder

pressure gauges indicate zero pressure. Open the cylinder and check the cylinder pressure gauge. Replace the cylinder if its contents are insufficient for the intended procedure. To check for a high pressure leak, close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure.

Section 3

NOTE: After testing all of the gas circuits, drain the oxygen

circuit by closing the oxygen cylinder and actuating the oxygen flush button on the front of the anesthesia machine. Hold the button in until the pressure gauges indicate no pressure.

The following table shows the full and minimum pressures (E-size cylinders at 70°F, 21°C) for all gases available for the anesthesia machine.

GAS PSI - FULL

Air 1900 1000

Carbon Dioxide 838 600

Nitrous Oxide 745 600

Oxygen 1900 1000

PSI - MIN

*typical full load

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Section 3 Daily Checkout

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Pipeline Supply System Verification

Low Pressure System Verification

*11. Pipeline Supply Verification

A. Inspect the supply hoses for cracks or wear. B. Connect the appropriate hospital pipeline supply hoses

from the wall outlet fittings to the pipeline inlet connectors.

C. Check for sufficient pipeline pressure readings for each gas

on the pipeline pressure gauges located below the flow control valves. The pressure for each gas must be between 50–55 psi. Open the flow control valve for each gas to a moderate value. The pressure indicated at the pipeline pressure gauge must not decrease more than 5 psi.

D. Verify that the correct gases are supplied to the anesthesia

machine inlets.

*12. Vaporizer Verification

A. Check for sufficient supply of liquid anesthetic in the

vaporizer(s). The liquid level indicated in the vaporizer sight glass must be between the minimum and maximum markings.

System Gas Circuit Verification

Oxygen Monitor Calibration

B. Make sure the fill and drain valves are completely closed. C. Check the vaporizer exclusion device, which prevents more

than one vaporizer from being activated simultaneously. Make sure that when one vaporizer handwheel is turned to a setting greater than 0, the others remain locked in their 0 positions. Test all of the vaporizer positions. Then, turn all vaporizers to the 0 position.

*13. Check the flowmeters. Adjust the flow control knob for each gas

and verify the proper operation of the corresponding flowmeters. The float must move freely over the full range of each flowmeter.

*14. Calibrate the oxygen monitor by exposing the sensor to ambient

air and activate the calibration key. (See Operation - Oxygen Monitoring “Calibrating the Oxygen Sensor” in Section 5 for more information.)

A. Place the oxygen sensor securely in the sensor mount. B. Verify that the correct gas concentrations are supplied to

the anesthesia system from the supply cylinders.

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Section 3

Daily Checkout

C. Close the cylinder supplies and deplete the pressure from

the system.

OFPD Verification

ORC Verification

Oxygen Flush Verification

*15. Check the oxygen failure protection device. With all gases

available on the machine set to a flow of about 4 l/min, close the oxygen supply by disconnecting the oxygen pipeline supply hose and closing the oxygen cylinder(s). The flow of all other gases indicated by their flowmeters must decrease in proportion to the decrease in oxygen flow and eventually shut off.

*16. Check the function of the ORC. With the nitrous oxide flow

control valve open to a flow of 10 l/min, vary the oxygen flow with the oxygen flow control valve. The nitrous oxide flow indicated on the nitrous oxide flowmeter must automatically vary in response to the adjustment of the oxygen flow control valve.

The ORC must maintain a fresh gas oxygen/nitrous oxide flow ratio of at least 25 ±4 % oxygen.

NOTE: When the nitrous oxide flow control valve is open

and oxygen is flowing at a minimum rate (150–200 ml/min), nitrous oxide flows at approximately 500 ml/min.

*17. Check the oxygen flush:

A. Press the oxygen flush button and listen for an audible gas

flow sound, accompanied by a marked increase in oxygen concentration in the breathing system.

Fresh Gas Verification

Bain Circuit Adapter Verification

B. Check the delivered oxygen concentration. Repeatedly

flush the patient breathing system by pressing the oxygen flush button. Open the oxygen flow control valve to a flow of 8 l/min and close the other flow control valves. The oxygen measurement display area should indicate 97% to 100% oxygen concentration.

*18. Make sure all vaporizers are closed. Open the oxygen flow control

valve to an 8 l/min flow and close all other flow control valves. Sniff the gas coming from the fresh gas common outlet. There should be no noticeable odor.

*19. Verify that the inner tube of the Bain circuit is intact and not

occluded. First deliver a flow of oxygen to the Bain circuit through the fresh gas hose. Then occlude the inner tube of the Bain circuit. The oxygen flowmeter float should drop in response to the occlusion.

3-5

Section 3 Daily Checkout

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As an alternate test, press the oxygen flush button with the Bain circuit’s patient port open to the atmosphere. The high flow of gas through the Bain circuit’s inner tube will draw in gas from the outer tube. As a result, the breathing bag should deflate. If the breathing bag does not deflate or it inflates, the fresh gas hose or inner tube may be improperly connected.

Absorber System Verification

*20. To check the absorber system:

A. Check the hose connections in the breathing system. B. Make sure the fresh gas hose of the breathing system is

securely connected to the fresh gas outlet.

C. Make sure a 22 mm patient breathing circuit is connected

between the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor.

D. Make sure a 22 mm breathing hose is connected between

the ventilator hose terminal and the manual/automatic selector valve breathing hose terminal.

E. Make sure a breathing bag of proper capacity and

appropriate construction is connected to the breathing bag terminal of the breathing system.

F. Make sure the breathing pressure pilot line is properly

connected between the BREATHING PRESSURE interface and either the absorber quick-connect fitting or the appropriate fitting at or near the patient Y-piece.

3-6

G. Make sure the oxygen sensor and respiratory volume

sensor are properly installed.

*21. Make sure the absorber canisters are filled with CO

Consult the absorbent manufacturer’s literature for information on what signs to expect when the absorbent is exhausted. Replace the absorbent when it appears exhausted. Make sure that the color change represents the absorbent’s true state of depletion and is not due to regeneration after a rest period. Flushing the anesthesia machine continuously with 100% oxygen for at least one minute before the first case of the day is recommended.

Remove accumulated absorbent dust and water from the absorber dust cup.

absorbent.

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Section 3

Daily Checkout

WARNING: Absorbent is caustic and is a strong eye, skin, and

respiratory tract irritant. When emptying the absorber dust cup, take care not to spill its caustic contents.

APL Valve

NOTE: When changing the CO

absorbent, take care not to

chip or crack the absorbent canister. Check the canister for signs of damage, especially along the rim, before reinstallation.

22. Close all vaporizers and flow control valves. Check for free gas passage in the patient breathing system. Wear a surgical mask to inhale and exhale through the breathing system (each limb individually, if possible). Verify the unidirectional flow in each limb and then reconnect the tubing.

*23. Check the APL valve to be sure it can relieve excess gas from the

breathing system into the scavenger system. To check the APL valve’s flow resistance: A. Set the manual/automatic selector valve to BAG. B. Remove the bag from the swivel arm bag mount. C. Interconnect the inspiratory valve and the expiratory hose

terminal on the ultrasonic flow sensor with a 22 mm hose.

Breathing System Leak Test

D. Completely open the APL valve by turning the control

knob fully counterclockwise to its stop position. E. Turn the SYSTEM POWER switch to ON. F. Open the oxygen flow control valve to a flow of 8 l/min. G. Occlude the bag mount opening and watch for a pressure

increase on the breathing system pressure gauge. This

pressure increase must not exceed 3 cmH

24. Perform a breathing and fresh gas delivery system pressure test. This test detects leaks from the patient breathing system and fresh gas delivery system.

To perform the test:

A. Close all flow control valves on the anesthesia machine.

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Section 3 Daily Checkout

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B. Turn the SYSTEM POWER switch to the STANDBY posi-

tion. C. Turn the vaporizers to 0% concentration. D. Interconnect the inspiratory valve and the expiratory hose

terminal on the ultrasonic flow sensor with a 22 mm

breathing hose. E. Set the manual/automatic selector valve to BAG. F. Close the APL valve by turning the knob fully clockwise to

its stop position. G. Check that the breathing pressure gauge is on 0. H. Attach the supplied test terminal to the breathing bag

mount.

Scavenger System

I. Connect a sphygmomanometer squeeze bulb (available

from North American Dräger) to the hose barb on the test

terminal. J. Pump the squeeze bulb by hand until the breathing

system pressure gauge indicates pressure of at least 50

O (not to exceed 80 cmH2O).

cmH

K. Observe the pressure drop at the breathing system

pressure gauge. When the pressure is at 50 cmH

counting seconds. The pressure must not drop more than

20 cmH

O in 30 seconds.

*25. Verify the performance of the scavenger system.

To test the open reservoir scavenger system: A. Make sure a 19 mm scavenger hose is connected between

the ventilator relief valve and the scavenger interface.

B. Make sure a 19 mm scavenger hose is connected between

the APL valve on the absorber and the 19 mm hose

terminal on the back of the absorber pole.

O, begin

3-8

C. Make sure a 19 mm scavenger hose is connected between

the bottom of the absorber pole and the scavenger

interface.

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Section 3

Daily Checkout

D. Check for moisture accumulation in the breathing and

scavenger hoses. Remove any moisture found.

E. Verify the safe performance of the open reservoir

scavenging system. With the scavenging system properly installed and operating, test for positive and negative

pressure relief. To test for negative pressure relief: F. Connect a vacuum hose to the DISS threaded terminal on

the left-hand side of the scavenger (or attach a wall

suction hose onto the adapter’s hose-barb fitting). G. Short-circuit the inspiratory valve and the expiratory hose

terminal on the ultrasonic flow sensor with a 22 mm

breathing hose. H. Set the absorber’s manual/automatic selector valve to BAG. I. Turn the APL valve control knob fully counterclockwise. J. Verify that the suction waste gas disposal system is active. K. Adjust the scavenger needle valve to a flowmeter

indication between the two white lines. L. Close all flow control valves on the anesthesia system. M. Occlude the absorber breathing bag terminal and observe

the breathing pressure gauge on the absorber. The gauge

should indicate only a negligible negative pressure (no

lower than -0.5 cmH

O). To test for positive pressure relief: N. Perform steps A through E. O. If the system is equipped with a PEEP valve, turn the

PEEP valve control knob fully counterclockwise to its lowest setting.

P. Adjust the scavenger needle valve to a completely closed

position by turning it fully clockwise.

Q. Open the oxygen flow control valve to a flow of 10 l/min

and occlude the absorber breathing bag terminal.

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Section 3 Daily Checkout

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R. The flow of oxygen must now exit through the relief ports

located on top of the canister. The absorber system’s breathing pressure gauge must indicate a pressure less than5cmH

S. After the test, adjust the scavenger needle valve to a

flowmeter indication halfway between the two white lines.

To test the scavenger interface for passive systems:

A. Make sure a 19 mm scavenger hose is connected between

the ventilator relief valve and the scavenger interface.

B. Make sure a 19 mm scavenger hose is connected between

the APL valve on the absorber and the 19 mm hose terminal on the back of the absorber pole.

C. Make sure a 19 mm scavenger hose is connected between

the bottom of the absorber pole and the scavenger interface.

D. Check for moisture accumulation in the breathing and

scavenger hoses. Remove any moisture found.

E. Short circuit the inspiratory valve and the expiratory hose

terminal on the ultrasonic flow sensor with a 22 mm breathing hose.

F. Set the absorber’s manual/automatic selector valve to

AUTO.

G. If the system is equipped with a PEEP valve, turn the

PEEP valve control knob fully counterclockwise to its lowest setting.

H. Open the oxygen flow control valve to a flow of 10 l/min

and occlude the 19 mm scavenger terminal labeled EXHAUST.

I. After the ventilator bellows inflates, the flow of oxygen

exits the system through the positive pressure safety relief valve. At this point, the absorber system’s breathing pressure gauge must indicate a pressure of less than 10

cmH

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Section 3

Daily Checkout

Manual and Automatic Ventilation Systems

*26. Test the ventilator.

A. Check for proper pressure and flow at the Y-piece during

the inspiratory and expiratory phases. Turn the SYSTEM POWER switch and ventilator power switch to their ON positions. Place the manual/automatic selector valve in the AUTO position. Adjust the oxygen flow control valve to a 3 l/min flow. Set the ventilator frequency to 3 BPM, the I:E ratio to 1:2, and the tidal volume to about 1 liter. (If testing the Pediatric Bellows or Adult/Pediatric Bellows, adjust the tidal volume to 200 ml.)

Adjust the ventilator flow control to the maximum of the “low” zone on the flow gauge. Occlude the patient side of the Y-piece. Fill the ventilator bellows by pressing the oxygen flush button. Observe the breathing system pressure gauge as the ventilator cycles.

The pressure gauge must indicate a pressure over 30

O when the bellows completes its downward travel.

cmH

The pressure should not exceed 3 cmH expiratory phase when the bellows completes its upward travel.

O at the end of the

Monitors

B. If the system is equipped with a PEEP valve, verify the

PEEP valve’s performance. Attach a breathing bag to the patient Y-piece with an appropriate adapter such as an NAD combination mask elbow with a 22 mm male fitting for the breathing bag and 15 mm male fitting for the Y-piece. With the manual/automatic selector valve in the AUTO position, set the ventilator to the preferred frequency.

Then adjust the PEEP valve to different values and observe the breathing system pressure gauge to verify performance. Turn the PEEP valve control knob fully counterclockwise to its lowest setting after the test is completed. Set the PEEP bypass switch to the PEEP OFF position.

27. Check the alarm limit settings. The monitor alarm limits are automatically set to a default configuration when the SYSTEM POWER switch is turned on. Check these settings and adjust them if necessary. Alarm limits can be adjusted at the beginning of or during a procedure. Also, make sure that any external monitors (if any) are connected properly and that the alarms sound through the anesthesia machine’s central audio annunciator.

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Section 3 Daily Checkout

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*28. Test the alarm functions for all monitors. Simulate alarm

conditions and check for appropriate alarm signals.

System Flush

Fresh Gas Oxygen Sensor Adapter Option Verification

Final Position

29. Flush the system with 100% oxygen by pressing the oxygen flush button.

30. If the optional fresh gas oxygen sensor adapter is installed, make sure the fresh gas hose connection is intact and not occluded. Verify that the oxygen analyzer is properly calibrated. (See Operation - Oxygen Monitoring “Calibrating the Oxygen Sensor” in Section 5 for more information.) When removing the oxygen sensor during calibration, insert the oxygen sensor port plug into the fresh gas adapter port.

31. When the daily checkout procedure is complete, verify that: A. all vaporizers are off (the handwheels are set to zero) B. the APL Valve is open (fully counterclockwise) C. the manual/automatic switch is set to BAG D. all flowmeters indicate 0 (or minimum) E. the patient suction is level adequate F. the breathing system is ready to use (the bag is in place

and all hoses are connected properly)

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Section 4

Preuse Checkout

Preuse Checkout Procedure

Reserve Power Verification

Perform the following abbreviated checkout procedure when the Narkomed 2C is used in successive cases. It may be performed only after the initial daily checkout procedure given in Section 3 was performed. This is a recommended procedure. Follow your institution’s policies regarding specific checkout procedures. If the anesthesia system fails any procedures identified by an asterisk (*), do not use the machine. Contact a North American Dräger qualified technical service representative for inspection of the unit.

NOTE: Do not insert any additional components into or modify the

anesthesia system after the checkout procedure is started.

*1. Check the reserve battery power. Make sure that the SYSTEM

POWER switch is turned to the ON position. Remove the power plug from the outlet. Press the BATTERY TEST button on the main switch panel. The green indicator to the left of the test button must light. The yellow BATTERY LOW indicator must remain unlit. Plug the power cable back into the electrical outlet.

NOTE: This test assumes that the anesthesia machine has been

Bain Circuit Adapter Verification

Absorber System Verification

*2. Verify that the inner tube of the Bain circuit is intact and not

*3. To check the absorber system:

A. Check the hose connections in the breathing system. B. Make sure the fresh gas hose of the breathing system is

securely connected to the fresh gas outlet.

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Section 4 Preuse Checkout

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C. Make sure a 22 mm patient breathing circuit is connected

between the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor.

D. Make sure a 22 mm breathing hose is connected between

the ventilator hose terminal and the manual/automatic selector valve breathing hose terminal.

E. Make sure a breathing bag of proper capacity and

appropriate construction is connected to the breathing bag terminal of the breathing system.

F. Make sure the breathing pressure pilot line is properly

connected between the BREATHING PRESSURE interface and either the absorber quick-connect fitting or the appropriate fitting at or near the patient Y-piece.

G. Make sure the oxygen sensor and respiratory volume

sensor are properly installed.

*4. Make sure the absorber canisters are filled with CO

Remove accumulated absorbent dust and water from the absorber dust cup.

WARNING: Absorbent is caustic and is a strong eye, skin, and

respiratory tract irritant. When emptying the absorber dust cup, take care not to spill its caustic contents.

NOTE: When changing the CO

absorbent, take care not to

chip or crack the absorbent canister. Check the canister for signs of damage, especially along the rim, before reinstallation.

absorbent.

4-2

5. Close all vaporizers and flow control valves. Check for free gas passage in the patient breathing system. Wear a surgical mask to inhale and exhale through the breathing system (each limb individually, if possible). Verify the unidirectional flow in each limb and then reconnect the tubing.

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Section 4

Preuse Checkout

APL Valve

*6. Check the APL valve to be sure it can relieve excess gas from the

terminal on the ultrasonic flow sensor with a 22 mm hose.

D. Completely open the APL valve by turning the control

increase on the breathing system pressure gauge. This

pressure increase must not exceed 3 cmH

Breathing System Leak Test

7. Perform a breathing and fresh gas delivery system pressure test. This test detects leaks from the patient breathing system and fresh gas delivery system.

To perform the test:

A. Close all flow control valves on the anesthesia machine. B. Turn the SYSTEM POWER switch to the STANDBY posi-

tion. C. Turn the vaporizers to 0% concentration. D. Interconnect the inspiratory valve and the expiratory hose

terminal on the ultrasonic flow sensor with a 22 mm

breathing hose. E. Set the manual/automatic selector valve to BAG. F. Close the APL valve by turning the knob fully clockwise to

its stop position. G. Check that the breathing pressure gauge is on 0.

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Section 4 Preuse Checkout

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H. Attach the supplied test terminal to the breathing bag

mount.

I. Connect a sphygmomanometer squeeze bulb (available

from North American Dräger) to the hose barb on the test terminal.

J. Pump the squeeze bulb by hand until the breathing

system pressure gauge indicates pressure of at least 50

O (not to exceed 80 cmH2O).

cmH

K. Observe the pressure drop at the breathing system

pressure gauge. When the pressure is at 50 cmH

O, begin

counting seconds. The pressure must not drop more than 20 cmH

O in 30 seconds.

Scavenger System

*8. Verify the performance of the scavenger system.

To test the open reservoir scavenger system: A. Make sure a 19 mm scavenger hose is connected between

the ventilator relief valve and the scavenger interface.

B. Make sure a 19 mm scavenger hose is connected between

the APL valve on the absorber and the 19 mm hose terminal on the back of the absorber pole.

C. Make sure a 19 mm scavenger hose is connected between

the bottom of the absorber pole and the scavenger interface.

D. Check for moisture accumulation in the breathing and

scavenger hoses. Remove any moisture found.

E. Verify the safe performance of the open reservoir

scavenging system. With the scavenging system properly installed and operating, test for positive and negative pressure relief.

4-4

To test for negative pressure relief: F. Connect a vacuum hose to the DISS threaded terminal on

the left-hand side of the scavenger (or attach a wall suction hose onto the adapter’s hose-barb fitting).

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Section 4

Preuse Checkout

G. Short-circuit the inspiratory valve and the expiratory hose

terminal on the ultrasonic flow sensor with a 22 mm

breathing hose.

H. Set the absorber’s manual/automatic selector valve to BAG. I. Turn the APL valve control knob fully counterclockwise. J. Verify that the suction waste gas disposal system is active. K. Adjust the scavenger needle valve to a flowmeter

indication between the two white lines.

L. Close all flow control valves on the anesthesia system. M. Occlude the absorber breathing bag terminal and observe

the breathing pressure gauge on the absorber. The gauge

should indicate only a negligible negative pressure (no

lower than -0.5 cmH

O). To test for positive pressure relief: N. Perform steps A through E. O. If the system is equipped with a PEEP valve, turn the

PEEP valve control knob fully counterclockwise to its lowest setting.

P. Adjust the scavenger needle valve to a completely closed

position by turning it fully clockwise.

Q. Open the oxygen flow control valve to a flow of 10 l/min

and occlude the absorber breathing bag terminal.

R. The flow of oxygen must now exit through the relief ports

located on top of the canister. The absorber system’s breathing pressure gauge must indicate a pressure less than5cmH

S. After the test, adjust the scavenger needle valve to a

flowmeter indication halfway between the two white lines.

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Section 4 Preuse Checkout

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To test the scavenger interface for passive systems:

A. Make sure a 19 mm scavenger hose is connected between

the ventilator relief valve and the scavenger interface.

B. Make sure a 19 mm scavenger hose is connected between

the APL valve on the absorber and the 19 mm hose terminal on the back of the absorber pole.

C. Make sure a 19 mm scavenger hose is connected between

the bottom of the absorber pole and the scavenger interface.

D. Check for moisture accumulation in the breathing and

scavenger hoses. Remove any moisture found.

E. Short circuit the inspiratory valve and the expiratory hose

terminal on the ultrasonic flow sensor with a 22 mm breathing hose.

Manual and Automatic Ventilation Systems

F. Set the absorber’s manual/automatic selector valve to

AUTO.

G. If the system is equipped with a PEEP valve, turn the

PEEP valve control knob fully counterclockwise to its lowest setting.

H. Open the oxygen flow control valve to a flow of 10 l/min

and occlude the 19 mm scavenger terminal labeled EXHAUST.

I. After the ventilator bellows inflates, the flow of oxygen

exits the system through the positive pressure safety relief valve. At this point, the absorber system’s breathing pressure gauge must indicate a pressure of less than 10 cmH

*9. Test the ventilator.

A. Check for proper pressure and flow at the Y-piece during

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Section 4

Preuse Checkout

The pressure gauge must indicate a pressure over 30

O when the bellows completes its downward travel.

cmH

The pressure should not exceed 3 cmH expiratory phase when the bellows completes its upward travel.

B. If the system is equipped with a PEEP valve, verify the

O at the end of the

Monitors

System Flush

10. Check the alarm limit settings. The monitor alarm limits are automatically set to a default configuration when the SYSTEM POWER switch is turned on. Check these settings and adjust them if necessary. Alarm limits can be adjusted at the beginning of or during a procedure. Also, make sure that any external monitors (if any) are connected properly and that the alarms sound through the anesthesia machine’s central audio annunciator.

*11. Test the alarm functions for all monitors. Simulate alarm

conditions and check for appropriate alarm signals.

12. Flush the system with 100% oxygen by pressing the oxygen flush button.

4-7

Section 4 Preuse Checkout

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Fresh Gas Oxygen Sensor Adapter Option Verification

Final Position

13. If the optional fresh gas oxygen sensor adapter is installed, make sure the fresh gas hose connection is intact and not occluded. Verify that the oxygen analyzer is properly calibrated. (See Operation - Oxygen Monitoring “Calibrating the Oxygen Sensor” in Section 5 for more information.) When removing the oxygen sensor during calibration, insert the oxygen sensor port plug into the fresh gas adapter port.

14. When the daily checkout procedure is complete, verify that: A. all vaporizers are off (the handwheels are set to zero) B. the APL Valve is open (fully counterclockwise) C. the manual/automatic switch is set to BAG D. all flowmeters indicate 0 (or minimum) E. the patient suction is level adequate F. the breathing system is ready to use (the bag is in place

and all hoses are connected properly)

4-8

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Section 5 - Operation

Gas Delivery System

Overview

Connecting the Pipeline Gas Supply

The Narkomed 2C is a continuous flow anesthesia system with pneumatic circuitry for mixing and delivering gases and anesthetic agent vapor. The pneumatic system can deliver up to four gases and one anesthetic agent simultaneously. Oxygen and nitrous oxide are standard on all machines. Available optional gases include air and carbon dioxide. Up to three vaporizers can be mounted on the machine. Available vaporizers are for halothane, enflurane, isoflurane, sevoflurane, and desflurane.

Gas from the hospital pipelines enters the Narkomed 2C through hoses connected to indexed inlets located on the side of the flowmeter housing. Depending on the country’s standards and regulations, the available inlets are Diameter-Indexed Safety System (DISS) inlets (body or nut fitting), or National Institute for Standards and Technology (NIST) inlets.

To connect a pipeline supply:

1. Connect the gas fitting on the supply hose to the corresponding gas fitting on the side of the flowmeter housing. Use a wrench to tighten the hex nut.

WARNING: Carefully check hoses each time you connect a machine to

a wall or ceiling outlet to ensure that both ends of the hose are indexed for the same gas. Pipeline delivery hoses used between wall outlets and anesthesia machines have caused accidents when an oxygen fitting was placed on one end of the hose and a nitrous oxide fitting on the other end.

2. Connect the other end of the supply hose to the appropriate functioning hospital pipeline supplies.

3. Check the pipeline pressure gauge on the front of the Narkomed 2C for sufficient pipeline pressure (50-55 psi).

5-1-1

Section 5 - Operation

Y G

Gas Delivery System

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NIST

OPTION

O2 NIST

GAS FITTING

AIR NIST

GAS FITTING

N2O NIST

GAS FITTING

DISS BODY

OPTION

O2 DISS BOD

GAS FITTIN

AIR DISS BODY

GAS FITTING

N2O DISS BODY

GAS FITTING

O2 DISS NUT

GAS FITTING

Connecting the Gas Cylinders

AIR DISS NUT

DISS NUT

OPTION

GAS FITTING

N2O DISS NUT

GAS FITTING

OP14700

When attaching a cylinder, make sure that only one washer is installed between the cylinder and the yoke gas inlet. Using multiple washers can compromise the pin-indexed safety system. Be sure to verify the integrity of both index pins when installing a new cylinder.

To connect a gas cylinder to its yoke:

1. Place a new washer on the seat of the yoke gas inlet connection. WARNING: Use only one cylinder washer for each yoke. Using more

than one washer could cause cylinder gas leakage and compromise the pin-indexing system.

5-1-2

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Section 5 - Operation

Gas Delivery System

2. Verify that the two index pins below the gas inlet are intact.

WARNING: Check cylinder yokes for the presence of two index pins

each time you attach a cylinder to the machine.

3. Insert the head of a gas cylinder with matching gas into the yoke from below, so the gas outlet and indexing holes on the cylinder head face the gas inlet and indexing pins on the yoke assembly.

4. Engage the indexing holes with the index pins. Screw the yoke handle clockwise against the cylinder head, so the point of the yoke handle bolt is aligned with the countersunk recess on the back of the cylinder head.

5. Verify that the sealing washer is in place, that the index pins are engaged, and that the cylinder hangs vertically. Tighten the handle securely.

YOKE HANDLE BOLT

YOKE PLUG

YOKE HANDLE

CYLINDER WRENCH

YOKE

ASSEMBLY

INDEX

PINS

GAS

INLET

CYLINDER

VALVE

SEALING WASHER

CYLINDER

HEAD

GAS CYLINDER

(COLOR CODED)

OP20035

5-1-3

Section 5 - Operation

(

)

Gas Delivery System

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Connecting the Fresh Gas Hose

Adjusting the Gas Flow

To connect the fresh gas hose, pull out the fresh gas locking bar located on the front of the Narkomed 2C to its extended position. Insert the 15 mm male fitting on the fresh gas hose into the 15 mm female terminal. Release the spring-loaded locking bar over the fitting, allowing it to “lock” the fitting into place.

WARNING: Do not pinch or kink the fresh gas hose leading from the

fresh gas outlet to the absorber.

To adjust the gas flow:

1. Turn the flow control knob located below the fine flowmeter tube for the preferred gas. Turning the valve knob counterclockwise increases flow. Turning the knob clockwise decreases flow.

2. While adjusting the flow control knob, observe the flow rate. Flow rate is indicated by the flowmeter scale reading at the center of the float.

CAUTION: The flow of oxygen cannot be completely shut off (see

“Minimum Oxygen Flow” in Section 2 - General Description). Do not force the oxygen flow control knob past the zero stop to shut off the minimum flow. Forcing the knob can damage the valve seat.

Using the Oxygen Flush

To use the oxygen flush, press the oxygen flush button, located on the front of the machine, for a few seconds. This introduces an unmetered flow of pure oxygen into the breathing circuit at a rate of about 55 l/min.

TABLETOP

FRESH GAS OUTLET

FRESH GAS HOSE

OP10011

RELEASE TO

EXTENDED POSITION

O2 FLUSH CONTROL

HANDLE

FRESH GAS

LOCKING BAR

5-1-4

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Section 5 - Operation

Vaporizer

Overview

The Vapor 19.1 adds an anesthetic gas to the fresh gas stream by producing a precisely metered amount of the vapor of a particular liquid anesthetic. The vaporizer is installed in the fresh gas line upstream of the patient breathing system (semi-closed, semi-open system).

WARNING: The vaporizer must not be connected downstream of the

fresh gas outlet of the anesthesia machine.

For low flow (fresh gas flows lower than 250 ml/min) or closed system anesthesia, breathing circuit concentrations may differ considerably from the vaporizer setting. When performing anesthesia with low flow or closed system techniques, it is essential to monitor inspiratory and expiratory anesthesia concentration, oxygen concentration, expiratory volume, and airway pressure in the circuit.

The carrier gases used must be dry and free of oil and dust. The limits for moisture are as follows:

• dew point of oxygen ≤5° C

• dew point of air ≤5° C

• water contents of nitrous oxide ≤2 mg/l

Filling Systems

NOTE: For information on the Tec 6 desflurane vaporizer, refer to its

instruction manual.

Two filling systems are available for the Vapor 19.1:

• open-funnel system

• key-indexed safety system The following figure shows vaporizers with the two different types of

available filling systems.

5-2-1

Section 5 - Operation Vaporizer

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OP10603

North American Dräger Exclusion System

KEY INDEXED

OPEN FUNNEL FILLER

SAFETY SYSTEM

A cam and lever exclusion (interlock) system incorporated into the vaporizer bank prevents more than one vaporizer from being activated at a time. The exclusion system requires all unused vaporizers to be locked in their zero percent positions.

WARNING: Only one vaporizer can be activated at a time. If the

exclusion system permits simultaneous activation of two or more vaporizers and the anesthesia machine is turned on, the Caution message MULTI VAP SEL appears on the remote display. Do not use the anesthesia machine under these circumstances. Contact a North American Dräger qualified technical service representative for adjustment.

5-2-2

OP10609

PIVOT

ARMS

VAPOR

MOUNT

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Section 5 - Operation

Vaporizer

Operating the Vaporizers

Turning the Vaporizer On

Before each case, check the following items.

1. Make sure the vaporizer contains a sufficient amount of anesthetic agent as indicated in the sight glass.

2. Make sure the filling and draining valves are closed. For vaporizers with the key-indexed safety system, make sure the sealing plug is properly fitted and locking screw is tight.

3. Make sure the handwheel is set to 0 (zero-point interlock) and that the button is engaged.

NOTE: The Narkomed 2C is configured internally with information

about what types of vaporizers are located in the vaporizer positions (left, center, and right). If a vaporizer is installed and the Narkomed’s internal configuration is not set, the Advisory message VAP NOT CONFIG appears on the remote display. If this happens, contact a North American Dräger qualified technical service representative to configure the system.

To turn the vaporizer on:

1. Adjust the fresh gas flow.

2. Turn the vaporizer handwheel to the preferred anesthetic concentration. Do not set the handwheel between 0 and 0.2% volume concentration (0.3% volume with Enflurane Vapor). This part of the handwheel actuates the on/off switch and cannot be calibrated.

5-2-3

Section 5 - Operation Vaporizer

NOTE: After turning on the vaporizer, activate the scavenger system

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to collect and remove vented gas form the operating room.

Turning the Vaporizer Off

Filling the Vaporizer

To turn the vaporizer off, turn the vaporizer handwheel to 0 (zero-point interlock) and make sure the button engages. Do not interrupt the fresh gas flow until you have turned off the vaporizer.

NOTE: If you will not be using the vaporizer for a long period of

time (longer than one month), or if the vaporizer will be removed from the anesthesia machine, drain the anesthetic agent from the vaporizer.

Before filling a vaporizer, identify the filling system on the device as one of the following:

• open-funnel system

• key-indexed safety system

When you have identified the filling system, locate the appropriate procedure and read it entirely before filling the device.

WARNING: Do not inhale anesthetic vapors while filling the vaporizer.

Uncontrolled inhalation of anesthetic vapors is injurious to health.

Before filling a vaporizer, note the expiration date of the anesthetic agent. Do not use anesthetics beyond the date of expiration.

CAUTION: Each vaporizer is specifically designed and calibrated for

one particular anesthetic agent. Do not fill a vaporizer with any anesthetic other than the particular agent indicated on the vaporizer.

• The Isoflurane vaporizer must be filled with Isoflurane only (trade names: Forane, Forene, Aerrane).

• The Enflurane vaporizer must be filled with Enflurane only (trade names: Ethrane, Alyrane).

• The Halothane vaporizer must be filled with Halothane only (trade name: Fluothane).

• The Desflurane vaporizer must be filled with Desflurane only (trade name: Suprane).

• The Sevoflurane vaporizer must be filled with Sevoflurane only (trade name: Ultane).

5-2-4

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Section 5 - Operation

Vaporizer

Do not use a vaporizer that has been inadvertently filled with the wrong anesthetic. Drain the vaporizer and return the device to North American Dräger’s Technical Service Department.

Filling the Vaporizer During a Case

Filling Vaporizer With Open-Funnel System

If you must fill the vaporizer during a case, be extremely careful. While fresh gas is flowing and the vaporizer is turned on, the vaporizing chamber is pressurized. Do not open the inlet valve (or the screw of the safety filling device) under these circumstances—liquid anesthetic may gush out. To safely add anesthetic agent while the machine is in use, depressurize the vaporizer by setting the handwheel to 0 (zero-point interlock). Make sure the button engages in the locked position. Allow at least 5 seconds for the vaporizing chamber to depressurize, then use the appropriate procedure to add the anesthetic agent.

WARNING: The vaporizer handwheel must be set to 0 (zero-point

interlock) before the vaporizer can be filled.

1. With the vaporizer in an upright position, turn the handwheel to 0 (zero-point interlock) and make sure the button engages in the locked position.

2. Make sure the filling spout is clean. To remove dust or other particles, use a clean, dry paper towel. Do not use water or other liquid cleaning solutions.

3. Make sure the drain valve is closed.

4. Open the inlet valve by turning it counterclockwise about three turns.

CAUTION: Be sure to fill the vaporizer in an upright position. Filling

the vaporizer in a tilted position can cause overfilling. Overfilling can cause the anesthetic concentration rate to be higher or lower than the handwheel setting.

5. Remove the cap from the anesthetic agent bottle. Check the sealing edge of the bottle for chipping or other damage. Do not use if damaged.

5-2-5

Section 5 - Operation Vaporizer

OP10622

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INLET VALVE

FILLING

SPOUT

MAX FILL LINE

SIGHT GLASS

MIN FILL LINE

DRAIN

VALVE

6. With the vaporizer in an upright position, pour the anesthetic agent into the funnel. As you pour the agent, observe the level through the sight glass. Fill the vaporizer to the MAX mark and close the inlet valve.

NOTE: The capacity of the vaporizer is approximately 140 cm

with wet wick, and approximately 200 cm3with dry wick.

7. After filling, check the level at the sight glass. When the vaporizer is in an upright position, the level must not exceed the MAX mark.

If the vaporizer is inadvertently overfilled (MAX mark exceeded), drain the excess anesthetic. For information on draining the vaporizer, refer to “Draining Vaporizer with Open-Funnel Spout” later in this section.

5-2-6

8. Place the cap back on the bottle.

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Section 5 - Operation

Vaporizer

Filling Vaporizer With Key-Indexed Safety System

The key-indexed safety system uses a matching assembly to prevent inadvertent use of the wrong agent in a Vapor 19.1 device. To fill a vaporizer with key-indexed safety system, you must have the appropriate keyed bottle adapter for the anesthetic agent.

1. With the vaporizer in an upright position, turn the handwheel to 0

(zero-point interlock) and make sure the button engages in the locked position.

2. Remove the cap and seal from the anesthetic agent bottle. Check the

sealing edge of the bottle for chipping or other damage. Do not use the bottle if it is damaged.

3. Attach the keyed bottle adapter to the keyed collar on the bottle.

Screw the parts together tightly to form an airtight seal.

4. Turn the filler port lock screw counterclockwise and remove the filler

port plug from the filler port.

5. Insert the keyed adapter into the filler port of the vaporizer so that

the two holes in the adapter face the Teflon seal surface of the filler port. Bend the filler tube so that the liquid level in the bottle is below the filler port. Adjust the plastic tubing to avoid kinks.

6. Turn the filler port lock screw clockwise to hold the adapter against

the Teflon seal.

7. Open the filler valve by turning the knob counterclockwise two or

three turns.

CAUTION: Be sure to fill the vaporizer in an upright position. Filling

the vaporizer in a tilted position can cause overfilling. Overfilling can cause the anesthetic concentration rate to be higher or lower than the handwheel setting.

8. Lift the bottle above the filler port level, avoiding kinks in the plastic

tube. The liquid should begin flowing within 10 seconds after raising the bottle. If liquid does not begin to flow within 10 seconds, move the bottle below filler port level and raise it above the filler port again. (This allows any air trapped in the tubing to escape.) Repeat as necessary to start the flow.

5-2-7

Section 5 - Operation Vaporizer

9. Watch the sight glass while the vaporizer is filling, and close the

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filler valve when the liquid level reaches the lower of the two marks at the upper end of the sight glass. The lower mark is the FULL mark. The upper mark is the OVERFLOW mark.

NOTE: The capacity of the vaporizer is approximately 140 cm

with wet wick, and approximately 200 cm3with dry wick.

10. Remove the adapter from the filler port.

11. Allow excess liquid to drain from the filler port.

12. Fully insert the filler port plug in the filler port and tighten the

plug in place by turning the lock screw clockwise.

13. After filling, check the level at the sight glass. When the

vaporizer is in an upright position, the level must not exceed the FULL mark.

If the vaporizer is inadvertently overfilled (FULL mark exceeded), drain the excess anesthetic. For information on draining the vaporizer, refer to “Draining Vaporizer with Key-Indexed Safety System” later in this section.

14. Remove the adapter from the bottle.

15. Place the cap back on the bottle.

5-2-8

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Section 5 - Operation

Vaporizer

OP10621A

SIGHT GLASS

OVERFLOW LINE

FILLER VALVE KNOB

FILLER PORT

LOCK SCREW

KEYED FILLER

PORT

FILLER

PORT PLUG

KEYED

BOTTLE

ADAPTER

FULL LINE

REFILL LINE

DRAIN

ALVE

KNOB

KEYED BOTTLE

ADAPTER

DRAIN PORT

LOCK SCREW

KEYED

DRAIN PORT

5-2-9

Section 5 - Operation

Vaporizer

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HALOTHANE

(RED)

OP10620

ENFLURANE

(ORANGE)

ISOFLURANE

(PURPLE)

SEVOFLURAN

(YELLOW)

5-2-10

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Section 5 - Operation

Vaporizer

Draining the Vaporizer

Draining Vaporizer With Open-Funnel System

Before draining a vaporizer, identify the filling system on the device as one of the following:

• open-funnel system

• key-indexed safety system

When you have identified the filling system, locate the appropriate procedure and read it entirely before draining the device.

WARNING: Do not inhale anesthetic vapors while draining the

vaporizer. Uncontrolled inhalation of anesthetic vapors is injurious to health.

1. With the vaporizer in an upright position, turn the handwheel to 0 (zero-point interlock) and make sure the button engages in the locked position.

2. Place an empty anesthetic-specific bottle under the drain hole of the filling spout. Mark the bottle to indicate that it contains a previously used anesthetic agent.

WARNING: The vaporizer handwheel must be set to 0 (zero-point

interlock) before the vaporizer can be drained.

3. Open the drain valve by turning it counterclockwise about three turns. Do not unscrew the valve completely.

4. Close the drain valve.

WARNING: Do not reuse drained agent.

5. Place the cap back on the bottle and dispose of the bottle in accordance with approved hospital procedures.

5-2-11

Section 5 - Operation Vaporizer

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Draining Vaporizer With Key-Indexed Safety System

The key-indexed safety system employs a matching pin-and-socket assembly to prevent inadvertent use of the wrong agent in a Vapor 19.1 device. To drain a vaporizer with key-indexed safety system valves, you must have the appropriate keyed bottle adapter for the anesthetic agent.

1. With the vaporizer in an upright position, turn the handwheel to 0 (zero-point interlock) and make sure the button engages in the locked position.

2. Attach the keyed bottle adapter to the appropriate empty bottle. Tighten to assure airtight seal. Mark the bottle to indicate that it contains a previously used anesthetic.

3. Insert the bottle adapter fitting into the drain port of the vaporizer. The two holes in the adapter fitting must face the Teflon seal surface in the drain port.

4. Turn drain port lock screw clockwise to hold the adapter against the Teflon seal.

WARNING: The vaporizer handwheel must be set to 0 (zero-point

interlock) before the vaporizer can be drained.

5. Hold the bottle below drain port level, and avoid kinking the plastic tube. Open the drain valve by rotating the knob counterclockwise. Allow the liquid to drain into the bottle until the vaporizer is empty. The vaporizer is empty when no anesthetic flows from the drain.

6. Close the drain valve and remove the adapter from the drain port.

WARNING: Do not reuse drained agent.

7. Place the cap back on the bottle and dispose of the bottle in accordance with approved hospital procedures.

5-2-12

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Section 5 - Operation

Absorber System

REFER TO SEPARATE MANUAL

5-3-1

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Section 5 - Operation

Bain Circuit Adapter

REFER TO SEPARATE MANUAL

5-4-1

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Section 5 - Operation

Open Reservoir Scavenger

Overview

The open reservoir scavenger is intended for use with suction (vacuum) waste gas disposal systems. This scavenging approach applies a continuous suction to transfer waste gas from the scavenger to the disposal system. The open reservoir scavenger is an “open” system, which uses continually open relief ports to provide positive and negative pressure relief.

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

5-5-1

Section 5 - Operation Open Reservoir Scavenger

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Connecting the Open Reservoir Scavenger System

The open reservoir scavenger system is installed on the Narkomed 2C before shipping. The only thing you need to do before operating the scavenger is to make the hose connections.

CAUTION: Take special care not to accidentally force 19 mm

scavenger hoses over 22 mm breathing hose terminals. Carefully follow the hose connection instructions for installing the scavenger and the absorber.

To connect the scavenger hoses:

1. Attach a 19 mm scavenger hose between the 19 mm terminal (marked SCAVENGER HOSE) on the bottom of the absorber pole and the 19 mm terminal (marked SCAVENGER HOSE) on the right side of the scavenger.

WARNING: Make sure the 19 mm scavenger hoses leading from the

absorber are not pinched, kinked, or blocked in any manner.

2. Attach the short 19 mm scavenger hose between the 19 mm terminal (marked SCAVENGER HOSE) on the rear of the APL valve and the 19 mm terminal (marked SCAVENGER HOSE) on the rear of the absorber pole.

3. Attach another 19 mm scavenger hose between the 19 mm terminal (marked SCAVENGER HOSE) on the ventilator relief valve and the 19 mm terminal (marked SCAVENGER HOSE) on the left-hand side of the scavenger.

WARNING: Make sure the 19 mm scavenger hose leading from the

ventilator relief valve is not pinched, kinked, or blocked in any manner.

4. Attach a wall suction hose between the wall suction outlet and the suction terminal (DISS or hose barb with adapter) on the scavenger.

5. Verify the proper functioning of the scavenger system.

5-5-2

VENTILATOR BELLOW S

W /22M M VE N TILA TO R HOSE TERMINAL

RELIEF VALVE W /19MM SCAVENG ER HOSE TERMINAL

EN TILA TO R 22M M

BREATHING HO SE

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Section 5 - Operation

Open Reservoir Scavenger

19M M

SCAVENG ER

HOSE

VACUUM

TER M IN AL

O P 75123A

Operating the Open Reservoir Scavenger System

19M M

CAVENG ER H O SE

19MM SCAVENG ER HOSE TERMINAL

Because the open reservoir scavenger’s reservoir canister is open to the atmosphere, it does not require spring-loaded relief valves. If the waste gas flow rate from the patient breathing system exceeds the disposal system’s suction flow fate, the canister initially accommodates excess waste gas. After excess waste gas fills the canister, waste gas then exits through the relief ports around the top of the canister. Thus, positive pressure does not build up within the patient breathing system.

CAUTION: Waste gas vented from the relief ports may contaminate

the operating room. To prevent such contamination, be sure to adjust the needle valve properly.

If the disposal system’s flow rate (suction) exceeds the waste gas flow rate from the patient breathing system, the disposal system draws room air through the relief ports. Thus, the disposal system does not apply a negative pressure to the patient breathing system.

5-5-3

Section 5 - Operation Open Reservoir Scavenger

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Adjusting the Needle Valve

You must properly adjust the waste gas flow rate to prevent waste gas contamination of the operating room. The needle valve wing nut regulates the waste gas exhaust flow.

To adjust the needle valve:

1. Attach all appropriate hoses and verify that the waste gas disposal system is active.

2. Turn the needle valve wing nut until the flowmeter indicates a flow halfway between the two white lines etched on the scavenger’s flowmeter. This setting corresponds to a suction flow rate of about 25 l/min.

Depending on the fresh gas flow rate, the needle valve setting may have to be increased or decreased to settings either above or below the lines on the flowmeter. If the suction flow rate is set too low, waste gas will exit the canister through the relief ports around the top of the canister and contaminate the operating room. If the suction flow rate is too high, the waste gas disposal system’s suction capacity will be needlessly depleted and the system will be noisy.

You may have to readjust the needle valve setting during a case. For example, a shared suction disposal system may provide a varying suction flow rate, depending on the number of users at any given time.

5-5-4

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Section 5 - Operation

Scavenger Interface for Passive Systems

Overview

The scavenger interface for passive systems is intended for use with nonrecirculating HVAC systems (also called exhaust systems). This scavenging approach relies on the pressure of the waste gas itself to transfer the gas from the scavenger to the disposal system. The scavenger interface is a “closed” system, which uses 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

INPUT PORT CAP

OP76131

WASTE GAS EXHAUST PORT,

19MM HOSE TERMINAL

5-6-1

Section 5 - Operation Scavenger Interface for Passive Systems

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Operating the Scavenger Interface for Nonactive Systems

In a typical anesthesia circle system, waste gas exits form the breathing system APL or ventilator relief valves and passes through the scavenger to the exhaust system. If the hospital exhaust system stopped functioning (or if the path between the scavenger and the exhaust system becomes blocked), positive pressure would build up within the scavenging and breathing systems. To prevent such a harmful pressure build-up, the scavenger’s positive pressure relief valve is set to open at a pressure of 5 cm H

O. Waste gas then exits through the holes in the

relief valve housing. Therefore, you do not have to adjust this scavenger. You must, however, make sure that hoses are properly connected and that the positive pressure safety relief valve is functioning.

WARNING: The positive pressure relief valve must be inspected and

cleaned (if necessary) at six month intervals.

SHO RT 19M M SCAVENG ER H O SE

VENTILATOR RELIEF VALVE 19MM SC AVENG ER HO SE TERM INAL

5-6-2

SCAVENG ER INTERFACE FOR NO N-ACTIVE SYSTEM S

O P 00170A

TO HO SPITAL

EXHAUST SYSTEM

19MM SC AVENG ER

HOSE

ABSORBER

POLE

19MM SC AVENG ER

HOSE

RED O2 SUPPLY PRESSURE LOW INDICATOR

YELLOW AC POWER FAIL INDICATOR

YELLOW BATTERY LOW INDICATOR

GREEN BATTERY TEST INDICATOR

SYSTEM

POWER

SWITCH

OP20050

STAND BY

SYSTEM POWER

POWER F AILAC

LOWBATTERY

BATTERY TEST

O SUPPLY PRE SSURE

BATTERY

TEST PUSH

BUTTON

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Section 5 - Operation

Main Switch Panel

Overview

The main switch panel, located between the ventilator bellows and flowmeter bank, incorporates the SYSTEM POWER switch and indicator lights for low O

supply pressure, AC power failure, and battery low

alarms. These alarms are annunciated and displayed on the central alarm display.

System Power Switch

The SYSTEM POWER switch on the Narkomed 2C has two positions: ON and STANDBY.IntheON position the gas (pneumatic) and electric power circuits are activated and the green LED indicator adjacent to the switch is illuminated. In the STANDBY position the gas supplies, the monitoring system, and all electrical power to the machine except the convenience receptacles and battery charging circuit are deactivated.

NOTE: The battery charging circuit and convenience receptacles are

active whenever the power cable is attached to an active wall receptacle, regardless of the switch setting.

5-7-1

Section 5 - Operation Main Switch Panel

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Testing the Battery

The backup battery system shall be tested daily. To test the battery:

1. Turn the SYSTEM POWER switch to ON.

2. Remove the machine’s power plug from the electrical outlet, and then press and hold the BATTERY TEST button.

3. If the battery is sufficiently charged, the green BATTERY TEST light illuminates after a short delay.

Usually, a fully charged battery can power the electrical components of the anesthesia machine for at least 30 minutes in the event of a power failure.

NOTE: During an AC power loss, the BATTERY LOW indicator is

illuminated when the battery reserve approaches depletion. However, do not rely solely on this indicator for an assessment of battery capacity. If the backup battery becomes completely depleted and the machine does not have AC power, the BATTERY LOW indicator light has no source of power and does not function. Therefore, always remember to perform the preuse battery test.

To prevent premature battery failure, use backup battery power only during interruption of primary AC power. Do not start an anesthetic procedure on the anesthesia machine if the AC POWER FAIL indicator light or the BATTERY LOW indicator light is illuminated.

5-7-2

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Section 5 - Operation

AV2+ Anesthesia Ventilator

Overview

The AV2+ anesthesia ventilator is a volume preset, time cycled, pressure limited ventilator with electronic timing, pneumatic circuitry and independent controls for frequency, inspiratory to expiratory (I:E) ratio, inspiratory flow rate, tidal volume, and inspiratory pressure limit.

Pneumatic power (bellows drive gas) to the ventilator is supplied through the hospital pipeline supply or through reserve cylinders on the anesthesia machine. The pressure of the supply gas must be between 40 and 60 psi. The ventilator will not function if this pressure drops below 32 psi. Electrical power is supplied by the Narkomed 2C’s AC power source, or, in event of AC power failure, by the backup battery. A fully charged battery can power the ventilator for approximately 30 minutes.

The anesthesia ventilator is designed for use with a North American Dräger absorber system, which incorporates a manual/automatic selector valve. This valve allows you to select either the breathing bag and adjustable pressure limiter (APL) valve for manual ventilation, or the ventilator bellows for automatic ventilation.

During automatic ventilation, the manual/automatic selector valve isolates the absorber’s APL valve from the breathing system. To compensate for the continuous introduction of fresh gas into the breathing system, the ventilator incorporates a relief valve mounted behind the bellows chamber.

The monitoring system’s breathing pressure and expiratory flow waveform displays can be used as an aid in adjusting the ventilator and establishing alarm criteria.

WARNING: Regardless of the indications of any alarm or monitoring

device, patient chest movement shall be the primary indication of a securely connected, properly ventilated patient.

A front view of the AV2+ anesthesia ventilator is shown in the following figure.

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Section 5 - Operation AV2+ Anesthesia Ventilator

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I:E RATIO CONTROL

EXTENDED RANGE ACCESS

I:E RATIO DISPLAY

FREQUENCY CONTROL

FREQUENCY DISPLAY

FREQUENCY

/min

AV2+

INSPIRATORY PRESSURE LIMIT

cmH2O

1:2.5

I:E RATIO

EXTENDED

RANGE

TIDAL VOLUME

PUSH TO TURN

PRESET TIDAL VOLUME (ml)

1400 1200 1000

800 600 400 200

INSPIRATORY FLOW GAUGE

INSPIRATORY

FLOW CONTROL

VENTILATOR

ON-OFF

CONTROL

INSPIRATORY

FLOW

VENTILATOR

FAULT

TIDAL VOLUME

CONTROL

PRESSURE

LIMIT CONTROL

Activating the Ventilator

TIDAL

BELLOWS CANISTER

VOLUME SETTING INDICATOR

OP91018c

BREATHING CIRCUIT

CONNECTOR

The ventilator can be activated by using the ventilator on/off control, or, optionally, by using the lever on the manual/automatic selector valve. The anesthesia machine’s SYSTEM POWER switch must be set to ON in order for the ventilator to function.

NOTE: The selector valve lever can activate the ventilator only when

the interface cable is connected between the manual/automatic selector valve and the SELECTOR fitting on the breathing system sensor interface panel (see the following illustration); when the interface cable is disconnected, the position of the selector lever has no effect on the ventilator.

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CONNECTOR

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Section 5 - Operation

AV2+ Anesthesia Ventilator

MANUAL/AUTOMATIC

SELECTOR VALVE

INTERFACE CABLE

SELECTOR FITTING

ON BREATHING SYSTEM

SENSO R INTERFACE

PANEL

Using the Ventilator On/Off Control

O P 05127

When the ventilator is activated, both pneumatic and electric power to the ventilator is turned on, and the monitoring system’s volume and pressure alarms are automatically enabled. When the ventilator is turned off, the FREQUENCY and I:E RATIO displays remain lighted, but the ventilator will not function.

The ventilator on/off control is a momentary switch that returns to its center position after being turned in either direction.

• To activate the ventilator, turn the switch clockwise; the green ON indicator is then turned on and the switch returns to its center position.

NOTE: The ventilator can only be activated when the

manual/automatic selector valve is in the AUTO position (with the interface cable between the selector valve and interface panel connected). If you attempt to activate the ventilator with the selector lever in the BAG position, the yellow FAULT indicator on the ventilator bezel will be turned on, indicating a fault condition.

• To shut down the ventilator, turn the switch counterclockwise; the green ON indicator is then turned off and the switch returns to its center position.

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Section 5 - Operation AV2+ Anesthesia Ventilator

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Using the Manual/Automatic Selector Valve Lever

Adjusting the Tidal Volume

The ventilator can be turned on and off using the selector lever on the manual/automatic selector valve (with the interface cable between the selector valve and interface panel properly connected).

• To activate the ventilator, move the manual/automatic selector valve lever to the AUTO position; the green ON indicator on the ventilator bezel is then turned on.

• To shut down the ventilator, move the manual/automatic selector valve lever to the BAG position; the green ON indicator on the ventilator bezel is then turned off.

The tidal volume is adjusted using a self-locking knob, located above the bellows assembly. The control knob positions a stop within the bellows canister which limits the upward travel of the bellows and thus sets the maximum tidal volume of gas delivered to the patient. To adjust the tidal volume, press the self-locking knob so that it can turn, then set the desired tidal volume as shown by the setting indicator on the bellows chamber scale (marked 200–1400 ml). The tidal volume can be adjusted to achieve volumes between 20 and 1500 ml.

Smaller tidal volumes can be adjusted by setting the pointer below the 200 ml marking on the bellows chamber; larger tidal volumes can be selected by setting the pointer above the 1400 ml calibration.

Setting the Respiratory Frequency

As in any volume-preset anesthesia ventilator, the actual tidal volume delivered to the patient’s lungs may differ from the preset volume at the bellows due to the compliance of the breathing system and fresh gas flow. To accurately set the tidal volume, refer to the tidal and minute volume measurements.

The position of the tidal volume indicator can be calibrated for a specific combination of fresh gas flow and equipment compliance by a North American Dräger qualified technical service representative.

Use the frequency control knob to set the respiratory frequency from 1 to 99 breaths per minute (BPM) in 1 BPM increments.

Clockwise rotation of the control knob increases the frequency setting, while counterclockwise rotation decreases the frequency setting.

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Section 5 - Operation

AV2+ Anesthesia Ventilator

Setting the Inspiratory/ Expiratory (I:E) Phase Time Ratio

Setting the Inspiratory Flow Rate

Use the I:E ratio control knob to set the inspiratory/expiratory (I:E) phase time ratio. The standard range of ratios is from 1:1 through 1:4.5, adjustable in increments of 0.5.

An extended range of ratios is also available which allows the setting of inverse I:E ratios. The specific extended range settings are: 4:1, 3:1, and 2:1. The extended range settings are accessible by pressing the EXTENDED RANGE switch while rotating the I:E ratio control knob.

Clockwise rotation of the control knob increases the I:E ratio setting, while counterclockwise rotation decreases the I:E ratio setting.

WARNING: The use of inverse I:E ratios will introduce auto-PEEP. Use the inspiratory flow control knob to set the inspiratory flow in the

range of 10 l/min to 100 l/min. This setting controls the flow rate of gas into the bellows canister, and thus the flow rate of gas delivered to the patient.

Because of patient circuit variables such as lung compliance, fresh gas flow, airway resistance and equipment compliance, the flow gauge is labeled with nominal zones of LOW, MEDIUM, and HIGH.

Setting the Inspiratory Pressure Limit

You should adjust the flow setting to a point where the ventilator bellows is fully compressed (but not deformed) at the end of the inspiratory phase of the breathing cycle.

You can also use the inspiratory flow control to create an inspiratory plateau at the end of the inspiratory cycle and to affect the potential peak inspiratory pressure within the patient breathing system. Always check the pressure indicated by the breathing system pressure gauge and waveform when adjusting the inspiratory flow control.

The pressure limit control, located above the bellows canister, is used to adjust the pressure limit. Nominal pressure zones are indicated by the label. This control determines the maximum pressure that can be delivered by the ventilator during the inspiratory phase of the respiratory cycle. Because of patient circuit variables, the scale on the label is only a reference; the pressure should be read from the breathing system pressure gauge or the anesthesia machine’s pressure monitoring system.

When the pressure limit control is turned fully counterclockwise, the peak inspiratory pressure will be less than or equal to 15 cmH

O. When

the control is turned fully clockwise, the peak inspiratory pressure will be less than or equal to 120 cmH

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Section 5 - Operation AV2+ Anesthesia Ventilator

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Problem Resolution

PPRROOBBLLEEMM PPOOSSSSIIBBLLEECCAAUUSSEE RREEMMEEDDYY

Excessive PEEP Improperly adjusted

ventilator relief valve

Insufficient suction scavenger flow setting

PEEP valve active Decrease PEEP valve

Inverse I:E ratios Reset ratios.

Excessive NEEP Excessive suction

scavenger flow

Bellows won’t reach tidal volume stop setting during expiration

Frequency too high for selected tidal volume

Contact NAD qualified technical service representative.

Increase suction scavenger flow valve.

setting.

Reduce suction scavenger flow rate.

Decrease frequency.

Increase expiratory phase time.

Ventilator won’t cycle

Moving manual/ automatic selector valve lever to AUTO position does not activate ventilator.

Improperly adjusted ventilator relief valve

Breathing system leak Repair leak.

Low oxygen supply pressure

SYSTEM POWER

switch is in STANDBY position

Interface cable is not connected

Contact NAD qualified technical service representative.

Provide sufficient oxygen supply pressure.

Turn SYSTEM POWER switch to ON.

Connect interface cable.

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NORTH AMERICAN DRÄGER Drager Narkomed 2C User manual

Specifications and Main Features

Frequently Asked Questions

User Manual