NORTH AMERICAN DRÄGER Drager Narkomed M Mobile User manual

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Operator’s
Instruction

Manual

Part Number: 4115139-001

Date: 30 January 2004

© 2004 Draeger Medical, Inc.

Rev: F

Narkomed Mobile

Anesthesia System

W ARNING: For a full understanding of the performance characteristics of this anesthesia

machine, the user should carefully read this manual before operating.

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Contents

Section 1. Safety Summary

Operator's Responsibility for Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2

Limitation of Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Restriction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Copyright. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Trademark Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3

Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4

Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4

Purpose of This Manual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4

Symbol Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-5

Warnings and Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-5

Section 2. General Description

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

Gas Delivery System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-5

Anesthetic Vaporizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-14

Absorber System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-15

Scavenger System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19

Anesthesia Ventilator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-20

Power Supply System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-22

System Interface Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-24

Remote Display and Support Arm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-24

Monitoring System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-25

Alarm System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-26

Section 3. Specifications

General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

Electrical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2

Gas Delivery System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-3

Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

Absorber System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

Oxygen Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-4

Breathing Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-5

Respiratory Volume Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-5

Serial Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-6

Section 4. Daily and Preuse Checkout Procedures

Daily Checkout Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-3

Preuse Checkout Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-11

Section 5. Operating the Anesthesia Machine

Gas Delivery System Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3

Anesthetic Vaporizer Operation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4

Absorber System Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7

Scavenger Interface Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-11

Anesthesia Ventilator Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-12

Part Number: 4115139-001

Rev: FNarkomed Mobile Operator’s Manual

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Section 6. Using the Monitoring System

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Power-On Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3

Monitor Screen and Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-4

Using the Alarm Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-10

Oxygen Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-12

Respiratory Volume Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-18

Breathing Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-23

Section 7. Routine Maintenance and Cleaning

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-3

Routine Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-3

Removing Parts for Cleaning and Disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-9

Disassembling Parts for Cleaning and Disinfection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-14

General Guidelines for Cleaning and Disinfection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-16

Reassembly Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-24

Section 8. Troubleshooting

Absorber System Problem Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2

Ventilator Problem Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-4

Oxygen Monitoring Problem Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-5

Respiratory Volume Monitoring Problem Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-6

Breathing Pressure Monitoring Problem Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-6

Appendix: Spare and Replacement Parts

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Part Number: 4115139-001

Rev: F

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1

Safety Summary

Table of Contents

Operator's Responsibilit y for Patient Safety .... .. .. ............... 1-2

Limitation of Lia b i l ity ........................................... ............... 1-3

Restricti on .... .... ... .... .... ... .... .... ... .... .... ..... .. .... ..... .. ..... .... .. .... 1-3

Copyright ........................................................................... 1-3

Trademark Notices .......................................................... ... 1-3

Disclaimer .. ................. .................... .................... ............... 1-4

Recommendations ............................................................. 1-4

Purpose of This Manual ..................................................... 1-4

Symbol Definition .. ............... ............................. ................. 1 -5

Warnings and Ca u tio n s .............. ............................. .......... 1-5

Warnings ....... ...... ..... ...... ....... .... ....... ...... ..... ....... ...... .... 1-6

Moving the Unit ........................... ................................. 1-6

Cautions .............................. ............................ ............. 1-8

Vaporizer Storage ........................................................ 1-9

Rev: F

Narkomed Mobile Operator’s ManualPart Number: 4115139-001

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1

Operator's Responsibility for Patient Safety

Draeger Medical 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 Draeger Medical design. This publication excludes
references to hazards that 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. Draeger Medical disclaims all liability for the consequences of
product alterations or modifications, as well as for the consequences that
might result from the combination of Draeger Medical products with
products supplied by other manufacturers if such a combination is not
endorsed by Draeger Medical.

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, Draeger Medical, disclaims responsibility for the adequacy of
the monitoring package selected for use with the anesthesia system.
However, Draeger Medical is available for consultation to discuss
monitoring options for different applications.

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Narkomed Mobile Operator’s Manual

Part Number: 4115139-001

Rev: F

Limitation of Liability

Draeger Medical'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 Draeger Medical's product warranty, is subject to and limited to
the exclusive terms of Draeger Medical's limited warranty, whether based
upon breach of warranty or any other cause of action whatsoever, regardless
of any fault attributable to Draeger Medical and regardless of the form of
action (including, without limitation, breach of warranty, negligence, strict
liability, or otherwise).

Draeger Medical shall in no event be liable for any special,
incidental, or consequential damages (including loss of profits)
whether or not foreseeable and even if Draeger Medical has been
advised of the possibility of such loss or damage. Draeger Medical
disclaims any liability arising from a combination of its product
with products from another manufacturer if the combination has
not been endorsed by Draeger Medical. Buyer understands that the
remedies noted in Draeger Medical's limited warranty are its sole
and exclusive remedies.

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1

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

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

Copyright

Copyright 2004 by Draeger Medical, Inc. All rights reserved. No part of this
publication may be reproduced, transmitted, transcribed, or stored in a
retrieval system in any form or by any means, electronic or mechanical,
including photocopying and recording, without written permission of
Draeger Medical, Inc.

Trademark Notices

Datagrip, DrägerService, Narkomed, Narkomed GS, ORM,
Quality Service For Life, Vigilance Audit, Vitalert, and Vitalink are
registered trademarks of Draeger Medical, Inc. All other products or name
brands are trademarks of their respective owners.

Rev: F

Narkomed Mobile Operator’s ManualPart Number: 4115139-001

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1

Disclaimer

The content of this manual is furnished for informational use only and is
subject to change without notice. Draeger Medical, Inc. assumes no
responsibility or liability for any errors or inaccuracies that may appear in
this manual.

Recommendations

In the interest of patient safety, Draeger Medical strongly advocates the use
of an oxygen analyzer, pressure monitor, and either a volume monitor or an
end-tidal CO

Because of the sophisticated nature of Draeger Medical 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. Contact
an authorized representative of DrägerService for service of this equipment.

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monitor in the breathing circuit at all times.

2

Draeger Medical also recommends that its anesthesia equipment be
serviced at three-month intervals. Periodic Manufacturer's Service
Agreements are available for equipment manufactured by Draeger Medical.
For further information concerning these agreements, contact
DrägerService at [phone].

Purpose of This Manual

This manual provides operating instructions for the Narkomed Mobile
Anesthesia System. It is intended for use by trained clinical professionals
familiar with accepted medical procedures, practices, and terminology used
in delivery of anesthesia and patient monitoring.

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Narkomed Mobile Operator’s Manual

Part Number: 4115139-001

Rev: F

Symbol Definition

The following symbols appear on the label on the back of the
Narkomed Mobile unit.

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CAUTION: Refer to accompanying documents before

operating equipment.

!

CAUTION: Risk of electric shock, do not remove cover.

Refer servicing to a qualified technical
service representative.

Degree of protection against electric shock:
Type B.

The following symbols appear on the shipping container of the
Narkomed Mobile unit.

60ºC

-20ºC

Warnings and Cautions

This manual contains warning and caution statements about the Narkomed
Mobile unit.

• Warni n g statements provide important information that, if
ignored, could lead directly to personal injury.

WARNI N G: This end up.

WARNI N G: Handle with care.

WARNI N G: Keep dry.

WARNI N G: Minimum and maximum storage

temperatures.

• Caution statements provide important information that, if
ignored, could lead directly to equipment damage and indirectly
to personal injury.

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Narkomed Mobile Operator’s ManualPart Number: 4115139-001

1-5

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1

Warnings The instruction manual provides important information about patient and

operator safety. Anyone involved with the setup, operation, or maintenance
of the Narkomed Mobile anesthesia system must be thoroughly familiar
with this instruction manual.

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. Constant surveillance is necessary to ensure patient
safety.

Do not attach third-party components to the anesthesia machine, ventilator,
or breathing system (except for certain approved exceptions). These devices
may affect the safe operation of the anesthesia machine. Contact
DrägerService at [phone] for further information.

Moving the
Unit

Prior to moving the Narkomed Mobile unit, the following functions must be
performed:

1. Disconnect the power cord from the mains and store properly.

2. Disconnect all gas supply lines from the wall supply. Ensure that these
supply lines are not in a position to interfere with the movement of the
machine.

3. Make sure the Vaporizer has been placed in the “0” position. Remove
and store the Vaporizer in the vaporizer holding area located on the base
of the unit. For more detailed information on storing the Vaporizer refer
to “Vaporizer Storage” on page 1-9. Move the monitor to its parked
position.

4. Move the absorber system to its parked position.

5. Unlock the caster brakes located on the two front wheels of the unit.

Before moving the assembled anesthesia machine, remove all monitors from
the top shelf of the machine, and use only the machine handles to push or
pull the unit. The anesthesia machine should only be moved by people who
are physically capable of handling the weight. Take special care that the
machine does not tip when moving up or down ramps and across thresholds
(i. e., door thresholds, elevator entrances etc.).

The Narkomed Mobile patient breathing system must not be used in
conjunction with any additional components that establish a flow direction.

1-6

Hoses and bags attached to the 22 mm hose terminals of the inspiratory
valve, expiratory valve, ventilator hose connect, and breathing bag mount
must comply with current ANSI standards.

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Part Number: 4115139-001

Rev: F

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Figure 1-1. Narkomed Mobile Showing Handle Locations.

1

HANDLE
(SIDE)

HANDLE
(REAR)

ROTATE MONITOR

INTO PARKED POSITION

ROTATE ABSORBER,

ELEVATE SLIGHTLY,

AND INSERT INTO

BRACKET OPENING FOR

PARKED POSITION

Rev: F

OP00104

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1

Oil and grease may combine explosively with oxygen or nitrous oxide. For
this reason, oil and grease must never come in contact with pipelines,
cylinders, cylinder valves, gauges, fittings, etc., that conduct oxygen or
nitrous oxide within the machine. For further information regarding safety
precautions in the use of medical gases, consult Compressed Gas
Association pamphlet P-2 and appropriate sections of the National Fire
Protection Association Standard 99.

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 amount of
previously exhaled gases. It is important that the gas mixture in the patient
circuit is monitored and that the fresh gas flow is adjusted to meet the
requirements of the patient and to compensate for patient intake, any
system leakage, or any gas drawn through sample lines and not returned.

Waste gas scavenging systems used with Draeger Medical absorber systems
must have safety features to ensure that excessive subatmospheric pressure
(lower than –0.5 cmH
+10 cmH

O) are not possible at the connection point.

2

O) and excessive positive pressure (higher than

2

Because the vaporizer funnel filling system does not limit the type of agent
poured into the vaporizer, using an agent monitoring device is
recommended to verify the agent.

Do not inhale anesthetic vapors while filling or draining the vaporizer.
Uncontrolled inhalation of anesthetic vapors is injurious to health.

Do not insert any additional components into, or modify, the anesthesia
system after any checkout procedure is started. Doing so can invalidate the
checkout results and could affect the patient's safety.

There is a possible explosion hazard if the Narkomed Mobile is used in the
presence of flammable anesthetics.

Cautions Although the Narkomed Mobile is designed to minimize the effects of

ambient radio-frequency interference, machine functions may be adversely
affected by the operation of electrosurgical equipment or shortwave or
microwave diathermy equipment in the vicinity.

Communications with external equipment may be temporarily affected by
electromagnetic interference due to the use of electrosurgical equipment.

Do not place sensitive electronic equipment on or adjacent to the display
screen.

The vaporizer is specifically designed and calibrated for one particular
anesthetic agent. Do not fill a vaporizer with any other anesthetic.

1-8

Do not place more than 35 pounds on top of the Narkomed Mobile unit.

Always operate the Narkomed Mobile on a level surface.

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Part Number: 4115139-001

Rev: F

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1

Vaporizer
Storage

Two vaporizer holders are located on the lower rear frame rail as shown in
the illustration.

Each holder will accommodate a single Dräger Vapor unit. For storing a
Dräger Vapor unit with a flat bottom, a single foam cushion is used. For
Dräger Vapor units that are not the flat bottom style (three exposed pads on
the bottom of the unit) you will need to place an additional foam cushion in
the holder. There are two additional foam cushions supplied with the
machine and are located in the drawer.

Figure 1-2. Vaporizer Storage Locations

SU00045

Rev: F

ADDITIONAL

FOAM PAD

(IF NEEDED)

VAPORIZER

HOLDERS

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General Description

Table of Contents

Overview .... ........... ........... ......... ........... ........... ......... .......... 2-3

Gas Delivery S y stem . .. .. .......................................... .... 2-5

Piping, Hoses, and Fittings ..................... ................ ..... 2-5

Oxygen Supply Pressure Failure Protection Device .... 2-9

Flowmeters .................................................................. 2-9

Minimum Oxygen Flow .............................................. 2-10

Oxygen Flus h ............... ............................. ................. 2 -1 1

Oxygen Rati o C o n troller .. ... ............... ........................ 2-12

Fresh Gas Outlet (15 mm) ......................................... 2-12

Auxiliary Oxygen Flowmeter ...................................... 2-12

Anesthetic Vaporizer ........................................................ 2-14

Absorber Sy st e m ............................ ............................. .... 2 -15

Inspiratory and Expiratory V alves .............................. 2-16

Canister ..................................................................... 2-17

Dust Cup ................................. ............................. ...... 2-17

Fresh Gas Hose ........... ............... ............................. .. 2-1 7

Breathing System Pressure Gauge ........................... 2-17

Pressure Se ns ing Hose Asse mbly ........ ... ............... .. 2-1 7

Manual/Automatic Se l e ctor Valve ............. .. ............... 2-1 7

Adjustable Press u re Limiter (APL) Valve ................. .. 2-1 7

Respiratory Volume Monitor Sensor .......................... 2-17

Oxygen Sen so r ..................... ............................. ........ 2-18

Positive End-Expiratory Pressure (PEEP) Valve ........ 2-18

Scavenger System ........................................................... 2-19

Anesthesia Ventilator ....................................................... 2-20

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Narkomed Mobile Operator’s Manual

2

Table of Contents (continued)

Power Supply System .................................................... 2-22

System Power Switch ........................................... ...... ..... 2-22

Circuit Breakers ............................................................... 2-22

Backup Battery System .................................................... 2-23

System Interface Panel .................................................. 2-24

Remote Display and Support Arm ................................. 2-24

Monitoring System ......................................................... 2-25

Monitor Screen and Controls ........................................... 2-25

Alarm Sys tem .. ... ............... ............................. ............... 2-26

Alarm Display ................. ....... ...... ...... ....... ...... ....... ...... ..... 2-26

Alarm Annunciation ........ ....... ...... ...... ....... ...... ....... ...... ..... 2-27

Ventilation Alarms ............................................................ 2-27

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Part Number: 4115139-001

Rev: F

Overview

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2

The Narkomed Mobile is a compact, lightweight, continuous flow anesthesia
system. All Narkomed Mobile machines are equipped with a monitoring
system and pneumatic circuitry for delivering gases and anesthetic vapor
for adult and pediatric patients.

Figure 2-1.

VENTILATOR
CONTROLS

DISPLAY
ASSEMBLY

BELLOWS

ULTRASONIC
FLOW SENSOR

Narkomed Mobile Front View

OP00087

HANDLE

FLOWMETER

BANK

AUXILIARY

OXYGEN

FLOWMETER

PRESSURE

GAUGES

VAPORIZER

ABSORBER
SYSTEM

Part Number: 4115139-001

Rev: F

Narkomed Mobile Operator’s Manual

SUPPORT

FRAME

2-3

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2

The Narkomed Mobile consists of these major systems:

• gas delivery

• vaporizer

• absorber

•scavenger

• ventilator

• power supply

• system interface

• monitoring/alarms.

Figure 2-2. Narkomed Mobile Back View

PIPELINE
GAS INLET

CYLINDER
YOKE

SYSTEM INTERFACE PANEL

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OP00086

Part Number: 4115139-001

Rev: F

Gas Delivery System

The pneumatic system can simultaneously deliver up to three gases and one
anesthetic agent. Gas is supplied to the system through pipelines and
cylinders. Pipeline connections for oxygen, air, and nitrous oxide are
standard. Gas cylinder yokes for one oxygen and one nitrous oxide cylinder
connection are provided. As a factory installed option, these gas cylinder
connections can be configured for two oxygen cylinders. Pipeline connectors
and the gas cylinder yokes are located on the back of the anesthesia
machine.

Figure 2-3. Gas Delivery Connections

PIPELINE

GAS SUPPLY

CONNECTIONS

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2

OP00085

Piping,
Hoses, and
Fittings

Color Coding

O2

AIR

N2O

CYLINDER YOKES

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 COLOR

Air AIR Yellow

Nitrous Oxide N2O Blue

Oxygen O2 Green

Part Number: 4115139-001

Rev: F

Narkomed Mobile Operator’s Manual

2-5

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2

Pipeline Gas
Entry

Pipeline
Pressure
Gauges

Gas from the pipeline supply enters the system through hoses connected to
indexed pipeline inlets. The indexed connector system reduces the risk of
delivering the wrong gas to a patient by preventing incorrect connection of
gas lines. The inlets have check valves that prevent backflow leakage into
the atmosphere when supply hoses are not connected or backflow into the
attached supply hoses when the cylinder is used. Each pipeline connection
is equipped with a filter to prevent foreign material from entering the
internal gas piping. Pipeline gases should be supplied at 50—55 psi.

Pipeline pressure gauges for oxygen, air, and nitrous oxide are standard.
These gauges are labeled and color-coded for their respective gases on the
flowmeter shield. The gauges are located directly below their corresponding
flowmeters and flow control valves. Pressure is indicated in psi and kPa.
The pressure gauge and flowmeter arrangements are shown in Figure 2-4
on page 2-7.

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Figure 2-4. Flowmeter and Pressure Gauge Assembly

OP00211

2

AUXILIARY
O2
FLOWMETER

PIPELINE
PRESSURE
GAUGE (N2O)

(N2O) CYLINDER
PRESSURE GAUGE

PIPELINE PRESSURE
GAUGE (AIR)

FLOW TUBE

(l/min)

FLOW

CONTROL

VALVE

FLOW

GUARD KNOB

N2O

AIR

O

2

PIPELINE

PRESSURE

GAUGE (O2)

(O2) CYLINDER

PRESSURE GAUGE

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 can
adversely affect operation. A fluctuating pipeline supply pressure, for
example, would cause a corresponding fluctuation of the gas flow delivered
from that pipeline. An excessively low pipeline pressure can activate the O
and N
the open position).

Part Number: 4115139-001

O cylinders and deplete their contents (if the cylinder valve is left in

2

Caution: To ensure gas supplies are adequate, pipeline pressure

gauges should show steady pressures of 50—55 psi.

Rev: F

Narkomed Mobile Operator’s Manual

2-7

2

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2

Cylinder Gas
Entry

The Narkomed Mobile is equipped with a two cylinder hanger yoke
assembly. The standard combination is one O
cylinder. A factory installed option for the mounting of two O

2 cylinder and one N2O

2 cylinders is

available. If this option is installed, the appropriate color coding scheme and
cylinder pin-index safety sytems will show this difference. To prevent a
cylinder from being improperly connected, the yoke is labeled, color-coded,
and keyed for oxygen and nitrous oxide cylinders using the pin-indexed
safety system.

A filter in the yoke prevents foreign material from entering the internal gas
piping. A check valve in the yoke prevents leakage into the atmosphere
when a cylinder is not mounted on the yoke. If a cylinder is not mounted to
the yoke, the attached yoke plug should be placed between the yoke 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 can
compromise the pin-indexed safety system. Be sure to verify the integrity of
both index pins when installing a new cylinder.

Warning: Make sure the cylinder yoke has two intact index pins each

time the cylinder is replaced. Use only one cylinder gasket.
Using more than one gasket can cause cylinder gas leakage
and compromise the pin-indexed safety system.

Cylinder
Pressure
Gauge

The cylinder attached to the hanger yoke must contain the proper gas at the
recommended pressures outlined in the table below. Any cylinder that
contains less than the recommended minimum shown in the table should be
replaced with a new, full cylinder.

GAS

Oxygen 1900

Nitrous Oxide 745 600

* Indicated pressure is for an E-size cylinder at 70 °F (21 °C).

† Due to differences in manufacture’s specifications and topping off during
refill of E-type cylinders, a full cylinder can be as high as 2015 psi.

PSI - FULL

*

PSI - MIN

†

1000

Within the cylinder gas circuit are the cylinder pressure gauges. These
gauges are labeled and color-coded on the flowmeter housing. When a
cylinder valve is opened, the associated pressure gauge indicates the gas
pressure in that cylinder. Pressure is indicated in psi and kPa. The
indicated pressure is proportional to the gas content of the cylinder.

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Part Number: 4115139-001

Rev: F

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2

Oxygen
Supply
Pressure
Failure
Protection
Device

The oxygen failure protection device (OFPD) is a pneumatically operated
valve that protects the patient in the event of partial or complete loss of
oxygen pressure. The valves are located in the internal supply lines for all
gases except oxygen. The gas pressure in the oxygen supply line controls the
valves. When the oxygen pressure is adequate, the valves remain open with
an unrestricted gas flow. Oxygen pressure loss causes the valves to close
proportionally to the loss of pressure. As a result, OFPD-controlled gases
can be restricted or shut down in response to loss of oxygen pressure.

Gas flow reductions are indicated on the flowmeter. When the oxygen
supply from the pipeline or cylinder pressure drops below about 37 psi:

• an O2 SUPPLY LOW Caution message appears in the Alarm
window on the monitor

• an intermittent alarm sounds.

Note: If only one source of oxygen supply pressure (either the cylinder or

pipeline) fails and the other source maintains proper supply
pressure in the oxygen supply lines, the OFPD and the alarm are not
activated.

Flowmeters The individual flowmeters for each gas are located directly above their

corresponding flow control valves. The flowmeters indicate the delivered
flow rate of each gas in the fresh gas mixture. The specific gas is labeled at
bottom of the flowtube.

Each flowmeter has a float indicator. To determine the flow rate, read the
flowmeter scale at the center of the float.

Part Number: 4115139-001

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2

Figure 2-5. Flowmeter and Indicator Float

OP00213

Minimum
Oxygen Flow

O

2

INDICATOR FLOAT

The oxygen dispensing system has a calibrated bypass flow of
150 ±50 mL/min (at 50 psi pipeline pressure) that delivers this flow of
oxygen even if the oxygen flow control valve is fully closed.

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Part Number: 4115139-001

Rev: F

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2

Flow Control
Valves

Oxygen
Flush

A valve located below each flowmeter tube is used to adjust the gas flow.
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, an authorized representative of Dräger Service can
readjust the stop.

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.
Each knob has a guard to prevent accidental adjustment to gas flow.

Caution: The oxygen flow cannot be completely shut off. Do not force

the oxygen flow control knob in an effort to shut off the
minimum flow (150 ±50 mL/min). Forcing the knob can
damage the valve seat.

A manually operated, self-closing oxygen flush valve is located on the front
of the power supply area of the machine. A bezel is mounted around the
push-button to prevent accidental engagement. When pressed, the valve
delivers an unmetered oxygen flow of about 55 L/mi directly to the fresh gas
common outlet. The SYSTEM POWER switch does not have to be on to use
the oxygen flush.

Figure 2-6. O

Flush Button

2

OP00097

FRESH GAS
OUTLET

FRESH
GAS HOSE

RELEASE TO LOCK

PULL TO INSERT OR

REMOVE HOSE

O2 FLUSH
CONTROL

FRESH GAS

LOCKING BAR

Part Number: 4115139-001

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2-11

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2

Oxygen Ratio
Controller

The Oxygen Ratio Controller (ORC) is a pneumatic oxygen/nitrous oxide
interlock system that maintains a fresh gas oxygen concentration of 25 ±4%.
The ORC allows independent control of the oxygen and nitrous oxide flows.

The ORC proportionally limits 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 was 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 amount of previously exhaled gases.
It is important that the gas mixture in the patient circuit is
monitored and that the fresh gas flow is adjusted to meet the
requirements of the patient and to compensate for patient
intake, any system leakage, or any gas drawn through
sample lines and not returned.

Fresh Gas
Outlet
(15 mm)

Auxiliary
Oxygen
Flowmeter

The fresh gas outlet (Figure 2-7 on page 2-13) delivers the fresh gas mixture
(consisting of oxygen, nitrous oxide, and air) and vapors of a liquid
anesthetic to the patient breathing system. The outlet is located on the front
of the anesthesia machine.

The 15 mm cylindrical female fitting accepts 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
Draeger Medical design and should not be replaced by a hose from any other
manufacturer.

For the delivery of a metered flow of pure oxygen (for example, delivery of
oxygen through a nasal cannula), an auxiliary oxygen flowmeter is mounted
on the left side of the flowmeter bank (Figure 2-6 on page 2-11). This
flowmeter can be used when the machine is turned off.

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Rev: F

Figure 2-7. Fresh Gas Outlet

OP00097

FRESH GAS
OUTLET

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2

O2 FLUSH
CONTROL

FRESH GAS

LOCKING BAR

FRESH
GAS HOSE

RELEASE TO LOCK

PULL TO INSERT OR

REMOVE HOSE

Part Number: 4115139-001

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2-13

2

Anesthetic Vaporizer

The Narkomed Mobile is equipped with a Dräger-Vapor 19.3 vaporizer. This
vaporizer enriches fresh gas with precisely metered vapor of liquid
anesthetic agent. The vapor is inserted into the fresh gas line. It is
connected between the fresh gas metering unit and the fresh gas outlet.

Figure 2-8. Dräger-Vapor 19.3 Vaporizer

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OP00329

INLET VALVE

FILLING

SPOUT

MAX FILL LINE

SIGHT GLASS

MIN FILL LINE

DRAIN
VALVE

Warning: If the wrong anesthetic is used, the delivered concentration

can be higher or lower than the concentration set on the
handwheel.

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

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

Caution: Handle the vaporizer with care. Do not drop, carry by the

handwheel, sealing plugs, or locking lever. Damage to the
vaporizer will result.

Caution: Ensure that the Vapor 19.3 handle is in the locked position

prior to use.

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Absorber System

A single-canister system absorbs exhaled carbon dioxide in the rebreathing
circuit of the anesthesia machine.

Figure 2-9. Absorber System

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2

PRESSURE
SENSOR ADAPTER

BREATHING
SYSTEM
PRESSURE
GAUGE

ABSORBENT
CANISTER

EXPIRATORY
VALVE

PEEP VALVE

OP00079

OXYGEN SENSOR

INSPIRATORY

VALVE

FRESHGAS

HOSE

APL VALVE

MANUAL/AUTO

SELECTOR

VALVE

BREATHING

BAG FITTING

ABSORBER

MOUNTING STUD

The absorber system is equipped to accommodate sensors to monitor oxygen
concentration, tidal volume, respiratory minute volume, pressure, and
respiratory frequency. The PEEP valve regulates positive end-expiratory
pressure in the patient breathing circuit.

The absorber system handles spontaneous, manually assisted, or automatic
ventilation. The preferred mode of operation is selected with the manual/
automatic selector valve. The “AUTO” position of the valve enables
automatic ventilation. The “BAG” position enables Manual/Spontaneous
ventilation.

Part Number: 4115139-001

Rev: F

Narkomed Mobile Operator’s Manual

ABSORBER

POLE

2-15

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2

The absorber system includes:

• an inspiratory valve and an expiratory valve

• an absorber canister and dust cup

• a breathing system pressure gauge

• a pressure sensing hose assembly

• fresh gas hose

• manual/automatic (ventilation) selector valve

• an adjustable pressure limiter (APL) valve

• respiratory volume sensor

• oxygen concentration sensor

• a positive end-expiratory pressure (PEEP) valve.

Inspiratory
and
Expiratory
Valves

The inspiratory and expiratory valves control the gas flow direction in the
absorber system. The valves are unidirectional, meaning they permit gas
flow in one direction only:

• The inspiratory valve allows gas to flow toward the patient only,
without backflow to the absorber.

• The expiratory valve allows gas to flow to the absorber only, with
no backflow to the patient.

The valves are

not interchangeable. They must be connected to the correct

mounts to ensure proper flow direction through the absorber system.
Different size mounting threads on each valve prevent connecting a valve to
the wrong vent.

Warning: Do not use the anesthesia machine if:

• a pin in the valve domes or valve body is bent, damaged,
or missing

• the valve disks are missing or damaged

• the valve seat is damaged.

The inspiratory valve dome is equipped with a pressure sensor adapter.
This adapter contains a port for the pressure sensor hose assembly. The
oxygen concentration sensor fits on top of the pressure sensor adapter. A cap
is tethered to the absorber for plugging into the inspiratory valve dome
when the oxygen sensor and pressure sensor hose assembly are not in place.

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Rev: F