Puritan-Bennett 800 User and technical manual

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Operator’s and

800

Series Ve nt i l at or S y s t e m

Technical Reference Manual

Part No. 4-070088-00 Rev. L August 2010

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Copyright 2010 Nellcor Puritan Bennett LLC. All rights reserved. The Puritan Bennett™ 840 Ventilator System is manufactured in accordance with Nellcor Puritan Bennett LLC proprietary information, covered by one or more of the following U.S. Patents and foreign equivalents: 5,271,389; 5,319,540; 5,339,807; 5,390,666; 5,771,884; 5,791,339; 5,813,399; 5,865,168; 5,881,723; 5,884,623; 5,915,379; 5,915,380; 6,024,089; 6,161,539; 6,220,245; 6,269,812; 6,305,373; 6,360,745; 6,369,838; 6,553,991; 6,668,824; 6,675,801; 7,036,504; 7,117,438; and RE39225. 840, 800 Series, DualView, SandBox, SmartAlert, Flow-by, and PTS 2000 are trademarks of Nellcor Puritan Bennett LLC.

The information contained in this manual is the sole property of Nellcor Puritan Bennett LLC and may not be duplicated without permission. This manual may be revised or replaced by Nellcor Puritan Bennett LLC at any time and without notice.

You should ensure you have the most current applicable version of this manual; if in doubt, contact Nellcor Puritan Bennett LLC or visit the Puritan Bennett product manual web page at:

http://www.puritanbennett.com/serv/manuals.aspx

While the information set forth herein is believed to be accurate, it is not a substitute for the exercise of professional judgment.

The ventilator should be operated and serviced only by trained professionals. Nellcor Puritan Bennett’s sole responsibility with respect to the ventilator, and its use, is as stated in the limited warranty provided.

Nothing in this manual shall limit or restrict in any way Nellcor Puritan Bennett’s right to revise or otherwise change or modify the equipment (including its software) described herein, without notice. In the absence of an express, written agreement to the contrary, Nellcor Puritan Bennett LLC has no obligation to furnish any such revisions, changes, or modifications to the owner or user of the equipment (including its software) described herein.

Applicability

Warning

Caution

The information in this manual applies to Puritan Bennett 840 ventilator versions manufactured or updated after August

2005. Some of this information may not apply to earlier versions. Contact your Puritan Bennett representative if in doubt.

Definitions

This manual uses three special indicators to convey information of a specific nature. They include:

Indicates a condition that can endanger the patient or the ventilator operator.

Indicates a condition that can damage the equipment.

NOTE:

Indicates points of particular emphasis that make operation of the ventilator more efficient or convenient.

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Warnings, cautions, and notes

Please take the time to familiarize yourself with the following safety considerations, special handling requirements, and regulations that govern the use of the Puritan Bennett 840 Ventilator System.

• To ensure proper servicing and avoid the possibility of physical injury, only qualified personnel should attempt to service or make authorized modifications to the ventilator.

The user of this product shall have sole responsibility for any ventilator malfunction due to operation or maintenance performed by anyone not trained by Puritan Bennett.

• To avoid an electrical shock hazard while servicing the ventilator, be sure to remove all power to the ventilator by disconnecting the power source and turning off all ventilator power switches.

• To avoid a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (e.g., flammable anesthetics and/or heaters) away from the Puritan Bennett 840 Ventilator System and oxygen hoses.

Do not use oxygen hoses that are worn, frayed, or contaminated by combustible materials such as grease or oils. Textiles, oils, and other combustibles are easily ignited and burn with great intensity in air enriched with oxygen.

In case of fire or a burning smell, immediately disconnect the ventilator from the oxygen supply, facility power, and backup power source.

• When handling any part of the Puritan Bennett 840 Ventilator System, always follow your hospital infection control guidelines for handling infectious material.

Puritan Bennett recognizes cleaning, sterilization, sanitation, and disinfection practices vary widely among health care institutions. It is not possible for Puritan Bennett to specify or require specific practices that will meet all needs, or to be responsible for the effectiveness of cleaning, sterilization, and other practices carried out in the patient care setting. As a manufacturer Puritan Bennett does not have any guidelines or recommendations regarding specific pathogens as they relate

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

to the usage of our products. In regards to transmission of any specific pathogen, Puritan Bennett can offer the specifications of our products as well as our recommendations for cleaning and sterilization. Any further clarification regarding pathogens as they relate to our products should be brought to the attention of your lab Pathologist as well as your infection control personnel and/or risk committee.

• Patients on life-support equipment should be appropriately monitored by competent medical personnel and suitable monitoring devices.

The Puritan Bennett 840 Ventilator System is not intended to be a comprehensive monitoring device and does not activate alarms for all types of dangerous conditions for patients on life-support equipment.

• For a thorough understanding of ventilator operations, be sure to thoroughly read this manual before attempting to use the system.

• Before activating any part of the ventilator, be sure to check the equipment for proper operation and, if appropriate, run SST as described in this manual.

• Do not use sharp objects to make selections on the graphic user interface (GUI) display or keyboard.

• US federal law restricts this device to sale by or on the order of a physician.

• Check the ventilator periodically as outlined in the Puritan Bennett 800 Series Ventilator System Service Manual; do not use if defective. Immediately replace parts that are broken, missing, obviously worn, distorted, or contaminated.

• An alternative source of ventilation should always be available when using the Puritan Bennett 840 Ventilator System.

• This ventilator offers a choice of breath delivery modes and types. Throughout the patient’s treatment, the clinician should carefully select the ventilation mode and/or breath type to use for that patient. This selection should be based on the clinician’s clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time, and considering the benefits,

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

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limitations and operating characteristics of each mode and/or breath type.

Warranty

The Puritan Bennett 840 Ventilator System is warranted against defects in material and workmanship in accordance with the Puritan Bennett Medical Equipment Warranty supplied with your ventilator. Keep a maintenance record to ensure the validity of the warranty.

Year of manufacture

The graphic user interface (GUI), breath delivery unit (BDU), backup power source (BPS), and compressor contain a specific year of manufacture applicable only for that assembly. The year of manufacture is indicated by the fifth and sixth digits of the serial number which is located at the back panel of the GUI, BDU, and BPS, and the side panel of the compressor.

Manufacturer

Tyco Healthcare Group LP Nellcor Puritan Bennett Division

4280 Hacienda Drive Pleasanton, CA 94588-2719 USA

Authorized representative Tyco Healthcare UK LTD 154 Fareham Road Gosport PO13 0AS, U.K.

Electromagnetic susceptibility

The Puritan Bennett 840 Ventilator System complies with the requirements of IEC 60601-1-2:2004 (EMC Collateral Standard), including the Efield susceptibility requirements at a level of 10 volts per meter, at frequencies from 80 MHz to 2.5 GHz, and the ESD requirements of this standard.

However, even at this level of device immunity, certain transmitting devices (cellular phones, walkie-talkies, cordless phones, paging transmitters, etc.) emit radio frequencies that could interrupt ventilator operation if operated in a range too

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

close to the ventilator. It is difficult to determine when the field

Warning

strength of these devices becomes excessive.

Practitioners should be aware radio frequency emissions are additive, and the ventilator must be located a sufficient distance from transmitting devices to avoid interruption. Do not operate the ventilator in a magnetic resonance imaging (MRI) environment.

Accessory equipment connected to the power receptacle, analog, and digital interfaces must be certified according to IEC 60601-1. Furthermore, all configurations shall comply with the system standard IEC 60601-1-1. Any person who connects additional equipment to the power receptacle, signal input part, or signal output part of the Puritan Bennett 840 ventilator configures a medical system, and is therefore responsible for ensuring the system complies with the requirements of the system standard IEC 60601-1-1. If in doubt, consult Puritan Bennett Technical Services at 1.800.255.6774 or your local representative.

This manual describes possible ventilator alarms and what to do if they occur. Consult with your institution’s biomedical engineering department in case of interrupted ventilator operation, and before relocating any life support equipment.

Customer assistance

For further assistance contact your local Puritan Bennett representative.

For online technical support, visit the

SolvIT http://www.puritanbennett.com

The SolvIT Center provides answers to frequently asked questions about the Puritan Bennett 840 Ventilator System and other Puritan Bennett products 24 hours a day, 7 days a week.

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Center Knowledge Base at

Preface

This manual is divided into two parts: the operator’s manual and the technical reference. The operator’s manual describes how to operate the Puritan Bennett 840 Ventilator System. It also provides product specifications and accessory order numbers. The technical reference includes background information about how the ventilator functions, including details on its operating modes, self-tests, and other features. In the table of contents and index, the prefix OP- identifies page numbers in the operator’s manual, and the prefix TR- identifies page numbers in the technical reference.

Any references to the software options BiLevel

(VV+) which includes VC+ and VS breath types, NeoMode®,

Plus Proportional Assist Ventilation

(PAV+), Tube Compensation (TC),

Respiratory Mechanics (RM) and Trending in this manual assume

that the option has been installed on the ventilator. If these options aren’t installed, then references to their functions do not apply.

While this manual covers the ventilator configurations currently supported by Puritan Bennett, it may not be all-inclusive and may not be applicable to your ventilator. Contact Puritan Bennett for questions about the applicability of the information.

Some illustrations and images are shown with a ready-to-assemble (RTA) cart, Puritan Bennett 800 Series Ventilator Compressor Mount Cart, or a Puritan Bennett 800 Series Ventilator Pole Cart. Please note that these images are for illustrative purposes only, and regardless of which cart you have, the required information is provided.

, Volume Ventilation

The term “RTA cart” refers to the ready-to-assemble cart and any earlier cart versions.

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Operator’s Manual

1 Introduction OP 1-1

1.1 Technical description. . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-3

1.1.1 General background . . . . . . . . . . . . . . . . . . . . . . OP 1-3

1.1.2 Pressure and flow triggering . . . . . . . . . . . . . . . .OP 1-5

1.1.3 Breathing gas mixture . . . . . . . . . . . . . . . . . . . . .OP 1-5

1.1.4 Inspiratory pneumatics . . . . . . . . . . . . . . . . . . . . OP 1-6

1.1.5 Patient circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-6

1.1.6 AC mains and backup power system . . . . . . . . . . OP 1-7

1.1.7 Ventilator emergency states. . . . . . . . . . . . . . . . .OP 1-8

1.2 Graphic user interface . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9

1.3 User interface controls and indicators . . . . . . . . . . . . .OP 1-11

1.3.1 Onscreen symbols and abbreviations . . . . . . . . . . OP 1-19

1.4 Ventilator system labeling symbols. . . . . . . . . . . . . . . . OP 1-25

2 How to set up the Puritan Bennett 840 ventilator OP 2-1

2.1 How to connect the electrical supply . . . . . . . . . . . . .OP 2-4

2.2 How to connect the air and oxygen supplies . . . . . . . .OP 2-10

2.3 How to connect the patient circuit components . . . . .OP 2-13

2.3.1 How to select and connect a patient circuit . . . . . OP 2-14

2.3.2 How to install the expiratory filter

and collector vial . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-17

2.3.3 How to install the flex arm. . . . . . . . . . . . . . . . . .OP 2-21

2.3.4 How to install the humidifier . . . . . . . . . . . . . . . . OP 2-23

2.3.5 How to use the ventilator cart . . . . . . . . . . . . . . .OP 2-26

3 How to run Short Self Test (SST) OP 3-1

3.1 Introduction to SST . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-1

3.2 When to run SST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-2

3.3 SST components and requirements . . . . . . . . . . . . . . .OP 3-3

3.4 SST Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-4

3.5 SST Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-12

3.5.1 How to interpret individual SST test results . . . . . OP 3-14

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Contents

3.5.2 SST outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-15

4 How to use the Puritan Bennett 840 ventilator OP 4-1

4.1 Structure of user interface . . . . . . . . . . . . . . . . . . . . . . OP 4-2

4.2 Patient setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-3

4.2.1 How to ventilate with most recent

control parameters . . . . . . . . . . . . . . . . . . . . . . . OP 4-4

4.2.2 How to ventilate with new control parameters . . OP 4-4

4.2.3 Patient data and current settings. . . . . . . . . . . . . OP 4-8

4.2.4 Ideal Body Weight (IBW). . . . . . . . . . . . . . . . . . . OP 4-10

4.3 How to change the main ventilator control

parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-17

4.4 Ideal Body Weight (IBW), vent type, mode,

and other changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-17

4.5 How to select a constant timing variable during

respiratory rate changes . . . . . . . . . . . . . . . . . . . . . . . OP 4-19

4.6 How to change apnea ventilation settings. . . . . . . . . . OP 4-21

4.7 How to set alarms OP 4-22

4.8 How to change other settings . . . . . . . . . . . . . . . . . . . OP 4-24

4.9 Expiratory pause maneuvers . . . . . . . . . . . . . . . . . . . . OP 4-25

4.10 Inspiratory pause maneuvers. . . . . . . . . . . . . . . . . . . OP 4-26

4.11 How to interpret inspiratory pause maneuver

results for static compliance and resistance. . . . . . . . OP 4-28

4.12 How to use NIV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-29

4.12.1 NIV intended use . . . . . . . . . . . . . . . . . . . . . . . OP 4-29

4.12.2 NIV breathing interfaces . . . . . . . . . . . . . . . . . . OP 4-29

4.12.3 NIV setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-30

4.12.4 High spontaneous inspiratory time limit setting. OP 4-34

4.12.5 Apnea setup . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-34

4.12.6 Alarm setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-34

4.12.7 Changing patient from INVASIVE to

NIV Vent Type . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-36

4.12.8 Changing patient from NIV to

INVASIVE Vent Type . . . . . . . . . . . . . . . . . . . . . OP 4-37

4.12.9 NIV patient data . . . . . . . . . . . . . . . . . . . . . . . . OP 4-38

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Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Contents

5 How to handle alarms OP 5-1

5.1 Ventilator alarm classifications . . . . . . . . . . . . . . . . . . .OP 5-1

5.2 Alarm silence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-2

5.3 Alarm reset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-5

5.4 Alarm log. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 5-6

5.5 Alarm volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-7

5.6 Alarm messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 5-8

6 How to view graphics OP 6-1

6.1 Graphics display function. . . . . . . . . . . . . . . . . . . . . . .OP 6-1

6.2 How to set up a graphics display . . . . . . . . . . . . . . . . . OP 6-3

6.3 Graphics display details and calculations . . . . . . . . . . . OP 6-4

6.4 How to adjust displayed graphics. . . . . . . . . . . . . . . . .OP 6-5

6.5 The graphics display FREEZE function . . . . . . . . . . . . .OP 6-6

6.6 How to print patient data graphics . . . . . . . . . . . . . . . OP 6-7

6.7 Automatic display of graphics . . . . . . . . . . . . . . . . . . .OP 6-7

6.8 When graphics are not accessible . . . . . . . . . . . . . . . . OP 6-8

7 Preventive maintenance OP 7-1

7.1 How to dispose of used parts. . . . . . . . . . . . . . . . . . . . OP 7-1

7.2 How to clean, disinfect and sterilize parts . . . . . . . . . . .OP 7-2

7.2.1 How to clean components. . . . . . . . . . . . . . . . . .OP 7-6

7.3 Disinfection and sterilization . . . . . . . . . . . . . . . . . . . . OP 7-6

7.4 Preventive maintenance procedures for the operator . . OP 7-8

7.4.1 Total operational hours . . . . . . . . . . . . . . . . . . . . OP 7-9

7.4.2 Inspiratory and expiratory bacteria filters . . . . . . . OP 7-12

7.4.3 Daily or as required: collector vial and drain bag . OP 7-14

7.4.3.1 How to remove the collector vial . . . . . . . . .OP 7-14

7.4.3.2 How to remove the drain bag . . . . . . . . . . .OP 7-14

7.4.4 Daily or as required: in-line water traps . . . . . . . . OP 7-16

7.4.5 Every 250 hours: compressor inlet filter . . . . . . . .OP 7-16

7.4.6 Every year: ventilator inspection. . . . . . . . . . . . . . OP 7-17

7.4.7 Every year or as necessary: oxygen sensor . . . . . .OP 7-17

7.4.7.1 Oxygen sensor replacement procedure . . . . OP 7-18

7.5 Additional preventive maintenance procedures . . . . . . OP 7-24

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Contents

7.6 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-26

7.7 Repacking and shipping . . . . . . . . . . . . . . . . . . . . . . . OP 7-26

A Specifications OP A-1

A.1 Physical characteristics . . . . . . . . . . . . . . . . . . . . . . . . OP A-2

A.2 Environmental requirements . . . . . . . . . . . . . . . . . . . . OP A-5

A.3 Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . OP A-6

A.4 Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . OP A-7

A.5 Compliance and approvals . . . . . . . . . . . . . . . . . . . . . OP A-11

A.5.1 Manufacturer’s Declaration . . . . . . . . . . . . . . . . . OP A-12

A.6 Technical specifications. . . . . . . . . . . . . . . . . . . . . . . . OP A-22

A.7 Ranges, resolutions, and accuracies. . . . . . . . . . . . . . . OP A-29

A.7.1 Recommended limits . . . . . . . . . . . . . . . . . . . . . OP A-29

A.7.2 Software options. . . . . . . . . . . . . . . . . . . . . . . . . OP A-30

B Part numbers OP B-1

C Pneumatic schematic OP C-1

D Alarm and oxygen sensor calibration testing OP D-1

D.1 Alarm test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP D-1

D.2 Oxygen sensor calibration test . . . . . . . . . . . . . . . . . . OP D-7

E Remote alarm and RS-232 ports OP E-1

E.1 Remote alarm port . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-2

E.2 RS-232 port. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3

E.3 How to configure the RS-232 ports . . . . . . . . . . . . . . . OP E-4

E.4 Printers and cables . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-5

E.5 RS-232 port commands. . . . . . . . . . . . . . . . . . . . . . . . OP E-7

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Contents

Technical Reference

1 Introduction to breath delivery TR 1-1

2 Detecting and initiating inspiration TR 2-1

2.1 Internally triggered inspiration. . . . . . . . . . . . . . . . . . .TR 2-2

2.1.1 Pressure sensitivity . . . . . . . . . . . . . . . . . . . . . . . TR 2-2

2.1.2 Flow sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-4

2.1.3 Time-cycled inspiration . . . . . . . . . . . . . . . . . . . . TR 2-6

2.2 Operator-triggered inspiration . . . . . . . . . . . . . . . . . . . TR 2-6

3 Detecting and initiating exhalation TR 3-1

3.1 Internally initiated exhalation. . . . . . . . . . . . . . . . . . . . TR 3-1

3.1.1 Time-cycled exhalation . . . . . . . . . . . . . . . . . . . .TR 3-1

3.1.2 End-inspiratory flow method . . . . . . . . . . . . . . . .TR 3-2

3.1.3 Airway pressure method . . . . . . . . . . . . . . . . . . .TR 3-3

3.2 Backup limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-4

3.2.1 Time limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 3-4

3.2.2 High circuit pressure limit . . . . . . . . . . . . . . . . . . TR 3-4

3.2.3 High ventilator pressure limit. . . . . . . . . . . . . . . . TR 3-4

4 Mandatory breath delivery TR 4-1

4.1 Comparison of pressure- and volume-based

mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-1

4.2 Compliance compensation for volume-based

mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-3

4.3 BTPS compensation for volume-based

mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-5

4.4 Manual inspiration. . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-5

5 Spontaneous breath delivery TR 5-1

6 Assist/control (A/C) mode TR 6-1

6.1 Breath delivery in A/C . . . . . . . . . . . . . . . . . . . . . . . . .TR 6-1

6.2 Rate change during A/C . . . . . . . . . . . . . . . . . . . . . . .TR 6-3

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Contents

6.3 Changing to A/C mode. . . . . . . . . . . . . . . . . . . . . . . . TR 6-3

7 Synchronous intermittent mandatory ventilation

(SIMV) TR 7-1

7.1 Breath delivery in SIMV . . . . . . . . . . . . . . . . . . . . . . . . TR 7-3

7.2 Apnea ventilation in SIMV . . . . . . . . . . . . . . . . . . . . . . TR 7-4

7.3 Changing to SIMV mode. . . . . . . . . . . . . . . . . . . . . . . TR 7-5

7.4 Rate change during SIMV . . . . . . . . . . . . . . . . . . . . . . TR 7-7

8 Spontaneous (SPONT) mode TR 8-1

8.1 Breath delivery in SPONT . . . . . . . . . . . . . . . . . . . . . . TR 8-1

8.2 Changing to SPONT mode . . . . . . . . . . . . . . . . . . . . . TR 8-1

9 Apnea ventilation TR 9-1

9.1 Apnea detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-1

9.2 Transition to apnea ventilation . . . . . . . . . . . . . . . . . . TR 9-3

9.3 Key entries during apnea ventilation . . . . . . . . . . . . . . TR 9-3

9.4 Resetting apnea ventilation. . . . . . . . . . . . . . . . . . . . . TR 9-3

9.4.1 Resetting to A/C . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4

9.4.2 Resetting to SIMV . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4

9.4.3 Resetting to SPONT . . . . . . . . . . . . . . . . . . . . . . TR 9-4

9.5 Phasing in new apnea intervals . . . . . . . . . . . . . . . . . . TR 9-5

Detecting occlusion and disconnect TR 10-1

10.1 Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-1

10.2 Disconnect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-3

10.3 Occlusions and disconnect annunciation. . . . . . . . . . TR 10-5

11 Phasing in setting changes TR 11-1

12 Ventilator settings TR 12-1

12.1 Apnea ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-1

12.2 Circuit type and Ideal Body Weight (IBW) . . . . . . . . TR 12-2

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Contents

12.3 Disconnect sensitivity (D

12.4 Expiratory sensitivity (E

12.5 Expiratory time (T

) . . . . . . . . . . . . . . . . . . . . . . . . . .TR 12-4

) . . . . . . . . . . . . . . . . . . TR 12-3

SENS

). . . . . . . . . . . . . . . . . . . .TR 12-3

SENS

12.6 Flow pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-4

12.7 Flow sensitivity (V

12.8 High spontaneous inspiratory time limit (2T

). . . . . . . . . . . . . . . . . . . . . . . .TR 12-5

SENS

). .TR 12-6

I SPONT

12.9 Humidification type . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-7

12.10 I:E ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-7

12.11 Ideal body weight (IBW) . . . . . . . . . . . . . . . . . . . . . TR 12-7

12.12 Inspiratory pressure (P

12.13 Inspiratory time (T

) . . . . . . . . . . . . . . . . . . . . . . TR 12-8

) . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-8

12.14 Mode and mandatory breath type. . . . . . . . . . . . . . TR 12-9

12.15 O

12.16 Peak inspiratory flow (V

% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 12-12

) . . . . . . . . . . . . . . . . . .TR 12-13

MAX

12.17 PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 12-13

12.17.1 PEEP restoration. . . . . . . . . . . . . . . . . . . . . . . . TR 12-14

12.18 Plateau time (T

12.19 Pressure sensitivity (P

12.20 Pressure support (P

) . . . . . . . . . . . . . . . . . . . . . . . . . .TR 12-14

) . . . . . . . . . . . . . . . . . . . . TR 12-15

SENS

) . . . . . . . . . . . . . . . . . . . . . TR 12-15

SUPP

12.21 Respiratory rate (f) . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-16

12.22 Rise time % . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-16

12.23 Safety ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-17

12.24 Spontaneous breath type. . . . . . . . . . . . . . . . . . . . . TR 12-18

12.25 Tidal volume (V

). . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-19

12.26 Vent type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-19

13 Alarms TR 13-1

13.1 Alarm handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-1

13.1.1 Alarm messages. . . . . . . . . . . . . . . . . . . . . . . . .TR 13-3

13.1.2 Alarm summary . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-5

13.2 AC POWER LOSS alarm . . . . . . . . . . . . . . . . . . . . . . . TR 13-22

13.3 APNEA alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-22

13.4 CIRCUIT DISCONNECT alarm . . . . . . . . . . . . . . . . . . TR 13-23

13.5 DEVICE ALERT alarm . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-23

13.6 High circuit pressure (P

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

) alarm. . . . . . . . . . . . . . TR 13-24

PEAK

xiii

Contents

13.7 High delivered O2% (O2%) alarm . . . . . . . . . . . . . . TR 13-25

13.8 High exhaled minute volume (V

13.9 High exhaled tidal volume (V

13.10 High inspired tidal volume alarm (V V

TI SPONT

13.11 High respiratory rate (f

) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-26

) alarm . . . . . . . . . . . . . TR 13-27

TOT

13.12 INSPIRATION TOO LONG alarm . . . . . . . . . . . . . . . TR 13-27

13.13 Low circuit pressure alarm (P

13.14 Low delivered O

% (O2%) alarm . . . . . . . . . . . . . TR 13-28

PEAK

13.15 Low exhaled mandatory tidal volume (V

TE MAND

) alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-29

13.16 Low exhaled spontaneous tidal volume (V

TE SPONT

) alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-30

13.17 Low exhaled total minute volume (V

13.18 PROCEDURE ERROR alarm. . . . . . . . . . . . . . . . . . . . TR 13-31

14 Patient data TR 14-1

14.1 Delivered O2% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-1

14.2 End expiratory pressure (PEEP) . . . . . . . . . . . . . . . . . TR 14-2

14.3 End inspiratory pressure (P

14.4 Exhaled minute volume (V

14.5 Exhaled tidal volume (V

14.6 I:E ratio (I:E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-4

14.7 Intrinsic (auto) PEEP (PEEP

(PEEP

14.8 Mean circuit pressure (P

14.9 Peak circuit pressure (P

14.10 Plateau pressure (P

) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-5

TOT

MEAN

PEAK

) . . . . . . . . . . . . . . . . . . . . . . . TR 14-6

14.11 Spontaneous minute volume (V

14.12 Static compliance and resistance (C

14.13 Total respiratory rate (f

TOT

) . . . . . . . . . . . . . . . . TR 14-2

I END

) . . . . . . . . . . . . . . . . TR 14-3

E TOT

) . . . . . . . . . . . . . . . . . . . . TR 14-4

) and total PEEP

). . . . . . . . . . . . . . . . . . TR 14-5

) . . . . . . . . . . . . . . . . . . . TR 14-5

) . . . . . . . . . . . . . . . . . . . TR 14-13

) alarm. . . . . . TR 13-25

ETOT

) alarm . . . . . . . . . . TR 13-26

, V

TI MAND

) . . . . . . . . . . . . . TR 13-28

) alarm . TR 13-30

E TOT

E SPONT

) . . . . . . . . . TR 14-6

STAT

and R

). TR 14-7

STAT

15 Safety net TR 15-1

15.1 Patient problems. . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-1

15.2 System faults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-2

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Contents

15.3 Ongoing background checks. . . . . . . . . . . . . . . . . . . TR 15-3

15.4 Hardware monitoring circuitry. . . . . . . . . . . . . . . . . .TR 15-4

15.5 Power on self test (POST). . . . . . . . . . . . . . . . . . . . . .TR 15-5

15.6 Short self test (SST) . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5

15.7 Extended self test (EST) . . . . . . . . . . . . . . . . . . . . . . . TR 15-5

15.8 Oxygen sensor calibration . . . . . . . . . . . . . . . . . . . . . TR 15-6

15.9 Exhalation valve calibration . . . . . . . . . . . . . . . . . . . . TR 15-6

15.10 Ventilator inoperative test . . . . . . . . . . . . . . . . . . . .TR 15-6

15.11 Flow sensor offset calibration . . . . . . . . . . . . . . . . . . TR 15-7

15.12 Atmospheric pressure transducer calibration . . . . . . TR 15-7

16 Power on self test (POST) TR 16-1

16.1 Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-1

16.2 POST characteristics. . . . . . . . . . . . . . . . . . . . . . . . . .TR 16-2

16.3 POST following power interruptions . . . . . . . . . . . . .TR 16-3

16.4 POST fault handling. . . . . . . . . . . . . . . . . . . . . . . . . . TR 16-4

16.5 POST system interface . . . . . . . . . . . . . . . . . . . . . . . .TR 16-4

16.6 POST user interface . . . . . . . . . . . . . . . . . . . . . . . . . .TR 16-5

17 Short self test (SST) TR 17-1

18 Extended self test (EST) TR 18-1

18.1 EST results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 18-2

18.2 EST failure handling. . . . . . . . . . . . . . . . . . . . . . . . . .TR 18-3

18.3 EST safety considerations . . . . . . . . . . . . . . . . . . . . . . TR 18-3

19 RS-232 commands TR 19-1

19.1 RSET command . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 19-1

19.2 SNDA command . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 19-1

19.3 SNDF command . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 19-8

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xvi

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Figures

Operator’s Manual

Figure 1-1. Puritan Bennett 840 Ventilator System block diagram . . OP 1-4 Figure 1-2. Puritan Bennett 840 Ventilator System

Graphic User Interface (GUI) . . . . . . . . . . . . . . . . . . . . . . OP 1-10

Figure 2-1. How to lift the ventilator components . . . . . . . . . . . . . . OP 2-2

Figure 2-2. How to connect the ventilator power cord . . . . . . . . . . . OP 2-6

Figure 2-3. Ventilator power switch, AC indicator, and AC panel . . . OP 2-7

Figure 2-4. Power cord storage on the RTA cart . . . . . . . . . . . . . . . . OP 2-8

Figure 2-5. Power cord storage on the newer Puritan Bennett

800 Series Ventilator Compressor Mount Cart and

Puritan Bennett 800 Series Ventilator Pole Cart (shown) . OP 2-9

Figure 2-6. How to connect the air and oxygen supplies . . . . . . . . . OP 2-12

Figure 2-7. How to connect the patient circuit . . . . . . . . . . . . . . . . . OP 2-16

Figure 2-8. How to install the expiratory filter and collector vial . . . . OP 2-18

Figure 2-9. How to use the collector vial with or without

the drain bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-19

Figure 2-10. How to install the flex arm on RTA cart . . . . . . . . . . . . . . OP 2-21

Figure 2-11. How to install the flex arm on the newer

Puritan Bennett 800 Series Ventilator Compressor

Mount Cart or Puritan Bennett 800 Series Ventilator

Pole Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-22

Figure 2-12. How to install the humidifier (Fisher & Paykel

version shown) for ventilators mounted on RTA carts . . . OP 2-25

Figure 2-13. Location of cart lot number label. . . . . . . . . . . . . . . . . . . OP 2-27

Figure 2-14. How to lock and unlock the RTA cart’s front wheels. . . . . OP 2-28

Figure 2-15. How to lock and unlock the Puritan Bennett 800 Series

Ventilator Compressor Mount Cart or Puritan Bennett

800 Series Ventilator Pole Cart front wheels. . . . . . . . . . . OP 2-28

Figure 3-1. Test button location . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-5

Figure 4-1. Touch screen user interface . . . . . . . . . . . . . . . . . . . . . . . OP 4-2

Figure 4-2. Ventilator Startup screen . . . . . . . . . . . . . . . . . . . . . . . . OP 4-3

Figure 4-3. Touch screen appearance during normal ventilation

(shown with alarm silence and

100% O

Figure 4-4.

Figure 4-5. Alarm setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-23

(or TH) selected as the constant during rate change. . . OP 4-20

/CAL in progress) . . . . . . . . . . . . . . . . . . . . . . . OP 4-9

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Figures

xvii

Figures

Figure 4-6. New patient setup screen — NIV . . . . . . . . . . . . . . . . . . OP 4-31

Figure 4-7. NIV ventilator settings screen . . . . . . . . . . . . . . . . . . . . . OP 4-33

Figure 4-8. New patient default alarm settings . . . . . . . . . . . . . . . . . OP 4-35

Figure 4-9. More patient data screen — NIV. . . . . . . . . . . . . . . . . . . OP 4-38

Figure 5-1. Alarm indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-1

Figure 5-2. Alarm Silence in Progress indicator (lower screen). . . . . . OP 5-4

Figure 5-3. Alarm log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-6

Figure 5-4. Alarm message format . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-9

Figure 6-1. Pressure-volume loop . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-2

Figure 6-2. Flow-volume loop. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-3

Figure 7-1. How to empty the collector vial and seal the drain bag . OP 7-15

Figure 7-2. 806 compressor with inlet filter. . . . . . . . . . . . . . . . . . . . OP 7-17

Figure 7-3. Dislodge the O Figure 7-4. Open O Figure 7-5. Locate O

sensor access port . . . . . . . . . . . . . . . . . . . . . . OP 7-21

Figure A-1. Recommended patient circuit configurations . . . . . . . . . OP A-27

Figure B-1. Ventilator accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-2

Figure B-2. Ventilator accessories (Puritan Bennett 800 Series

Ventilator Compressor Mount Cart shown) . . . . . . . . . . OP B-11

Figure B-3. Puritan Bennett 840 Ventilator System shown

mounted on Puritan Bennet 800 Series Ventilator

Pole Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-19

Figure C-1. Pneumatic schematic . . . . . . . . . . . . . . . . . . . . . . . . . . . OP C-1

Figure E-1. Remote alarm and RS-232 ports . . . . . . . . . . . . . . . . . . . OP E-1

Figure E-2. Remote alarm port pinout (view from back of GUI). . . . . OP E-2

Figure E-3. RS-232 serial port pinout . . . . . . . . . . . . . . . . . . . . . . . . OP E-3

sensor access cover . . . . . . . . . . . . . . . . OP 7-20

sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-22

Technical Reference

Figure 2-1. Declaring inspiration using pressure sensitivity . . . . . . . . TR 2-3

Figure 2-2. Declaring inspiration using flow sensitivity . . . . . . . . . . . TR 2-4

Figure 2-3. Time-cycled inspiration . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-6

Figure 3-1. Initiating exhalation using the end-inspiratory

flow method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-2

Figure 3-2. Initiating exhalation using the airway pressure method . TR 3-3

Figure 6-1. A/C mode, no patient effort detected . . . . . . . . . . . . . . TR 6-2

Figure 6-2. A/C mode, patient effort detected . . . . . . . . . . . . . . . . . TR 6-2

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

xviii

Figures

Figure 6-3. A/C mode, VIM and PIM breaths . . . . . . . . . . . . . . . . . . TR 6-2

Figure 7-1. SIMV breath cycle (mandatory and

spontaneous intervals) . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-1

Figure 7-2. SIMV breath cycle, PIM delivered within

mandatory interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2

Figure 7-3. SIMV breath cycle, PIM not delivered within

mandatory interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2

Figure 7-4. Apnea ventilation in SIMV . . . . . . . . . . . . . . . . . . . . . . . TR 7-5

Figure 9-1. Apnea interval equals breath period . . . . . . . . . . . . . . . . TR 9-2

Figure 9-2. Apnea interval greater than breath period . . . . . . . . . . . TR 9-2

Figure 9-3. Apnea interval less than breath period . . . . . . . . . . . . . . TR 9-2

Figure 12-1. Puritan Bennett 840 Ventilator System modes

and breath types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-11

Figure 13-1. Alarm message format (upper GUI screen) . . . . . . . . . . . TR 13-3

Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

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Figures

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Puritan Bennett 800 Series Ventilator System Operator’s and Technical Reference Manual

Tables

Operator’s Manual

Table 1-1. Controls and indicators . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-11

Table 1-2. BDU indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-18

Table 1-3. Symbols and abbreviations . . . . . . . . . . . . . . . . . . . . . . . OP 1-19

Table 2-1. Patient circuit and IBW values. . . . . . . . . . . . . . . . . . . . . . OP 2-15

Table 3-1. SST test sequence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-8

Table 3-2. Individual SST test results . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-14

Table 3-3. Overall SST outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-15

Table 4-1. Ideal Body Weight (IBW) based

on patient height (cm to kg) . . . . . . . . . . . . . . . . . . . . . . OP 4-10

Table 4-2. Determining IBW based

on patient height (ft., in. to lb.) . . . . . . . . . . . . . . . . . . . . OP 4-13

Table 4-3. Soft bound ranges for Ideal Body Weight and tube

Internal Diameter (ID) . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-15

Table 4-4. Patient circuit and IBW values. . . . . . . . . . . . . . . . . . . . . . OP 4-16

Table 4-5. Monitored ventilator control parameters . . . . . . . . . . . . . OP 4-17

Table 4-5. Automatic settings changes — INVASIVE to NIV

on same patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-36

Table 4-6. Automatic settings changes — NIV to INVASIVE

on same patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-37

Table 5-1. Alarm messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-10

Table 7-1. Procedures to clean, disinfect, and sterilize parts. . . . . . . . OP 7-3

Table 7-2. Disinfection and sterilization procedures. . . . . . . . . . . . . . OP 7-7

Table 7-3. Operator preventive maintenance procedures

and frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-10

Table 7-4. Service preventive maintenance procedures and intervals . OP 7-25

Table A-1. Physical characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-3

Table A-2. Environmental requirements . . . . . . . . . . . . . . . . . . . . . . . OP A-5

Table A-3. Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-6

Table A-4. Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-7

Table A-5. Compliance and approvals . . . . . . . . . . . . . . . . . . . . . . . . OP A-11

Table A-6. Electromagnetic Emissions . . . . . . . . . . . . . . . . . . . . . . . . OP A-13

Table A-7. Electromagnetic Immunity . . . . . . . . . . . . . . . . . . . . . . . . OP A-15

Table A-8. Electromagnetic Immunity – conducted and radiated RF . OP A-17

Puritan Bennett 800 Series Operator’s and Technical Reference Manual

xxi

Tables

Table A-9. Recommended separation distances between

portable and mobile RF communications equipment

and the Puritan Bennett 840 Ventilator System . . . . . . . . OP A-19

Table A-10. Compliant cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20

Table A-11. Technical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-22

Table 1-12. Patient circuit configurations . . . . . . . . . . . . . . . . . . . . . . OP A-28

Table A-13. Ventilator settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-30

Table A-14. Alarm settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-48

Table A-15. Patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-54

Table A-16. Other Screens — displayed data. . . . . . . . . . . . . . . . . . . . OP A-60

Table B-1. Ventilator parts and accessories . . . . . . . . . . . . . . . . . . . . OP B-3

Table B-2. Ventilator parts and accessories . . . . . . . . . . . . . . . . . . . . OP B-12

Table B-3. Ventilator Pole Cart and accessories . . . . . . . . . . . . . . . . . OP B-20

Technical Reference

Table 4-1. Comparison of pressure- and volume-based

mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-2

Table 4-2. Compliance volume factors . . . . . . . . . . . . . . . . . . . . . . . TR 4-5

Table 5-1. Spontaneous breath delivery characteristics . . . . . . . . . . TR 5-1

Table 12-1. Modes and breath types . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-9

Table 13-1. Alarm urgency levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-2

Table 13-2. Alarm summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-5

Table 13-3. Applicability of high inspired tidal volume alarm symbols. TR 13-26

Table 14-1. Inspiratory pause maneuver displays . . . . . . . . . . . . . . . . TR 14-9

Table 19-1. MISCA response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-3

Table 19-2. MISCF response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-9

Puritan Bennett 800 Series Operator’s and Technical Reference Manual

xxii

CHAPTER

1 Introduction

The intended use of the Puritan Bennett™ 840 Ventilator System is for acute and subacute care of infant, pediatric, and adult patients. Software options, available from Puritan Bennett, provide additional ventilation functions.

The Puritan Bennett 840 Ventilator System facilitates work of breathing management, offers selectable modes of breath delivery, and assists the practitioner in the selection of the most appropriate ventilator control parameters for the patient. The user interface is intuitive and easy to operate for those with prior knowledge of ventilator operation.

The user interface includes DualView™ touch screens that display monitored patient data for easy assessment of the patient’s condition. The touch screens also display the current ventilator control parameters.

The SandBox™ area on the touch screen allows the practitioner to preview the selected ventilator control parameters prior to active ventilation of the patient.

The SmartAlert™ system intercepts alarms, or events, provides specific information about the cause, and prompts the user with actions to resolve the reported condition(s).

The breath delivery unit (BDU) comprises the pneumatics and the patient circuit.

The ventilator uses two independent Central Processing Units (CPUs):

• Breath delivery unit (BDU) CPU

• Graphic user interface (GUI) CPU

The BDU CPU uses the ventilator control parameters, selected by the practitioner, to deliver breaths to the patient. The BDU CPU also runs continuous and extensive operational background checks to ensure proper operation of the ventilator.

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The GUI CPU monitors the ventilator and the ventilator/patient interaction. The GUI CPU also monitors the operation of the BDU CPU and prevents simultaneous failure of control and monitor functions when a single fault is reported.

The Puritan Bennett 840 Ventilator System supplies mandatory or spontaneous breaths with a preset level of positive end expiratory pressure (PEEP), trigger sensitivity, and oxygen concentration. A mandatory breath can either be pressure- or volume-controlled, but it is always pressure-controlled in the optional BiLevelmode. A spontaneous breath allows patient inspiratory flows of up to 200 L/min, with or without pressure support.

The optional 806 Compressor unit provides compressed air to the BDU, and can be used in place of wall or bottled air. The compressor unit is powered through and communicates with the BDU.

The 802 Backup Power Source (BPS) or 803 Extended Backup Power Source provides DC power to the BDU and GUI in the event AC power is lost. A new, fully charged BPS runs the ventilator (without a compressor or a humidifier) for at least 60 minutes (30 minutes on ventilators built prior to July 2007), which allows transport of the patient and the ventilator within the healthcare facility. The 803 extended BPS (available after October 2009) can power the ventilator for at least four hours under the same conditions.The same conditions apply, respectively, to the one-hour or four-hour BPS assembly in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart and the one-hour or four-hour batteries in the Puritan Bennett 800 Series Ventilator Pole Cart.

This manual tells you how to operate and perform simple maintenance for the Puritan Bennett 840 Ventilator System. Become familiar with this manual and accompanying labels before attempting to operate or maintain the ventilator.

To ensure optimum performance of the Puritan Bennett 840 Ventilator System, Puritan Bennett strongly recommends certified biomedical engineering technicians, or other personnel with equivalent experience and training in the service of this type of equipment, perform periodic maintenance on the ventilator. For more information, contact your representative.

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1.1 Technical description

1.1.1 General background

The practitioner uses the GUI touch screens, the off-screen keys, and GUI knob to select the ventilator control parameters and input data (see Figure 1-1). The GUI CPU processes this information and stores it in ventilator memory. The BDU CPU uses this stored information to control and monitor the flow of gas to and from the patient. The two CPUs communicate to transfer and verify any new ventilator control parameters or alarm limits. Each CPU then performs continuous background verification of operational and data integrity.

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Active exhalation valve Pressure transducer Flow sensor

Exhalation module:

Expiratory filter

Collector

vial

(Expiratory

limb)

(Inspiratory limb)

Patient

circuit

Humidification device

Inspiratory

filter

Oxygen

supply

Air

supply

Air

regulator

Oxygen regulator

PSOLs Safety valve Oxygen sensor Pressure transducers Flow sensors

Inspiratory module:

interface (GUI)

Graphic user

Puritan Bennett 800 Series Ventilator System Operator’s Manual

Figure 1-1. Puritan Bennett 840 Ventilator System block diagram

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Introduction OP 1

1.1.2 Pressure and flow triggering

The ventilator uses flow or pressure triggering to recognize patient effort. When pressure triggering is in effect, the ventilator monitors pressure in the patient circuit. As the patient draws gas from the circuit and airway pressure drops by at least the value selected for pressure sensitivity, the ventilator delivers a breath.

When flow triggering (Flow-by the difference between the inspiratory and expiratory flow sensor measurements. As the patient inhales, the ventilator measures less exhaled flow while the delivered flow remains constant. The result is an increase in the difference between the inspiratory and expiratory flows. When the difference is at least the operatorselected value for flow sensitivity, the ventilator delivers a breath.

If the patient is not inhaling, any difference between the delivered and exhaled flow is due to sensor inaccuracy or leaks in the patient system. To compensate for leaks in the patient system which can cause autotriggering, the operator can increase the flow sensitivity setting.

As a backup method of triggering inspiration, a pressure sensitivity of 2 cmH

O is also in effect. This setting is the most

sensitive setting still large enough to avoid autotriggering, yet will trigger with acceptable patient effort.



) is in effect, the ventilator monitors

1.1.3 Breathing gas mixture

Air and oxygen from cylinders, wall supplies, or compressor (air only) enter the ventilator through hoses and fittings (the fittings are available in several versions). Once inside the ventilator, air and oxygen are regulated to pressures appropriate for the ventilator, then mixed according to the selected O

The ventilator delivers the mixed air and oxygen through the inspiratory module and out to the patient. The oxygen concentration of the delivered gas is monitored here, using a galvanic oxygen sensor. The galvanic sensor generates a voltage proportional to the oxygen concentration. The ventilator reports an alarm if the O

sensor is enabled and monitored oxygen

concentration is more than seven percent above or below the O

% setting, or below 18% after the concentration stabilizes.

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The inspiratory manifold also includes a safety valve to relieve patient pressure if necessary (for example, if the patient circuit is kinked or occluded). The inspiratory module also corrects for gas temperature and humidity, based on the practitioner-set humidification type.

1.1.4 Inspiratory pneumatics

Ventilator inspiratory pneumatics consist of two parallel circuits: one for oxygen and one for air. The primary elements of the inspiratory pneumatics are two proportional solenoid valves (PSOLs), which control the flow of gas delivered to the patient. Air and oxygen flow sensors, along with pressure signals from the patient circuit, provide feedback that the BDU CPU uses to control the PSOLs.

As a result, the ventilator supplies mixed breathing gas to the patient, based on the practitioner-set ventilator control parameters. The mixed air and oxygen passes through the patient circuit external to the ventilator. The system delivers the breathing gas mixture to the patient at the patient wye, located in the external patient circuit.

1.1.5 Patient circuit

The patient circuit comprises the components external to the ventilator that route gas between the ventilator and the patient. These components include:

•an inspiratory filter that protects against contamination between the patient and ventilator

• a humidification device (optional) in line with the patient circuit

• the inspiratory and expiratory limbs of the patient circuit that conduct the breathing gas to and from the patient

•a collector vial that protects the expiratory pneumatics from bulk moisture in the exhaled gas

•an expiratory filter that limits the escape of microorganisms and particulates in the patient’s exhaled gas into the room air or inside the ventilator exhalation pneumatics

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NOTE:

The ventilator actively controls the exhalation valve that the software accurately positions throughout the patient’s inspiration and exhalation. The exhalation valve allows the ventilator to deliver aggressive breaths while pressure overshoots are minimized, PEEP is controlled, and excess patient pressures are relieved. The exhalation system monitors the exhaled gas leaving the patient circuit for spirometry.

The Puritan Bennett 840 Ventilator System does not have the capability to reduce pressure below the PEEP pressure during the expiratory phase.

Throughout the respiratory cycle, pressure transducers monitor inspiratory, expiratory, and atmospheric pressures. The temperature of the exhaled gas is heated to a temperature above its dew point to prevent condensation in the exhalation compartment. Refer to Appendix C for a detailed diagram of the ventilator’s pneumatic system and patient circuit.

1.1.6 AC mains and backup power system

The ventilator derives its power to operate from the AC mains (wall) power or the backup power system (BPS). The design of the BDU integral power supply protects against excessive voltages, temperatures, or current draws. A power cord retainer prevents accidental disconnection of the BDU from the AC mains. A power switch cover on the front face of the BDU protects against spills and accidental AC power-off.

The ventilator connects to the 802 or 803 BPS, which supplies DC power to the ventilator if AC power is lost. A fully charged 802 BPS operating under nominal ambient conditions, can power the ventilator for at least 60 minutes (30 minutes on ventilators built prior to July 2007). The 803 extended BPS can power the ventilator for at least 4 hours under the same conditions. Neither BPS powers the compressor unit or the humidifier, if present. The 803 BPS must be used on Puritan Bennett 840 ventilators with software version AB or higher (part number 4-070212-85) or equivalent. The operation and alarms of the 803 BPS are identical

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to the 802 BPS. The GUI indicates when the ventilator is operating on the BPS, rather than AC mains.

When AC power is connected, it recharges the BPS. The BPS continues to recharge from the AC power during normal ventilator operation. If the ventilator is mounted on a Puritan Bennett 800 Series Ventilator Compressor Mount Cart and has a four-hour BPS or the ventilator is mounted on a Puritan Bennett 800 Series Ventilator Pole Cart with a four-hour battery, the software version, battery life, and operating conditions are the same as described for the 803 BPS. The battery life and operating conditions for each cart with a one-hour BPS or one-hour battery are equivalent to the description given for the 802 BPS.

1.1.7 Ventilator emergency states

Emergency states include ventilator inoperative and safety valve open (SVO). When a ventilator inoperative condition occurs, it always

includes the SVO state. A SVO state can also occur independent of a ventilator inoperative condition.

The following describe the two ventilator emergency states:

• Safety valve open (SVO): The ventilator enters a SVO state if both air and oxygen supplies are lost, or an occlusion is detected, or the ventilator enters the Ventilator Inoperative condition.

The safety valve open (SVO) state allows the patient to breathe room air unassisted by the ventilator. The ventilator remains in the SVO state until the condition that caused the emergency state is corrected.

When the ventilator enters the SVO state, the SVO indicator on the front face of the BDU illuminates, and a high-urgency alarm sounds.

In case of a malfunction that prevents software from opening the safety valve, there is also an analog circuit that opens the safety valve if system pressure exceeds 100 to 120 cmH

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•Ventilator inoperative: The ventilator declares a ventilator inoperative condition if a hardware failure or critical software error occurs that could compromise safe ventilation of the patient.

When a ventilator inoperative condition occurs, the ventilator

inoperative indicator on the front face of the BDU illuminates and the ventilator enters the SVO state, which in turns sounds a high-urgency alarm.

If a ventilator inoperative condition occurs, immediately remove the ventilator from use until qualified service personnel evaluate and correct the Ven t I n o p condition.

If the ventilator declares a ventilator inoperative state, the power on self test (POST) must first verify power levels to the ventilator are acceptable and the functions of the major electronics systems are satisfactory before normal ventilation can resume. Qualified service personnel must repair the ventilator to correct the problem and execute EST successfully before normal ventilation is allowed.

1.2 Graphic user interface

This section describes the graphic user interface (GUI), the GUI keys, the GUI indicators, and the symbols you see on the GUI.

The graphic user interface (GUI) of the Puritan Bennett 840 Ventilator System comprises the DualView touch screens, the off-screen keys located below the touch screens, and a knob. Use the knob to set a given ventilator control parameter to its desired value. Press the of the knob — to enter the selected value or parameter into memory.

Figure 1-2 identifies the components of the GUI, and the location of information on the DualView touch screens.

ACCEPT key — the off-screen key above and right

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Vital patient data

Alarm and ventilator status

Assorted patient data, including graphical displays

Active alarm log, if applicable

Primary patient parameters

Setup of ventilator control parameters, alarm limits, breath timing parameters, and other parameters

Symbol definitions

Prompt area

Status indicators

Off-screen keys

CLEAR key

ACCEPT key

Knob

Upper screen:

monitored

information

(alarms,

patient data)

Lower screen:

ventilator

control

parameters

Figure 1-2. Puritan Bennett 840 Ventilator System Graphic User Interface

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Introduction OP 1

1.3 User interface controls and indicators

Descriptions of the controls and indicators on the graphic user interface are given in Table 1-1 below.

Table 1-1: Controls and indicators

Control or indicator Function

Screen lock key: When the yellow light on the screen lock key

is lit, the screen or off-screen controls (including the knob and

ACCEPT key) have no effect when touched until you press

the screen lock key again. New alarms automatically unlock the screen and controls.

The screen lock allows you to clean the touch screen and prevents inadvertent changes to settings and displays.

Alarm volume key: Allows you to adjust the alarm volume when you hold down this key while turning the knob. You cannot turn off the alarm volume.

Alarm silence key: Turns off the audible alarm sound for two minutes. The yellow light on the alarm silence key illuminates during the silence period. An ALARM SILENCE IN PROGRESS indicator displays on the lower touch screen, along with a CANCEL button, if there is not a higher-priority alarm display active. To exit out of the alarm silence, touch the CANCEL button.

The system automatically exits the alarm silence when the two-minute interval times out. High-urgency alarms such as Device Alerts, Safety Valve Open, Occlusion, and loss of either gas supply cancel the alarm silence.

Each time you press the alarm silence key, the silence period resets to two minutes. Each time you press the alarm silence key (whether or not there is an active alarm), the keypress is recorded in the alarm log.

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Table 1-1: Controls and indicators

Control or indicator Function

Alarm reset key: Clears active alarms or resets high-urgency

alarms and cancels an active alarm silence., and is recorded in the alarm log. Each time you press the reset key, it is recorded in the alarm log, if there is an active alarm. You cannot reset a DEVICE ALERT alarm.

Information key: Displays basic operating information about the ventilator. Press the key to display a menu of information topics, then touch the button corresponding to the desired topic. Browse topical information using the , ,

, and buttons located in the information header.

Oxygen sensor calibration key: Older ventilators use the 100% O INCREASE O for two minutes and calibrates the oxygen sensor. The green light on this key illuminates and a message (100% O Progress) on the lower touch screen indicates 100% O delivery is active. If you press the O restarts the two-minute delivery interval. Press CANCEL to stop the calibration. See page TR 15-6 for information on calibrating the oxygen sensor.

Use the procedure in Section D.2 to test the oxygen sensor calibration.

/CAL 2 min key and newer ventilators use the

2 min key. Delivers 100% oxygen (if available)

key again, the system

Cal in

Manual inspiration key: In A/C, SIMV, and SPONT modes, delivers one manual breath to the patient in accordance with the current mandatory breath parameters. In BILEVEL mode, transitions from Low PEEP (PEEP vice versa). To avoid breath stacking, a manual inspiration is not delivered during inspiration or during the restricted phase of exhalation.

You can use the MANUAL INSP key to supplement minute volume or to assist measurement of a patient data parameter, such as peak inspiratory pressure, or to run an inspiratory pause maneuver in SPONT mode.

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) to High PEEP (PEEPH) (or

Introduction OP 1

Table 1-1: Controls and indicators

Control or indicator Function

Expiratory pause key: Causes the ventilator to seal the

patient’s breathing circuit when the expiratory phase of a designated breath, mandatory or spontaneous, is followed by a time-cycled mandatory inspiration. An expiratory pause is used to estimate PEEP

The ventilator performs two types of pause maneuver: automatic, which you initiate by a momentary press of the EXP PAUSE key, and manual, which you control by a continuous press of the EXP PAUSE key. An automatic pause performs the maneuver until the pressure stabilizes, then takes its measurements. The pause lasts at least 0.5 second and does not exceed 3.0 seconds.

During a manual pause, the ventilator takes its measurements as soon as the pressure stabilizes or the pause ends. The ventilator continues the maneuver until you release the EXP PAU SE key. The pause cannot exceed 20 seconds. Section 4.9 on page OP 4-25 describes in detail how to use the EXP PAUSE key.

and PEEPI (autoPEEP).

TOT

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Table 1-1: Controls and indicators

Control or indicator Function

Inspiratory pause key: Causes the ventilator to seal the

patient’s breathing circuit at the conclusion of the gas delivery phase of a designated, volume- or pressure-based mandatory inspiration. The inspiratory pause maneuver provides a means to measure the patient’s static lung-thoracic compliance

), static resistance (R

STAT

The inspiratory pause maneuver maintains the inflated state of the lungs.

The ventilator performs two types of pause maneuver: auto-

matic, which is initiated by the momentary press of the INSP PAU SE key, and manual, which you control by a continuous

press on the key. An automatic pause performs the maneuver until the pressure

stabilizes, then the system takes its measurements. The pause event lasts at least 0.5 second but no longer than 2.0 seconds.

In a manual pause, the maneuver continues until you release the INSP PAUSE key, but cannot exceed 7 seconds. The ven- tilator computes C

STAT

and R and displays the values at the end of the maneuver. P computed and updated continuously during the plateau, and its value is frozen at the end of the plateau. Section 4.10 on page OP 4-26 describes in detail how to use the INSP PAUSE key.

), and plateau pressure (PPL).

STAT

at the end of the plateau

STAT

Knob: Adjusts the value of a setting. A highlighted button on a touch screen means the knob is linked to that setting. Where applicable, a clockwise turn of the knob increases the highlighted value, and a counterclockwise turn of the knob decreases the highlighted value.

Clear: Cancels a proposed ventilator parameter value change.

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Table 1-1: Controls and indicators

Control or indicator Function

Accept: Applies and saves new ventilator parameter value(s).

Red high-urgency alarm indicator ( ! ! ! ): This alarm

indicator blinks rapidly if active; it is steadily lit if autoreset. Yellow medium-urgency alarm indicator ( ! ! ): This alarm

indicator blinks slowly if active; it turns off if autoreset. Yellow low-urgency alarm indicator ( ! ): This indicator is

steadily lit if active; it turns off if autoreset. Green normal ventilator operation indicator: When

ventilation is active and no alarm states exist, this indicator is steadily lit. This indicator is off if the ventilator is not in a ventilation mode, for example, during service mode or short self test (SST).

Gray normal ventilator operation indicator: No ventilator inoperative condition exists when indicator is not illuminated.

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Table 1-1: Controls and indicators

Control or indicator Function

Red ventilator inoperative indicator: The ventilator cannot support ventilation and requires service. The ventilator enters the safe state (safety ventilation) and discontinues detection of new patient data or alarm conditions. Qualified service personnel must repair the ventilator to correct the problem and execute EST successfully before normal ventilation is allowed. This indicator is accompanied by an audio signal and cannot be reset.

Gray normal GUI operation indicator: No loss of GUI condition exists when indicator is not illuminated.

Red safety valve open (SVO) indicator: The ventilator has entered its safe state and opened its safety valve to allow the patient to breathe unassisted from room air.

Green BPS ready indicator: The ventilator senses the BPS is installed, operational, and has at least two (2) minutes of estimated run time.

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Table 1-1: Controls and indicators

Control or indicator Function

On battery power indicator: When the yellow bar to the

right of a lit BPS ready indicator (battery symbol) is lit, the ventilator is operating on BPS, and AC power is insufficient to support ventilator operation. During BPS operation, power to the compressor unit and the humidifier outlet (if available) is off.

Green compressor ready indicator: The compressor logic cable and air supply hose are connected to the ventilator. The compressor is up to operating pressure but not supplying gas to the ventilator. The compressor motor turns on intermittently to keep the compressor chamber pressurized.

Green compressor operating indicator: When symbol to the right of a lit compressor unit ready indicator is lit, compressor is supplying air to the ventilator. This indicator does not light unless the compressor is actually supplying air to the ventilator.

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The indicators on the breath delivery unit are shown in Table 1-2.

Table 1-2: BDU indicators

Red ventilator inoperative indicator: The ventilator cannot

support ventilation and requires service. The ventilator enters the safe state (safety ventilation) and discontinues detection of new patient data or alarm conditions. Qualified service personnel must repair the ventilator to correct the problem and execute EST successfully before normal ventilation is allowed. This indicator is accompanied by an audio signal and cannot be reset.

Red safety valve open (SVO) indicator: The ventilator has entered its safe state and opened its safety valve to allow the patient to breathe unassisted from room air.

Red loss of GUI indicator: The ventilator has detected a malfunction that prevents the GUI from reliably displaying or receiving information.

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MAX

21.8

min

MAX

= Peak flow

(blinking)

1.3.1 Onscreen symbols and abbreviations

Touch an onscreen symbol to display its definition in the lower left corner of the lower screen. Table 1-3 summarizes the symbols and abbreviations the ventilator uses.

For example, if you touch:

The symbol definition area shows this message:

Table 1-3: Symbols and abbreviations

Symbol or

abbreviation

Definition

Additional active alarms related to the monitored information are active. The symbol blinks when there is not enough screen area to display all active alarms.

The upper alarm limit

The lower alarm limit

Press to access the alarm log

Alarm log contains events not yet viewed

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RAMP SQUARE

Table 1-3: Symbols and abbreviations

Symbol or

abbreviation

Definition

Rise time percent

Flow pattern

The value you selected for a ventilator control parameter exceeds its recommended limit (soft bound) and requires acknowledgement to continue

The value selected exceeds its allowable minimum or maximum limit (hard bound)

Press to view more patient data

Press to view patient data graphics

Press to view additional screens

X-axis (time or pressure) adjust of patient data graphics

Y-axis (pressure, volume, or flow) adjust of patient data graphics

Baseline pressure (PEEP) adjust

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SENS

TOT

 f

TOT

MEANPPEAK

2P

PEAK

Table 1-3: Symbols and abbreviations

Symbol or

abbreviation

Definition

A/C Assist/control ventilation mode

AV Apnea ventilation

STAT

Static compliance

Spont expiratory sensitivity percentage

EST Extended self test

f Respiratory rate (ventilator control parameter)

Total respiratory rate (monitored)

High respiratory rate alarm

GUI Graphic user interface

HME Heat-moisture exchanger

I:E Inspiratory to expiratory ratio

Monitored oxygen percentage (patient data)

Oxygen percentage (ventilator control parameter)

% High delivered O2% alarm

O

%Low delivered O

% alarm

PC Pressure control (mandatory breath type)

Mean circuit pressure

High circuit pressure alarm

High circuit pressure alarm limit

Low circuit pressure alarm

Low circuit pressure alarm limit

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PEAK

PEEP

I END

SENS

SUPP

P-TRIG

P

VENT

Table 1-3: Symbols and abbreviations

Symbol or

abbreviation

Definition

Peak circuit pressure (patient data)

PEEP Positive end expiratory pressure (ventilator control parameter)

PEEP

TOT

High PEEP (ventilator control parameter, BILEVEL mode only)

Intrinsic PEEP (patient data)

Low PEEP (ventilator control parameter, BILEVEL mode only)

Total PEEP (patient data)

End expiratory pressure (patient data)

Inspiratory pressure (ventilator control parameter)

End inspiratory pressure (patient data)

Plateau pressure (patient data)

POST Power on self test

PS Pressure support (spontaneous breath type)

Pressure sensitivity

Pressure support (ventilator control parameter)

Pressure triggering

High internal ventilator pressure alarm

STAT

Static resistance

SIMV Synchronous intermittent mandatory ventilation mode

SPONT Spontaneous ventilation mode

SST Short self test

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E SPONT

1V

E TOT

MAX

SENS

Table 1-3: Symbols and abbreviations

Symbol or

abbreviation

I SPONT

E SET

Expiratory time

High PEEP time (BILEVEL mode only)

Inspiratory time

High spontaneous inspiration time alarm

High spontaneous inspiration time alarm limit

Low PEEP time (BILEVEL mode only)

Plateau time

Set minute volume (calculated from ventilator control

Definition

parameters)

Exhaled spontaneous minute volume

High exhaled minute volume alarm

Low exhaled minute volume alarm

VC Volume control (mandatory breath type)

Peak flow (ventilator control parameter)

Flow sensitivity

TE MAND

TE SPONT

Tidal volume

Exhaled tidal volume

High exhaled tidal volume alarm

Low exhaled mandatory tidal volume alarm

Low exhaled spontaneous tidal volume alarm

Inspired tidal volume

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V -TRIG

Table 1-3: Symbols and abbreviations

Symbol or

abbreviation

High inspired (mandatory or spontaneous) tidal volume

Definition

alarm*

TI MAND

TI SPONT

Inspired mandatory tidal volume

High inspired mandatory tidal volume alarm*

Inspired spontaneous tidal volume

High inspired spontaneous tidal volume alarm*

Flow triggering

*Refer to Technical Reference Section 13.10 for information regarding inspired tidal volume alarms.

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NOTE:

1.4 Ventilator system labeling symbols

The following symbols appear on the various components of the Puritan Bennett 840 Ventilator System.

All labels shown are examples, and may not reflect the exact configuration of your ventilator.

Power switch positions: I represents the power on position

and located on the BDU front panel, turns ON/OFF the BDU and the GUI. When the power switch is in the off position, the BPS continues to charge if AC power is present.

Refer to manual: When this symbol appears on the product, it means refer to documentation for information.

Type B equipment, per IEC 60601-1

represents power off position. The power switch,

Potential equalization point (ground): Provides a means of connection between the equipment and the potential equalization busbar of the electrical connection. A common grounding point for the entire ventilator.

Indicates the degree of protection provided by enclosure (drip-proof)

Signifies compliance with the Medical Device Directive, 93/42/EEC

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1996-05

CSA certification mark that signifies the product has been evaluated to the applicable ANSI/Underwriters Laboratories Inc. (UL) and CSA standards for use in the US and Canada.

Date of manufacture label

Serial number

802 BPS charging status indicator: When the ventilator is operating on mains power, the top symbol (green LED next to gray battery icon) on the front of the 802 BPS indicates the BPS is charged, and the bottom symbol (yellow LED next to gray battery icon) on the front of the BPS indicates the BPS is charging.

803 BPS charging status indicator: Indicates the charging status of the 803 BPS. A yellow LED next to the partially full battery icon indicates the battery is charging. A green LED next to the full battery icon indicates the battery is charged.

Charging status indicator on Puritan Bennett 800 Series Ventilator Compressor Mount Cart: Indicates the charging

status of the BPS. A yellow LED next to the partially full battery icon indicates the battery is charging. A green LED next to the full battery icon indicates the battery is charged.

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Caution

Battery indicator label: Indicates a one-hour battery is

installed in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart.

Battery indicator label: Indicates a four-hour battery is installed in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart.

Charging status indicator on Puritan Bennett 800 Series Ventilator Pole Cart: Indicates the charging status of the

battery. A yellow indicator next to the partially full battery icon indicates the battery is charging. A green indicator next to the full battery icon indicates the battery is charged.

Battery indicator label: Indicates a one-hour battery is installed in the Puritan Bennett 800 Series Ventilator Pole Cart

Battery indicator label: Indicates a four-hour battery is installed in the Puritan Bennett 800 Series Ventilator Pole Cart

Data key connection

Do not remove the data key. The data key enables software options and stores ventilator operational hours, compressor unit operational hours, and the serial numbers for the BDU and GUI. The ventilator will not operate without its factory-installed data key.

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NOTE:

TEST

PTS 2000

TEST (service) button: After you touch the Short Self Test

(SST) onscreen key (available only during ventilator startup), you must press the TEST button within 5 seconds in order to access SST.

PTS 2000™ Performance Test System connection, for use by qualified service personnel only.

GUI connection

Circuit breaker for ventilator power supply, located in the BDU.

Ventilator circuit breaker for compressor and humidifier

A humidifier connection is only available on 100 - 120 V ventilators.

Alternating current (at AC inlet and AC power indicator)

Maximum allowed output to auxiliary mains socket (compressor electrical connection)

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IOIOI

BPS electrical connection

Exhalation filter latch unlock/lock

Exhalation filter latch open indicator: This red indicator is located on the surface behind the closed latch, and is easily visible when the filter latch is open.

GUI mounting latch unlock/lock

Remote alarm port

RS-232 port

Susceptible to electrostatic discharge

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OP 1 Introduction

Electric shock hazard

Explosion hazard

Fire hazard

802 BPS product information label

803 BPS product information label

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Introduction OP 1

GUI product information label

GUI ports label Remote alarm and RS-232 port (9.4-inch GUI only). Refer to Appendix E for GUI remote

alarm and RS-232 port specifications.

Humidifier electrical label (This label not visible unless cover plate over humidifier electrical connection is

removed. A humidifier connection is only available on 100 - 120 V ventilators.)

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OP 1 Introduction

BDU gas inlet label

BDU To patient label

Compressor gas connection label

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Introduction OP 1

Compressor information label

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OP 1 Introduction

BDU information label

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Introduction OP 1

BDU cooling vent label

BDU I/O disconnect label

BDU exhaust information label

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OP 1 Introduction

From patient

BPS electrical connection label

Compressor lint filter label

Expiratory limb connector on exhalation filter

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2 How to set up the Puritan Bennett

Warning

CHAPTER

840 ventilator

Chapter 2 describes how to set up the Puritan Bennett™ 840 Ventilator System:

• How to connect the electrical supply

• How to connect the air and oxygen supplies

• How to connect the patient circuit and accessories

A Puritan Bennett Customer Service Engineer (CSE) must first install the ventilator and run an extended self test (EST), which calibrates the exhalation valve, flow sensors, and atmospheric pressure transducer, before you connect a patient to the ventilator for the first time.

• When you lift the ventilator, use assistance and appropriate safety precautions. Figure 2-1 shows the proper technique to lift each ventilator component.

• To avoid interrupted ventilator operation or possible damage to the ventilator, always use the ventilator on a level surface in its proper orientation.

• To avoid the possibility of injury to the patient and ensure proper ventilator operation, do not attach any device to the port labeled EXHAUST unless the device is specifically authorized by Puritan Bennett.

• To minimize the increased risk of fire due to an oxygenenriched environment, do not use the ventilator in a hyperbaric chamber.

• To avoid raising the oxygen concentration of room air, use the ventilator in an adequately ventilated room.

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OP 2 How to set up the Puritan Bennett 840 ventilator

Lift GUI from base and handle

Lift the BDU

from horizontal

surfaces as shown.

Lift the GUI from the base and the handle.

the compressor from

base and the handles.

Use two people to lift

Puritan Bennett 800 Series Ventilator System Operator’s Manual

OP 2-2

Figure 2-1. How to lift the ventilator components

How to set up the Puritan Bennett 840 ventilator OP 2

Caution

NOTE:

• Do not connect or disconnect the ventilator’s graphic user interface (GUI), backup power source (BPS), or compressor while the power switch is on or the ventilator is connected to AC power.

• All components must be securely mounted and connected by qualified service personnel according to the appropriate Puritan Bennett installation instructions.

• Do not obstruct the breath delivery unit (BDU), GUI, or compressor cooling vents or fan vents.

• To avoid possible damage to ventilator components, do not use the horizontal surfaces of the ventilator to place or stack objects.

Before you use the ventilator for the first time, wipe the ventilator exterior clean and sterilize its components according to the instructions in Chapter 7 of this manual. Follow your institution’s protocol for cleaning and sterilizing the ventilator and its components.

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OP 2 How to set up the Puritan Bennett 840 ventilator

Warning

2.1 How to connect the electrical supply

• To minimize the risk of electrical shock, always connect the ventilator power cord into a grounded AC power outlet.

• The 802 or 803 BPS must always be installed if you are using an RTA cart. Without the BPS, the ventilator is not protected against low or lost AC power. Do not use the ventilator unless a BPS with at least minimal charge is installed.

• If you are using a newer Puritan Bennett 800 Series Ventilator Compressor Mount Cart or Puritan Bennett 800 Series Ventilator Pole Cart, you must ensure you connect the battery back-up system harness to the ventilator.

• Do not disconnect the battery back-up system, GUI, or compressor from the ventilator while in use.

• When possible, connect the ventilator to an outlet connected to the hospital emergency back-up power system. Refer to Section A.4 for ventilator electrical specifications.

Normally the Puritan Bennett 840 Ventilator System is mainspowered. The 802 or 803 BPS or battery backup system in newer Puritan Bennett 800 Series Ventilator Compressor Mount Cart and Puritan Bennett 800 Series Ventilator Pole Cart operates the ventilator when AC power is lost or drops below a minimum level.

A new, fully charged 802 BPS can operate the ventilator (without the compressor or a humidifier) for at least 60 minutes (30 minutes on ventilators built prior to July 2007); allowing the ventilator to be used for transport purposes within the healthcare facility. A new, fully charged 803 BPS (available after October

2009) can operate the ventilator (without the compressor or a humidifier) for at least four hours. The same conditions apply, respectively, to the one-hour or four-hour BPS assembly in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart

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How to set up the Puritan Bennett 840 ventilator OP 2

Warning

and the one-hour or four-hour batteries in the Puritan Bennett 800 Series Ventilator Pole Cart.

The 802 or 803 BPS and the battery backup systems in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart and the Puritan Bennett 800 Series Ventilator Pole Cart are intended for short-term use only, and are not intended as primary alternative power sources. The BPS and battery backup systems are intended to power the BDU and GUI only. In case of AC power loss, power is not available to run either the compressor or the humidifier.

If you turn on the ventilator after it has been unplugged for an extended period, the LOW BATTERY alarm may sound. If this occurs, recharge the 802 or 803 BPS or battery back up system in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart or Puritan Bennett 800 Series Ventilator Pole Cart by leaving it connected to a ventilator connected to AC power for up to eight hours (ventilator does not need to be turned on). Because of the larger battery capacity, the 803 BPS or four-hour BPS or battery in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart or Puritan Bennett 800 Series Ventilator Pole Cart may take up to 20 hours to recharge. If, after turning the ventilator back on, the LOW BATTERY alarm is still active or if the INOPERATIVE BATTERY alarm is active, qualified service personnel must replace the battery. The batteries should be recharged whenever they have been depleted. Leaving them in a discharged state for longer than 24 hours may reduce their capacity. The same conditions apply, respectively, to the one-hour or four-hour BPS assembly in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart and the one-hour or four-hour batteries in the Puritan Bennett 800 Series Ventilator Pole Cart.

Figure 2-2 shows how to connect the power cord to AC power. Built-in power cord retainer tabs protect against accidental disconnection. Ensure the power cord is securely fastened into the AC receptacle prior to operation. To remove the cord, squeeze the tabs on the top and bottom of the plug and pull outward.

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OP 2 How to set up the Puritan Bennett 840 ventilator

To AC power

Power

cord

Power cord retainer tabs. Squeeze tabs and pull outward to disconnect power cord.

Figure 2-2. How to connect the ventilator power cord

Figure 2-3 shows the power switch and AC indicator. When illuminated, the AC indicator indicates the ventilator is receiving AC power and the 802,and 803 BPS and battery backup systems in the Puritan Bennett 800 Series Ventilator Compressor Mount Cart and the Puritan Bennett 800 Series Ventilator Pole Cart will be recharged as needed. The AC indicator is independent of the power switch, and the power switch does not turn off AC power to the ventilator power supply. When both the power switch and AC indicator are on, power is available for the humidifier and compressor.

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How to set up the Puritan Bennett 840 ventilator OP 2

NOTE:

AC indicator

AC panel

AC power

Compressor

Ventilator power supply circuit breaker

connection

Potential

equalization

(ground

point)

Humidifier

and compressor

circuit breaker

Ventilator power switch

Figure 2-3. Ventilator power switch, AC indicator, and AC panel

If the ventilator power supply circuit breaker (located on the ventilator's AC panel, Figure 2-3) opens but AC power is still present and the ventilator is operating on BPS, power is still available to the humidifier and compressor connectors (although ventilator software disables compressor operation).

A humidifier connection is only available on 100 - 120 V ventilators.

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OP 2 How to set up the Puritan Bennett 840 ventilator

When the power cord is not in use, wrap the power cord around the hook on the back of the cart for convenient storage (Figure 2-4 and Figure 2-5). The power cord is stored the same way on the Puritan Bennett 800 Series Ventilator Compressor Mount Cart and the Puritan Bennett 800 Series Ventilator Pole Cart.

Figure 2-4. Power cord storage on the RTA cart

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How to set up the Puritan Bennett 840 ventilator OP 2

Figure 2-5. Power cord storage on the newer Puritan Bennett 800

Series Ventilator Compressor Mount Cart and Puritan Bennett

800 Series Ventilator Pole Cart (shown)

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OP 2 How to set up the Puritan Bennett 840 ventilator

Warning

2.2 How to connect the air and oxygen supplies

The Puritan Bennett 840 Ventilator System can use air and oxygen from cylinder or wall supplies. Follow these steps to connect the air and oxygen supplies:

1 Ensure the supply pressures are 35 to 100 psi

(241 to 690 kPa), and the hospital gas piping system complies with ISO 7396:1987, Non-flammable Medical Gas Pipeline Systems, or an equivalent standard. Gas hoses must meet the requirements of EN 739:1998, Low-pressure Hose Assemblies for use with Medical Gases, and NFPA 99:2002, Standard for Healthcare Facilities.

Due to excessive restriction of certain hose assemblies (listed in Table B-1), reduced ventilator performance may result when oxygen or air supply pressures< 50 psi (345 kPa) are employed.

2. Connect the supply hoses to the inlet connectors at the rear of the ventilator (see Figure 2-6).

• Connect only air to the air inlet, and only oxygen to the oxygen inlet. Do not attempt to switch air and oxygen or connect any other gas.

• Always connect at least two gas sources to the ventilator to ensure a constant gas supply is available to the patient. There are three gas source connections: the compressor, air inlet, and oxygen inlet.

• Do not use anti-static or electrically conductive hoses in the ventilator breathing system.

• Use only gas supply hoses recommended by Puritan Bennett. Other hoses may be restrictive and may cause improper ventilator operation.

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How to set up the Puritan Bennett 840 ventilator OP 2

Caution

NOTE:

To prevent damage to the ventilator, ensure the connections to the air and oxygen supplies are clean and unlubricated, and there is no water in the air or oxygen supply gas. If you suspect water in the air supply gas, use an external wall air water trap to prevent water damage to the ventilator or its components.

When you connect a pressurized air or oxygen source, the ventilator air and oxygen regulators have a maximum bleed rate of 3 L/min, even when the ventilator is not in use. Always take this bleed rate into account when calculating air and oxygen usage.

When the air and oxygen hoses are not in use, you can wrap them around the hook on the back of the cart for convenient storage (Figure 2-6).

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OP 2 How to set up the Puritan Bennett 840 ventilator

Oxygen

Oxygen hose (from oxygen

Air hose

(from air

supply)

inlet

connector

Air inlet

connector

supply)

Figure 2-6. How to connect the air and oxygen supplies

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OP 2-12

How to set up the Puritan Bennett 840 ventilator OP 2

Warning

2.3 How to connect the patient circuit components

• To minimize the risk of bacterial contamination or component damage, inspiratory and expiratory filters must always be handled with care and connected to the ventilator during use.

• To minimize the risk of patient injury, use only patient circuits qualified for use in oxygen-enriched environments with the Puritan Bennett 840 Ventilator System. Do not use antistatic or electrically conductive tubing in the ventilator breathing system. To ensure a leak-tight connection, only use connectors and tubes with ISO-standard cone and socket fittings (or use adapters to connect barbed cuff fittings to ISO-standard fittings).

• If you use an external, pneumatically-powered nebulizer with the Puritan Bennett 840 Ventilator System, it adds flow to the patient circuit and can adversely affect spirometry, delivered O breath triggering. Additionally, aerosolized particulates in the ventilator circuit can lead to an increase in exhalation filter resistance.

• Use one of the patient circuits listed in Appendix B to ensure the maximum pressure/flow values specified by IEC 60601-2-12:2001 are not exceeded (see Table A-11 on page OP A-18 for patient circuit testing specifications). Using a circuit with a higher resistance does not prevent ventilation, but can cause a short self test (SST) fault or compromise the patient’s ability to breathe through the circuit.

%, delivered tidal volumes, and

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OP 2 How to set up the Puritan Bennett 840 ventilator

NOTE:

Warning

• Puritan Bennett recommends you run Short Self Test (SST) every 15 days, between patients, and when you change the patient circuit (particularly when you change circuit type, for example, from adult to pediatric or neonatal).

• Puritan Bennett recognizes the protocol for running SST varies widely among health care institutions. Puritan Bennett does not specify or require specific practices that will meet the needs of all institutions, nor is Puritan Bennett responsible for the effectiveness of institutional practices.

2.3.1 How to select and connect a patient circuit

Use low-compliance patient circuits to ensure optimum compliance compensation, and use pediatric patient circuits when the patient ideal body weight (IBW) is greater than 7 kg (15 lb) but less than or equal to 24 kg (53 lb). Use the NeoMode software option and neonatal patient circuits for patients whose IBW is less than or equal to 7 kg.

For patients whose IBW is less than or equal to 24 kg, the compliance compensation volume limit is four times the set tidal volume, in addition to the set tidal volume. To avoid activating a severe occlusion alarm, only use neonatal patient circuits with the NeoMode software option.

Table 2-1 shows IBW values and patient circuit types. The “Allowed but not recommended” ranges require an override.

Recommended ranges exist to ensure patient safety. Only those with the expertise to judge the appropriate circumstances should override the recommended ranges.

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How to set up the Puritan Bennett 840 ventilator OP 2

Table 2-1: Patient circuit and IBW values

Recommendation Ideal body weight (IBW) in kg (lb)

Recommended Neonatal: 0.3-7.0 kg (0.66-15 lb)*

Pediatric: 7.0-24 kg (15-53 lb) Adult: 25-150 kg (55-330 lb)

*Assumes NeoMode 2.0 software option is installed

Allowed but not

recommended

Neonatal: Not applicable

Pediatric: 3.5-6.5 kg (7.7-14.3 lb), and

25-35 kg (55-77 lb)

Adult: 7-24 kg (15-53 lb)

Figure 2-7 shows how to connect the patient circuit, including the inspiratory filter, humidifier (if used), inspiratory limb, patient wye, expiratory limb, collector vial, and expiratory filter.

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OP 2 How to set up the Puritan Bennett 840 ventilator

Warning

(From patient)

Expiratory

Collector vial

Expiratory limb

Patient wye

Inspiratory limb

Humidifier

Inspiratory

(To patient)

Tubing

filter

of patient circuit

Figure 2-7. How to connect the patient circuit

To ensure all patient circuit connections are leak-tight, always perform a circuit leak test by running SST each time you install the expiratory filter on the ventilator.

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How to set up the Puritan Bennett 840 ventilator OP 2

Warning

Adding accessories to the ventilator can increase system resistance. Ensure any changes to the recommended ventilator circuit configurations do not exceed the specified values for inspiratory and expiratory resistance (Appendix A). If adding accessories to the patient circuit, always run SST to measure circuit compliance before beginning ventilation of the patient.

2.3.2 How to install the expiratory filter and collector vial

Install the expiratory filter and collector vial as follows:

1. Place the expiratory filter latch in the up position (see Figure 2-8).

2. Slide the expiratory filter into the housing area with the expiratory limb connection facing you.

3. Push the expiratory filter latch down; it will position the filter properly.

4. Attach the expiratory limb of the patient circuit to the filter’s expiratory limb connection.

If you do not use a drain bag, be sure to cap the collector vial drain port on the expiratory filter (Figure 2-9).

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OP 2 How to set up the Puritan Bennett 840 ventilator

Figure 2-8. How to install the expiratory filter and collector vial

Item Description

1 Pull latch up to install filter, pull down to hold filter and

collector vial in place

2 Slide the filter rim onto these tracks

3 Filter housing area

4 Expiratory filter

If you use a drain bag:

5 Expiratory limb connection (from patient)

6 Collector vial

1 Install the expiratory filter. (Refer to the instructions above.) 2 Install the clamp on the drain bag tubing, ensuring the clamp

is closed.

3 Uncap collector vial drain port at the base of the collector vial. 4 Connect the collector bag tubing to the vial drain port.

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How to set up the Puritan Bennett 840 ventilator OP 2

Warning

Clamp

TubingDrain bag

Place the drain bag

The collector vial drain port must be capped if you do not use a drain bag

in the drawer of the RTA cart

or hang the drain bag on

the button provided on the side of the

cart

5 Connect the other end of tubing to drain bag. 6 If the ventilator is mounted on the cart, place the drain bag in

the cart drawer (if you have an older style ready-to-assemble cart) or hang the drain bag on the button provided on the side of the newer style Puritan Bennett 800 Series Ventilator Compressor Mount Cart or Puritan Bennett 800 Series Ventilator Pole Cart (Figure 2-9).

Do not attempt to clean, reprocess, or reuse the drain bag as this poses the risk of infection to medical personnel and the patient.

Figure 2-9. How to use the collector vial with or without the drain bag

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OP 2 How to set up the Puritan Bennett 840 ventilator

NOTE:

Check the inspiratory and expiratory limbs of the patient circuit, the collector vial, and the in-line water traps regularly for water buildup. Under certain conditions, they can fill quickly. Empty and clean the collector vial and in-line water traps as necessary.

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How to set up the Puritan Bennett 840 ventilator OP 2

Flex arm

Threaded socket (one of two)

2.3.3 How to install the flex arm

The flex arm supports the patient circuit between the ventilator and the patient. Figure 2-10 and Figure 2-11 show how to install the flex arm onto one of the two (in ready-to-assemble carts) or four (in newer Puritan Bennett 800 Series Ventilator Compressor Mount Cart or Puritan Bennett 800 Series Ventilator Pole Cart threaded sockets on the ventilator cart.

Figure 2-10. How to install the flex arm on RTA cart

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OP 2 How to set up the Puritan Bennett 840 ventilator

Caution

Flex arm

Threaded

socket

(one of four)

Figure 2-11. How to install the flex arm on the newer Puritan Bennett 800

Series Ventilator Compressor Mount Cart or Puritan Bennett 800 Series

Ventilator Pole Cart

Use only the cart handles to move the ventilator. Do not pull or push the ventilator with the flex arm.

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How to set up the Puritan Bennett 840 ventilator OP 2

Warning

Caution

Flex arm replacement parts can be found in the Purian Bennett 800 Series Ventilator Service Manual.

2.3.4 How to install the humidifier

An electrical outlet for a humidifier is located on the front of the BDU. Figure 2-12 shows how to install a Fisher & Paykel humidifier onto the ventilator for ventilators mounted on RTA carts. Separate humidifier installation instructions are shipped with humidifier mounting kits listed in Table B-2 and Table B-3 of Appendix B for humidifiers mounted on Puritan Bennett 800 Series Ventilator Compressor Mount Carts and Puritan Bennett 800 Series Ventilator Pole Carts, respectively.

• When using a Fisher & Paykel humidifier with the Puritan Bennett 840 Ventilator System, use the appropriate Fisher & Paykel humidifier chambers for adult, pediatric, and neonatal patients.

• Take proper precautions to prevent water/condensate from splashing into the patient circuit during circuit disconnects and high peak flow rate conditions.

• To avoid possible patient injury or damage to the ventilator system, follow your institution’s protocol for proper patient circuit condensate management.

• Qualified service personnel must first install the humidifier mounting hardware.

• To avoid equipment damage to the ventilator due to liquid ingress:

- Install the plug cover when the humidifier is plugged into the

ventilator.

- Install the flat cover plate over the humidifier electrical outlet on

the front of the BDU when the humidifier is not plugged into the ventilator.

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OP 2 How to set up the Puritan Bennett 840 ventilator

NOTE:

• To ensure uninterrupted ventilator operation, do not install a humidifier whose maximum current capabilities exceed 2.3 A, with a maximum power consumption of 270 VA.

• When you install a Fisher & Paykel humidifier, make sure the humidifier has a right-angle electrical plug. A short power cord is preferable.

• To ensure ventilator occlusion detection operates properly, do not use Puritan Bennett Cascade humidifiers with the Puritan Bennett 840 Ventilator System.

• If you have further questions about humidifiers qualified for use with the Puritan Bennett 840 Ventilator System, contact your representative.

• A humidifier connection is only available on 100 - 120 V ventilators.

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How to set up the Puritan Bennett 840 ventilator OP 2

Humidifier

Plug cover

BDU

Mounting bracket on front of ventilator

Figure 2-12. How to install the humidifier

(Fisher & Paykel version shown) for ventilators mounted on RTA

carts

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OP 2 How to set up the Puritan Bennett 840 ventilator

Warning

2.3.5 How to use the ventilator cart

Three optional carts are available for use with the Puritan Bennett 840 ventilator: the RTA (ready-to-assemble) cart, the Puritan Bennett 800 Series Ventilator Compressor Mount Cart, and the Puritan Bennett 800 Series Ventilator Pole Cart. The RTA cart can be used with the 802 or 803 BPS, and newer Puritan Bennett 800 Series Ventilator Compressor Mount Cart can be used with a BPS having a one-hour battery or an optional four-hour battery. The Puritan Bennett 800 Series Ventilator Pole Cart also has a onehour or optional four-hour battery as part of its battery backup system.

Install only ventilator BDUs with serial numbers starting with 3512 onto the newer Puritan Bennett 800 Series Ventilator Compressor Mount Cart and Puritan Bennett 800 Series Ventilator Pole Cart. Other ventilator serial numbers are not compatible with the newer carts.

The Puritan Bennett 800 Series Ventilator Compressor Mount Cart and the Puritan Bennett 800 Series Ventilator Pole Cart may not be available in all regions. Please contact your local Puritan Bennett representative for more information.

To locate the cart’s lot number, a label is applied underneath the cart handle on the cart’s spine weldment (Figure 2-13).

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How to set up the Puritan Bennett 840 ventilator OP 2

Warning

Lot number label

Figure 2-13. Location of cart lot number label

Lock the cart’s wheels prior to installing or removing ventilator components.

Figure 2-14 and Figure 2-15 show how to lock and unlock the cart’s front wheels.

To avoid interrupted ventilator operation or damage to ventilator components, use the cart to move the ventilator. Do not use the cables, the power cord, GUI, or patient circuit components to push or pull the ventilator.

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OP 2 How to set up the Puritan Bennett 840 ventilator

Press large tab down to lock

Unlocked position Locked position

Press small tab down to unlock

Lift up to unlock

Press down to lock

Unlocked position Locked position

Figure 2-14. How to lock and unlock the RTA cart’s front wheels

Figure 2-15. How to lock and unlock the Puritan Bennett 800

Series Ventilator Compressor Mount Cart or Puritan Bennett 800

Series Ventilator Pole Cart front wheels

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OP 2-28

CHAPTER

3 How to run Short Self Test (SST)

Chapter 3 tells you:

•When to run SST

• Required equipment for SST

• How to set up and run SST

• The SST tests and their functions

• How to understand the results of SST

3.1 Introduction to SST

SST uses an internal, programmed sequence of tests to:

• Verify proper function of the flow and pressure sensors

• Check the patient circuit for gas leaks

• Measure the expiratory filter resistance

• Measure patient circuit resistance

• Measure patient circuit compliance

SST requires approximately three minutes to complete.

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OP 3 How to run Short Self Test (SST)

Warning

NOTE:

• Always disconnect the ventilator from the patient before you run SST. If you run SST while the ventilator is connected to the patient, physical injury to the patient may occur.

• An ALERT reported by SST indicates the ventilator or a related component has a defect. Repair the ventilator or related component before you use the ventilator on a patient, unless you can determine with certainty the defect cannot create a hazard for the patient, or add to the risks that may occur from other hazards.

• When you run SST, configure the patient circuit exactly as it will be used on the patient (for example, with same accessories). If you add accessories to the patient circuit after you run SST, you must rerun SST with the new accessories installed before you begin to ventilate the patient.

3.2 When to run SST

Puritan Bennett recognizes health care institutions may have their own ventilator protocols. However, Puritan Bennett is not responsible for the effectiveness of any institution’s protocols. Nor can Puritan Bennett specify, or require, specific practices to meet the internal needs of every health care institution.

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How to run Short Self Test (SST) OP 3

Puritan Bennett recommends running SST when one or more of the events below occurs:

• When you replace the patient circuit and the exhalation filter after 15 days of use

• When you are ready to connect a new patient to the ventilator

• When you connect a different patient circuit to the ventilator

• When you install a new or sterilized expiratory filter

• When you change the patient circuit type

• When you change the humidification device type

• When you remove or add accessories to the patient circuit, such as a humidifier, water trap, or drain bag

Use SST at any time, provided a patient is not attached to the ventilator, to:

• Check the patient circuit for gas leaks

• Calculate patient circuit compliance and resistance

• Calculate expiratory filter resistance

After SST begins, the system prompts you to prepare the ventilator to conduct certain tests. The system waits indefinitely at a prompt until you take action and respond appropriately.

3.3 SST components and requirements

When you conduct SST, you must have available the components and equipment you will use on the patient:

• Patient tubing

• Expiratory filter and collector vial

•Inspiratory filter

• Humidifier, as applicable

• Other accessories (e.g. water traps, drain bag), as applicable

Additional requirements include:

• A No. 1 rubber stopper to block the airway at the patient wye

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OP 3 How to run Short Self Test (SST)

Caution

Warning

• Two gas sources (air and oxygen) connected to the ventilator

• Each gas source pressure must be between 35-100 psi (241 to 690 kPa)

• To prevent SST failures due to leaks, ensure any circuit components such as collector vial drain port cap (if not using a drain bag), the seal between the expiratory filter and collector vial, and water trap (if used) seals are properly installed.

• If you are using a drain bag, ensure the tubing is properly installed on the collector vial drain port and the tubing is clamped. If the drain bag tubing is not clamped during SST, large leaks and large compliance values are possible which may cause SST to report ALERTs or FAILURES.

Wait at least ten minutes after you turn on the ventilator before you run SST. The warm up time of ten minutes will stabilize the ventilator and ensure the accuracy of the SST tests.

3.4 SST Procedure

Always disconnect the ventilator from the patient before you run SST. If you run SST while the ventilator is connected to the patient, physical injury to the patient may occur.

1 Turn the power switch (located on the front of the BDU). The

system conducts the POST (power-on self test) and displays the Ventilator Startup screen.

2 Allow the ventilator to stabilize for ten minutes with the

power on.

3 Install the patient circuit, the expiratory and inspiratory filters

you will use to ventilate the patient.

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How to run Short Self Test (SST) OP 3

Caution

NOTE:

The patient circuit must be unobstructed and properly connected to the ventilator to ensure accurate circuit resistance measurement.

4At the Ventilator Startup screen, touch the SST button (lower

touch screen), then press the

TEST button (on the left side of

the BDU) within five seconds. (Refer to Figure 3-1 for location of

TEST button.)

The system displays the SST Setup screen (lower touch screen).

You must press the TEST button within five seconds of touching the SST button or SST will not start.

Test button

Figure 3-1. Test button location

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OP 3 How to run Short Self Test (SST)

Caution

Warning

Do not press the test button when powering up the ventilator. This may cause the ventilator to enter Service Mode. If you enter Service Mode, do not attempt to run Extended Self Test (EST) with a patient circuit. Doing so will cause EST to fail. If EST fails, the ventilator will remain in a Ventilator Inoperative state until EST successfully passes.

If you accidentally enter Service Mode, exit Service Mode by touching the EXIT button on the lower GUI screen and then pressing the ACCEPT key.

5Touch the PATIENT CIRCUIT key in the lower touch screen,

then use the knob to select either Adult, Pediatric, or Neonatal (if NeoMode software option is installed) patient circuit.

6Touch the

screen, then use the knob to select the humidification type you will use for patient ventilation.

If you will not use a humidifier, set the humidification type to

HME.

7 Press

and humidification types.

HUMIDIFICATION TYPE key in the lower touch

ACCEPT to complete your selection of the patient circuit

Incorrectly specifying the patient circuit type or changing the patient circuit type after you have run SST can affect the accuracy of the compliance calculation, the measured exhaled tidal volume, and delivered/measured inspired tidal volumes. You must rerun SST when you change the circuit type. Compliance calculation and tidal volume accuracy may also be affected by incorrectly specifying or changing the humidifier after running SST. If you change humidifiers, ensure you change the humidification type as described in Section 4.8. For optimum accuracy, rerun SST using the new humidifier.

Puritan Bennett 800 Series Ventilator System Operator’s Manual

OP 3-6

How to run Short Self Test (SST) OP 3

Warning

8 The ventilator automatically starts the test sequence. Refer to

Table 3-1 for details regarding each SST test step.

The SST Flow Sensor, Expiratory Filter, Circuit Resistance, and Compliance Calibration tests require your intervention. The system will wait indefinitely for your response. Otherwise you don’t need to do anything unless a test result is

FAILURE, or SST is complete.

ALERT or

9 As each test is performed, the SST Status screen shows test

results (see Table 3-2).

To ensure reliable SST results, do not repeat an individual test with a different patient circuit if the test result is FAILURE or ALERT. If you suspect a defective patient circuit, replace the patient circuit and restart SST from the beginning.

10 You can touch EXIT SST during SST to halt testing. You can

touch

EXIT SST again to resume testing, or press ACCEPT to

restart the ventilator (if SST has not detected an

FAILURE).

ALERT or

To ensure correct compensation for circuit resistance and compliance, do not exit SST until the entire SST is successfully completed. Do not begin normal ventilation until the entire SST is successfully completed with the correct patient circuit installed.

11 When all of the tests in SST are complete, the SST Status screen

displays all individual test results and SST outcome. Table 3-3 summarizes overall SST outcomes and how to proceed in each case.

12 To begin normal ventilation (if SST has not detected an

FAILURE), touch EXIT SST, then press ACCEPT.

13 The ventilator reruns

POST.

Puritan Bennett 800 Series Ventilator System Operator’s Manual

ALERT

OP 3-7

OP 3 How to run Short Self Test (SST)

Warning

14 The ventilator displays the Ventilator Startup screen. Proceed

with Ventilator S t a r t u p to configure the system for the patient.

Table 3-1: SST test sequence

Test step Function Comments

SST Setup The system prompts you to

specify the patient circuit type and humidification type you will use for patient ventilation.

1 Specify the patient circuit

type.

2 Specify the humidification

type.

You can select one of three humidification types:

• Heated expiratory tube

• Non-heated expiratory tube

• HME (heat-moisture exchanger)

3 For non-HME humidifiers,

specify the dry humidifier volume. Use the specified volume, not the compressible volume, of the humidifier.

4 Press the

Select the correct patient circuit type and humidification type. Otherwise, faulty occlusion detection and erroneous expiratory spirometry can result.

ACCEPT key.

Puritan Bennett 800 Series Ventilator System Operator’s Manual

OP 3-8

How to run Short Self Test (SST) OP 3

NOTE:

Table 3-1: SST test sequence

Test step Function Comments

The HUMIDIFIER VOLUME button is not visible on the touch screen if you select

HME.

SST Setup (cont) The system prompts you to

connect the patient circuit to inspiratory filter.

Use Figure 2-6 on page OP 2-14 to connect the patient circuit.

Do not run the Flow Sensor Test with a humidifier installed, even if you will use a humidifier when you begin patient ventilation.

The system prompts you to block the patient wye.

The system checks the accuracy of the inspiratory and expiratory flow sensors.

After the test completes, the system prompts you to connect the humidifier.

If you will use a humidifier during patient ventilation, connect the humidifier to the patient circuit after the system passes the SST Flow Sensor Test. Refer to Figure 2-6 on page OP 2-14 for connection information.

1 Connect the patient circuit

to the inspiratory filter— but without the humidifier.

2 Press

3 Block the wye with a

4 Press

If the status of the SST Flow Sensor Test is

cannot use the function.

ACCEPT to begin

the test.

No. 1 stopper.

ACCEPT.

FAILURE, you

OVERRIDE

Circuit Pressure Test The system verifies proper

function of the BDU pressure sensors.

Puritan Bennett 800 Series Ventilator System Operator’s Manual

If the status of the Circuit Pressure Test is FAILURE, you cannot use the function.

OVERRIDE

OP 3-9

OP 3 How to run Short Self Test (SST)

Table 3-1: SST test sequence

Test step Function Comments

Circuit Leak Test The system determines the

ability of the circuit to hold pressure.

The system displays the drop in circuit pressure over a 10 second interval.

Expiratory Filter Resistance Test

The system prompts you to detach circuit tubing from the expiratory filter.

At the conclusion of the

Expiratory Filter Resistance Tes t, the system displays the

pressure drop across the expiratory filter.

If the system reports and you choose to override the alert status, the result can be improper compliance compensation, inaccurate tidal volume delivery, or autotriggering during patient ventilation.

If the test detects excessive leaks, the system reports a

FAILURE.

1 Detach the patient circuit

from the expiratory filter.

2 Press

If the system reports an for the Expiratory Filter Resistance Test and you override the inaccurate patient pressure estimation can result.

The system will report a

FAILURE if the test detects an

exhalation compartment occlusion or an expiratory filter occlusion.

If you do not correctly follow the prompts to disconnect and connect the patient circuit, the system will report a

FAILURE.

ACCEPT to begin

the test.

ALERT, an

ALERT

The system prompts you to reattach the patient circuit.

Puritan Bennett 800 Series Ventilator System Operator’s Manual

OP 3-10

3 Reattach the patient

circuit to the expiratory filter.

4 Press

ACCEPT to begin

the next test.

How to run Short Self Test (SST) OP 3

Table 3-1: SST test sequence

Test step Function Comments

Circuit Resistance The system prompts you to

unblock the patient wye.

The system displays the pressure drop across the inspiratory and expiratory limbs.

The reported pressure drop includes the effect of all devices installed on each limb, such as filters, water traps, or a humidifier.

Compliance Calibration

The system prompts you to block the patient wye.

If you selected a humidification type of either

Heated exp tube or Nonheated exp tube, the

ventilator prompts you to indicate if there is water in the humidifier.

1 Remove the stopper from

the wye.

2 Press ACCEPT to begin

the test.

If the system reports an

ALERT

for the pressure drop across the two limbs and you override the

ALERT, an

inaccurate patient pressure estimation can result.

The system reports a

FAILURE

if the test detects excessive high or low limb resistance, or if you do not follow the prompt to unblock the wye.

1 Block the wye with a

No. 1 stopper.

2 Press

ACCEPT to begin

the patient circuit compliance test.

3 Press ACCEPT to indicate

YES or CLEAR to indicate NO, as appropriate, to

indicate whether or not there is water in the humidifier.

Puritan Bennett 800 Series Ventilator System Operator’s Manual

OP 3-11

OP 3 How to run Short Self Test (SST)

NOTE:

Table 3-1: SST test sequence

Test step Function Comments

Compliance Calibration (cont)

3.5 SST Results

The Puritan Bennett™ 840 Ventilator System uses four status categories to characterize the individual SST test results, and the overall SST outcome.

ALERT

You can override an ALERT reported for an individual test if you can determine with certainty the defect in the ventilator or related component cannot create a hazard for the patient, or add to the risks arising from other hazards.

The system displays the compliance of the patient circuit.

The system prompts you to unblock the patient wye.

If the system reports an for the patient circuit compliance and you override

ALERT, improper

the compliance compensation or inaccurate tidal volume delivery can result.

The system reports a if the test detects an out-ofrange compliance condition.

4 Remove the stopper from

the patient wye.

5 Press

ACCEPT to

complete the SST test sequence.

ALERT

FAILURE

If an ALERT is reported and you exit SST without overriding the ALERT, the ventilator will enter the safety valve open (SVO) state and cannot be used for normal ventilation until SST passes or the ALERT is overridden.

Puritan Bennett 800 Series Ventilator System Operator’s Manual

OP 3-12

Puritan-Bennett 800 User and technical manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Contents

Operator’s Manual

1 Introduction OP 1-1

2 How to set up the Puritan Bennett 840 ventilator OP 2-1

3 How to run Short Self Test (SST) OP 3-1

4 How to use the Puritan Bennett 840 ventilator OP 4-1

5 How to handle alarms OP 5-1

6 How to view graphics OP 6-1

7 Preventive maintenance OP 7-1

A Specifications OP A-1

B Part numbers OP B-1

C Pneumatic schematic OP C-1

D Alarm and oxygen sensor calibration testing OP D-1

E Remote alarm and RS-232 ports OP E-1

Technical Reference

1 Introduction to breath delivery TR 1-1

2 Detecting and initiating inspiration TR 2-1

3 Detecting and initiating exhalation TR 3-1

4 Mandatory breath delivery TR 4-1

5 Spontaneous breath delivery TR 5-1

6 Assist/control (A/C) mode TR 6-1

8 Spontaneous (SPONT) mode TR 8-1

9 Apnea ventilation TR 9-1

Detecting occlusion and disconnect TR 10-1

11 Phasing in setting changes TR 11-1

12 Ventilator settings TR 12-1

13 Alarms TR 13-1

14 Patient data TR 14-1

15 Safety net TR 15-1

16 Power on self test (POST) TR 16-1

17 Short self test (SST) TR 17-1

18 Extended self test (EST) TR 18-1

19 RS-232 commands TR 19-1

Figures

Tables

1 Introduction

1.1 Technical description

1.1.1 General background

1.1.2 Pressure and flow triggering

1.1.3 Breathing gas mixture

1.1.4 Inspiratory pneumatics

1.1.5 Patient circuit

1.1.6 AC mains and backup power system

1.1.7 Ventilator emergency states

1.2 Graphic user interface

1.3 User interface controls and indicators

1.3.1 Onscreen symbols and abbreviations

2.1 How to connect the electrical supply

2.2 How to connect the air and oxygen supplies

2.3 How to connect the patient circuit components

2.3.1 How to select and connect a patient circuit

2.3.2 How to install the expiratory filter and collector vial

2.3.3 How to install the flex arm

2.3.4 How to install the humidifier

2.3.5 How to use the ventilator cart

3 How to run Short Self Test (SST)

3.1 Introduction to SST

3.2 When to run SST

3.3 SST components and requirements

3.4 SST Procedure

3.5 SST Results