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

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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Rev: F

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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

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

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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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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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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 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.

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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.

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 (800) 543-5047.

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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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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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 (800) 543-5047 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.

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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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Figure 1-1. Narkomed Mobile Showing Handle Locations.

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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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.

O) and excessive positive pressure (higher than

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.

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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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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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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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Overview

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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

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SUPPORT

FRAME

2-3

Page 18

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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

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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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OP00085

Piping, Hoses, and Fittings

Color Coding

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

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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

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

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

Caution: To ensure gas supplies are adequate, pipeline pressure

gauges should show steady pressures of 50—55 psi.

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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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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.

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Figure 2-5. Flowmeter and Indicator Float

OP00213

Minimum Oxygen Flow

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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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

OP00097

FRESH GAS OUTLET

FRESH GAS HOSE

RELEASE TO LOCK

PULL TO INSERT OR

REMOVE HOSE

O2 FLUSH CONTROL

FRESH GAS

LOCKING BAR

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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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Figure 2-7. Fresh Gas Outlet

OP00097

FRESH GAS OUTLET

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O2 FLUSH CONTROL

FRESH GAS

LOCKING BAR

FRESH GAS HOSE

RELEASE TO LOCK

PULL TO INSERT OR

REMOVE HOSE

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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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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.

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ABSORBER

POLE

2-15

Page 30

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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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Canister The absorber system has a transparent plastic canister that houses the

absorbent. The absorbent—soda lime or barium hydroxide lime—is available in either loose, granular form or in a prepacked cartridge.

When using loose absorbent, do not fill above the maximum fill level line located about a quarter-inch from the top of the canister. The clearance and the ratio of canister diameter to screen opening minimize the potential for

channeling. In channeling, gas flows through the canister along the path of

least resistance. The gas depletes the efficiency of the absorbent along this route, bypassing absorbent in other areas of the absorber. Draeger Medical recommends the use of DrägerSorb for the absorber system.

Dust Cup A removable cup at the bottom of the absorber canister assembly collects

absorbent dust and excess moisture that can cause increased flow resistance in the system.

Fresh Gas Hose

Breathing System Pressure Gauge

Pressure Sensing Hose Assembly

Manual/ Automatic Selector Valve

The fresh gas hose is connected to the upper absorber dome. This flexible hose delivers fresh gas to the breathing system. It has a 15 mm male fitting designed to fit the Draeger Medical fresh gas outlet and must not be replaced by another manufacturer's fitting.

The absorber system has a pressure gauge for quick visual readings of breathing circuit pressure. The gauge is marked for measurements from –20 to +80 cmH

O in increments of 2 cmH2O. The pressure gauge line is

connected to the absorber at the pressure sensing adapter.

Warning: Frequent observation of the breathing system pressure gauge

is mandatory to ensure adequate pressure buildup and relief, regardless of the mode of operation.

Pressure is monitored at the absorber. A pilot line connects the anesthesia system pressure monitoring and alarm system.

The manual/automatic selector valve has two-position control knob for selecting gas pathways for automatic or manually assisted ventilation. Turning the knob clockwise sets the system to AUTO. Turning the knob counterclockwise, sets the system to BAG.

Adjustable Pressure Limiter (APL) Valve

Respiratory Volume Monitor Sensor

Part Number: 4115139-001

The APL valve relieves excess gas from the breathing circuit into the scavenger system. The APL valve expels excess gas containing expired carbon dioxide before it contacts the absorbent, which extends the life of the absorbent.

The respiratory volume sensor is an ultrasonic flow sensor that monitors tidal volume, respiratory minute volume, and respiratory frequency.

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Oxygen Sensor

Positive EndExpiratory Pressure (PEEP) Valve

The oxygen sensor analyzes oxygen concentration in the patient circuit. The sensor mounts in the port at the top of the pressure sensor adapter, which is connected to a port in the inspiratory valve dome. A plug for closing off the port when an oxygen sensor is not in place is tethered on the absorber system. Draeger Medical strongly advocates using an oxygen concentration sensor in the patient circuit.

The PEEP valve regulates the positive end-expiratory pressure in the patient breathing circuit. PEEP is increased by turning the knob clockwise and diminished by turning the knob counterclockwise. The adjustment range is about 2 to 15 cmH

O. The pressure gauge reading includes the

PEEP.

Warning: 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) and excessive positive pressure (higher than

O) are not possible at the connection point.

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Scavenger System

The scavenger interface is an exhaust collector manifold. It is intended for use with suction (vacuum) or passive waste gas disposal systems.

The suction approach uses continuous suction to transfer the gas from the scavenger to the disposal system. Passive systems rely on the pressure of the waste gas to convey the waste gas to the exhaust system.

This is a closed system that has one spring-loaded valve for positive pressure relief and one for negative pressure relief.

Figure 2-10. Scavenger Interface

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VACUUM NEGATIVE PRESSURE RELIEF VALVE

OP00088

19MM OUTLET HOSE CONNECTION (PASSIVE) OR

3.0 LITER RESERVOIR BAG (ACTIVE)

POSITIVE RESSURE

RELIEF VALVE

19MM INLET

HOSE

CONNECTION

NEEDLE VALVE

ADJUSTMENT KNOB

(SHOWN DOTTED)

SUCTION

HOSE BARB

The exhaust collector manifold has two 19 mm male fittings to connect 19 mm hoses from the ventilator and absorber APL valve to the exhaust system.

The exhaust collector manifold connects to a suction waste gas disposal system with the hose barb. An adjustable needle valve regulates the waste gas exhaust flow. A 3.0 liter reservoir bag contains the excess waste gas. This system accommodates a variety of waste gas flow rates from the patient breathing system.

A 19 mm hose connects to the fitting below the hose barb for passive exhaust systems. A relief valve guards against excessive pressure build-up if the exhaust hose is restricted.

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Anesthesia Ventilator

The 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 limiting.

Figure 2-11. Anesthesia Ventilator Assembly

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I:E RATIO CONTROL

I:E RATIO DISPLAY

EXTENDED RANGE ACCESS

FREQUENCY CONTROL

FREQUENCY DISPLAY

INSPIRATORY PRESSURE LIMIT

BELLOWS CANISTER

cmH2O

MIN MAX

OP00096

INSIRATORY FLOW GAUGE

INSPIRATORY

FLOW CONTROL

VENTILATOR

ON-OFF

CONTROL

TIDAL VOLUME

CONTROL

PRESSURE

LIMIT CONTROL

2-20

TIDAL VOLUME SETTING INDICATOR

BREATHING CIRCUIT

CONNECTOR

Pneumatic power (bellows drive gas) to the ventilator is supplied through the hospital pipeline supply or through the cylinder. A switch on the right side of the housing is used to select either oxygen or air as the drive gas (Figure 2-12 on page 2-21). The ventilator will not function properly if this pressure drops below 32 psi. Electrical power is supplied by the AC power source, or, in event of AC power failure, by the backup battery. A fully charged battery can power the ventilator for at least 90 minutes.

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Figure 2-12. Drive Gas Selector Switch

DRIVE GAS SELECTOR SWITCH

AIR

VENTILATOR DRIVE GAS

OP00078

N2O

AIR

FLOWMETER HOUSING

The anesthesia ventilator is designed for use with a Draeger Medical absorber with a manual/automatic selector valve. This valve is for selecting either the breathing bag using the 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 breathing bag and APL valve from the breathing system. To compensate for the continuous introduction of fresh gas into the breathing system, the ventilator has a relief valve mounted behind the bellows chamber.

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. For the Narkomed Mobile, the PEEP is approximately 2cmH

The pressure limit control is used to set the peak inspiratory pressure produced by the ventilator to limit the maximum pressure to the patient. The pressure limit control can also improve ventilation for patients with reduced lung compliance (neonatal/pediatric patients and patients with adult respiratory distress syndrome).

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Power Supply System

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

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System Power Switch

The SYSTEM POWER switch is located at the front of the power supply. It has two positions; ON and STANDBY. In the ON position, the gas (pneumatic) and electric power circuits are actuated. In the STANDBY position, the switch shuts down the fresh gas supply, the monitoring system, and all electrical power to the machine except the battery charging circuit. When power is on, the green LED power-on indicator illuminates.

Figure 2-13. System Power Supply

POWER APPLIED INDICATOR

OP00098

SYSTEM

POWER

SWITCH

BATTERY TEST

BUTTON

BATTERY TEST

INDICATOR

Circuit Breakers

2-22

The electrical system has two magnetic circuit breakers to protect machine functions (primary AC power input and backup battery power). The circuit breakers are located on the lower part of the power supply in the back of the machine.

A circuit breaker is in its normal, closed position when the plunger is flush with the surface of its base. 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.

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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.

The backup battery system automatically provides power with no delay during the period between line power failure and activation of an emergency generator during a power outage. It also provides power if the cord is accidentally unplugged during a case. The system automatically switches back to AC power and recharges its battery when power is restored.

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 getting 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 is displayed.

These events signal backup battery system activation:

• The Caution message AC POWER FAIL is displayed.

• A three-pulse pattern audio alarm sounds every 30 seconds.

These alarms signify that about 90 minutes of backup battery power remains from the time the alarm is activated if the battery was fully charged. All monitoring functions continue to operate, using the battery for power.

Battery Test Indicator and Button

When the battery reserve approaches depletion after an AC power loss, the Caution message AC BATTERY FAIL is displayed.

This alarm signifies that about 10 minutes of backup battery power remains from the time the message is 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.

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 become depleted. Plugging the power cord into an active AC outlet for about 12 hours will recharge a depleted battery.

The battery test button and indicator located near the system power switch are used to determine the backup battery status (Figure 2-13 on page 2-22). A detailed testing procedure is included in the checkout procedures in this manual.

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System Interface Panel

The system interface panel has receptacles for the remote display, oxygen sensor cord, the breathing pressure pilot line, and the respiratory volume sensor cord. The panel is located on the display side of the anesthesia machine near the top of the housing.

Figure 2-14. System Interface Receptacles

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REMOTE DISPLAY INTERFACE

OP00083

FROM: ULTRASONIC FLOW SENSOR

Remote Display and Support Arm

The remote display (monitor screen and controls) is mounted on the absorber side of the machine. The display can be adjusted up or down to place it in the most convenient position. The support arm below the monitor screen supports an external patient monitor.

REMOTE DISPLAY

VOLUME SENSOR

OXYGEN SENSOR

BREATHING PRESSURE

BREATHING

PRESSURE

MONITOR

INTERFACE

OXYGEN ANALYZER

INTERFACE

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Part Number: 4115139-001

Rev: F

Page 39

Monitoring System

The monitoring system integrates the functions of the electronic monitors and organizes information from these monitors on the monitor screen.

The Narkomed Mobile monitors:

• oxygen concentration

• breathing pressure

• respiratory volume

• oxygen supply pressure

•system status.

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Monitor Screen and Controls

All monitoring data and alarm messages are displayed on the monitor screen. Use the control keys on either side of the screen to establish monitoring settings. With the left keypad, you can control system-wide settings, such as alarm annunciation and monitor configuration. With the right keypad, you can control settings for specific monitors oxygen concentration, breathing pressure, and respiratory volume.

Figure 2-15. Monitor Screen and Controls

OP87005

Config

Alarms

All Stby

LEFT

KEYPAD

WARNING:

ADVISORY:

TID VOL

0.35

CAUTION:

INSP O2 LOW SUB ATM PRESSURE AC / BATTERY FAIL O2 SUPPLY LOW SERVICE VENT MON PORT A ERROR

BPM

MONITOR

SCREEN

OXYGEN

MIN VOL

3.5

PEAK

MEAN

PEEP

100

Oxygen(%)

High Limit

Breathing Volume

Low Limit

Breathing Pr essure

2.0

High Limit

Low Limit

Auto Set

Cal

(Liters)

Off

(cm H O)

Off

RIGHT

KEYPAD

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Rev: F

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2-25

Page 40

Alarm System

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Alarms are organized into three categories, depending on the urgency of the alarm condition.

Warn i ngs The highest priority alarms requiring an

immediate response

Cautions Second priority alarms requiring a prompt

response

Advisories The lowest priority alarms requiring the

operator's awareness

Visual and audible notification announce the most urgent conditions.

Alarm Display

Messages for active alarm conditions appear in the Alarm window at the top of the monitor screen. Messages are displayed for up to six of the highest priority active alarm conditions. Any additional lower priority active alarm conditions are retained in the monitor's memory. Messages for these lower priority conditions are displayed when the higher priority alarm conditions are resolved and their messages are removed from the display.

Figure 2-16. Alarm Window Display

ALARM WINDOW

WARNING:

CAUTION:

ADVISORY:

TID VOL

0.35

INSP O2 LOW SUB ATM PRESSURE AC / BATTERY FAIL O2 SUPPLY LOW SERVICE VENT MON PORT A ERROR

BPM

OXYGEN

MIN VOL

3.5

100

2.0

PEAK

OP87001

MEAN

PEEP

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Part Number: 4115139-001

Rev: F

Page 41

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Alarm Annunciation

Ventilation Alarms

Each alarm category has a specific audible signal:.

Warn i ngs A three-pulse tone pattern that is

initially repeated every few seconds in a series of descending volumes, and then constantly at full volume until the alarm condition is resolved

Cautions A three-pulse tone pattern that is

repeated every 30 seconds

Advisories A single tone or no sound at all,

depending on the urgency of the advisory

The alarm sounds only for the highest-priority, currently active alarm condition. Tones for lower priority alarm conditions are temporarily suppressed eliminate simultaneous alarms. If the primary speaker fails, the Advisory message SERVICE SPEAKER appears in the Alarm window.

When the system power switch is turned ON, the volume and pressure apnea alarms default to Standby to allow machine setup without sounding alarms. An interlock with the ventilator ensures that when the ventilator is turned on, the alarms are enabled. You can also enable the alarms individually using the keypad.

When the ventilator is turned off:

• If the pressure apnea threshold was greater than 15 cmH

when the ventilator was turned off, the threshold setting is changed to 15 cmH than 15 cmH

O when the ventilator was turned off, the threshold

O. (If the pressure apnea threshold was less

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.

Part Number: 4115139-001

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Page 43

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Specifications

Table of Contents

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

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

Storage ........................................................................ 3-2

Operating ... ........................... ....................................... 3-2

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

Main Power Supply ...................................................... 3-2

Backup Battery ........ .......................................... .......... 3-2

Gas Delivery S y stem ......... .. ................ ............................ .. 3-3

Cylinder Gas Pressure .......................... ................ ....... 3-3

Flowmeter Accuracy (at 20 °C and 760 mmHg) .......... 3-3

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

Absorber Sy st e m ............................ ............................. ...... 3-4

Inspiratory Valve .......................................................... 3-4

Expiratory Valve ........................................................... 3-4

PEEP Valve ................................................................. 3-4

APL Valve .................................................................... 3-4

Bag Mount ............................................... .................... 3-4

Oxygen Mon it o ring . .. ................ ......................................... 3-4

Breathing Pr e ss u r e M o n it o ring ....... ................ ................... 3 -5

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

Minute Volume ............................................................. 3-5

Tidal Volume .............. .. ............................. ................... 3 -5

Respiratory Rate .......................................................... 3-5

Serial Inte r face ..... .. ............... ............................. ............... 3-6

Serial Port s ......... ................ ............................ ............. 3-6

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Rev: F

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Page 44

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General

Anesthesia machine dimensions (approx.)

(W x H x D). . . . . . . . . . . . . . . . . . . . . . . . . . . 23½ x 53½ x 24½ inches

Anesthesia machine Weight (Approx). . . . . . . . . . . . . . . . . . . .163 lbs.

Environmental

Storage Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .–20—+60 °C

Humidity . . . . . . . . . . . .10—90% relative humidity (noncondensing)

Barometric Pressure . . . . . . . . . . . . . . . . . . . . . . . . . 787—523 mmHg

Operating Temperature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10—35 °C

Humidity . . . . . . . . . . . .30—70% relative humidity (noncondensing)

Barometric Pressure . . . . . . . . . . . . . . . . . . . . . . . . . 787—523 mmHg

Electrical

Equipment class UL 2601 Class 1, Type B, continuous operation, IPXO

Main Power Supply

Leakage current

Ground impedance

Dielectric withstand

Chassis resistance (between any metallic point and ground pin on power cord)

Primary input voltage (acceptable range) .100—240 VAC (@ 50/60 Hz)

Primary input current . . . . . . . . . . . . . . . . . . . .≤ 2.5 amps (@ 50/60 Hz)

. . . . . . . . . . . . . . . . . . . . ≤ 300 microamps (UL 2601)

. . . . . . . . . . . . . . . . . . . . ≤ 0.1 ohm (60 Hz source)

. . . . . . . . . . . . . . . . . . . . . ≥ 1500 VAC (UL 2601)

. . . . . . . . . . . . . . . . . . . . . . .≤ 0.1 ohm

Backup Battery

3-2

Type . . . . . . . . . . . . . . . . . . . . . . . . Sealed Lead Acid, 12 VDC, 3.4 Ah

Charging time

Reserve power time (from full charge) . . . . . . . . . . . . . . . . . . . 90 min

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ≤ 12 hours

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Part Number: 4115139-001

Rev: F

Page 45

Gas Delivery System

Pipeline inlet connections . . . . . . . . . . DISS/male (ANSI B57.1-1977)

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Cylinder Gas Pressure

Pipeline inlet pressure. . . . 50—55 psi (345—380 kPa) (O

, N2O, Air)

Pipeline gauge accuracy . . . . . . . . . . . . . . . . . . . . . .±3 psi (0—25 psi)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .±2 psi (25—75 psi)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .±3 psi (75—100 psi)

Cylinder connection . . . . . . . . . . . . . . . . . . . Pin-indexed hanger yoke

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (ANSI/CGA V-1-1987)

Over pressure relief valve . . . . . . . . . . . . . . . . . . . . . .95 psi (655 kPa)

Fresh gas common outlet. . . . . . . . . . . . . . . . . . . . . . . . 15 mm female

Fresh gas oxygen concentration (ORC). . . . . . . . . . . . . . . . . . . 25 ±4%

Oxygen flush flow rate. . . . . . . . . . . . . . . . . . . . . . . . . . 55 (±10) L/min

Minimum oxygen flow (at 50 psi pipeline pressure) 150 ±50 mL/min

Low oxygen supply pressure alarm. . . . . . . . . . . . . . . . . . . 34—40 psi

Cylinder gauge accuracy . . . . . . . . . . . . . . . . . . . .±90 psi (0—750 psi)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .±60 psi (750—2250 psi)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .±90 psi (2250—3000 psi)

Oxygen . . . . . . 1900 psi (13100 kPa) E-size cylinder (at 70 °F, 21 °C)

Nitrous Oxide . . . 745 psi (5130 kPa) E-size cylinder (at 70

°F, 21 °C)

Flowmeter Accuracy (at 20 °C and 760 mmHg)

Part Number: 4115139-001

Oxygen, Nitrous Oxide, Air

Dual Tapered 0—8 L/min . . . . . . . . . . . .0.1—0.2 L/min ± 50 mL/min

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.2—1.0 L/min ±100 mL/min

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.0—8.0 L/min ±5% FS

Oxygen (Auxiliary Oxygen) . . . . . . . . . . . . . . . . . 0—10 L/min ±5% FS

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3-3

Page 46

Ventilator

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Frequency. . . . . . . . . . . . . . . . 1—99, ±1 BPM (in 1 BPM increments)

I:E ratio

. . . Standard range: 1:1—1:4.5, ±0.1 (in increments of 0.5);

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Extended range: 4:1, 3:1, 2:1

Inspiratory flow . . . . . . . . . . . . . . . . . . .10—100 L/min (uncalibrated)

Tidal volume. . . . . . . . . . . . . . . . . . . . . . . . . . .20—1500 mL, ±100 mL

Pressure limit control adjustment range . . . . . . . . . .15—120 cmH

Absorber System

Inspiratory Valve

Expiratory Valve

PEEP Valve Range . . . . . . . . . . . approx. 2—15 cmH

APL Valve APL Valve Nominal low flow resistance . . . . . . . 2 cmH

Mounting ring nut size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M35 x 1

Hose terminal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 mm male

Mounting ring nut size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M33 x 1

Hose terminal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 mm male

O (continuously adjustable)

Hose terminal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 mm male

O at 8 L/min

Bag Mount Breathing Bag Terminal . . . . . . . . . . . . . . . . . . . . . . . . . . 22 mm male

Oxygen Monitoring

Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10—100 vol % O

Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 vol % O

Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ±3 vol % O2

(When calibrated within 18 hrs, and constant temperature and pressure)

Response time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .≤ 25 sec (T90)

Zero drift. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Span drift

Temperature error

Sensor service life

. . . 50% relative humidity, 50% O

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ≤ 1 vol % O

. . . . . . . . . . . . . . ≤ ± 3% of reading (15 °C—40 °C)

. . . . . . . . . . . . . . . . . . . . . . . . ≥ 8 months at 25 °C,

gas mixture (or ≥ 5000% hr CO

≤0.1 vol % O

/month

/8 hours

)

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Rev: F

Page 47

Breathing Pressure Monitoring

Numeric display range. . . . . . . . . . . . . . . . . . . . . . .–10—+125 cmH2O

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Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 cmH

Accuracy . . . . . . . . . . . . . . . . . . . . . . . .±3 cmH

O or ±10% of reading,

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . whichever is greater

Waveform display range - full . . . . . . . . . . . . . . . . . . . .0—100 cmH

Waveform resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 cmH

Waveform accuracy . . . . . . . . . . . . . . .±3 cmH

O or ±10% of reading,

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . whichever is greater

Waveform display scales . . . . . . . . . . . . 0—20, 0—50, 0—100 cmH

Respiratory Volume Monitoring

Minute Volume

Tidal Volume Display Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0.01—2.01 L

Display Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0.1—50.0 L

Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.1 L

Accuracy

. . . . . . . . . . . . . . . . ±10% of reading or 0.01 L x breath rate

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . whichever is greater*

NOTE:

The standard bellows will deliver up to 1.5 L

Respiratory Rate

Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.01 L

Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . ±10% of reading or 0.015 L,

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . whichever is greater*

Volume Apnea Threshold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.02 L

Numeric display range. . . . . . . . . . . . . . . . . . . . . . . . . . . . .2—99 BPM

Resolution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 BPM

Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . .±10% of reading or ±1 BPM,

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . whichever is greater

Exclusive of hose compliance

Part Number: 4115139-001

Rev: F

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3-5

Page 48

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Serial Interface

Serial Ports Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RS-232/422

Baud Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300—38400

Parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Odd, Even, or None

Data Bits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 or 8

Stop Bits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 or 2

Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Vitalink

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Daily and Preuse Checkout Procedures

Table of Contents

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

Initial Setup a nd Verification .......... .. ............................ 4-3

System Software Diagnostics ...................................... 4-3

Battery Power Verification ............................................ 4-3

Emergency Ventilation Equipment V erification ............ 4-3

High Pressure System Verification .............................. 4-4

Pipeline Supply System Verification ............................ 4-4

System Gas C ir c uit Verificatio n ........... ................ ........ 4-4

Low Pressure Sys t e m Verification . .. ............... ............. 4-5

Oxygen Mon it o r C al ibration .......................... ............... 4-5

OFPD Verification ............ ............................. ............... 4-5

ORC Verification ............................ .............................. 4 -5

Oxygen Flus h Verification .................. .......................... 4-5

Fresh Gas Verificatio n .. ............... ............................. .... 4-5

Absorber Sy st e m Verification ........... .. ................ .......... 4-6

APL Valve Verification .................................................. 4-7

Breathing System Leak Test ........................................ 4-7

Scavenger System Verification .................................... 4-8

Manual and Automat ic Ventilation System s ............. .. .. 4-9

Monitors ... ...................... ........................ .................... 4 -10

System Flush .............................................. ............... 4-1 0

Final Position ...... ............................. .......................... 4-10

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Table of Contents (continued)

Preuse Checkout Procedur e .......... ...................... .......... 4-11

Reserve Power Verification .............................................. 4-11

Absorber System Verification ........................................... 4-11

APL Valve .......................................... ....... ...... ....... ...... ..... 4-12

Breathing System Leak Test ............................................ 4-13

Scavenger System ........................................................... 4-14

Manual and Automatic Ventilation Systems ..................... 4-15

Monitor ............................................................................. 4-16

System Flush ................................................................... 4-16

Final Position .................................................................... 4-16

4-2

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Rev: F

Page 51

Daily Checkout Procedure

Before operating the Narkomed Mobile, 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 important note symbol , do not use the machine. Contact an authorized representative of DrägerService for inspection of the unit.

Note: Do not insert any additional components into, or modify, the

anesthesia system after the checkout procedure is started.

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Initial Setup and Verification

System Software Diagnostics

Battery Power Verification

1. Enter the serial number of the anesthesia machine. The serial number is located on the leg of the transport trolley assembly.

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 an authorized representative of DrägerService.

3. Verify that a cylinder wrench is tethered next to the cylinder yoke.

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 cable from the

outlet. Press the BATTERY TEST button. The green indicator must light. 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.

Emergency Ventilation Equipment Verification

Part Number: 4115139-001

7. Verify that backup ventilation equipment is available and

functional.

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High Pressure System Verification

8. Check the oxygen and nitrous oxide cylinder supplies.

a. Disconnect all pipeline gas supply hoses and drain the system.

b. Close the both cylinder valves and remove the cylinders from the

yoke. Verify that there is one cylinder gasket and there are two index pins at each cylinder mounting point. Verify that the cylinders match the yoke label. Replace the cylinders.

c. Open the oxygen cylinder and check the cylinder pressure gauge. A

†

1900

full oxygen cylinder registers about

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. With the oxygen cylinder closed, press the oxygen flush button on the front of the anesthesia machine. Hold the button in until the pressure gauges indicate no pressure.

d. Open the nitrous oxide cylinder and check the cylinder pressure

gauge. A full oxygen cylinder registers about 745 psi. Replace any cylinder with 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.

The full and minimum pressures for the oxygen and nitrous oxide cylinders:

GAS

Oxygen 1900 Nitrous Oxide 745 600

PSI - FULL

PSI - MIN

†

1000

Pipeline Supply System Verification

System Gas Circuit Verification

* 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.

9. Pipeline Supply Verification

a. Inspect the supply hoses for cracks or wear.

b. Connect the appropriate pipeline supply hoses 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 over the full range. 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.

10. 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.

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Low Pressure System Verification

Oxygen Monitor Calibration

OFPD Verification

11. Vaporizer Verification

a. Check for sufficient supply of liquid anesthetic in the vaporizer. Fill

the vaporizer with liquid anesthetic to the maximum fill line.

b. Make sure the cap is on the spout and the drain is completely closed.

c. Make sure the handwheel is set to 0.

d. d. Vapor handle is in the locked position

12. 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 concentration is supplied to the

anesthesia system from the pipeline and cylinder supplies.

c. Close the cylinder supply and deplete the pressure from the system.

13. 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. The flow of all other gases indicated by their flowmeters must decrease in proportion to the decrease in oxygen flow and eventually shut off.

ORC Verification

Oxygen Flush Verification

Fresh Gas Verification

14. Check the function of the ORC. With the nitrous oxide flow control

valve open to a flow of 8 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 21% oxygen.

15. 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.

b. Check the delivered oxygen concentration. Repeatedly flush the

patient breathing system by pressing the oxygen flush button. Close all the other flow control valves. The oxygen measurement display area should indicate 97% to 100% oxygen concentration.

16. Make sure the handwheel is set to 0. 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.

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Absorber System Verification

17. 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 hose assembly is properly

connected between the pressure sensor adapter and the system interface panel.

g. Make sure the oxygen sensor and respiratory volume sensor are

properly installed.

18. Make sure the absorber canister is filled with CO

absorbent.

Consult the absorbent manufacturer's literature for information on what signs to expect when the absorbent is exhausted. Draeger Medical recommends the use of DrägerSorb. 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 for at least one minute with 100% oxygen before the first case of the day is recommended.

4-6

If the anesthesia machine has been out of use or in storage, replace the absorbent before using the machine. Draeger Medical recommends establishing a routine schedule with a sufficient safety margin for replacing the absorbent.

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

WARNING:

NOTE: When changing the CO

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.

absorbent, take care not to chip or crack the absorbent canister. Check the canister for signs of damage, especially along the rim before reinstallation.

19. Close the vaporizer and all gas flow sources. 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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APL Valve Verification

Breathing System Leak Test

20. 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. Set the PEEP valve to its minimum position.

c. Remove the bag from the bag mount.

d. Interconnect the inspiratory valve and the expiratory hose terminal

on the ultrasonic flow sensor with a 22 mm hose.

e. Completely open the APL valve by turning the control knob fully

counterclockwise to its stop position.

f. Turn the SYSTEM POWER switch to ON.

g. Open the oxygen flow control valve to a flow of 8 L/min.

h. 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

21. 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 position.

c. Turn the vaporizer 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.

i. Connect a sphygmomanometer squeeze bulb (available from Draeger

Medical) 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 cmH 80 cmH

O).

O (not to exceed

k. Observe the pressure drop at the breathing system pressure gauge.

When the pressure is at 50 cmH pressure must not drop more than 20 cmH

O, begin counting seconds. The

O in 30 seconds.

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Scavenger System Verification

22. Verify the performance of the scavenger system.

To test negative pressure relief:

a. Connect a 19 mm scavenger hose to the ventilator relief valve and

the scavenger interface.

b. Connect a 19 mm scavenger hose between the APL valve and the

scavenger interface.

c. Connect the 3.0 liter reservoir bag to the reservoir bag terminal.

d. Connect the scavenger to the suction waste gas disposal system.

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 BAG.

g. Turn the APL valve fully counterclockwise.

h. Verify that the suction waste gas disposal system is active.

i. Open the scavenger needle valve enough to allow typical suction

through the scavenger.

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

k. Occlude the absorber breathing bag mount. At this point, the

breathing pressure gauge should indicate a negligible negative pressure no lower than –1.0 cmH

To test positive pressure relief:

a. Connect a 19 mm scavenger hose to the ventilator relief valve and

the scavenger interface.

b. Connect a 19 mm scavenger hose between the APL valve and the

scavenger interface.

c. Connect the 3.0 liter reservoir bag to the reservoir bag terminal.

d. Connect the scavenger to the suction waste gas disposal system.

e. Short circuit the absorber's inspiratory and expiratory valves with a

22 mm breathing hose.

f. Set the absorber's manual/automatic selector valve to BAG.

g. Turn the APL valve fully counterclockwise.

h. Verify that the suction waste gas disposal system is active.

i. Turn the PEEP valve control knob fully counterclockwise to its

lowest setting.

j. Turn the scavenger needle valve fully counterclockwise.

k. Push the O

flush button to inflate the scavenger reservoir bag.

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l. Open the oxygen flow control valve to a flow of 8 L/min.

m. Occlude the absorber breathing bag terminal. The oxygen flow

should exit through the positive pressure relief valve. The pressure gauge should indicate pressure less than 10 cmH

n. Adjust the scavenger needle valve to a proper initial setting.

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 and the scavenger interface.

c. Make sure a 19 mm scavenger hose is connected between the bottom

scavenger interface and the hospital exhaust system.

Manual and Automatic Ventilation Systems

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. 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 5 cmH2O.

23. 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.

Part Number: 4115139-001

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.

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The pressure gauge must indicate a pressure over 30 cmH2O when the bellows completes its downward travel. The pressure should not

exceed 3 cmH completes its upward travel.

b. Verify the PEEP valve's performance. Attach a breathing bag to the

patient Y-piece with an appropriate adapter such as a Draeger Medical 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 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.

O at the end of the expiratory phase when the bellows

Monitors 24. 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.

25. Test the alarm functions for all monitors. Simulate alarm conditions

and check for appropriate alarm signals.

System Flush 26. Flush the system for at least one minute with 100% oxygen by pressing

the oxygen flush button.

Final Position 27. When the daily checkout procedure is complete, verify that:

a. the vaporizer is off (the handwheels is set to zero)

b. the vaporizer is filled to the maximum fill line

c. Vaporizer properly locked into position.

d. the APL valve is open (fully counterclockwise)

e. the manual/automatic selector is set to BAG

4-10

f. all flowmeters indicate 0 (or minimum)

g. the breathing system is ready to use (the bag is in place and all hoses

are connected properly).

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Preuse Checkout Procedure

Perform the following abbreviated checkout procedure when the Narkomed Mobile 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 important note symbol , do not use the machine. Contact an authorized representative of DrägerService for inspection of the unit.

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Reserve Power Verification

Absorber System Verification

NOTE:

1. Check the reserve battery power. Turn the SYSTEM POWER switch

Do not insert any additional components into or modify the anesthesia system after the checkout procedure is started.

to the ON position. Remove the power cable from the outlet. Press the BATTERY TEST button located to the left of the SYSTEM POWER switch. The green indicator to the right of the test button must illuminate. Plug the power cable back into the electrical outlet.

NOTE:

2. 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 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.

Part Number: 4115139-001

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 hose assembly is properly

connected to the pressure sensor adapter and the system interface panel.

g. Make sure the oxygen sensor and respiratory volume sensor are

properly installed.

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3. Check the CO2 absorbent in the absorber system. Make sure the

absorber canister is filled with CO manufacturer's literature for information on what signs to expect when

the absorbent is exhausted. Draeger Medical recommends the use of DrägerSorb. 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 for at least one minute with 100% oxygen before the first case of the day is recommended.

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

absorbent. Consult the absorbent

WARNING:

NOTE: When changing the CO

Absorbent is caustic and is a strong eye, skin, and respiratory tract irritant. When emptying the absorber dust cup, take care not to spill is caustic contents.

absorbent, take care not to chip or crack the absorbent canister. Check the canister for signs of damage, especially around the rim, before reinstallation.

4. Close the vaporizer 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.

APL Valve 5. Check the APL valve. The APL valve must be capable of relieving

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 bag mount.

c. Interconnect the inspiratory valve and the expiratory hose terminal

on the ultrasonic flow sensor with a 22 mm hose.

d. Completely open the APL valve by turning the control knob fully

counterclockwise to its stop position.

4-12

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

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Rev: F

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Breathing System Leak Test

6. 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 position.

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.

i. Connect a sphygmomanometer squeeze bulb (available from Draeger

Medical) 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 cmH 80 cmH

O).

O (not to exceed

k. Observe the pressure drop at the breathing system pressure gauge.

When the pressure is at 50 cmH

O, begin counting seconds. Thirty

seconds or longer are needed for a pressure drop from 50—30 cmH

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Scavenger System

7. Verify the performance of the scavenger system.

To test negative pressure relief:

a. Connect a 19 mm scavenger hose to the ventilator relief valve and

the scavenger interface.

b. Connect a 19 mm scavenger hose between the APL valve and the

scavenger interface.

c. Connect the 3.0 liter reservoir bag to the reservoir bag terminal.

d. Connect the scavenger to the suction waste gas disposal system.

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 BAG.

g. Turn the APL valve fully counterclockwise.

h. Verify that the suction waste gas disposal system is active.

i. Open the scavenger needle valve enough to allow typical suction

through the scavenger.

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

k. Occlude the absorber breathing bag mount. At this point, the

breathing pressure gauge should indicate a negligible negative pressure no lower than –1.0 cmH

To test positive pressure relief:

a. Connect a 19 mm scavenger hose to the ventilator relief valve and

the scavenger interface.

b. Connect a 19 mm scavenger hose between the APL valve and the

scavenger interface.

c. Connect the 3.0 liter reservoir bag to the reservoir bag terminal.

d. Connect the scavenger to the suction waste gas disposal system.

e. Short circuit the absorber's inspiratory and expiratory valves with a

22 mm breathing hose.

f. Set the absorber's manual/automatic selector valve to BAG.

g. Turn the APL valve fully counterclockwise.

h. Verify that the suction waste gas disposal system is active.

i. Turn the PEEP valve control knob fully counterclockwise to its

lowest setting.

j. Turn the scavenger needle valve fully counterclockwise.

k. Push the O

flush button to inflate the scavenger reservoir bag.

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l. Open the oxygen flow control valve to a flow of 8 L/min.

m. Occlude the absorber breathing bag terminal. The oxygen flow

should exit through the positive pressure relief valve. The pressure gauge should indicate pressure less than 10.0 cmH

n. Adjust the scavenger needle valve to a proper initial setting.

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 and the scavenger interface.

c. Make sure a 19 mm scavenger hose is connected between the bottom

scavenger interface and the hospital exhaust system.

Manual and Automatic Ventilation Systems

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. 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.

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

8. Test the ventilator.

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

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The pressure gauge must indicate a pressure over 30 cmH2O when the bellows completes its downward travel. At the end of the

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

b. Verify the PEEP valve's performance. Attach a breathing bag to the

patient Y-piece with an appropriate adapter such as a Draeger Medical 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.

Monitor 9. Check the alarm limit settings. The monitor alarm limits set

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

10. Test the alarm functions of all monitors. Simulate alarm conditions

and check for appropriate alarm signals.

System Flush 11. Flush the system with 100% oxygen by pressing the oxygen flush button.

Final Position 12. At the completion of the checkout procedure, verify that:

a. the vaporizer is off (handwheel is set to zero)

b. the vaporizer is filled to the maximum fill line

c. the APL Valve is open (fully counterclockwise)

d. the manual/automatic switch is set to BAG

e. all flowmeters indicate 0 (or minimum)

f. the patient suction level is adequate

4-16

g. the breathing system is ready to use (bag is in place and all hoses

connected are properly).

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Operating the Anesthesia Machine

Table of Contents

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

Adjusting the G a s Flow .......................................... ...... 5-3

Using the Oxygen Flush .............................................. 5-4

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

Turning the Vaporizer On ............................................. 5-5

Turning the Vaporizer Off ............................................. 5-5

Filling the V aporizer During a Case ............................. 5-6

Absorber Sy st e m O p era tion ......... .. .. ................................. 5-7

Using the Manual/ Automatic Selector Valve ............... 5-8

Using the APL Valve .................................................... 5-9

Using the PEEP Valve ............................. .. ................ 5-10

Part Number: 4115139-001

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

Needle Valve Adjustment for Suction Systems .......... 5-12

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Table of Contents (continued)

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

Activating the Ventilator .................................................... 5-14

Using the Ventilator On/Off Control .................................. 5-14

Adjusting the Tidal Volume ............................................... 5-14

Setting the Respiratory Frequency ................................... 5-15

Setting the Inspiratory/Expiratory (I:E) Phase Time Ratio 5-15

Setting the Inspiratory Flow Rate ..................................... 5-15

Setting the Inspiratory Pressure Limit .............................. 5-15

Selecting the Bellows Drive Gas ...................................... 5-16

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Gas Delivery System Operation

The Narkomed Mobile is a continuous flow anesthesia system with pneumatic circuitry for mixing and delivering fresh gas and anesthetic agent vapor. The pneumatic system can deliver up to three gases (oxygen, nitrous oxide, and air) and one anesthetic agent simultaneously.

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Adjusting the Gas Flow

To adjust the gas flow:

1. Turn the flow control knob located below the flowmeter tube for the gas you want to adjust. Turning the valve knob counterclockwise increases flow. Turning the knob clockwise decreases flow.

2. As you adjust 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 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.

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Using the Oxygen Flush

To use the oxygen flush, press the oxygen flush button, located on the front of the Narkomed Mobile. This introduces an unmetered flow of pure oxygen into the breathing circuit at a rate of about 55 L/min.

Figure 5-1. Oxygen Flush Button

OP00097

FRESH GAS OUTLET

FRESH GAS HOSE

Anesthetic Vaporizer Operation

The Dräger-Vapor 19.3 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). Refer to the

Dräger-Vapor 19.n Anesthetic Vaporizer Instructions for Use for detailed

information about operating the vaporizer.

RELEASE TO LOCK

PULL TO INSERT OR

REMOVE HOSE

O2 FLUSH CONTROL

FRESH GAS

LOCKING BAR

5-4

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.

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.

Before each case, perform the preuse checkout procedures and check the following:

1. Make sure the drain valve is closed and the locking lever is in the locked position.

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2. Set the handwheel to 0 (zero-point interlock) and make sure the button is engaged. Then press the 0 button and turn the handwheel to 0 and engage the button. Wait 5 seconds for the pressure to equalize.

Figure 5-2. Locking Lever Open/Handwheel Moved to Zero

LOCKING LEVER (LOCKED)

LOCKING LEVER

(UNLOCKED)

Turning the Vaporizer On

Turning the Vaporizer Off

HANDWHEEL

OP00330

3. Fill the vaporizer to the maximum fill line.

4. Tighten the filler sealing plug.

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. This part of the handwheel actuates the on/off switch and cannot be calibrated.

Note: Verify that the scavenger system, to collect and remove vented gas

from the operating room, is properly functioning.

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 the vaporizer is turned off.

Note: Drain the anesthetic agent if the vaporizer will not be used for longer

Part Number: 4115139-001

than six months or if the vaporizer will be removed from the anesthesia machine.

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Filling the Vaporizer During a Case

Be extremely careful when filling the vaporizer during a case. The vaporizing chamber is pressurized when fresh gas is flowing and the vaporizer is turned on.

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 add the anesthetic agent.

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

interlock) before the vaporizer can be filled. If the vaporizer is not depressurized before unsealing the filling spout, liquid anesthetic can gush out.

Warning: 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.

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Absorber System Operation

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

Figure 5-3. Absorber System

PRESSURE SENSOR ADAPTER

BREATHING SYSTEM PRESSURE GAUGE

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OXYGEN SENSOR

INSPIRATORY

VALVE

FRESHGAS

HOSE

APL VALVE

ABSORBENT CANISTER

EXPIRATORY VALVE

PEEP VALVE

OP00079

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/AUTO

SELECTOR

VALVE

BREATHING

BAG FITTING

ABSORBER

MOUNTING STUD

ABSORBER

POLE

• manual/automatic ventilation selector valve

• an adjustable pressure limiter (APL) valve

• respiratory volume sensor

• oxygen concentration sensor

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

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The absorber system handles spontaneous, manually assisted, or automatic ventilation. The preferred mode of operation is selected with the manual/ automatic selector valve.

Warning: 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) and excessive positive pressure (higher than

O) are not possible at the connection point.

Using the Manual/ Automatic Selector Valve

The manual/automatic selector control knob must be positioned properly for either the ventilator bellows or the breathing bag to be properly engaged in the breathing circuit. Turn the knob counterclockwise for the BAG setting. Turn the knob to the clockwise for the AUTO setting. The settings are labeled on the control knob. The current setting appears near the top.

Set the knob to BAG for spontaneous breathing or manually assisted ventilation. Set the knob to AUTO for automatic ventilation.

Selecting the ventilator (AUTO) pathway removes the APL valve and the breathing bag from the active gas pathway of the absorber. When the system is set in the automatic mode, excess gas is relieved from the breathing circuit through a relief valve mounted on the ventilator bellows.

Selecting BAG eliminates the ventilator and its relief valve from the active gas pathway and includes the APL valve and breathing bag. In this mode, the breathing bag acts as a passive reservoir for breathing gases and the patient's thoracic movements drive the gases through the breathing circuit. When breathing is manually assisted, the breathing bag contains breathing gases and functions as the sole means of driving them through the breathing circuit when the bag is squeezed.

Warning: Do not use the anesthesia machine if:

• The pins in the I E valves or valve body(ies) are bent, damaged, or missing,

5-8

• The valve disks are missing or damaged.

• The valve seat is damaged.

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Using the APL Valve

The APL valve relieves excess gas from the breathing circuit into the scavenger system during spontaneous or manual ventilation. The APL valve expels excess gas containing expired carbon dioxide before it contacts the absorbent, which extends the life of the absorbent.

Turning the APL valve knob clockwise increases the flow resistance into the scavenging system. Complete clockwise rotation eliminates all flow through the valve. Turning the knob counterclockwise decreases the flow resistance.

In addition to regulating the amount of waste gas flow, adjusting the APL valve also affects the patient peak inspiratory pressure during manual ventilation. Turning the APL valve knob counterclockwise reduces the valve's flow resistance and lowers the peak inspiratory pressure. Turning the APL valve knob clockwise increases the valve's flow resistance and raises the peak inspiratory pressure. However, a variety of additional factors, such as fresh gas flow rate and the method used to squeeze the breathing bag, also affect patient peak inspiratory pressure during manual ventilation.

During spontaneous ventilation, the APL valve control knob must be fully open (turned fully counterclockwise) to minimize mechanical resistance to patient exhalation.

Figure 5-4. APL Valve

APL VALVE

CONTROL KNOB

OP00089

A gravity-loaded check valve within the APL valve prevents gas flow from the scavenging system into the breathing system. For instance, during spontaneous ventilation when patient inspiratory effort produces a negative pressure on the breathing circuit side of the check valve, the valve closes and prevents gas from the scavenger system from entering the breathing

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circuit. Also, the check valve minimum opening pressure of about 1 cmH2O enables the breathing bag to reinflate before the valve opens.

Warning: To minimize mechanical resistance to the patient's exhalation

during spontaneous breathing, the APL valve's control knob must be turned fully counterclockwise. For manually assisted or manually controlled ventilation, APL valve resistance must be increased as needed by turning the APL valve control knob clockwise.

Using the PEEP Valve

The absorber system regulates positive end-expiratory pressure (PEEP) through the PEEP valve. The PEEP valve is located on the absorber downstream of the breathing system pressure gauge As a result, the pressure gauge reading includes PEEP. Its integral design also prevents accidents that are possible with accessory PEEP valves, such as inadvertent reversal and misplacement in the inspiratory limb.

Turning the PEEP control knob clockwise increases PEEP, and turning the knob counterclockwise reduces PEEP. The actual PEEP in the system is indicated on the absorber pressure gauge at the end of exhalation and can be adjusted from about 2—15 cmH

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Scavenger Interface Operation

The scavenger interface is an exhaust collector manifold. It is intended for use with suction (vacuum) or passive waste gas disposal systems.

This is a closed system that has one spring-loaded valve for positive pressure relief and one for negative pressure relief.

Figure 5-5. Scavenger Interface

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VACUUM NEGATIVE PRESSURE RELIEF VALVE

OP00088

19MM OUTLET HOSE CONNECTION (PASSIVE) OR

3.0 LITER RESERVOIR BAG (ACTIVE)

POSITIVE RESSURE

RELIEF VALVE

19MM INLET

CONNECTION

NEEDLE VALVE

ADJUSTMENT KNOB

(SHOWN DOTTED)

SUCTION

HOSE BARB

Warning: The scavenger interface for suction systems requires proper

adjustment for safe operation. The needle valve regulates the waste gas exhaust flow. During a case, the needle valve must be readjusted as needed. Needle valve adjustment depends on several factors, including the fresh gas flow rate and type of suction disposal system.

HOSE

Part Number: 4115139-001

Warning: The positive pressure relief valve must be inspected and

cleaned (if necessary) at six month intervals.

Warning: Waste gases vented through the positive pressure relief valve

enter the operating room. Properly adjusting the needle valve keeps such venting to a minimum.

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Needle Valve Adjustment for Suction Systems

1. Attach breathing hoses and a Y-piece to the absorber system.

2. Attach a breathing bag to the Y-piece, using an appropriate adapter such as a Draeger Medical combination mask elbow with a 15 mm male fitting for the Y-piece and a 22 mm male fitting for the breathing bag.

3. Set the manual/automatic selector valve to AUTO and set the ventilator to the preferred frequency.

4. Adjust the O

flow control valve to the expected total flow of all gases.

5. Verify that the suction disposal system is active.

6. Watch the scavenger reservoir bag as the oxygen flow passes through the scavenger. The bag should not overextend or collapse.

7. Adjust the needle valve to provide either more or less suction.

Anesthesia Ventilator Operation

The 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.

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Figure 5-6. Anesthesia Ventilator Components and Controls

I:E RATIO CONTROL

I:E RATIO DISPLAY

EXTENDED RANGE ACCESS

FREQUENCY CONTROL

FREQUENCY DISPLAY

INSPIRATORY PRESSURE LIMIT

BELLOWS CANISTER

cmH2O

MIN MAX

OP00096

INSIRATORY FLOW GAUGE

INSPIRATORY

FLOW CONTROL

VENTILATOR

ON-OFF

CONTROL

TIDAL VOLUME

CONTROL

PRESSURE

LIMIT CONTROL

TIDAL VOLUME SETTING INDICATOR

BREATHING CIRCUIT

CONNECTOR

Pneumatic power (bellows drive gas) to the ventilator is supplied through the hospital pipeline supply or through reserve cylinders on the anesthesia machine. A switch on the side of the machine allows the use of either oxygen or air as the drive gas. The ventilator will not function if this pressure drops below 32 psi. Electrical power is supplied by the Narkomed Mobile's AC power source, or, in event of AC power failure, by the backup battery. A fully charged battery can power the ventilator for at least 90 minutes.

The anesthesia ventilator is designed for use with a Draeger Medical 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.

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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.

Activating the Ventilator

Using the Ventilator On/ Off Control

Adjusting the Tidal Volume

The ventilator is activated by using the ventilator on/off control. The anesthesia machine's SYSTEM POWER switch located at the bottom of the flowmeter housing must be set to ON for the ventilator to function.

The ventilator power switch controls the pneumatic and electrical power to the ventilator. In the OFF position, the FREQUENCY and I:E RATIO displays remain lighted, but the ventilator will not function. The ON position activates the ventilator. The monitoring system's volume and pressure alarms are automatically enabled when the power switch is in the ON position.

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 that limits the upward travel of the bellows and sets the maximum tidal volume of gas delivered to the patient.

To adjust the tidal volume, press the self-locking knob in so it can turn, then set the tidal volume by the setting indicator on the bellows chamber scale (marked 200—1400 mL). The tidal volume can be adjusted for volumes between 20 and 1500 mL ±100mL.

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.

5-14

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 an authorized representative of DrägerService.

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Setting the Respiratory Frequency

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

Setting the Inspiratory Flow Rate

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.

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 that 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: Using 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, affecting 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

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.

The inspiratory flow control can be used 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 over a scale labeled MIN-30-MAX (see Figure 5-6). 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 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 is less than or equal to 15 cmH

O. When the control is

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

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Selecting the Bellows Drive Gas

A toggle switch located on the side of the flowmeter housing is for selecting the bellows drive gas. To select oxygen as the drive gas, move the switch to the O

position. To select air as the drive gas, move the switch to the AIR

position.

Figure 5-7. Drive Gas Selector Switch

DRIVE GAS SELECTOR SWITCH

AIR

VENTILATOR DRIVE GAS

OP00078

N2O

AIR

FLOWMETER HOUSING

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Using the Monitoring System

Table of Contents

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

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

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

Monitor Screen ............................................................ 6-4

Left Keypad ............................ ................. ................ ..... 6-6

Right Keypad ........................... ...................... .............. 6-7

Configur i ng th e A nesthesia Mac h in e .......... ................. 6 -7

Displaying the Configure Screen ................................. 6-8

Understanding the Keys ............................................... 6-8

Changing Par a meter Values ............................ ............ 6-9

Exiting the Configure Screen ............................ .. ......... 6-9

Part Number: 4115139-001

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

Displaying the Alarm Log ........................................... 6-10

Clearing the Alarm Log .................................. .. .......... 6-10

Exiting the Ala rm Log ......... .. ............... ...................... 6-11

Setting Alarms to Standby ......................................... 6-11

Silencing Ala rms .............. ............................. ............. 6-11

Oxygen Mon it o ring . .. ............................. .......................... 6-12

Oxygen Mon it o ring Display . .. .. ............................. ...... 6-12

Oxygen Mon it o r C on t ro ls . ... ............................ ........... 6-13

Setting Alarm Limits ................................................... 6-13

Calibrating the Oxygen Sensor .................................. 6-14

Unsucessfu l C a libration ........ .. ............... .................... 6-15

Oxygen Alarm Messages .......................................... 6-17

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Table of Contents (continued)

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

Respiratory Volume Display ............................................. 6-19

Respiratory Volume Monitor Controls .............................. 6-20

Setting the Minute Volume Low Alarm Limit ..................... 6-20

Turning Respiratory Volume Alarms Off ........................... 6-21

Turning Respiratory Volume Alarms On ........................... 6-21

Respiratory Volume Alarm Messages .............................. 6-21

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

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

Breathing Pressure Monitor Window ............................... 6-24

Breathing Pressure Trace Window ................................... 6-24

Breathing Pressure Monitor Controls ............................... 6-26

Setting the Pressure High Alarm Limit ............................. 6-27

Setting the Threshold Pressure Alarm Limit .................... 6-27

Manually Setting the Threshold Limit ............................... 6-28

Automatically Setting the Threshold Limit ........................ 6-28

Turning the Apnea Pressure Alarm Off ............................ 6-30

Turning the Apnea Pressure Alarm On ............................ 6-30

Breathing Pressure Alarm Messages .............................. 6-31

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Overview

In addition to monitoring clinical parameters, the Narkomed Mobile performs diagnostic self-tests every time the machine is turned on. After the initial power-on screen appears, the Monitor screen is displayed. This section of the manual describes these screens, and explains how to establish general monitoring settings.

Power-On Screen

When you turn the SYSTEM POWER switch ON, the Narkomed Mobile performs extensive self-tests on its internal hardware. As these diagnostics are performed, each test and its result appear on the screen. The result, PASS or FAIL, indicates the status of the tested component.

Figure 6-1. Power-On Screen

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(%)

Config

DIAGNOSTIC TESTS

FIRMWARE RAM VIDEO

Alarms

A/D CONVERTER AUDIO - PRIMARY

All

- BACKUP

Stby

SERIAL I/O CLOCK NON-VOLATILE M EMORY

PASS PASS PASS PASS PASS PASS PASS PASS PASS

Oxygen

Low

High

Limit

Breathing Volum e

Low

Limit

Breathing Pressure

High Limit

Auto Set

Cal

(Liters)

Off

(cm H O)

OffOn

FUNCTIONAL

OP00215

At the end of the self-diagnostics, one of three possible conclusions to the self-tests is posted on the screen:

FUNCTIONAL

The monitoring system is in satisfactory operational order. After a brief delay, the Monitor screen appears.

CONDITIONALLY FUNCTIONAL

A noncritical fault was detected, such as a speaker failure. The Narkomed Mobile may be used, but an authorized representative of DrägerService should be notified to correct the problem. When you are ready to resume operation, press any key on the keypad.

NONFUNCTIONAL

Part Number: 4115139-001

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A serious fault was detected and operation of the monitor is inhibited. Do not use the machine. Immediately notify an authorized representative of DrägerService to correct the problem.

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Monitor Screen and Controls

Following a successful power-up, monitoring information is displayed on the Monitor screen. The control keys to the left and right of this screen allow you to establish monitoring settings.

Figure 6-2. Monitor Screen and Controls

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OP87005

Monitor Screen

Config

Alarms

All Stby

WARNING:

ADVISORY:

TID VOL

0.35

CAUTION:

INSP O2 LOW SUB ATM PRESSURE AC / BATTERY FAIL O2 SUPPLY LOW SERVICE VENT MON PORT A ERROR

BPM

OXYGEN

MIN VOL

3.5

PEAK

MEAN

PEEP

100

Oxygen (%)

High Limit

Breathing Volume

Low Limit

Breathing Pres sure

2.0

High Limit

Low Limit

Auto Set

(Liters)

(cm H O)

LEFT

KEYPAD

MONITOR

SCREEN

The Monitor screen displays information in five separate windows.

Figure 6-3. Monitor Screen Window Locations

ALARM WINDOW

OXYGEN

MONITOR WINDOW

Cal

Off

RIGHT

KEYPAD

6-4

WARNING:

CAUTION:

ADVISORY:

TID VOL

0.35

INSP O2 LOW SUB ATM PRESSURE AC / BATTERY FAIL O2 SUPPLY LOW SERVICE VENT MON PORT A ERROR

BPM

BREATHING PRESSURE

TRACE WINDOW

Narkomed Mobile Operator’s Manual

OXYGEN

MIN VOL

3.5

100

RESPIRATORY

2.0

PEAK

VOLUME

MONITOR WINDOW

MEAN

PEEP

BREATHING PRESSURE

MONITOR WINDOW

Part Number: 4115139-001

OP87006

Rev: F

Page 85

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• Alarm Window—Displays up to six of the highest priority alarms.

• Oxygen Monitor Window—Displays the patient's oxygen concentration and the anesthesia machine's oxygen alarm limits.

• Respiratory Volume Monitor Window—Displays the patient's tidal volume, respiratory rate (breaths per minute), and minute volume, as well as the anesthesia machine's minute volume low alarm limit.

• Breathing Pressure Monitor Window—Displays the patient's peak airway pressure, mean airway pressure, and positive end expiratory pressure (PEEP).

• Breathing Pressure Trace Window—Displays a trace, or waveform, of the patient's breathing pressure, and the anesthesia machine's breathing pressure alarm limits (to the left of the waveform).

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Left Keypad You use the left keypad to initiate system-wide monitoring functions.

Figure 6-4. Left Keypad

Config

Alarms

All Stby

OP87007

All Standby

When the ventilator is off, turns off audible tones and message displays associated with the breathing pressure alarm and respiratory volume alarms, until a valid breath is detected.

Silence Alarms

Silences all audible alarm tones for 2 minutes.

Configure Displays the Configure

screen, where you can set system parameters, such as the time, date, and alarm volume. You also enter the Alarm Log by way of the Configure screen.

6-6

These functions are described in detail later in this section.

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Right Keypad You use the right keypad to perform functions associated with a specific

monitor. These functions are described in the following sections: “Oxygen Monitoring,” “Respiratory Volume Monitoring,” and “Breathing Pressure Monitoring.”

Figure 6-5. Right Keypad

(%)

Oxygen

High Limit

Breathing Volume

Low Limit

Breathing Pressure

High Limit

Low Limit

Cal

(Liters)

Off

(cm H O)

Off

Configuring the Anesthesia Machine

Auto Set

OP87008

You can configure the following parameters on the Narkomed Mobile:

• Trace Speed—Speed of the breathing pressure waveform trace: either FAST or SLOW

• Alarm Volume—Volume of annunciated alarms

• Current Time—The current hour and minute in 24-hour format

hour:minute)

(

• Current Date—The current day, month, and year

• Display Alarms—On/Off status of the anesthesia machine's Alarm window.

The Display Alarms parameter is configurable only when the anesthesia machine is connected to another Narkomed product that can display the anesthesia machine's alarms on a central alarm display. An On status indicates that the anesthesia machine's Alarm window will continue to display alarms as usual. An Off status indicates that the anesthesia machine's Alarm window will not display alarms; instead, alarms will be displayed on the other product's central alarm display.

When you start the anesthesia machine, it uses the values that were established the last time the machine was configured. You can view or change these values on the Configure screen.

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Displaying the Configure Screen

Understanding the Keys

To display the Configure screen, press the Config key, which is located on the left keypad.

The Configure screen replaces the standard Monitor screen. You must begin configuration within 1 minute, or the Monitor screen will replace the Configure screen.

Figure 6-6. Configure Screen

ALARM

WINDOW

CONFIGURE

SCREEN

WARNING:

ADVISORY:

TRACE SPEED:

ALARM VOLUME:

TIME: DATE: DISPLAY ALARMS:

INSP O2 LOW SUB ATM PRESSURE

CAUTION:

AC / BATTERY FAIL O2 SUPPLY LOW SERVICE VENT MON PORT A ERROR

CONFIGURE SCREEN

SLOW

11:10

18 JUN 1996

ALARM

LOG

SELECT

EXIT

OP87009

KEY LABELS

When the Configure screen is displayed, the system control keys function according to the labels on the screen.

Key Label Function

ALARM LOG

Displays the Alarm Log, a separate screen that lists cautions and warnings that have occurred

SELECT Selects a parameter by

highlighting it with a box

EXIT Exits the Configure screen

and returns to the Monitor screen

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Changing Parameter Values

Exiting the Configure Screen

Follow this procedure for each parameter you want to change.

1. Press the SELECT key until the variable you want to change is highlighted with a box.

2. Press the up or down arrow key to increase or decrease the value of the highlighted variable.

To exit the Configure screen immediately, press the EXIT key.

NOTE:

The monitoring system automatically exits the Configure screen if a minute passes and no keys are pressed.

When you exit the Configure screen, the values displayed on the screen are saved. The monitoring system uses these values until they are changed.

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Using the Alarm Log

If you miss a warning or caution message in the Alarm window, you can look for it in the Alarm Log. It contains up to 100 of the most recent warning and caution messages. When there are more than 100 warnings and cautions, the oldest message is deleted to make room for the newest.

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Displaying the Alarm Log

Follow this procedure to display the Alarm Log.

1. From the Monitor screen, press the Config key.

The Configure screen is displayed.

2. From the Configure screen, press the ALARM LOG key.

The Alarm Log appears, with the first warning or caution that occurred at the top of the list.

3. If the list extends beyond the page, scroll forward by pressing the down arrow key, and scroll backward by pressing the up arrow key.

Figure 6-7. Alarm Log Screen

OP87029

CLEAR

LOG

ALARM LOG

TIME

12:49 14:03 14:03 14:03 14:03 14:03

MESSAGE

INSP O2 LOW APNEA - PRESSURE APNEA - VOLUME APNEA - PRESSURE APNEA - VOLUME MINUTE VOLUME LO

EXIT

Clearing the Alarm Log

6-10

To delete all of the messages from the Alarm Log, press the CLEAR LOG key.

The messages are permanently deleted from the LOG.

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Exiting the Alarm Log

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To exit the Alarm Log immediately, press the EXIT key.

Note: The monitoring system automatically exits the Alarm Log if a

minute passes and no keys are pressed.

When you exit the Alarm Log, you return to the Monitor screen.

Setting Alarms to Standby

Silencing Alarms

When the ventilator is off, you can use the All Stby key to turn off audible tones and message displays associated with the breathing pressure alarm and respiratory volume alarms. The alarms remain in this standby condition until the monitor detects a valid breath.

Note: If the ventilator is on, setting alarms to standby has no effect on the

pressure alarm. The pressure alarm cannot be turned off when the ventilator is on.

To set alarms to standby, press the All Stby key.

The LED next to the All Stby key lights to indicate the standby condition.

You can silence all audible alarm tones for 2 minutes while retaining the alarm message display on the monitor.

To silence alarm tones for 2 minutes, press the Silence Alarms key.

The LED next to the Silence Alarms key lights and remains lit for the duration of the silence period. Pressing the Silence Alarms key while the LED is lit restarts the 2-minute silence period.

If a new alarm condition occurs during the silence period, a single tone pattern sounds corresponding to the priority of the alarm.

After the silence period, one of the following occurs:

• If no alarm conditions are active, audio annunciation reverts to

• If any Warning or Caution conditions are active, the tone

Note: All continuous audible alarms are automatically silenced for 2

Part Number: 4115139-001

normal.

associated with the highest existing alarm condition sounds. The alarm continues to sound once every minute, for up to 3 minutes, or until alarm conditions have been cleared for 10 seconds.

minutes following power-up. During this period, the occurrence of a new alarm produces a non-repeating tone pattern appropriate for that alarm's level of urgency.

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Oxygen Monitoring

Inspiratory oxygen concentration is measured with a dual galvanic cell sensor, which is attached to the inspiratory valve dome. The sensor contains two independent electrochemical cells, or sensor halves. When the sensor takes in oxygen, an electrochemical reaction occurs within each cell. The oxygen monitor reads the voltage produced in each cell, computes an average for the two cells, and translates the average into an oxygen concentration measurement.

Caution: Never remove an oxygen sensor from its housing, except to

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replace it. If a sensor is removed from its housing, you must do the following before continuing normal operations:

• Reinstall the sensor in the housing.

• Wait for a period equal to the time that the sensor spent outside the housing.

Oxygen Monitoring Display

• Calibrate the sensor.

Note: When the machine is not in use, remove the oxygen sensor assembly

from the inspiratory valve dome, and insert the inspiratory valve dome plug into the inspiratory valve dome.

Information about the oxygen analysis is presented in the Oxygen Monitor window at the top right of the monitor display. The numerical value for inspiratory oxygen concentration is shown in large type. To the right of this figure, in small type, are the high and low oxygen concentration alarm limits.

Figure 6-8. Oxygen Monitor Window

OP87010

WARNING:

CAUTION:

ADVISORY:

TID VOL

0.35

INSP O2 LOW SUB ATM PRESSURE AC / BATTERY FAIL O2 SUPPLY LOW SERVICE VENT MON PORT A ERROR

BPM

OXYGEN

MIN VOL

3.5

100

2.0

PEAK

MEAN

PEEP

INSPIRATORY

OXYGEN

CONCENTRATION

HIGH OXYGEN

CONCENTRATION

ALARM LIMIT

LOW OXYGEN

CONCENTRATION

ALARM LIMIT

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Oxygen Monitor Controls

Setting Alarm Limits

You use the oxygen monitor control keys and the arrow keys on the right keypad to set oxygen concentration alarm limits and calibrate the oxygen sensor. The oxygen monitor control keys are located next to the Oxygen Monitor window.

Figure 6-9. Oxygen Monitoring Control Keys

HIGH OXYGEN

CONCENTRATION

ALARM LIMIT KEY

LOW OXYGEN

CONCENTRATION

ALARM LIMIT KEY

OP87011

Oxygen (%)

High Limit

Breathing Volume

Low Limit

Breathing Pressure

High Limit

Low Limit

Auto Set

Cal

(Liters)

Off

(cm H O)

Off

CALIBRATION

ARROW

KEYS

KEY

At power-up, the oxygen high and low alarm limits are automatically set to their system defaults. You can adjust these limits within specified ranges. Valid settings for the alarm limits, and their system defaults, are shown in the following table.

Alarm Limit Default Valid Settings

High 100% 19%—100%; must be greater

than low alarm limit

Low 30% 18%—99%; must be less than

high alarm limit

Follow these steps to change the high or low alarm limit:

1. Press the Oxygen High Limit or Low Limit key, depending on which alarm limit you want to change.

A box is drawn around the selected alarm limit.

2. Press the up arrow or down arrow key to increase or decrease the highlighted alarm limit.

3. To save the new value, stop pressing arrow keys until the highlighting box disappears (5 seconds), or press a different alarm Limit key.

The new value is saved as the alarm limit.

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Calibrating the Oxygen Sensor

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To calibrate the oxygen sensor correctly, make sure it is exposed only to room air during the entire calibration period. You should calibrate the oxygen sensor as part of the daily preoperative setup of the anesthesia equipment.

1. Remove the sensor assembly from the inspiratory valve dome and close off the dome with the inspiratory valve dome plug. (Do not disassemble the sensor assembly further.)

2. Expose the sensor to ambient air only (21% oxygen concentration) and allow it to stabilize for several minutes. To ensure an ambient air exposure, hold the sensor away from any open part of the breathing system.

3. With the sensor exposed only to room air, press the Cal key.

Calibration begins.

4. View the monitor screens to track progress of the calibration.

• During calibration, the LED next to the Cal key lights,

and the label CAL appears in the Oxygen Monitor window.

• Following successful calibration, the currently sensed

oxygen concentration appears in the Oxygen Monitor window. (If the calibration was not successful, the Oxygen Monitor window is blank. See “Unsuccessful Calibration” in this section for further information.)

Typically, calibration lasts less than 30 seconds. However, the time may vary depending on the amount of oxygen the sensor was exposed to before calibration.

Oxygen Exposure

Typical Calibration Time

21% 10 seconds

> 21% up to 50 seconds

6-14

5. When the Narkomed Mobile successfully completes the calibration, pull the inspiratory valve dome plug and reinsert the sensor assembly.

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Unsucessful Calibration

If, at the end of the calibration period, if the Oxygen Monitor window is blank, the calibration was not successful. (This condition is also indicated by the CAL O2 SENSOR Advisory message in the Alarm window.)

An unsuccessful calibration can be caused by several conditions.

Cause Solution

Sensor was exposed to an excessively lean or excessively rich oxygen calibration mixture.

Sensor was exposed to a constantly changing calibration mixture.

Sensor did not receive the proper waiting period.

Make sure that the sensor is exposed to room air only for the entire calibration period.

If the sensor capsule was removed from the sensor assembly, a waiting period equal to the time that the capsule spent outside the sensor assembly (up to one week) is necessary prior to calibration. New sensors require a 15-minute waiting period.

Sensor is exhausted. If the oxygen sensor has decayed

beyond its useful service life (see the “Specifications” section of the manual), replace the decayed sensor with a new sensor and allow the proper waiting period.

Sensor failure. If there is too great a difference

between the outputs of the two sensor halves, replace the failed sensor with a new sensor, and allow the proper waiting period prior to calibration.

Sensor is disconnected. When the sensor is disconnected,

the display area is blank, and the message 02 SENSOR DISC appears in the Alarm window. If this happens, reconnect the sensor cord to the OXYGEN SENSOR interface beneath the rear panel of the ventilator box and try to calibrate the oxygen sensor again.

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If the oxygen sensor is improperly calibrated, it can cause inaccurate measurements. When a calibration gas mixture is excessively rich or lean in oxygen, the Narkomed Mobile will not complete an attempted calibration; however, if the calibration gas is rich or lean but is within certain limits, the Narkomed Mobile will complete the calibration. As a result, when displaying sensor measurements, the Narkomed Mobile displays an oxygen percentage either greater or less than the actual oxygen percentage. Therefore, make sure that the sensor is exposed only to room air during the entire calibration period.

The following figure illustrates the relationship between the calibration mixture and the accuracy of oxygen measurement.

Figure 6-10. Relationship Between Calibration Mixture and Oxygen Measurement Accuracy

100

G A

A L

OP10098A

At calibration, sensor exposed to < 21% O2. Thus, displayed % O2 will be higher than actual O2.

Correct calibration of room air (21% O2) for entire calibration period. Displayed % O2 = actual % O2.

At calibration , sensor exp osed to > 21% O2. Thus, displayed % O2

lower than actual % O2.

will be

100908070605040302010

ACTUAL O2 PERCENTAGE

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Oxygen Alarm Messages

INSP O2 LOW

(Warning)

INSP O2 HIGH (Advisory)

O2 SENSOR DISC (Advisory)

REPLACE O2 CELL

(Advisory)

The following list contains all warning, caution, and advisory alarms associated with oxygen monitoring.

The Narkomed Mobile continuously compares the current inspiratory oxygen percentage with the preset low oxygen alarm limit. If the measured oxygen concentration falls below the low alarm limit, the Warning message INSP O2 LOW appears in the Alarm window, and a continuous audible alarm sounds.

If the measured inspiratory oxygen concentration exceeds the preset high alarm limit, the Advisory message INSP O2 HIGH appears in the Alarm window, and a single-tone audible alarm sounds.

If the oxygen sensor cord becomes disconnected (or is damaged enough to cause an open circuit), the Advisory message O2 SENSOR DISC appears in the Alarm window, and a single-tone audible alarm sounds.

During oxygen sensor calibration and monitoring, the Narkomed Mobile checks for a difference between the outputs of the two sensor channels. If the difference exceeds a predetermined percentage, the Advisory message REPLACE O2 CELL appears in the Alarm window.

During oxygen sensor calibration, the Narkomed Mobile also checks the sensor's output against a range of acceptable output voltages. There are three possible causes for deviation from within this range.

CAL O2 SENSOR

(Advisory)

Exhausted sensor. If the sensor's capacity is exhausted, its output

• voltage will not meet the required minimum.

•

Incorrect calibration environment. If the sensor is exposed to an

excessive oxygen during calibration, the sensor's output will be above or below the acceptable output range.

Improper waiting. If the proper waiting period is not allowed for

• a new sensor or for a sensor removed from the sensor housing, the sensor's output may be above or below the acceptable output range.

If a sensor error condition is detected during monitoring, the Advisory message REPLACE O2 CELL appears in the Alarm window and operation continues. Try to recalibrate the sensor; if the message remains, replace the sensor cell.

The Advisory message CAL O2 SENSOR appears in the Alarm window in the following instances:

• the oxygen sensor enters a noncalibrated state

• the Narkomed Mobile is unable to calibrate the oxygen sensor

• more than 18 hours have elapsed since the last calibration

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SERVICE VENT MON

(Advisory)

If the Narkomed Mobile detects an internal electronic failure that would prevent proper operation, the Advisory message SERVICE VENT MON appears in the Alarm window. If this happens, contact an authorized representative of DrägerService.

Respiratory Volume Monitoring

Respiratory volume is measured by an ultrasonic flow sensor which is attached to the expiratory valve and mounted to the top of the absorber assembly. The ultrasonic flow sensor has two transducers that measure the time of flight of ultrasonic pulses transmitted upstream and downstream in the respiratory flow path. The difference in the time of flight is used to determine the velocity and the flow rate of gas through the patient circuit. The flow sensor output is converted to meaningful readings for minute volume, tidal volume, and respiratory rate displays

Warning: The ultrasonic flow sensor can be used with all normal

anesthetic gases except oxygen-helium (heliox). Incorrect flow measurements will result if heliox is used.

Caution: Although the Narkomed Mobile is designed to minimize the

effects of ambient radio-frequency interference, the functioning of the respiratory volume monitor may be adversely affected by the operation of electrosurgical equipment or short wave or microwave diathermy equipment in the vicinity.

Note: Sudden, irregular expiratory flow may cause erratic tidal volume

and respiratory rate displays. To avoid such erroneous measurements, defer reading the display until a full minute has elapsed after the irregular flow has stopped.

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Respiratory Volume Display

Information about the patient's respiratory volume is presented in the Respiratory Volume Monitor window in the middle of the monitor display. From left to right, numerical values are shown in large type for tidal volume, respiratory rate, and minute volume. At the extreme right, in small type, is the minute volume low alarm limit.

Figure 6-11. Respiratory Volume Monitor Window

WARNING:

CAUTION:

ADVISORY:

TID VOL

0.35

INSP O2 LOW SUB ATM PRESSURE AC / BATTERY FAIL O2 SUPPLY LOW SERVICE VENT MON PORT A ERROR

BPM

OXYGEN

MIN VOL

3.5

PEAK

MEAN

PEEP

100

MEASUREMENT

2.0

OP87012

MINUTE

VOLUME

(l/min)

MINUTE

VOLUME

ALARM LIMIT

TIDAL VOLUME

MEASUREMENT (l)

BREATHING RATE

MEASUREMENT

(breaths/min)

• Tidal Volume Measurement (TID VOL)—Displays the volume for each valid breath (at least 20 mL). If the monitor does not detect a valid breath within 30 seconds, the display area goes blank.

• Breathing Rate Measurement (BPM)—Shows the number of breaths during the previous minute of respiration. If the BPM display is blank, a full minute of respiration has not occurred.

• Minute Volume Measurement (MIN VOL)— Continuously displays the volume of exhaled gas accumulated during the previous minute of respiration. A blank MIN VOL display area indicates that a full one-minute history of exhaled volume is not available.

• Minute Volume Alarm Limit—Indicates the volume below which an alarm condition occurs.

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Respiratory Volume Monitor Controls

You use the respiratory volume monitor control keys and the arrow keys on the right keypad to set the minute volume low alarm limit and to turn the volume alarms on and off. The respiratory volume monitor control keys are located next to the Respiratory Volume Monitor window.

Figure 6-12. Respiratory Volume Monitor Control Keys

Oxygen (%)

Low Limit

Auto Set

Cal

(Liters)

Off

(cm H O)

Off

VOLUME

ALARMS

OFF KEY

ARROW

KEYS

LOW MINUTE

VOLUME

ALARM LIMIT KEY

VOLUME

ALARMS ON KEY

OP87013

High Limit

Breathing Volume

Low Limit

Breathing Pressure

High Limit

Fixed alarms are provided for low tidal volume (apnea-volume), low minute volume, and reverse flow through the sensor. While the ventilator is on, apnea volume alarms are generated at 15 seconds (Caution) and 30 seconds (Warning) if the respiratory volume monitor does not sense a valid breath. While the ventilator is off, these alarms are generated at 30 seconds (Caution) and 60 seconds (Warning).

Setting the Minute Volume Low Alarm Limit

The Narkomed Mobile's volume alarms are automatically enabled when the ventilator power switch is turned to the ON position. A disconnected or damaged sensor causes a sensor failure alarm.

If the low minute volume falls below the minute volume low alarm limit, an alarm condition occurs. The alarm limit is automatically set to a default of

1.0 liter at power-up. You can change the default to a value within the range

of 0.2 liters to 10.0 liters.

Follow these steps to adjust the minute volume low alarm limit:

1. Press the Breathing Volume Low Limit key.

A box is drawn around the minute volume low alarm limit.

2. Press the up arrow or down arrow key to increase or decrease the highlighted alarm limit.

3. To save the new value, stop pressing arrow keys until the highlighting box disappears (5 seconds), or press a different alarm Limit key.

The new value is saved as the alarm limit.

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