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NOxBOX
i
®
& NOxMixer Operating Instructions
1
Set- Up
Before you use the NOxBOX Ltd NOxBOXi intelligent Nitric Oxide delivery and monitoring system it is important to follow these steps:
Ensure the device does not require maintenance (monthly) and that the maintenance is not due during the expected duration of the therapy such as:
• NO sensor high calibration
• NO2 sensor high calibration
• Pump calibration
• Vent calibration
Checklist
• Ensure the device is clean and free from damage
• Ensure the water trap is empty and has been cleaned from previous use
• Ensure all single use items from previous patient have been discarded
Equipment you will need for set-up:
• A NOxBOXi system test kit (NOXBOX-I TEST)
• A NOXKIT (inspiratory limb size dependant)
• Two cylinders of delivery gas
Additional items
• NOxAIR Environmental monitors
• EMER kit- Emergency backup
• Oxygen hose for NOxMixer
• A 22mm one-way valve for HFO ventilator circuits (FXS555)
NOTE: If you do not have the parts listed above or the device has not been maintained the NOxBOXi may not be suitable for use and you may be unable to
set-up the device. Failure to follow these procedures may result in harm to to the operator or the patient.
NOxBOX Ltd, Station Road, Harrietsham, Maidstone, Kent, ME17 1JA
+44 (0)1622 854868 +44 (0)1622 854860 ask@noxboxltd.com www.noxboxltd.com
Issue 7.0 (Software V.17.1) March 2016. Part No: LAB637
© NOxBOX Ltd
NOxBOX Limited reserves the right to change or update this literature without prior notice. Registered ofce: England and Wales. Registered No: 9563860
Page 2
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NOxBOX
i
& NOxMixer Operating Instructions
®
2
Setup
Engage trolley brakes to
stabilise system prior to use.
Carefully attach monitor
to trolley and fully tighten
clamp.
Connect power supply to
suitable rated mains outlet.
Press power button to start
system.
Once zero test is complete,
follow instructions on screen
to set-up system.
Experienced users may
choose to skip directly to
system tests or skip to dose.
System test circuit set-up:
NOxFlow
TM
arrow points in
direction of ow. 1m vent
tubing between sample
point and NOxFlow
TM
.
Perform system
test to ensure correct system
functionality prior to
connecting to patient.
Connect to patient circuit;
sample near patient Y-piece.
Retain NOxFlow
TM
orientation for ow and 1m
distance from sample point.
1 2
3
4
5
6 7
8
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NOxBOX
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®
& NOxMixer Operating Instructions
3
Engage trolley brakes to
stabilise system prior to
changing cylinder.
Check cylinder concentration
matches the setting for the
system.
Check regulator surfaces
and O ringsare damage free.
Do not use
damaged equipment.
Attach regulator to cylinder.
Screw rmly by hand. Attach
supply line to regulator.
Apply supply line to port on
rear of monitor
1
2 3
5
Slowly open cylinder valve.
Read gauge. If needle in red
zone, replace cylinder before
starting treatment.
Perform a leak test: open the
cylinder valve then close.
Observe gauge for 30
seconds, needle should
remain stationary.
Load cylinders onto trolley.
Secure with straps.
4
6
8
Cylinder setup
7
1000
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NOxBOX
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& NOxMixer Operating Instructions
®
4
System tests
System test circuit set-up:
NOxFlow arrow points in
direction of ow. 1m vent
tubing between sample
point and NOxFlow.
Re-open NO cylinder.
Connect O
2
supply to
NOxFlow
TM
inlet. Set O2 ow
to 10 L/min. Press “Next” on
system screen to run test.
System test takes approx.
5 minutes to run. This purges
NO2 and ensures correct
NOxBOX
i
operation.
System test passed. Stop O
2
ow and disconnect from
NOxow. Ready to connect
to patient.
System test failed. Check:
NOxFlow orientation; O
2
ow at 10 L/min, NO cylinder
connected and valve open.
Re-run test.
Put unit in stand-by mode
by setting dose to zero and
disconnecting supply hoses,
otherwise the unit may time
out and may require you to
repeat step 3.
Connect to patient circuit.
Enter dose and check alarm
levels before commencing
treatment.
1
2
3
4
5
6
7
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NOxBOX
i
®
& NOxMixer Operating Instructions
5
Ventilator connections
The NOxFlowTM is single
patient use. Unwrap and
carefully uncoil the lines.
Push and click-to-lock twin
sensor line to unit.
Twist dose line luer to unit.
Select a vent connector with
luer port from the NOXKIT
TM
.
Connect the male luer of the
sample line.
1
2 3
Connect sample line and
hydrophobic lter.
4
NOxFlow
TM
is situated in the inspiratory limb, before the
humidier.
The sample line is up to 30cm from patient.
Situated in the inspiratory limb just prior
to the patient Y-piece.
NOxFlow should be approx. 1 metre back from the sample
point. Ideal range 0.7 m – 1.3 m.
For system test, high frequency and manual bagging circuit
diagrams please refer to Technical Guide.
5
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NOxBOX
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& NOxMixer Operating Instructions
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Dose setting & main screen features
The navigation tabs access the alarm history and user settings screens.
Alarm history: shows last 10 alarms for current treatment. Unresolved
alarms are listed at the top.
User settings: change user settings, access Manual Override
calculator, Sensor Zero and Service Engineer area.
To set or change dose press
‘edit dose’ . The NOxBOX
i
will
then guide you through setting
the dose and high/low alarms.
Once conrmed the delivery
and monitoring will adjust
accordingly.
Maximum dose - 80ppm
Minimum dose - 0.1ppm
(Gas available)
(Depleted)
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NOxBOX
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®
& NOxMixer Operating Instructions
7
Cylinder replacement
Engage trolley brakes to
stabilise system prior to
changing cylinder.
Fully close cylinder valve.
Check regulator gauge
pressure is relieved and
remove regulator from
depleted cylinder.
Remove depleted cylinder
from trolley and replace with
new supply cylinder. Check the
concentration matches the value
displayed on-screen.
Check O rings and attach
regulator to new cylinder.
1
2
5
Perform a leak test: Slowly open
the cylinder valve then close.
Observe gauge for 30 seconds,
needle should remain
stationary.
Purge pressure from hose, then
reconnect the hose to inlet port
monitor. Open valve on cylinder
fully.
7
Detach hose from monitor and
depressurise on purge needle.
8
3
4
6
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NOxBOX
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& NOxMixer Operating Instructions
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8
Conrm on-screen that
shutdown is required. Follow
on-screen instructions.
Fully close each cylinder and
depressurise the supply lines
using the purge needle.
Check regulator gauge
pressure is relieved and
remove regulator from each
cylinder and stow on system
trolley.
Remove all single patient
use devices from monitor
and dispose of according to
local regulations.
Drain water trap and dispose
of drainage syringe.
On completion of last
instruction screen, system
will purge and shutdown
safely ready for storage.
2
3
4
5
6
7
Shutdown
Remove power supply and
store on trolley for transport.
Ensure system is attached to
suitable mains supply whilst
in storage.
8
When ready to shutdown
the system, briey press the
power button on the
monitor .
1
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NOxBOX
i
®
& NOxMixer Operating Instructions
9
Priority Colour & Tone Meaning
High
Red
5 tone pattern & Red L.E.D. alarm
strip.
Critical problem detected. Condition poses immediate threat to patient health or correct
functioning of the NOxBOXi monitor. Alarm condition should be diagnosed and resolved
immediately.
Medium
Amber
3 tone pattern
Problem detected. Condition may impair the functioning of the NOxBOXi. If left unresolved,
problem may worsen and cause a high priority alarm condition.
NOxBOXi Troubleshooting Guide
ALARMS TROUBLESHOOTING
The NOxBOXi is equipped with audible and visible alarm notications; this chapter is a guide to the alarm conditions that can occur and common actions for alarm
resolution. All alarms are graded into high priority or medium priority alerts.
NOTE: In all instances of alarms sounding, the health and condition of the patient must be ensured before attempting to resolve any issue with the NOxBOX
i
system.
Alarm Priorities
The system alarms are colour coded to help identify priority of detected issue. Additionally, the two alarm priorities each have an
audible warning to help dierentiate them.
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NOxBOX
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& NOxMixer Operating Instructions
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10
Notication Priority Possible Cause Recommended
NOxBOXi System
Diagnostics
High The NOxBOXi performs self-tests at start-up and during operation
to ensure safe performance is maintained. In the event that a
critical test fails, the system will display a full-screen notice
indicating that the system can no longer be used safely.
Press the on screen reset button.
Sensor Bias Lost The Nitric Oxide sensor requires a constant very low trickle charge
to maintain its calibration. In the event that the system is not
stored on mains power charge, after an extended period of time
the battery may completely discharge and the sensors will lose
their calibration bias.
In the event of power loss, connect the unit to mains power
and allow 6 hours for the unit to charge before
calibrating the NO sensor and re-commissioning the unit.
If another system is not readily available and patient
requires therapy, engage the manual override mode, replace
the system as soon as practically possible and alert the
Service Engineer.
The Nitric Oxide sensor is sensitive to extreme temperature
variation, contact with VOCs (such as alcohol based cleaning
products), strong fragrances, direct contact with moisture or
vibrations (such as during transit in a vehicle).
Follow setup steps as normal, if sensor zero fails re
attempt until the unit passes, this can take up to 30
minutes in some cases.
The NO sensor may require replacing. If another system is not readily available and patient
requires therapy, engage the manual override mode, replace
the system as soon as practically possible and alert the
Service Engineer.
Notications at Switch on
The below are a series of notications which may be seen at start-up (before the home screen) if an issue is detected with the NOxBOXi.
NOxBOXi Troubleshooting Guide
High
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NOxBOX
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®
& NOxMixer Operating Instructions
11
Alarm Priority Possible Cause Recommended Action
NO Low High Monitored levels of NO gas being delivered to
the patient have dropped below the alarm
setting boundary. NOxBOXi delivery system
cannot maintain correct dose setting.
Check sample line is correctly attached to ventilator circuit and NOxBOXi water trap inlet.
Check sample line and lter for blockages.
Check water trap (including barrel thread) for damage and/or leaks.
Check no ventilator circuit breaks or leakages have occurred.
Check supply cylinder is connected, open; there are no leaks and the concentration matches the
system settings.
Check correct orientation of NOxFLOW.
Check NOxFLOW dose line and connection is connected and there are no blockages or leaks.
Check NOxFLOW ow detection lines and connection (including O rings) are connected and
there are no blockages or leaks.
The ventilator minute volume may be too low. Check ventilator minute volume (see NOxBOXi technical guide for ow specications), you may
need to increase the ventilator bias ow.
The NO low alarm may be inappropriately set
by user.
Check NO low alarm value and reduce value if ventilator settings deem necessary.
The NO sensor may require replacing. If another system is not readily available and patient requires therapy, engage the manual
override mode, replace the system as soon as practically possible and alert the Service Engineer.
NO High High Monitored levels of NO gas being delivered to
the patient have risen above the alarm setting
boundary. NOxBOX
i
delivery system cannot
maintain the correct dose setting.
Check supply cylinder concentration matches the system settings. If possible, change the NO
supply cylinder for the correct concentration. If not, call Service Engineer to resolve.
Check no ventilator circuit break/leakage has occurred that may cause build-up of NO
concentration due to lack of ventilator ow.
Check correct orientation of NOxFLOW.
Check NOxFLOW connection (and O rings) to NOxBOX
i
.
The NO high alarm may be inappropriately set
by user.
Check NO high alarm value and increase value if ventilator settings deem necessary.
The NO sensor may require replacing. If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
High Priority Alarms during therapy
NOxBOXi Troubleshooting Guide
The below are a series of alarms which may be seen during therapy (once the device has been setup) if an issue is detected with the NOxBOXi.
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NOxBOX
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& NOxMixer Operating Instructions
®
12
NO2 High High Monitored levels of NO2 gas being
delivered to the patient have risen
above the alarm setting boundary.
High NO dose settings on low ventilator ows with High O2 content may cause higher NO2 build-up than expected.
Increase ventilator bias ow to help reduce stagnation in delivery.
Poor quality NO cylinders can
contain high levels of NO
2
Connect a second supply cylinder to the alternate inlet port. Open the cylinder and
disconnect the previous cylinder, forcing a cylinder changeover to see if this resolves the issue.
The NO2 high alarm is set to a default
value of 1.0ppm. NO2 is extremely
toxic and poses risk to patient
health.
The alarm value can be increased to a maximum of 5.0ppm if required. Please see INO guidelines for more information
on maximum NO2 values during INO therapy.
Incorrect placement of
NOxFLOW and sample line.
See ventilator circuit diagram for correct placement of NOxFLOW and sample line.
Whilst in standby mode NO
2
can build
up in supply lines.
Purge supply lines (see cylinder change procedure).
Stagnant gas in manual bag circuit
causing NO2.
Purge manual bag circuit before connecting to
patient (see manual bagging procedure).
The NO
2
sensor may require
replacing.
If another system is not readily available and patient requires therapy, engage the manual override mode, replace the
system as soon as practically possible and alert the Service Engineer.
O2 Low High Monitored levels of O2 gas being
delivered to the patient have fallen
below the alarm setting boundary.
Check sample line for blockages.
Check water trap (including barrel thread) for
damage and/or leaks.
Check sample line is correctly attached to ventilator circuit and NOxBOXi water trap inlet.
Check no ventilator circuit breaks or leakages have occurred.
The NO gas is balanced in N2, this is
an asphyxiant gas. At high NO dose
levels for low concentration cylinders
(e.g. 200 ppm) the level of gas
delivered into the ventilator stream
can reduce the % v/v of O
2
being
delivered to the patient.
Check O2 concentration setting at ventilator.
Adjust O
2
alarm value if deemed necessary.
The O
2
sensor may require
replacing.
If another system is not readily available and patient requires therapy, engage the manual override mode, replace the
system as soon as practically possible and alert the Service Engineer.
NOxBOXi Troubleshooting Guide
Page 13
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NOxBOX
i
®
& NOxMixer Operating Instructions
13
Water
Trap
Full
High Water trap is lled with condensate from sample
line. If the water trap is allowed to overow, the
sample path will block and water ingress to the
NOxBOXi system could damage the internal
mechanisms and gas sensors. Delivery accuracy is
compromised and patient safety could be put at risk.
Use disposable male-luer lock syringe contained in NOXKIT to empty uid from
water trap via the self-sealing drain tap located at the bottom of the water trap.
Dispose of entire syringe and contents according to local directives (e.g. sharps waste).
The water trap uses a small oat to activate the alarm,
if no moisture is present gently tap the barrel to
see if the alarm oat is in the o position.
If issues persist, remove the barrel and check position of alarm oat.
Removing the water trap barrel will dilute NO sample causing inaccurate dose and readings. Take
care not to damage/cross thread the water trap thread when
replacing the barrel.
Sample
Line
block
High Sample line to monitor has become blocked,
pinched or occluded. Sample monitoring is
aected which may compromise delivery accuracy
and patient safety.
Check sample line for any pinch/crush points from external bodies, or blockages that may have
occurred.
Check water trap does not require emptying.
Change sample line and hydrophobic lter.
If another system is not readily available and patient requires therapy, engage the manual
override mode, replace the system as soon as practically possible and alert the Service
Engineer.
Battery
Critical
High NOxBOXi is running from internal battery and
battery charge level has been detected as critical.
System power could fail within the next 10
minutes. Power failure will stop automatic
intelligent delivery of NO.
Reconnect the NOxBOXi system to the mains using the NOxBOXi power supply. This will ensure
continued powered operation of the NOxBOXi and will start to recharge the internal battery.
Check green (mains power) L.E.D on mains power plug is lit indicating mains supply OK. If not,
try a dierent mains power socket/supply.
Disconnect power supply and reconnect, check blue (charging) L.E.D is lit indicating mains
supply OK. If not, try a dierent mains power/supply.
If possible replace NOxBOX
i
power supply and alert service engineer.
NOxBOXi Troubleshooting Guide
Page 14
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NOxBOX
i
& NOxMixer Operating Instructions
®
14
In the event that no mains power can be restored to the device, be prepared to engage the
manual override mode.
Cylinder
Supply
Critical
High NOxBOXi detects that available NO gas
supply is running low, and no alternate
cylinder supply is detected. Without
action to replenish the NO gas supply
treatment delivery will cease.
Install a new gas cylinder supply and connect to the alternate gas inlet port at the rear of
NOxBOXi.
If a new gas cylinder is already installed, ensure the cylinder valve is fully open and
connected to inlet port at rear to allow the device to use the supply for delivery.
Check the supply cylinder regulator gauges indicate adequate cylinder pressure (>20bar). If
regulator gauge indicates adequate pressure, check for leaks. If issues persist, replace regulator
and alert service engineer.
Vent Idle High The NOxFLOW has not detected any
vent ow activity for an extended
period of time (typically over 30
seconds) during delivery.
Check correct orientation of NOxFLOW; the green arrow printed on the NOxFLOW should be
pointing towards the patient in the direction of the ventilator ow.
Check NOxFLOW ow detection lines and connection (including O rings) are connected and
there are no blockages or leaks.
Check there is not a serious leak or break in the ventilator circuit. Attend to the ventilator circuit
requirements.
Check the ventilator is connected and supplying sucient ow.
Critical
Delivery
Fault
High The NOxBOX
i
has detected a critical
fault within the intelligent delivery
system, and can no longer guarantee
safe delivery function.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
Check for occlusions on the NO outlet, delivery line or NOxFLOW. Once resolved reset the dose
to resume delivery.
Occlusion on NO outlet.
Touch
screen
won’t
respond.
High The NOxBOXi has detected a critical
fault within the intelligent delivery
system, and can no longer guarantee
safe delivery function. NO delivery to
the patient may have stopped.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
NOxBOXi Troubleshooting Guide
Page 15
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NOxBOX
i
®
& NOxMixer Operating Instructions
15
Alarm Priority Possible Cause Recommended Action
Zero
Calibration
Medium Every 24 hours during use the NOxBOXi prompts
the user to perform a sensor zero. This operation
ensures the most accurate system performance
by checking the gas sensor
reading performance.
NOTE: This test takes up to 2 minutes to perform.
During this time the monitored patient gases will
be oine. The NOxBOXi continues to deliver NO
during this time.
No special connections are required; the zero calibration is fully automatic.
Press the tick to start the zero calibration.
The zero calibration can be delayed if the system is not currently in a stable dose delivery state:
e.g. If the patient dose has recently been changed and the system is still stabilising to the new
dose level, dismiss this alarm message and perform the zero when the notice next appears.
Zero
Calibration
Fail
Medium A sensor may have become unstable or residual
gas may be present in the system.
Check ambient NOxAIR monitor for high levels of NO. If high levels are detected, check the
regulator(s) and supply line(s) for leaks.
Repeat zero calibration.
Check the zero port (rear) has not been blocked.
If another system is not readily available and patient requires therapy, engage the manual
override mode, replace the system as soon as practically possible and alert the Service
Engineer.
Cylinder Low Medium This will appear when an alternate viable gas
supply is detected, but the current feed cylinder is
nearly depleted.
Replace the cylinder with a fresh supply to resolve this alarm.
Alternatively, once the cylinder is empty, close the cylinder valve fully, remove the feed hose
from the rear of the system and release the pressure using the purge needle on the monitor.
Please note, once the second cylinder begins to deplete, if this rst cylinder has not been
replaced in the interim period, the ‘cylinder supply critical’ alarm will be triggered.
NOxBOXi Troubleshooting Guide
Medium Priority Alarms during therapy
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NOxBOX
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& NOxMixer Operating Instructions
®
16
High Calibration
Overdue
Medium To keep the NOxBOXi functioning accurately, it is
important that the system sensors be fully calibrated by
a suitably qualied Service Engineer once a month.
The system records the last date of each successful
calibration in the service engineer section.
This action may be performed whilst the system is in use via the service
engineer area. However Bedfont strongly recommend that the sensor high
calibrations are not performed during therapy to minimise risk to the patient.
To resolve, the system sensors must be calibrated by the appointed Systems
Engineer using calibration gases.
Manual
Override
Medium Manual Override mode is engaged.
The system alarms to alert the user that the system is
not delivering in intelligent mode. Changes to the
ventilator setting or patient demand cannot be
automatically corrected on the system. A specic dose
setting cannot be dialled in and achieved.
The patient must be closely monitored and ensure the
gas alarms are correctly set to alert for any
abnormal gas delivery behaviour.
This alarm will resolve when the system is returned to normal Intelligent
Delivery Mode.
NOxBOXi Troubleshooting Guide
Page 17
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NOxBOX
i
®
& NOxMixer Operating Instructions
17
General Troubleshooting
NOxBOX
I
Issue Possible Cause Recommended Action
NOxBOX
i
turns on and o
immediately. NOxBOXi
attempts to start up but shuts
down.
NOxBOXi won’t turn on at all.
Low battery power. Connect NOxBOXi to mains power and turn on NOxBOXi.
Check mains power is connected and battery is charging (see battery critical).
An internal fault has occurred; the system shuts
down to protect integral components.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
Zero Calibration Fail One or all of the sensors have failed the zero (low)
calibration.
Ambient conditions may be aecting the zero
sample.
Check ambient NOxAIR monitor for high levels of NO. If high levels are detected, check the
regulator(s) and supply line(s) for leaks.
One or all of the sensors may have become
unstable or residual gas may be present in the
system.
Repeat zero calibration.
Check the zero port (rear) has not been blocked.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
System Test Fail The NOxBOX
i
has failed the safety test and
cannot accurately deliver and monitor Nitric Oxide
inintelligent mode.
Check the Oxygen source is owing.
Check the NOxFLOW is connected to the Oxygen source and the NOxBOXi-TEST kit.
Check the correct orientation of NOxFLOW.
Check the NOxFLOW is connected to the NOxBOXi.
Check NOxFLOW ow detection lines and connector O rings for damage.
Check sample line is connected to the water trap and the NOxBOXi-TEST kit.
Check water trap (including barrel thread) for damage.
Repeat the system test.
If second test fails, replace the NOxFLOW and sample line.
One or all of the sensors may have become
unstable.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
Fluctuations/ Oscillations in
excess of 3ppm.
May be due to Noxow. Ensure O-ring and NOxFLOW are present and connected.
Mass ow sensor due for service. Contact Service Engineer.
HFO frequency. Adjust the frequency slightly based upon your clinical judgement.
NOxBOXi Troubleshooting Guide
Page 18
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NOxBOX
i
& NOxMixer Operating Instructions
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18
Issue Possible Cause Recommended action
NOxMixer is not delivering a
dose (NO monitor shows no NO
dose)
Ensure mode selector valve is
correctly oriented. Ensure all lines are connected.
Flow meter ball stuck Moisture ingress Contact service engineer
Control knob not working Could be loose/faulty/broken Contact service engineer
NOxMixer unit emits sound
when used.
Due to vibration Ensure that O
2
input line is connected correctly and secured.
Ensure that all lines are connected and secured. If sound is still
apparent, disconnect the unit and contact service engineer.
NOxMixer ow does not register
a ow rate.
Check Oxygen supply is connected and turned on.
NOxMixer
NOxBOXi Troubleshooting Guide
Page 19
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NOxBOX
i
®
& NOxMixer Operating Instructions
19
Manual override
NOTE: All dose information for the Manual Override are
approximations. Monitoring must be used to ensure the patient
is receiving the correct dose.
B
If Manual Override is required:
First check suitable ow rate is set.
2
A
A
F
Using on-screen
calculator access the
manual override
calculator from Settings.
Adjust vent ow to best
match patient settings. Table
displays approx. dose per
valve setting.
Use the look-up tables in this
guide. To set ow rate, nd
the table matching NO
supply concentration.
Find the vent ow setting to
best match patient settings.
The column lists the approx.
dose per valve setting.
A
A
B
To set ow rates
1
OR
B
Check that oxygen ow meter is turned o.
Attach the Schrader probe of Oxygen hose to Oxygen
cylinder or wall outlet) and the other end to the inlet
port situated at the back of NOxMixer. For pressure
information, please check the specications.
Set Oxygen flow to desired rate on the NOxMixer.
Connect the manual bagging line to the outlet of NOxMixer.
Then engage mode selection valve to the
position seen on right hand side image
.
B
C
D
E
F
600
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NOxBOX
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& NOxMixer Operating Instructions
®
20
NOTE: To improve accuracy, it is recommended to have up to 30cm between the patient Y-Piece (8) and the sample line (7).
Emergency backup
1. Ventilator
2. Ventilator Inspiratory Port
3. NOxFLOWTM (use 22F or 15M to vent tube adaptors)
4. Humidier
5. 0.7m-1.3m Corrugated Tubing (15mm or 22mm)
6. NOxBOXi Sample Line
7. 10M-10F, 12M-12F, 15M-15F or 22M-22F luer port connector
8. Patient Y-piece
9. Expiratory limb
10. NOxBOXi with NOxMixer
11. Emergency backup
Page 21
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NOxBOX
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®
& NOxMixer Operating Instructions
21
Image showing two ends of EMER
tubing. End 1-without luer
End 2- with luer
Attach the end of the tubing
without the luer to the outlet of
NOxMixer.
Disconnect the NO dose line from
NOxBOX
i
. Attach the luer end of the
tubing, to the NO dose line.
Switch to manual override once
connected to engage emergency
backup mode. Refer to page 19,
image F.
1
2
Note: Refer to manual override page 19, number 1 to set ow rates.
Emergency backup
WARNING: Ensure Oxygen ow meter is turned off when using in conjunction with
the ventilator to avoid Oxygen overdosing.
Page 22
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NOxBOX
i
& NOxMixer Operating Instructions
®
22
All dose information shown in these tables is for guidance only. The patient monitored gas levels should be used for actualy dose delivery information. All nitric oxide (NO) doses shown in parts per million (ppm)
when introduced to continuous ow rates indicated. Doses of NO above 40 ppm are not recommended. Doses above 20ppm are considered clinically high.
Flow valve setting
Minute ow volume
Clinder Concentration (ppm)
800
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50
73 38 26 20 16 13 11 9.9 8.8 7.9 7.2 6.6
6.1 5.7 5.3 5 4.7 4.4 4.2 4 3.8 3.6 3.5 3.3 3.2 3.1 3 2.8 2.7 2.7 2.6 2.5 2.4 2.3 2.3 2.2 2.2 2.1 2 2
100
133 73 50 38 31 26 22 20 17 16 14 13 12 11 11 9.9 9.3 8.8 8.3 7.9 7.5 7.2 6.9 6.6 6.3 6.1 5.9 5.7 5.5 5.3 5.1 5 4.8 4.7 4.5 4.4 4.3 4.2 4.1 4
200
229 133 94 73 59 50 43 38 34 31 28 26 24 22 21 20 18 17 16 16 15 14 14 13 13 12 12 11 11 11 10 9.9 9.6 9.3 9 8.8 8.6 8.3 8.1 7.9
300
300 185 133 104 86 73 63 56 50 45 41 38 35 33 31 29 27 26 24 23 22 21 20 20 19 18 17 17 16 16 15 15 14 14 13 13 13 12 12 12
400
356 229 168 133 110 94 82 73 65 59 54 50 46 43 41 38 36 34 32 31 29 28 27 26 25 24 23 22 21 21 20 20 19 18 18 17 17 16 16 16
500
400 267 200 160 133 114 100 89 80 73 67 62 57 53 50 47 44 42 40 38 36 35 33 32 31 30 29 28 27 26 25 24 24 23 22 22 21 21 20 20
600
436 300 229 185 155 133 117 104 94 86 79 73 68 63 59 56 53 50 48 45 43 41 40 38 37 35 34 33 32 31 30 29 28 27 27 26 25 24 24 23
1000
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50
91 48 32 24 20 16 14 12 11 9.9 9 8.3
7.6 7.1 6.6 6.2 5.8 5.5 5.2 5 4.7 4.5 4.3 4.1 4 3.8 3.7 3.6 3.4 3.3 3.2 3.1 3 2.9 2.8 2.8 2.7 2.6 2.6 2.5
100
167 91 63 48 38 32 28 24 22 20 18 16 15 14 13 12 12 11 10 9.9 9.4 9 8.6 8.3 7.9 7.6 7.4 7.1 6.8 6.6 6.4 6.2 26 5.8 5.7 5.5 5.4 5.2 5.1 5
200
286 167 118 91 74 63 54 48 43 38 35 32 30 28 26 24 23 22 21 20 19 18 17 16 16 15 15 14 14 13 13 12 12 12 11 11 11 10 10 9.9
300
375 231 167 130 107 91 79 70 63 57 52 48 44 41 38 36 34 32 31 29 28 27 25 24 23 23 22 21 20 20 19 18 18 17 17 16 16 16 15 15
400
444 286 211 167 138 118 103 91 82 74 68 63 58 54 51 48 45 43 40 38 37 35 34 32 31 30 29 28 27 26 25 24 24 23 22 22 21 21 20 20
500
500 333 250 200 167 143 125 111 100 91 83 77 71 67 63 59 56 53 50 48 45 43 42 40 38 37 36 34 33 32 31 30 29 29 28 27 26 26 25 24
600
545 375 286 231 194 167 146 130 118 107 98 91 85 79 74 70 66 63 59 57 54 52 50 48 46 44 43 41 40 38 37 36 35 34 33 32 31 31 30 29
WARNING: Dose >40 ppm
Dose over 20ppm
Minute Volume (L/Min)
Minute Volume (L/Min)
Dial
Dial
Minute Volume (L/Min)
Dial
500
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50
45 24 16 12 9.8 8.2 7 6.2 5.5 5 4.5 4.1
3.8 3.5 3.3 3.1 2.9 2.8 2.6 2.5 2.4 2.3 2.2 2.1 2 1.9 1.8 1.8 1.7 1.7 1.6 1.6 1.5 1.5 1.4 1.4 1.3 1.3 1.3 1.2
100
83 45 31 24 19 16 14 12 11 9.8 8.9 8.2 7.6 7 6.6 6.2 5.8 5.5 5.2 5 4.7 4.5 4.3 4.1 4 3.8 3.7 3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.8 2.7 2.6 2.6 2.5
200
143 83 59 45 37 31 27 24 21 19 18 16 15 14 13 12 11 11 10
9.8
9.3 8.9 8.5 8.2 7.9 7.6 7.3 7 6.8 6.6 6.4 6.2 6 5.8 5.6 5.5 5.3 5.2 5.1 5
300
188 11 5 83 65 54 45 39 35 31 28 26 24 22 21 19 18 17 16 15 15 14 13 13 12 12 11 11 10 10
9.8
9.5 9.2 8.9 8.7 8.4 8.2 8 7.8 7.6 7.4
400
222 143 105 83 69 59 51 45 41 37 34 31 29 27 25 24 22 21 20 19 18 18 17 16 16 15 14 14 13 13 13 12 12 11 11 11 11 10 10 9.8
500
250 167 125 100 83 71 63 56 50 45 42 38 36 33 31 29 28 26 25 24 23 22 21 20 19 19 18 17 17 16 16 15 15 14 14 14 13 13 13 12
600
273 188 143 115 97 83 73 65 59 54 49 45 42 39 37 35 33 31 30 28 27 26 25 24 23 22 21 21 20 19 19 18 18 17 17 16 16 15 15 15
Dial
Minute Volume (L/Min)
Dose look-up table
1000ppm, 900ppm, 800ppm, 500ppm
Page 23
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NOxBOX
i
®
& NOxMixer Operating Instructions
23
All dose information shown in these tables is for guidance only. The patient monitored gas levels should be used for actualy dose delivery information. All nitric oxide (NO) doses shown in parts per million (ppm)
when introduced to continuous ow rates indicated. Doses of NO above 40 ppm are not recommended. Doses above 20ppm are considered clinically high.
Flow valve setting
Minute ow volume
Clinder Concentration (ppm)
WARNING: Dose >40 ppm
Dose over 20ppm
Dose look-up table
450ppm, 400ppm , 300ppm, 250ppm
400
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50
36 19 13 9.8 7.8 6.6 5.6 4.9 4.4 4 3.6 3.3
3.1 2.8 2.6 2.5 2.3 2.1 2.1 2 1.9 1.8 1.7 1.7 1.6 1.5 1.5 1.4 1.4 1.3 1.3 1.2 1.2 1.2 1.1 1.1 1.1 1 1 1
100
67 36 25 19 15 13 11 9.8 8.7 7.8 7.1 6.6 6.1 5.6 5.3 4.9 4.7 4.4 4.2 4 3.8 3.6 3.4 3.3 3.2 3.1 2.9 2.8 2.7 2.6 2.6 2.5 2.4 2.3 2.3 2.2 2.2 2.1 2 2
200
114 67 47 36 30 25 22 19 17 15 14 13 12 11 10 9.8 9.2 8.7 8.2 7.8 7.5 7.1 6.8 6.6 6.3 6.1 5.8 5.6 5.4 5.3 5.1 4.9 4.8 4.7 4.5 4.4 4.3 4.2 4.1 4
300
150 92 67 52 43 36 32 28 25 23 21 19 18 16 15 14 14 13 12 12 11 11 10 9.8 9.4 9 8.7 8.4 8.1 7.8 7.6 7.4 7.1 6.9 6.7 6.6 6.4 6.2 6.1 5.9
400
178 114 84 67 55 47 41 36 33 30 27 25 23 22 20 19 18 17 16 15 15 14 13 13 12 12 12 11 11 10 10 9.8 9.5 9.2 8.9 8.7 8.5 8.2 8 7.8
500
200 133 100 80 67 57 50 44 40 36 33 31 29 27 25 24 22 21 20 19 18 17 17 16 15 15 14 14 13 13 13 12 12 11 11 11 11 10 10 9.8
600
218 150 11 4 92 77 67 59 52 47 43 39 36 34 32 30 28 26 25 24 23 22 21 20 19 18 18 17 16 16 15 15 14 14 14 13 13 13 12 12 12
Minute Volume (L/Min)
Dial
Minute volume (L/Min)
Dial
300
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50
27 14 9.7 7.3 5.9 4.9 4.2 3.7 3.3 3 2.7 2.5
2.3 2.1 2 1.9 1.8 1.7 1.6 1.5 1.4 1.4 1.3 1.2 1.2 1.1 1.1 1.1 1 1 1 0.9 0.9 0.9 0.8 0.8 0.8 0.8 0.8 0.7
100
50 27 19 14 12 9.7 8.3 7.3 6.5 5.9 5.4 4.9 4.5 4.2 3.9 3.7 3.5 3.3 3.1 3 2.8 2.7 2.6 2.5 2.4 2.3 2.2 2.1 2.1 2 1.9 1.9 1.8 1.8 1.7 1.7 1.6 1.6 1.5 1.5
200
86 50 35 27 22 19 16 14 13 12 11 9.7 9 8.3 7.8 7.3 6.9 6.5 6.2 5.9 5.6 5.4 5.1 4.9 4.7 4.5 4.4 4.2 4.1 3.9 3.8 3.7 3.6 3.5 3.4 3.3 3.2 3.1 3 3
300
113 69 50 39 32 27 24 21 19 17 16 14 13 12 12 11 10 9.7 9.2 8.7 8.3 8 7.6 7.3 7 6.8 6.5 6.3 6.1 5.9 5.7 5.5 5.4 5.2 5.1 4.9 4.8 4.7 4.5 4.4
400
133 86 63 50 41 35 31 27 24 22 20 19 17 16 15 14 13 13 12 12 11 11 10 9.7 9.3 9 8.6 8.3 8.1 7.8 7.5 7.3 7.1 6.9 6.7 6.5 6.3 6.2 6 5.9
500
150 100 75 60 50 43 38 33 30 27 25 23 21 20 19 18 17 16 15 14 14 13 13 12 12 11 11 10 10 9.7 9.4 9.1 8.8 8.6 8.3 8.1 7.9 7.7 7.5 7.3
600
164 113 86 69 58 50 44 39 35 32 30 27 25 24 22 21 20 19 18 17 16 16 15 14 14 13 13 12 12 12 11 11 11 10 9.9 9.7 9.4 9.2 9 8.7
Minute Volume (L/Min)
Minute Volume L/Min)
Dial
Dial
Page 24
www.noxboxltd.com
NOxBOX
i
& NOxMixer Operating Instructions
®
24
All dose information shown in these tables is for guidance only. The patient monitored gas levels should be used for actualy dose delivery information. All nitric oxide (NO) doses shown in parts per million (ppm)
when introduced to continuous ow rates indicated. Doses of NO above 40 ppm are not recommended. Doses above 20ppm are considered clinically high.
Minute Volume (L/Min)
Minute Volume (L/Min)
Dose look-up table
225ppm, 200ppm, 100ppm
Dial
Dial
Flow valve setting
Minute ow volume
Clinder Concentration (ppm)
WARNING: Dose >40 ppm
Dose over 20ppm
100
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50
9.1 4.8 3.2 2.4 2 1.6 1.4 1.2 1.1 1 0.9 0.8
0.8 0.7 0.7 0.6 0.6 0.6 0.5 0.5 0.5 0.5 0.4 0.4 0.4 0.4 0.4 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.2
100
17 9.1 6.3 4.8 3.8 3.2 2.8 2.4 2.2 2 1.8 1.6 1.5 1.4 1.3 1.2 1.2 1.1 1 1 0.9 0.9 0.9 0.8 0.8 0.8 0.7 0.7 0.7 0.7 0.6 0.6 0.6 0.6 0.6 0.6 0.3 0.3 0.3 0.3
200
29 17 12 9.1 7.4 6.3 5.4 4.8 4.3 3.8 3.5 3.2 3 2.8 2.6 2.4 2.3 2.2 2.1 2 1.9 1.8 1.7 1.6 1.6 1.5 1.5 1.4 1.4 1.3 1.3 1.2 1.2 1.2 1.1 1.1 1.1 1 1 1
300
38 23 17 13 11 9.1 7.9 7 6.3 5.7 5.2 4.8 4.4 4.1 3.8 3.6 3.4 3.2 3.1 2.9 2.8 2.7 2.5 2.4 2.3 2.3 2.2 2.1 2 2 1.9 1.8 1.8 1.7 1.7 1.6 1.6 1.6 1.5 1.5
400
44 29 21 17 14 12 10 9.1 8.2 7.4 6.8 6.3 5.8 5.4 5.1 4.8 4.5 4.3 4 3.8 3.7 3.5 3.4 3.2 3.1 3 2.9 2.8 2.7 2.6 2.5 2.4 2.4 2.3 2.2 2.2 2.1 2.1 2 2
500
50 33 25 20 17 14 13 11 10 9.1 8.3 7.7 7.1 6.7 6.3 5.9 5.6 5.3 5 4.8 4.5 4.3 4.2 4 3.8 3.7 3.6 3.4 3.3 3.2 3.1 3 2.9 2.9 2.8 2.7 2.6 2.6 2.5 2.4
600
55 38 29 23 19 17 15 13 12 11 9.8 9.1 8.5 7.9 7.4 7 6.6 6.3 5.9 5.7 5.4 5.2 5 4.8 4.6 4.4 4.3 4.1 4 3.8 3.7 3.6 3.5 3.4 3.3 3.2 3.1 3.1 2 2.9
Minute Volume (L/Min)
Dial
Loading...