Novametrix 7300 User manual

User’s Manual

™

Non-Inva si ve Cardiac Output M onitor

Model 7300

February 1, 2001

Catalog No. 9226-23-05

Thank you …

Thank you for purchasing the NICO® Non-Invas ive Cardiac Output monitor from Novame tr i x .

NICO

measures cardiac output through respiratory gas analysis based on the well accepted Fick Principle, providing continuous and accurate display of cardiac output. The monitor also operates in Respiratory Mechanics-only mode, providing the clinician with a respiratory profile of the patient through a combination of capnography, airway flow and pressure, and pulse oximetry.

We expect that you will fi nd the application and u se o f NI C O to adopt th is exciti n g tec hno log y in to your clin ic al p ractic e . NICO® can provide accurate cardiac output values without the need for invasive procedures, benefitting the patient, the clinician, and the health care system in general.

We appreciate your patro na ge and look forwar d to de velo p ing a long-term rela tionship with you and your institution.

Sincerely,

extremely simple, making it easy

USA TOLL F REE 1-800-243-3444

PHONE 205-265-7701

FAX 205-284-0753

WORLD WIDE WEB:

http://www.novametrix.com

Customer Service

sales@novametrix.com

Technical Service

techline@novametrix.com

E-MAIL:

Rev. 05 NICO User’s Manual iii

Introduction

About this manual This manua l is wr itten fo r clin ical pers onne l us ing t he No vametr ix NI CO

Output Monitor , Model 7300, and the sensors and accessories intended for use with the monitor .

This document contains information which is proprietary and the property of Novametrix Medical Systems Inc., and may not be reproduced, stored in a retrieval system, translated, transcribed, or transmitted, in any form, or by any means, without the prior explicit written permission of Novametrix Medical Systems Inc. Novametrix reserves the right to change specifications without notice.

NICO® Monitor Technical Description

Manufacturing Quality & Safety

Declaration of

Per requirements of IEC 601-1, the NICO® monitor is classified as class II equipment, internally powere d, wit h typ e BF applie d pa rt, and an enc losur e prot ecti on rat ing o f IPX0 . The NIC O monitor is Year 2000 compliant.

Transport/Storage: -10 to +55° C (14-131° F), 10-95% R.H. no n-condensing Operating Conditions: 10 to +40° C (50 to 104° F), 10-90% R.H. non-condensing

The NICO service personn el. A t echn ical Service Manual is availab le for use by technical personnel.

The Novametrix Medical Systems Inc. manufacturing facility is certified to both ISO 9001 and EN46001 (MDD93/42/EEC Annex II). Novametrix’ products bear the “CE 0086” mark. The product is certified by Underwriter’s Laboratories (UL) to bear the UL mark; and tested by TÜV Rheinland to IEC 601-1/EN60 601-1.

The Autho r ized Repr es entative f or Novametr ix equipment is:

monitor, Model 7300, contains no use r serv iceab le parts. Refer servicing to qualified

Confor mity with European Union Directive

D.R.M. Green European Compliance Services Limited, Oakdene Hou s e, Oak Road, Watchfield Swindon, Wilts SN6 8TD United Ki ngdom

Non-Invasive Cardiac

Trademarks and Patents

Manual Revision History

CAPNOSTAT CO2 Sensor and NICO are regis ter ed tr ade mar ks (®); NICO2 and the stylized NICO with CO2 shadow, NICO Sensor, NICO Loop and CObar (cardiac output confidence b ar), SuperBright and Y-Sensor are trademarks (™) of Novametrix Medical Systems Inc. Other trademarks and registe r ed tra d em arks are the pr o perty of their r espective own er s.

NICO

and its sensors and accessories are covered by the following USA patents: 4,859,858, 4,859,859, 4,914,720, 5,146,092, 5,153,436, 5,190,058, 5,206,511, 5,251,121, 5,347,843, 5,369,277, 5,379,650, 5,398,680, 5,535,633, 5,616,923, 5,693,944, 5,789,660, 5,793,044, 5,820,550, 5, 891,026 , 5, 999,834 , 6,098 ,62 2, 6,12 6,6 10, D42 4,19 3, 6,17 9,7 84. Oth er pate nts pending.

11-Mar-99 Release at Rev. 00. 23-Mar-99 Revision 01. 05-Oct-99 Revision 02. R-N677 20-Mar-00 Revision 03. R-N741 19-Oct-00 Revision 04, R-N807 01-Feb-01 Revision 05, R-N850

iv NICO User’s Manual Rev. 05

Table of Contents

Welcome to NICO

General Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Front Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Rear Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

AC/Battery Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

NICO® Parameter List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Principles of Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Navigating in Cardiac Output mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Areas of the Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Navigating the Display System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

KNOB selectable Monitoring Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

MENU key Screen Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

DATA ENTRY key Screen Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Navigating in Respiratory Mechanics mode . . . . . . . . . . . . . . . . . . . . . . . . . 16

Areas of the Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Navigating the Display System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

KNOB selectable Monitoring Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

MENU key Screen Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

DATA ENTRY key Screen Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Monitoring Cardiac Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Preparing for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Begin NICO® monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Entering Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Entering ABG Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

C.O. Averaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Respiratory Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Preparing for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Begin Respiratory Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Entering Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Entering ABG Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Monitoring and Setup Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Cardiac Output mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Respiratory Screens (Optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Respiratory Mechanics mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Rev. 05 NICO User’s Manual v

Notes on Patien t Mo nitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Automatic Purging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Manual Purging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Intra-Aortic Balloon Pump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Configuration Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Reference Handbooks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

NICO® Alert Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Responding to Alert Audio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Parameter Limit Alerts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

No Respiration Alert . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

NICO Sensor™ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Disposable NICO Sensors™ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

CO2/Flow Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

Choosing a CO2/Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Connecting a CO2/Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

CAPNOSTAT® CO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

The CAPNOSTAT® CO2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

CAPNOSTAT® Adapter Zero . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Pulse Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Oximetry Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Finger Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Y-Sensor™ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Single Patient Use Sensors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Message Areas - Cardiac Output mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Message Areas - Respiratory Mechanics mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

External Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

GE Medical Systems Solar® Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Agilent Technologies VueLink Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

ASCII Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Analog Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Alerts and Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Cleaning and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Monitor Maintenance Schedules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Battery Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

NICO® Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

vi NICO User’s Manual Rev. 05

General Descriptio n

Welcome to NICO

General D escription

NICO®, a Non-Invasive Cardiac Output monitor from Novametrix Medical Systems Inc., noninvasively m ea sures an d d isp lays card ia c out put (C .O.). Th e NI C O displays cardiac index and stroke volume, as well as various respiratory monitoring parameters including CO mode, NICO® can be used as a respiratory profile monitor, without cardiac output displayed. In either mod e, NIC O efficien t pa tient man ag ement.

Indications The NI CO

Output mode, t he m onitor is use d for t he m onito ring of cardi ac out put a nd various resp iratory parameters of adult patients receiving mechanical ventilation. In Respiratory Mechanics mode, the NICO neonatal patients. NICO® is not intended for any other purpose.

Contraindications In Cardiac Output mode, use of the NICO

small rise (3-5 mmHg, 0.4-0.67 kPa) in their PaCO2 level cannot be tolerated.

Front Panel

elimination (VC O2) and alveolar minute ventilation. In Respiratory Mechanics

provide s the clinic ian wi th im porta nt inf ormat ion t o aid in pre cise and

monitor is in dicat ed for use b y techn ically sk illed cli nical pe rsonnel . In Cardi ac

monitor is used for monitoring the respiratory parameters of adult, pediatric and

monitor, Model 7300, also

monitor is contraindicated in patients in whom a

The NICO® monitor ’s front pane l includ es a di splay sc reen, se nsor inp ut conn ector s, a cont rol knob, and operational push button keys and indicators that are explained below.

54321 6

Rev. 05 NICO User’s Manual 1

Rear Panel

1 Display Screen. The screen displays NICO

waveforms and messages, along with setup and configuration data.

2 CAPNOSTAT

Sensor, Catalog Number 9567-00 here.

CO2 Sensor Inpu t C o nnec to r. Connect only a Novametrix CAPNOSTAT®

data, respiratory mechanics, trends,

3 Connector Isolation Icon. Identifies t h e connector to either side of this icon as a type

BF patient isolation connection.

4 Pulse Oximetry Sensor Input Connector. Connect only Novametrix pulse oximetry

sensors and extension cables approved for use with the NICO

monitor.

5 NICO Sensor™ Input Connector. Connect only Novametrix NICO Sensors™, Catalog

Number 8950-00, 8951-00 a nd 89 52-00 or Novametrix CO

Number 9765-00, 9766-00 a nd 97 67-00.

/Flow sensors, Catalog

6 KNOB. The KNOB is used to select monitoring screens, scroll through menus and to

change or enter values. The KNOB is generally turned to access different monitoring

screens and to highlight menu options, and pressed to accept or change those selections.

7 DATA ENTRY key. Press to activ ate the DATA ENTRY screen and illuminate the key’s green

icon. Press th e key again to return t o th e p r evio usly displayed s cr een. From the

DATA ENTRY screen, you can enter patient information including height, weight and

respiratory gas mixture, and access the ABG DATA ENTRY screen.

8 MENU key. Press to activate the SELECT A SCREEN menu and illuminate the key’s green

icon. Press th e key again to return t o th e p r evio usly displayed s cr een. From the

SELECT A SCREEN menu you can, by turning the knob, highlight the screen you wish to

display. Press the MENU key or the KNOB to display that selected screen .

9 SILENCE key. The SILENCE key is used to mute/prevent audible alerts. It also visua lly

indicates the presence of a “High Priorit y Alert”. The Silence feat u r e ope rate s in two

modes; a temporary “2 Minute Silence” mode and an “Audio Disabled” mode.

• 2 Minute Silence — Press and release to activate or deactivate the two minute silence. The key’s icon illuminates amber when active and audible alerts will be muted for two minutes, after which the icon turns off and any audible alert will sound.

• Audio Disabled — Press and hold for one second to prevent or allow any audible alerts. The key’s icon illumin a t es a nd f las h es a mb er to ind icate that all audible alerts are being suppressed.

• High Priority Alerts — (See “NICO® Aler t Prio r it ies” on page 56) The SILENCE key’s icon illuminates and fla shes red to indicate High Prior it y Alert is active. The icon alternately flashes red and amber if the audio is disabled and a High Priority Alert is active.

10 STOP/CONTINUE REBREATHING key. Press to start NICO

automatic rebrea thi n g pr ocess. Subsequent presses will stop (amber indicato r illuminated) or continue (amber indicator off) the rebreathing process. Press and hold for two seconds to reset the NICO cleared. The STOP/CONTINUE REBREATHING key will be amber and ina c t ive in Respiratory Mechanics mode.

algorithm; the C.O. value and averaging filter will b e

monitoring and the

11 AC Mains Power Indicator. This ico n illuminates green to indicate AC Ma ins power is

applied to the mon it o r. To illum inate the icon, the m on it o r must be plugged into t he AC outlet and the monitor’s rear panel power switch must be on (“|”).

12 OPERATE/STANDBY key. Press this key to turn the monitor on. If connected to the AC

outlet, the mon itor uses AC power, o t h erwise it powers up us ing its internal bat te r y (provided the battery is cha r ged). Pres s th e OPERATE/STANDBY key aga in to put the monitor into Standby mode (if using AC power) or to turn it off (if using battery power).

13 Kickstand (front and rear). The NICO

from above or below by extending the kickstand at the front or rear of the monitor.

monitor c an be positioned for better view ing

Rear Panel

The NICO® monitor’s rea r panel inc ludes an AC Mai ns pow er input mo dule , three R S232 ser ial communications ports, an analog inpu t/outp ut port, equip otenti al connector, fan and ventilation slots, and th e monitor ’s seri a l nu m b er label. These ar e explained belo w.

2 NICO User’s Manual Rev. 05

Symbols

14 16 17 18

2019 21

14 AC Mains Power Cord Connection. Connect only approved hospital-grade line cords to

this connector.

15 AC Mains Power Switch. This switch controls the flow of AC current into the NICO

monitor. Press the “|” portion of the switch to supply the monitor with AC power, or the “O” portion of the switch to interrupt the flow of AC power. If supplied with AC power, the monitor illuminates the front panel AC Mains Power Indicator, energizes the fan and recharges the internal battery.

16 RS232 Communications Ports. Three 9-pin serial communications ports provide for

digital communications with the NICO® monitor. (See “RS232 Communications” ).

17 Fan. The fan draws air in through the monitor. Do not block the fan’s air intake slots. 18 Serial Number Label. The N ICO

servicing to qualifie d p erso nnel.

monitor’s serial number is shown here. Refer

19 Power cord retaining clip. If desired, remove the screw, slip the cord through the clip

and insert and tighten the screw. Use only the supplied screw to secure the clip.

20 Equipotentiality. Connection to the monitor’s chassis (earth ground system). 21 Analog Input/ O ut put Por t. This 15-pin connector provides analog signal output

capability for the NICO® monitor (Input reserved for future use).

22 Ventilation Slots. Do no t block the air v en tilation slots.

Symbols

These sy mbols may be found o n the NICO® monitor, its sensors, accessories and documentation.

Attention

Consult manual for detailed

information.

Single Patient Use

Treat in accordance with protocol

for “single patient use” items.

Patient Isolatio n

Identifies the patient iso la tio n connection as type BF.

AC Mains Power Switch

“|” ON-connectio n to m a ins; “O” OFF-disconnection from mains

Rev. 05 NICO User’s Manual 3

AC/Battery Opera tion

Mains Fuse Rating

Mains rating for replacement fuses

250V

Separate colle ction

Take appropriate steps to ensure that spent batteries ar e collected separately when disposed of. This symbol is found on the internal battery and the monitor enclosure.

Recyclable item

This symbol is found on the internal battery an d the monitor en clo sure.

AC/Battery Operation

The NICO® monitor is designed to be operated from AC Mains power. An internal battery provides uninterrupted monitoring and trending capability for short periods (no more than 45 minutes) if the AC power is removed.

AC Mains Operation To ope ra te NICO

1 Plug the line cord into the r ear pan e l co n nect o r and the AC Mains power outlet. 2 Set the rear panel power switch to the On “|” position.

• The front panel AC Mains Power indicator illuminates.

• The monitor’s fan turns on.

• The inte r n al battery s tarts to rec h arge.

from AC Mains power:

Equipotentiality

Connection to monitor’s chassis.

Heavy Metal Content

Indicates heavy metal content, specifically le ad. This symbol is found on the internal battery and the moni to r enc losure.

3 Press the front panel Operate/Standby key to tu r n th e m o n itor on and of f.

Battery Operation The NICO

from AC Ma ins powe r if the AC sou rce is r emoved. A fu lly charged battery will power the moni tor fo r up t o 45 minutes. While on battery pow er, NICO “drains” as power is consume d .

The battery icon starts to flash when approximately 5 minutes of battery power remain. An audible alert tone also sounds.

Reconnect to AC Mains power or the monitor will automati ca lly shut o ff. A deplet ed ba tt ery may re quire 12 -16 hours to fully recharge.

To ope ra te NICO

1 Unplug the line cord or set the rear panel power switch

to the Off “O ” p o s ition.

2 Press the front panel Operate/Standby key to tu r n th e m o n itor on and of f.

monitor automatically switches to battery power

displays a battery icon that

on battery power:

• The front panel AC Mains Power indicator turns off.

Operate

/Standby

Battery icon shows capacity

full half depleted

4 NICO User’s Manual Rev. 05

NICO® Parameter List

NICO® Paramet er List

Cardiac Output mode The NICO

monitor displays the parameters described in thi s tabl e.

Label Parameter Range/Units Description Screen Display

C.O. Cardiac Output 0.5-19.9 L/min Volume of blood pumped by the

All

heart each minute

CO-a Average Cardiac Output 0.5-19.9 L/min C.O. averaged value, displayed

when the fast-mode cardiac output mode is chosen for la r ge dis pla y.

CO-f Fast-mode Cardiac

Output

0.5-19.9 L/min C.O. unaveraged value, displayed when the aver age cardiac output mode is chosen for la r ge dis pla y.

Cdyn Dynamic Compliance 0-500 ml/cmH

O Volume the lungs expand for a

given pressure

Last Completed Cycle rebreathi n g cur ve & Tabular Data

Numerics & Tabular Data

Note that if the ventilator is set for an inspiratory paus e th at is detected by NICO, Cdyn becomes Cstat.

CI Cardiac Index 0-9.9 L/min/m ETCO

End Tidal Carbon

Dioxide

0-150 mmHg 0-20.0 % 0-20.0 kPa

Insp CO

Inspired Carbon Dioxide 3-50 mmHg

0.4-6.7 %

0.4-6.7 kPa

C.O. divided by body surface area All Maximum CO2 plateau value at t he

end of the breath (r eflects al v eolar CO

)

Maximum CO2 value observed during the baseline portion of the Inspiratory phase of the breath

Numerics, Respiratory Numerics, CO SBCO rebreathi n g cur ves

General Message Area (if above 3 mmHg for 10 sec (0.4 % or kPa))

, T abular Data &

(baseline shift above zero point)

MAP Mean Airway Pressure 0-100 cmH

MV Minute Volume 2-40 L/min Adult Volume (in liters) of gas delivered

O Mean (average) pressure in the

airway throughout the breath

to the patient per minute

Numerics & Tabular Data

Numerics, Respiratory Numerics & Tabular Data

MV alv Alveolar Minut e Volume 0.05-16 L/min MV less deadspace (wasted)

ventilation

Numerics, Respiratory Numerics & Tabular Data

PCBF Pulmonary Capillary

Blood Flow

0.5-19.9 L/min Portion of the cardiac output that is effecti v e in gas exchang e

3 min Cycle in Progress rebreathing curve & Tabular Data

PeCO FeCO

Mixed expir e d CO2 0-100 mmHg,

PEEP Positive End Expiratory

Pressure

0-13.2 kPa or % 0-99 cmH

O Pressure in th e lu ngs at the end of

Volume weighted average CO2 in the breath

expiration

Respiratory Numerics & Tabular Data

Numerics, Flow/ Pressure & Tabular Data

PEF Peak Expiratory Flow 2-180 L/min Highest absolute flow rate during

Tabular Data

expiration

PIF Peak Inspiratory Flow 2-180 L/min Highest absolute flow rate during

Tabular Data

inspiration

PIP Peak Inspiratory

Pressure

0-120 cmH

O Peak (highest) pressure in the

airway during inspiration

Numerics, Flow/ Pressure & Tabular Data

/SpO2,

Rev. 05 NICO User’s Manual 5

NICO® Parameter List

Label Parameter Range/Units Description Screen Display

Pulse Rate 30-250 bpm Number o f pulse beats per minu te Numerics, CO

/SpO2 &

Tabular Data

Raw Airway Resistance 0-1 00 cmH

O/L/sec Pressure required to cause gas

flow at a given rate

RR Respiration Rate 2-120 br/min Number of breaths per minut e Numerics, CO

Numerics & Tabular Data

/SpO2 &

Tabular Data

RSBI Rapid Shallow

Breathing Index

0-1000 br/min/L Respiratory rate divided by

average spontaneous tidal volume

Respiratory Numerics & Tabular Data

(only calculated when RR < 57)

SpO

Oxygen Saturation 0-100 % Oxyhemoglobin as a percentage of

total hemoglobin less dysfunctional hemoglobin

SV Stroke Volume 0-250 ml Volume of blood pumped by the

Numerics, CO Tabular Data &

/SpO2,

rebreathi n g cur ves All

heart each beat

SVI S troke Volume Index 0-125 ml Stroke volume divided by body

Tabular Data

surface area

SVR Systemic Vascular

Resistance

0-5000 dynes sec/

Resistance exerted by the blood vessels on blood flow and is an

SVR Calculation &

Tabular Data indicator of left ventricular afterload.

SVRI Systemic Vascular

Resistance Index

Carbon Dioxide Elimination

VCO

0-5000 dynes sec/

SVR normalized to body surface area

0-3000 ml/min Volume of CO2 eliminated through

the breath each minute

Tabular Data

Numerics, Respiratory

Numerics, SBCO

Tabular Data &

rebreathi n g cur ves

Vd Aw Airway deadspace 0-500 ml Includes added mechanical

deadspace proximal to the flow

Respiratory Numerics,

, Tabular Data

SBCO

sensor

Vd/Vt Deadspace to tidal

0-1.00 ml (PaCO

-PeCO2)/PaCO

volume ratio

Vd alv Alveolar deadspace 0-500 ml Difference between physiologic and

airway deadspace

Vt alv Alveolar tidal volume 0-2400 ml Tidal volume less airway

deadspace

Respiratory Numerics

& ABG Data E n tr y

Respiratory Numerics

& ABG Data E n tr y

Respiratory Numerics,

& Tabular Data

SBCO

Vte Expired Tidal Volume 200-3000 ml Volume of ga s exha le d p er bre a th Respiratory Num eri cs,

Flow/Pres sure &

SBCO

Vte-m Expired Ti da l Volume -

mechanical

Vte-s Expired Tidal Volume -

spontaneous

200-3000 ml Volume of mechanically exhaled

gas, per breath

200-3000 ml Volume of spontaneously exhaled

gas, per breath

Tabular Data

Vti Inspired Tidal Volume 200-3000 ml Volume of gas inh al ed per breath Respiratory Numerics ,

Flow/Pres sure &

SBCO

Vti-m Inspired Tidal Volu m e -

mechanical

Vti-s Inspired Tidal Volume -

spontaneous

200-3000 ml Volume of mechanically inhaled

gas, per breath

200-3000 ml Volume of spontaneously inhaled

gas, per breath

Tabular Data

6 NICO User’s Manual Rev. 05

NICO® Parameter List

Respiratory

The NICO® monitor displays the parameters described in thi s tabl e.

Mechanics mode

Label Parameter Range/Units Description Screen Display

Cdyn Dy nam ic Compliance 0-500 ml/cmH

ETCO

End Tidal Carbon

Dioxide

0-150 mmHg 0-20.0 % 0-20.0 kPa

I:E I:E Ratio 1:9.9 or 4:1 Ratio of inspiratory time (ti) to

MAP Mean Airway Pressure 0-100 cmH

MV Minute Volume 0.4-40 L/min adult

0.06-30 L/min pedi.

0.01-5 L/min neo na t al

MV alv Alveolar Minute Volume 0-16 L/min adult

0-8 L/min pediat r ic 0-4 L/min neonatal

NIP Negative Insp iratory

0 to -120 cmH

Pressure

PeCO FeCO

PEEP Positive End Expiratory

Mixed expir e d CO2 0-100 mmHg,

2 2

0-13.2 kPa or % 0-99 cmH

Pressure

PEF Peak Expiratory Flow 2-180 L/min adult

0.5-100 L/min pedi.

0.25-25 L/min neo.

PIF Peak Inspiratory Flow 2-180 L/ min adult

0.5-100 L/min pedi.

0.25-25 L/min neo.

PIP Peak Inspiratory

0-120 cmH2O Peak (highest) pressure in the

Pressure

Pulse Rate 30-250 bpm Num ber o f pulse bea ts per minute All

Raw Airway Resistance 0-1 00 cmH

adult/pediatric

O Volume the lungs expand for a

given pressure Maximum CO2 plateau value at t he

end of the breath (r eflects al v eolar CO

)

expiratory time (te)

O Mean (average) pressure in the

airway throughout the breath Volume (in liters) of gas delive r ed

to the patient per minute

MV les s deadspace (wasted ) ventilation

O Maximum negative pr essure during

inspiratory cycle Volume weighted average CO2 in

the breath

O Pressure in th e lu ngs at the end of

expiration

Highest absol u te flow rate during expiration

Highest absol u te flow rate during inspiration

airway during inspiration

O/L/sec

Pressure required to cause gas flow at a given rate

Numerics & Tabular

Data

All

Flow/Pressure

Numerics & Tabular

Data

All except Flow/

Pressure & Loops

Numerics & Tabular

Data

Loops

Numerics, SBCO2 &

Tabular Data

Numerics, Flow/

Pressure & Tabular

Data

Loops & Tabular Data

Numerics, Flow/

Pressure & Tabular

Data

Numerics & Tabular

Data

0-500 cmH neonatal

RR Respiration Rate 2-120 br/min adult

O/L/sec

Number of breaths per minute All

2-150 br / min pedi . 10-150 br/min neo.

RSBI Rapid Shallow

Breathing Index

0-1000 br/min/L (adult only)

Respiratory rate divided by average spontaneous tidal volume

Loops

(only calculated when RR < 57)

SpO

Oxygen Saturation 0-100 % Oxyhemoglobin as a percentage of

All total hemoglobin less dysfunctional hemoglobin

Rev. 05 NICO User’s Manual 7

Principles of Operation

Label Parameter Range/Units Description Screen Display

VCO

Carbon Dioxide Elimination

1-3000 ml/min adult/pediatric

Volume of CO

eliminated through

the breath each minute

All except Flow/

Pressure & Loops

0-300 ml/min neonatal

Vd Aw Airway deadspace 0-500 ml Includes added mechanical

deadspace proximal to the flow

Numerics, SBCO

Tabular Data sensor

Vd/Vt Deadspace to tidal

0-1.00 ml (PaCO

-PeCO2) / PaCO

volume ratio

Vd alv Alveolar deadspace 0-500 ml Difference between physiologic and

airway deadspace

Vt alv Alveolar tidal volume 0-2400 ml adult

0-1200 ml pediatric

Tidal volume less airway deadspace

Numerics, SBCO2 &

ABG Data E ntr y

Numerics, SBCO

ABG Data E ntr y

Numerics, SBCO

Tabular Data

0-160 ml neonatal

Vte Expired Tidal Volume 200-3000 ml adult

30-400 ml pediatric

Volume of gas exhaled per breath All except Flow/

Pressure & Loops

1-100 ml neonatal

Vte-m Expired Ti da l Volume -

mechanical

200-3000 ml adult 30-400 ml pediatric

Volume of mechanically exhaled gas, per breath

Tabular Data

1-100 ml neonatal

Vte-s Expired Tidal Volume -

spontaneous

200-3000 ml adult 30-400 ml pediatric

Volume of spontaneously exhaled gas, per breath

Tabular Data

1-100 ml neonatal

Vti Inspired Tidal Volume 200-3000 ml adult

30-400 ml pediatric

Volume of gas inhaled per breath All except Flow/

Pressure & Loops

1-100 ml neonatal

Vti-m Inspired Tidal Volu m e -

mechanical

200-3000 ml adult 30-400 ml pediatric

Volume of mechanically inhaled gas, per breath

Tabular Data

1-100 ml neonatal

Vti-s Inspired Tidal Volume -

spontaneous

200-3000 ml adult 30-400 ml pediatric

Volume of spontaneously inhaled gas, per breath

Tabular Data

1-100 ml neonatal

Principles of Operation

Non-Invasive Cardiac Output (NICO)

8 NICO User’s Manual Rev. 05

NICO® calculates cardiac output (C.O.) non-invasively based on respiratory gas analysis, using a technique known as “differential Fick partial rebreathing.” The key to this technique is a NICO Sensor™, consisting of a rebreathing valve and a combined CO breathing circuit. The NICO Sensor™ is placed into th e ventilator circuit betw een the patient

/Flow s ensor plac ed in the

elbow and ven tilator w ye. The rebreath ing valve is automat ically con trolled b y the m onitor. When the valve is activated, the flow of the inspired and expired gas is diverted through a rebreathing NICO Loop.™ When the valve is deactivated, this additional rebreathing volume is bypassed and normal ventilation resumes. Every three minutes, a baseline, rebreathing and stabilization pha se occurs. (See “The NICO® Cycle” o n p a ge 27.) A non-invasive ca r d ia c ou t put calculation is made following the end of each three minute cycle. The calculation is based on the changes induced in CO The increase in end tidal CO

0.67 kPa) and returns to baseline in less than 30 seconds.

The Fick equation using CO elimination divided by the ven ou s-a r te r ia l d if fe r ence in the CO2 content: VCO2/(CvCO2-CaCO2).

elimination and end tidal CO2 in response to the r ebreat hing vol ume.

, which ref lects the incr eas e in PaCO2, is usually 3-5 m mHg (0.4 -

as an indicator states that cardiac output is equal to CO

The partial rebreathing method yields a differential form of the Fick equation, eliminating the need to me asure mixed venous CO

(assumed constant during the rebreathing period and

therefore cancels out of the equation). This indirect Fick method is then corrected for shunt,

Principles of Operation

based on the Nunn’s iso-shunt curves using SpO2 (or entered PaO2) and a user-entered value for FiO2 (INSP O2).

Carbon Dioxide (CO2) NICO

uses the CAPNOSTAT® CO2 Sensor to measure CO2 by using the infrared absorption technique. The principle is based on the fact that CO2 molecule s absorb infrare d (IR) light energy of specific wavelengths, with the amount of energy absorbed being directly related to the CO

concentration. When an IR beam is passed through a gas sample containing CO2, the

electronic signal from the photodetector (which measures the remaining light energy) can be obtained . This sig nal is t hen comp ared to the e nergy of the IR s ource a nd calibrat ed to accurately reflect CO a known concentration of CO channel accounts for optical changes in the sensor, allowing the system to remain in calibration

concentration in the sample. To calibrate, the photodetector’s response to

is stored at the fac tory in the m onitor ’s memory. A reference

without us er in terventio n .

Flow and Pressure Flow and pressure measurements in the NICO

pressure pneumotachometer. Respired gas flowing through the flow sensor causes a small pressure drop across th e two tubes conne cted to the sensor. This pressure drop is transmitted through the tubing to a differential pressure transducer located inside the monitor, and is correlated to flow according to the factory stored calibration. User calibration is not required due to the ability of the p lastic injection mo ld to repeate dly produce p recision flow sen sors. The

Carbon Dioxide Elimination (VCO2)

pressure transducer is automatically “zeroed” to correct for changes in ambient temperature and electronics. The NICO volume measurem ents in th e presence o f high oxygen concent rations, anes thetic gas es and helium-oxygen mixtures. When compensated, gas density and viscosity effects do not cause significant errors in f lo w m eas ur e m e n t.

Carbon dioxide elimination (VCO2) is a key measurement for NICO® calculations. It is calculated based on a mathematical integration of the measured flow and CO2 signals. These signals are obtained from practically the same point at the patient’s airway, thereby insuring optimal accuracy. Both the flow and CO

monitor system software compensations allow accurate flow and

sensors are integral components of the NICO Sensor™.

monitor are made by a fixed orifice differential

Oxygen Saturation

) & Puls e Rate

(SpO

Oxygen saturation (SpO2) is used by the NICO® monitor to calculate the shunt correction of the NICO® calculation, and the p ulse rate is used to calculate stroke volu me.

is determine d using se nsors con tain ing red and infrared light emit ting diod es (LED s). The

SpO

light from each LED is be amed throug h a pulsati ng vascular b ed su ch as the patient ’s finger or toe. The remaining light not absorbed by the tissue reaches a photodiode light receptor in the sensor. Oxygen saturated blood absorbs different amounts of light at each wavelength as compared to unsaturated blood. Therefore, the amount of light absorbed by the blood in each pulse can be u s ed to c al c u la te oxygen saturat io n .

NICO

is calibrate d to display “fu nctional ” saturation . This diffe rs from the “f ractional” saturation value displayed by most co-oximeters. Functional saturation represents the amount of oxyhemoglobin as a perce ntage of the he moglobin that can be oxygenated. Dy sfunctional hemoglobins, (COHb and METHb) are not included in the measurement of functional saturation.

• Functional Saturation = HbO COHb is carboxyhemoglobin, and METHb is methemoglobin.

/100-(COHb+METHb ); Hb O2 is fractional hemoglobin,

Pulse Rate, derived from the pulse oximetery sensor, is calculated by measuring the time interval between the peaks of the infrared light waveform. The inverse of this measurement is displayed as pulse rate.

Rev. 05 NICO User’s Manual 9

Areas of the Display

Navigating in Cardiac Output mode

Areas of the Display

The major sections of the Cardiac Output mode screen are identified below.

Stroke Volume (SV) and Cardiac Index (CI) are displayed in all views. A batter y icon also appear s if on bat te r y power.

A General Message area for status, alert and error information. Displayed in all views (here shown blank).

A Cardiac Output Message area for C.O. info rmation is displayed in all views. The Rebreathing Bar is displayed during the rebreathing por tion of the cycle.

Cardiac Output (C.O.) value is displayed in all views. The CObar™ confidence indicator is replaced by FAST MODE when in fast mode.

The lower half of the disp la y pre sen t s tre n d, waveform, respiratory and numeric data to the user. Various data entry, setup and aler t menus are also presented here. Use the KNOB and the MENU and DAT A ENTRY keys to select the various displays.

Navigating the Display System

Use the KNOB, MENU, and DATA ENTRY keys to navigate the NICO® display system (as outlined in the following sections).

10 NICO User’s Manual Rev. 05

KNOB selectable Monitoring Sc reen s

KNOB selectable Monitoring Screens

The KNOB is used to p age through monitoring screens, scroll through menus and make selections, and to change or enter values. The KN OB is generally turned to access different monitoring screens and to highlight menu options, and pressed to accept or change select ions.

C.O. Trend Screen

TURN

PUSH

Rebreathing Curves Scre en

PUSH

CO2/SpO2 Screen

(No Options)

Flow/Pressure Screen

(No Options)

Numerics Screen

(No Options)

Rev. 05 NICO User’s Manual 11

KNOB selectable Monitoring Sc reen s

KNOB Selectable Respiratory Screens

TURN

The following Respiratory Screens are available in the monitoring mode only when activated. Press the MENU key and se lect RESP SCREENS from the SELECT A SC RE EN m enu by tur n ing a nd the n pressing the KNOB.

From the ADD RESPIRATORY SCREENS menu, highlight and then select which screens will appear in the base m oni toring mode by tur ning and the n pre ssing the KNOB . Wh en ena bled, select ed screens can be di splayed by tur n ing the KNOB while vie wing any m on it o rin g scr een.

Respiratory Numerics

Flow Volume Loop and Pressure Volume Loop

Single Breath CO2 Waveform

/MValv Trend

VCO

12 NICO User’s Manual Rev. 05

MENU key Screen Displays

PUSH

MENU key Screen Displays

Press the MENU key to activate the SELECT A SCREEN menu and illumina te th e key ’s green ic o n. Press the key again to re tu r n to th e previousl y di s played scre en . From the SE L EC T A SC RE EN menu turn the KNOB to highlight the screen you wish to d isplay. Press the MENU key or the KNOB to display that selected screen.

PUSH

TURN

Rev. 05 NICO User’s Manual 13

DATA ENTRY key Screen Displays

Press the DATA ENTRY key to activate the DATA ENTRY screen and illuminate the key’s green icon. Press the key again to return to the previously displayed screen. From the DATA ENTRY screen, you can enter patient information including height, weight and respiratory gas mixture, and access the ABG DATA ENTRY scr een. (See “Enterin g Pat ien t D at a ” o n pa ge 28 for det ail s .)

PUSH

TURN

PUSH

TURN

TO ADJUST

PUSH

TO ACCEPT

14 NICO User’s Manual Rev. 05

DATA ENTRY key Screen Displays

ABG Data Entry Screens

PUSH

From the DATA ENTRY screen, select ABG DATA ENTRY. Turn and press the KNOB to enter PaCO2, PaO

, and Hemoglobin entry screens. (See “Entering Patient Data” on page 28 for details.)

TURN

PUSH

TURN

TO SE LECT

Rev. 05 NICO User’s Manual 15

PUSH

TO ACCEPT