Puritan Bennett 840 User Manual

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840

Ventilator System

Part No. 4-070088-00 Rev. F October 2006

Technical Reference Manual

Operator’s and

4-070088-00 Rev. F (10/06) 840 Ventilator System Operator’s & Technical Reference Manual

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Copyright 1997, 1998, 2003, 2005, 2006 Puritan-Bennett Corporation. All rights reserved. The 840 Puritan Bennett proprietary information, covered by one or more of the following U.S. Patents and foreign equivalents: 4,954,799; 5,161,525; 5,271,389; 5,301,921; 5,319,540; 5,339,807; 5,368,019; and 5,390,666. 840, 800 Series, DualView, SandBox, SmartAlert, Flow-by, and PTS 2000 are trademarks of Puritan-Bennett Corporation.

The information contained in this manual is the sole property of Puritan-Bennett Corporation and may not be duplicated without permission. This manual may be revised or replaced by Puritan-Bennett Corporation at any time and without notice. You should ensure that you have the most current applicable version of this manual; if in doubt, contact Puritan-Bennett Corporation or visit the Puritan Bennett product manual web page at:

http://www.mallinckrodt.com/respiratory/resp/Serv_Supp/

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. 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 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, Puritan Bennett has no obligation to furnish any such revisions, changes, or modifications to the owner or user of the equipment (including its software) described herein.

Ventilator System is manufactured in accordance with

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Applicability

The information in this manual applies to

ventilator versions

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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:

Warning

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

Caution

Indicates a condition that can damage the equipment.

NOTE:

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

840 Ventilator System Operator’s & Technical Reference Manual 4-070088-00 Rev. F (10/06)

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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

• 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

Ventilator System and oxygen

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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.

Ventilator System.

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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

Ventilator System, always

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follow your hospital infection control guidelines for handling infectious material.

Puritan Bennett recognizes that 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.

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

The

Ventilator System is not intended to be a

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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

840 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

Ventilator System.

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Warranty

The 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.

Ventilator System is warranted against defects in material

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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.

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Manufacturer

Puritan-Bennett Corporation 4280 Hacienda Drive Pleasanton, CA 94588 USA

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

Electromagnetic susceptibility

The 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 close to the ventilator. It is difficult to determine when the field strength of these devices becomes excessive.

Practitioners should be aware that radio frequency emissions are additive, and that 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.

Ventilator System complies with the requirements of

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Warning

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 840 ventilator configures a medical system, and is therefore responsible for ensuring that 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.

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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.

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 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

Plus

(VV+)

which includes VC+ and VS breath types

Proportional Assist Ventilation

that are made 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.

Ventilator System. It also

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, Volume Ventilation

Tube Compensation (TC)

(PAV+),

BiLevel

and

, NeoMode®,

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.

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Contents

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 1-18

1.4 Ventilator system labeling symbols. . . . . . . . . . . . . . . . . . . . . . . . . OP 1-24

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

2.1 How to connect the electrical supply . . . . . . . . . . . . . . . . . . . . . . OP 2-3

2.2 How to connect the air and oxygen supplies . . . . . . . . . . . . . . . . . OP 2-8

2.3 How to connect the patient circuit components . . . . . . . . . . . . . . OP 2-11

2.3.1 How to select and connect a patient circuit . . . . . . . . . . . . . . OP 2-12

2.3.2 How to install the expiratory filter and collector vial. . . . . . . . OP 2-15

2.3.3 How to install the flex arm. . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-18

2.3.4 How to install the humidifier . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-19

2.3.5 How to use the ventilator cart . . . . . . . . . . . . . . . . . . . . . . . . OP 2-22

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

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

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Contents

4 How to use the 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 4-7

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

4.3 How to change the main ventilator control parameters. . . . . . . . . OP 4-15

4.4 Mode, breath type, and other changes . . . . . . . . . . . . . . . . . . . . . OP 4-16

4.5 How to select a constant timing variable during

respiratory rate changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-17

4.6 How to change apnea ventilation settings. . . . . . . . . . . . . . . . . . . OP 4-19

4.7 How to set alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-20

4.8 How to change other settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-22

4.9 Expiratory pause maneuvers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-23

4.10 Inspiratory pause maneuvers. . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-24

4.11 How to interpret inspiratory pause maneuver results

for static compliance and resistance . . . . . . . . . . . . . . . . . . . . . . OP 4-26

4.12 How to use NIV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-27

4.12.1 NIV intended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-27

4.12.2 NIV breathing interfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-27

4.12.3 NIV setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-28

4.12.4 High spontaneous inspiratory time limit setting. . . . . . . . . . OP 4-32

4.12.5 Apnea setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-32

4.12.6 Alarm setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-32

4.12.7 Changing patient from INVASIVE to NIV Vent Type. . . . . . . OP 4-34

4.12.8 Changing patient from NIV to INVASIVE Vent Type. . . . . . . OP 4-35

4.12.9 NIV patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-35

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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 5-4

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

5.5 Alarm volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-6

5.6 Alarm messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-7

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 6-2

6.3 Graphics display details and calculations . . . . . . . . . . . . . . . . . . . . OP 6-3

6.4 How to adjust displayed graphics. . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-4

6.5 The graphics display FREEZE function . . . . . . . . . . . . . . . . . . . . . . OP 6-5

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

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

6.8 When graphics are not accessible . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-7

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 7-15

7.4.5 Every 250 hours: compressor inlet filter . . . . . . . . . . . . . . . . . OP 7-15

7.4.6 Every year: ventilator inspection. . . . . . . . . . . . . . . . . . . . . . . OP 7-16

7.4.7 Every 2 years or as necessary: oxygen sensor . . . . . . . . . . . . . OP 7-17

7.4.7.1 Oxygen sensor replacement procedure . . . . . . . . . . . . . OP 7-17

7.5 Additional preventive maintenance procedures . . . . . . . . . . . . . . . OP 7-23

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Contents

7.6 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-25

7.7 Repacking and shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-25

A Specifications OP A-1

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

A.2 Environmental requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-3

A.3 Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-4

A.4 Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-5

A.5 Compliance and approvals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-7

A.5.1 Manufacturer’s Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-9

A.6 Technical specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-18

A.7 Ranges, resolutions, and accuracies . . . . . . . . . . . . . . . . . . . . . . . . OP A-23

A.7.1 Recommended limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-23

A.7.2 Software options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-24

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-6

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-6

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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

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

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Contents

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

10 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

12.3 Disconnect sensitivity (D

12.4 Expiratory sensitivity (E

12.5 Expiratory time (T

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

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

SENS

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

SENS

Page 15

Contents

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

12.7 Flow sensitivity (V

12.8 High spontaneous inspiratory time limit (2T

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

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

12.15 O

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

12.16 Peak inspiratory flow (V

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

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

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

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

SENS

I SPONT

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

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

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

MAX

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

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

SENS

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

SUPP

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

). . . . . . . . . . . TR 12-6

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 (

13.7 High delivered O

13.8 High exhaled minute volume (

13.9 High exhaled tidal volume (

4-070088-00 Rev. F (10/06) 840 Ventilator System Operator’s and Technical Reference Manual

↑P

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

PEAK

% (↑O2%) alarm . . . . . . . . . . . . . . . . . . . . . . . TR 13-25

↑V

↑

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

ETOT

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

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Contents

13.10 High inspired tidal volume alarm (↑VTI, ↑V

↑V

TI SPONT

13.11 High respiratory rate (

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

↑f

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

TOT

TI MAND

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

13.13 Low circuit pressure alarm (

13.14 Low delivered O

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

↓P

) . . . . . . . . . . . . . . . . . . . . . . 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

13.17 Low exhaled total minute volume (

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

↓

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

E TOT

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

14.8 Mean circuit pressure (P

14.9 Peak circuit pressure (P

14.10 Plateau pressure (P

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 (PEEP

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

TOT

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

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

E SPONT

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

STAT

and R

) . . . . . . . . . . TR 14-7

STAT

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

15 Safety net TR 15-1

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

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

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

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Contents

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 15-6

15.12 Atmospheric pressure transducer calibration . . . . . . . . . . . . . . . TR 15-6

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

Glossary

Index

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Contents

This page is intentionally blank.

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Page 19

Figures

Operator’s manual

Figure 1-1. 840 Ventilator System block diagram . . . . . . . . . . . . . . . OP 1-4

Figure 1-2. 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 2-5

Figure 2-3. Ventilator power switch, AC indicator, and AC panel. . . . OP 2-6

Figure 2-4. Power cord storage on the cart . . . . . . . . . . . . . . . . . . . . OP 2-7

Figure 2-5. How to connect the air and oxygen supplies. . . . . . . . . . OP 2-10

Figure 2-6. How to connect the patient circuit . . . . . . . . . . . . . . . . . OP 2-14

Figure 2-7. How to install the expiratory filter and collector vial . . . . OP 2-16

Figure 2-8. How to use the collector vial with or

without the drain bag . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-17

Figure 2-9. How to install the flex arm. . . . . . . . . . . . . . . . . . . . . . . . OP 2-18

Figure 2-10. How to install the humidifier

(Fisher & Paykel version shown) . . . . . . . . . . . . . . . . . . . OP 2-21

Figure 2-11. How to lock and unlock the cart’s front wheels . . . . . . . . OP 2-22

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.

(or TH) selected as the constant during rate change. . . OP 4-18

Figure 4-5. Alarm setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-21

Figure 4-6. New patient setup screen — NIV. . . . . . . . . . . . . . . . . . . OP 4-29

Figure 4-7. NIV ventilator settings screen . . . . . . . . . . . . . . . . . . . . . OP 4-31

Figure 4-8. New patient default alarm settings . . . . . . . . . . . . . . . . . OP 4-33

Figure 4-9. More patient data screen — NIV . . . . . . . . . . . . . . . . . . . OP 4-36

Figure 5-1. Alarm indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-2

Figure 5-2. Alarm Silence in Progress indicator (lower screen) . . . . . . OP 5-3

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

Figure 5-4. Alarm message format. . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-8

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

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 7-16

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

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Page 20

Figures

Figure 7-3. Dislodge the O2 sensor access cover . . . . . . . . . . . . . . . . OP 7-19

Figure 7-4. Open O Figure 7-5. Locate O

Figure A-1. Recommended patient circuit configurations . . . . . . . . . OP A-22

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

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

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

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. 840 ventilator modes and breath types. . . . . . . . . . . . . . TR 12-11

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

sensor access port . . . . . . . . . . . . . . . . . . . . . . OP 7-20

sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-21

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Page 21

Tables

Operator’s manual

Table 1-1. 840 Ventilator System controls and indicators . . . . . . . . . OP 1-11

Table 1-2. BDU indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-17

Table 1-3. 840 Ventilator System symbols and abbreviations . . . . . . OP 1-18

Table 2-1. Patient circuit and IBW values . . . . . . . . . . . . . . . . . . . . . OP 2-13

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. Determining 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. Patient circuit and IBW values . . . . . . . . . . . . . . . . . . . . . OP 4-15

Table 4-4. Monitored ventilator control parameters . . . . . . . . . . . . . OP 4-16

Table 4-5. Automatic settings changes—INVASIVE to NIV . . . . . . . . OP 4-34

Table 4-6. Automatic settings changes—NIV to INVASIVE . . . . . . . . OP 4-35

Table 5-1. Alarm messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-9

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 7-24

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

Table A-2. Environmental requirements . . . . . . . . . . . . . . . . . . . . . . OP A-3

Table A-3. Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . OP A-4

Table A-4. Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-5

Table A-5. Compliance and approvals . . . . . . . . . . . . . . . . . . . . . . . OP A-8

Table A-6. Electromagnetic Emissions. . . . . . . . . . . . . . . . . . . . . . . . OP A-10

Table A-7. Electromagnetic Immunity . . . . . . . . . . . . . . . . . . . . . . . OP A-11

Table A-8. Electromagnetic Immunity – conducted and radiated RF . OP A-13 Table A-9. Recommended separation distances between portable

and mobile RF communications equipment

and the 840 Ventilator System . . . . . . . . . . . . . . . . . . . . OP A-15

Table A-10. Compliant cables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-16

Table A-11. Technical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-18

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Tables

Table A-12. Ventilator settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-24

Table A-13. Alarm settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-40

Table A-14. Patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-45

Table A-15. Other Screens — displayed data . . . . . . . . . . . . . . . . . . . OP A-52

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

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. 840 ventilator 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

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Page 23

HAPTER

Introduction

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

The 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 monitored patient data, for easy assessment of the patient’s condition. The touch screens also display the current ventilator control parameters.

The preview the selected ventilator control parameters prior to active ventilation of the patient.

The specific information about the cause, and prompts the user with actions to resolve the reported condition(s).

Ventilator System facilitates work of breathing

840

SandBox

SmartAlert

Ventilator System is

840

DualView

™ area on the touch screen allows the practitioner to

™ system intercepts alarms, or events, provides

™ touch screens that display

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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Introduction

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 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 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) provides DC power to the BDU and GUI in the event that AC power is lost. A new, fully charged BPS runs the ventilator (without a compressor or a humidifier) for at least 30 minutes, which allows transport of the patient and the ventilator within the healthcare facility.

This manual tells you how to operate and perform simple maintenance for the this manual and accompanying labels before attempting to operate or maintain the ventilator.

To ensure optimum performance of the Puritan Bennett strongly recommends that 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 Puritan Bennett representative.

Ventilator System supplies mandatory or spontaneous

840

BiLevel

Ventilator System. Become familiar with

840

Ventilator System,

840

mode. A

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Introduction

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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Exhalation module:

Active exhalation valve Pressure transducer Flow sensor

Introduction

Graphic user

interface (GUI)

Inspiratory module:

PSOLs Safety valve Oxygen sensor Pressure transducers Flow sensors

Collector

vial

supply

Oxygen

Expiratory filter

(Expiratory

limb)

(Inspiratory limb)

Patient

circuit

supply

Figure 1-1. 840 Ventilator System block diagram

Air

regulator

Air

Humidification device

Oxygen regulator

Inspiratory

filter

8-00001

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Introduction

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1.1.2 Pressure and flow triggering

The ventilator uses flow or pressure triggering to recognize patient effort. When

pressure triggering

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

monitors 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 operator-selected 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 that is still large enough to avoid autotriggering, yet will trigger with acceptable patient effort.

is in effect, the ventilator monitors



) is in effect, the ventilator

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

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sensor is enabled and monitored oxygen

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Introduction

concentration is more than seven percent above or below the O

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

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

ventilator that route gas between the ventilator and the patient. These components include:

•an

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

• the inspiratory and expiratory limbs of the patient circuit that

•a

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inspiratory filter

between the patient and ventilator

circuit

conduct the breathing gas to and from the patient

collector vial

bulk moisture in the exhaled gas

comprises the components external to the

that protects against contamination

that protects the expiratory pneumatics from

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Introduction

OP 1

•an

expiratory filter

particulates in the patient’s exhaled gas into the room air or inside the ventilator exhalation pneumatics

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.

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.

that limits the escape of microorganisms and

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 BPS, which supplies DC power to the ventilator if AC power is lost. A fully charged BPS operating under nominal ambient conditions, can power the ventilator for at least 30 minutes (the BPS does not power the compressor unit or the humidifier, if present). 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.

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Introduction

1.1.7 Ventilator emergency states

Emergency states include

. When a

(SVO)

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

ventilator inoperative

The following describe the two ventilator emergency states:

•

Safety valve open (SVO)

enters a oxygen supplies are lost, or an occlusion is detected, or the ventilator enters the condition.

The safety valve open the patient to breathe room air unassisted by the ventilator. The ventilator remains in the caused the emergency state is corrected.

When the ventilator enters the 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

•

Ventilator inoperative

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 which in turns sounds a high-urgency alarm.

ventilator inoperative

state if both air and

SVO

Ventilator Inoperative

ventilator inoperative

condition occurs, it always

condition.

: The ventilator

state allows

(SVO)

state until the condition that

SVO

: The ventilator

and

state, the

safety valve open

indicator

SVO

state,

SVO

If a ventilator inoperative condition occurs, immediately remove the ventilator from use until qualified service personnel evaluate and correct the

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Vent Ino p

condition.

Page 31

Introduction

If the ventilator declares a ventilator inoperative state, the power on self test (POST) must first verify that power levels to the ventilator are acceptable and that 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.

OP 1

The graphic user interface (GUI) of the comprises the below the touch screens, and a knob. Use the knob to set a given ventilator control parameter to its desired value. Press the key—the off-screen key above and right 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, the off-screen keys located

DualView

touch screens.

Ventilator System

840

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Introduction

Upper screen:

monitored

information

(alarms,

patient data)

Lower screen:

ventilator

control

parameters

Figure 1-2. 840 Ventilator System graphic user interface (GUI)

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

Prompt

Symbol definitions

area

Status indicators

Off-screen keys

CLEAR key

ACCEPT key

Knob

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Introduction

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: 840 Ventilator System 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

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.

key) have no effect when touched until you press the

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Table 1-1: 840 Ventilator System controls and indicators (cont)

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.

GO BACK

Oxygen sensor calibration key: Delivers 100% oxygen (if available) for two minutes and calibrates the oxygen sensor. The green light on this key illuminates and a message (100%

Cal in Progress) on the lower touch screen indicates that

100% O

delivery is active. If you press the O2 key again, the

system restarts the two-minute delivery interval. Press CANCEL to stop the calibration.

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

DIAGRAM

Introduction

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

) to High PEEP (PEEPH) (or

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

INSP PAUSE

maneuver in SPONT mode.

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Introduction

Table 1-1: 840 Ventilator System controls and indicators (cont)

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 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

PAU SE

key. The pause cannot exceed 20 seconds. Section 4.9

describes in detail how to use the

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

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

INSP PAUSE

the

key, but cannot exceed 7 seconds. The ventilator computes C 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 describes in detail how to use the

and PEEPI (autoPEEP).

TOT

EXP PAUSE

), and plateau pressure (PPL).

STAT

and R

STAT

key. An automatic pause

EXP PAUSE

key.

at the end of the plateau

INSP PAUSE

key.

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EXP

INSP

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Table 1-1: 840 Ventilator System controls and indicators (cont)

Control or indicator Function

Knob: Adjusts the value of a setting. A highlighted button on

a touch screen means that 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.

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

Introduction

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).

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Introduction

Table 1-1: 840 Ventilator System controls and indicators (cont)

Control or indicator Function

Gray normal ventilator operation indicator: No ventilator

inoperative condition exists when indicator is not illuminated.

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.

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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.

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Table 1-1: 840 Ventilator System controls and indicators (cont)

Control or indicator Function

Green BPS ready indicator: The ventilator senses that the

BPS is installed, operational, and has at least two (2) minutes of estimated run time.

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.

Introduction

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Introduction

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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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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:

MAX

21.8

The symbol definition area shows this message:

MAX

Table 1-3: 840 Ventilator System symbols and abbreviations

min

= Peak flow

Introduction

Symbol or

abbreviation

(blinking)

Definition

Additional active alarms that relate 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 that you have not yet viewed

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Introduction

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Table 1-3: 840 Ventilator System symbols and abbreviations (cont)

Symbol or

abbreviation

RAMP SQUARE

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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Introduction

Table 1-3: 840 Ventilator System symbols and abbreviations (cont)

Symbol or

abbreviation

Definition

A/C Assist/control ventilation mode

AV Apnea ventilation

SENS

STAT

Static compliance

Spont expiratory sensitivity percentage

EST Extended self test

f Respiratory rate (ventilator control parameter)

TOT

↑

TOT

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)

O2% High delivered O2% alarm

↓

%Low delivered O

% alarm

PC Pressure control (mandatory breath type)

MEAN

↑

PEAK

2 P

PEAK

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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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Introduction

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Table 1-3: 840 Ventilator System symbols and abbreviations (cont)

Symbol or

abbreviation

PEAK

Peak circuit pressure (patient data)

Definition

PEEP Positive end expiratory pressure (ventilator control parameter)

PEEP

I END

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)

SENS

Pressure sensitivity

↑P

SUPP

-TRIG

VENT

STAT

Pressure support (ventilator control parameter)

Pressure triggering

High internal ventilator pressure alarm

Static resistance

SIMV Synchronous intermittent mandatory ventilation mode

SPONT Spontaneous ventilation mode

SST Short self test

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Apnea interval

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Introduction

Table 1-3: 840 Ventilator System symbols and abbreviations (cont)

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)

E SPONT

E TOT

E TO

Exhaled spontaneous minute volume

High exhaled minute volume alarm

Low exhaled minute volume alarm

VC Volume control (mandatory breath type)

MAX

SENS

TE MAND

TE SPONT

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Peak flow (ventilator control parameter)

Flow sensitivity

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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Introduction

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Table 1-3: 840 Ventilator System symbols and abbreviations (cont)

Symbol or

abbreviation

TI MAND

TI SPONT

-TRIG

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

High inspired (mandatory or spontaneous) tidal volume alarm*

Inspired mandatory tidal volume

High inspired mandatory tidal volume alarm*

Inspired spontaneous tidal volume

High inspired spontaneous tidal volume alarm*

Flow triggering

Definition

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1.4 Ventilator system labeling symbols

The following symbols appear on the various components of the

Ventilator System.

840

NOTE:

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,

Introduction

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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OP 1-24

Page 47

Introduction

OP 1

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

1996-05

TEST

PTS 2000

Serial number

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

Data key connection

Caution

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.

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.

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

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OP 1-25

Page 48

OP 1

Introduction

GUI connection

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

Ventilator circuit breaker for compressor and humidifier

NOTE:

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)

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.

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Introduction

OP 1

GUI mounting latch unlock/lock

Remote alarm port

IOIOI

RS-232 port

Susceptible to electrostatic discharge

Electric shock hazard

Explosion hazard

Fire hazard

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Page 50

OP 1

802 BPS product information label

Puritan-Bennett Corporation Pleasanton, CA USA

Made in Ireland

GUI product information label

Made in Ireland

™

Puritan-Bennett Corporation Pleasanton, CA USA

Introduction

4-072504-00 Rev C 0603

4-073044-00 Rev C 060

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.

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Introduction

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.)

BDU gas inlet label

OP 1

BDU To patient label

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OP 1

Compressor gas connection label

Compressor information label

Introduction

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Introduction

BDU information label

OP 1

Puritan-Bennett Corporation Pleasanton, CA USA

Authorized Representative Tyco Healthcare UK LTD Gosport PO13 0AS, U.K.

Made in Ireland

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4-071587-00 Rev E 0603

OP 1-31

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OP 1

BDU cooling vent label

BDU I/O disconnect label

Introduction

BDU exhaust information label

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Introduction

BPS electrical connection label

Compressor lint filter label

Expiratory limb connector on exhalation filter

From patient

OP 1

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OP 1

Introduction

This page is intentionally blank.

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HAPTER

How to set up the 840 ventilator

Chapter 2 describes how to set up the ventilator:

• 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.

Warning

• 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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Page 58

OP 2

Lift the BDU

from horizontal

surfaces as shown.

Use two people to lift

the compressor from

the base and the handles.

How to set up the 840 ventilator

Lift GUI from base and handle

Lift the GUI from the base and the handle.

8-00011

Figure 2-1. How to lift the ventilator components

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How to set up the 840 ventilator

Caution

• 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.

NOTE:

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.

OP 2

2.1 How to connect the electrical supply

Warning

• To minimize the risk of electrical shock, always connect

the ventilator power cord into a grounded AC power outlet.

• The 802 BPS must always be installed. 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.

• 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.

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OP 2

How to set up the 840 ventilator

Normally the BPS operates the ventilator when AC power is lost or drops below a minimum level.

A new, fully charged BPS can operate the ventilator (without the compressor or a humidifier) for at least 30 minutes; allowing the ventilator to be used for transport purposes within the healthcare facility.

Warning

The 802 BPS is intended for short-term use only, and is not intended as a primary alternative power source. The BPS is 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 BPS by leaving it connected to a ventilator connected to AC power for up to 8 hours (ventilator does not need to be turned on). 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 BPS battery.

Ventilator System is mains-powered. The 802

840

Figure 2-2 shows how to connect the power cord to AC power. Built-in power cord retainer tabs protect against accidental disconnection. Ensure that 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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How to set up the 840 ventilator

Power

cord

To AC power

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

OP 2

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

8-00002

Figure 2-3 shows the power switch and AC indicator. When illuminated, the AC indicator indicates that the ventilator is receiving AC power and that the 802 BPS 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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OP 2

How to set up the 840 ventilator

AC indicator

Ventilator power switch

AC panel

Humidifier

and compressor

circuit breaker

Ventilator power supply circuit breaker

Potential

equalization

(ground

point)

Compressor connection

AC power connection

8-00046

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).

NOTE:

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

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How to set up the 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).

OP 2

8-00004

Figure 2-4. Power cord storage on the cart

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OP 2

How to set up the 840 ventilator

2.2 How to connect the air and oxygen supplies

The or wall supplies. Follow these steps to connect the air and oxygen supplies:

1. Ensure that the supply pressures are 35 to 100 psi

2. Connect the supply hoses to the inlet connectors at the rear of

Ventilator System can use air and oxygen from cylinder

840

(241 to 690 kPa).

Warning

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

the ventilator (see Figure 2-5).

Warning

• 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 that 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 conductive, high-pressure supply hoses. Doing so may negatively affect the ventilator’s ground isolation characteristics.

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

< 50 psi

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How to set up the 840 ventilator

Caution

To prevent damage to the ventilator, ensure that the connections to the air and oxygen supplies are clean and unlubricated, and that 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.

NOTE:

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 2-5).

OP 2

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OP 2

Air inlet

connector

Oxygen

connector

How to set up the 840 ventilator

inlet

Oxygen hose (from oxygen supply)

Air hose

(from air

supply)

8-00005

Figure 2-5. How to connect the air and oxygen supplies

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How to set up the 840 ventilator

2.3 How to connect the patient circuit components

Warning

• 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 840 Ventilator System. Do not use antistatic or electrically conductive tubing. 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 840 ventilator, it adds flow to the patient circuit and can adversely affect spirometry, delivered O delivered tidal volumes, and 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 that 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.

OP 2

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OP 2

How to set up the 840 ventilator

NOTE:

• Puritan Bennett recommends that you run SST every 15 days, and 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 that 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 software option and neonatal patient circuits for patients whose IBW is less than or equal to 7 kg.

NeoMode

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

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

840 Ventilator System Operator’s Manual 4-070088-00 Rev. F (10/06)

OP 2-12

software option.

Warning

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

Page 69

How to set up the 840 ventilator

Table 2-1: Patient circuit and IBW values

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

Recommended Neonatal: 0.5-7.0 kg (1.1-15 lb)

OP 2

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

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 2-6 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 840 ventilator

(From patient)

Expiratory

filter

(To patient)

Patient wye

Inspiratory limb of patient circuit

Figure 2-6. How to connect the patient circuit

Warning

To ensure that 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.

Expiratory limb of patient circuit

Collector vial

Inspiratory filter

Tubing

Humidifier

8-00006

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How to set up the 840 ventilator

Warning

Adding accessories to the ventilator can increase system resistance. Ensure that any changes to the recommended ventilator circuit configurations do not exceed the specified values for inspiratory and expiratory resistance (Appendix A). If you add accessories to the patient circuit, always run SST to measure circuit compliance before you begin 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 2-7).

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.

OP 2

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 2-8).

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OP 2-15

Page 72

OP 2

Pull latch up to

install filter, pull

down to hold filter

and collector vial

in place

Expiratory

filter

Expiratory limb connection (from patient)

Figure 2-7. How to install the expiratory filter and collector vial

How to set up the 840 ventilator

Slide filter rim onto these tracks

Filter housing area

Collector vial

8-00018

If you use a drain bag:

Install the expiratory filter. (Refer to the instructions above.)

Install the clamp on the drain bag tubing, making sure that

the clamp is closed.

Uncap collector vial drain port at the base of the collector vial.

Connect the collector bag tubing to the vial drain port.

Connect the other end of tubing to drain bag.

If the ventilator is mounted on the cart, place the drain bag in

the cart drawer (Figure 2-8).

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How to set up the 840 ventilator

Tubing

Drain bag

OP 2

Place the drain bag

in the cart drawer

Clamp

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

8-00007

Figure 2-8. How to use the collector vial with or without the drain bag

NOTE:

• The drain bag is designed to lie flat and should not be

suspended.

• 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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OP 2

Flex arm

How to set up the 840 ventilator

2.3.3 How to install the flex arm

The flex arm supports the patient circuit between the ventilator and the patient. Figure 2-9 shows how to install the flex arm onto one of the two threaded sockets on the ventilator cart.

Threaded

socket

Threaded socket in the cart (one of two)

8-00008

Figure 2-9. How to install the flex arm

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How to set up the 840 ventilator

Caution

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

OP 2

Flex arm replacement parts can be found in the

System Service Manual

840 Ventilator

2.3.4 How to install the humidifier

An electrical outlet for a humidifier is located on the front of the BDU. Figure 2-10 shows how to install a Fisher & Paykel humidifier onto the ventilator.

Warning

• When using a Fisher & Paykel humidifier with the 840 ventilator, 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.

Caution

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

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

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

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How to set up the 840 ventilator

Plug cover

OP 2

BDU

Humidifier

Mounting bracket on front of ventilator

Figure 2-10. How to install the humidifier

(Fisher & Paykel version shown)

8-00009

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OP 2

How to set up the 840 ventilator

2.3.5 How to use the ventilator cart

Figure 2-11 shows how to lock and unlock the cart’s front wheels.

Warning

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, or patient circuit components to push or pull the ventilator.

Press down to lock

Unlocked position Locked position

Press down to unlock

8-00010

Figure 2-11. How to lock and unlock the cart’s front wheels

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HAPTER

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 3-1

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OP 3

Warning

• 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 that 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 that 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

How to run Short Self Test (SST)

NOTE:

Puritan Bennett recognizes that 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 that will meet the internal needs of every health care institution.

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OP 3-2

Page 81

How to run Short Self Test (SST)

Puritan Bennett recommends that you run 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

OP 3

Use SST at any time, provided that a patient is 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 that 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:

attached to the

not

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

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OP 3

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

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

Caution

• To prevent SST failures due to leaks, ensure that 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 that the tubing is properly installed on the collector vial drain port and that 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 10 minutes after you turn on the ventilator before you run SST. The warm up time of 10 minutes will stabilize the ventilator and ensure the accuracy of the SST tests.

3.4 SST Procedure

How to run Short Self Test (SST)

Warning

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

2 Allow the ventilator to stabilize for ten minutes with the

power on.

3 Install the patient circuit, the expiratory and inspiratory filters

that you will use to ventilate the patient.

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OP 3-4

screen.

Page 83

How to run Short Self Test (SST)

Caution

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

OP 3

4At the

Ventilator Startup

touch screen), then press the

screen, touch the SST button (lower

button (on the left side of

TEST

the BDU) within 5 seconds. (Refer to Figure 3-1 for location of

button.)

TEST

The system displays the

SST Setup

screen (lower touch screen).

NOTE:

You must press the TEST button within 5 seconds of touching the SST button or SST will not start.

Test button

Figure 3-1. Test button location

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OP 3-5

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OP 3

How to run Short Self Test (SST)

Caution

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

6Touch the

software option is installed) patient circuit.

HUMIDIFICATION TYPE

key in the lower touch screen, then use the knob to select the humidification type that you will use for patient ventilation.

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

HME

7 Press

to complete your selection of the patient circuit

and humidification types.

Warning

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.

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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

Compliance Calibration

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.

9 As each test is performed, the

results (see Table 3-2).

Warning

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.

OP 3

, and

tests require your intervention. The

ALERT

SST Status

screen shows test

10 You can touch

touch

EXIT SST

again to resume testing, or press

restart the ventilator (if SST has not detected an

FAILURE

during SST to halt testing. You can

ALERT

Warning

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

13 The ventilator reruns

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), touch

EXIT SST

POST

, then press

ALERT

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How to run Short Self Test (SST)

14 The ventilator displays the

with

Ventilator Startup

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 that you will use for the 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

screen. Proceed

key.

Warning

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

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How to run Short Self Test (SST)

Table 3-1: SST test sequence (cont)

Test step Function Comments

NOTE:

HUMIDIFIER VOLUME

The HME.

button is not visible on the touch screen if you select

OP 3

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.

1 Connect the patient circuit

to the inspiratory filter— but without the humidifier.

2 Press

the test.

NOTE:

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.

3 Block the wye with a

No. 1 stopper.

4 Press

If the status of the SST Flow Sensor Test is cannot use the function.

FAILURE

NOTE:

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.

to begin

, you

OVERRIDE

Circuit Pressure Test The system verifies proper

function of the BDU pressure sensors.

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

OVERRIDE

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How to run Short Self Test (SST)

Table 3-1: SST test sequence (cont)

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.

ALERT

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

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

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

from the expiratory filter.

the test.

if the test detects an

ALERT

to begin

, an

ALERT

The system prompts you to reattach the patient circuit.

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OP 3-10

3 Reattach the patient

circuit to the expiratory filter.

4 Press

the next test.

to begin

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How to run Short Self Test (SST)

Table 3-1: SST test sequence (cont)

Test step Function Comments

OP 3

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

If the system reports an for the pressure drop across the two limbs and you override the inaccurate patient pressure estimation can result.

The system reports a 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

2 Press

3 Press ACCEPT to indicate

the test.

No. 1 stopper.

the patient circuit compliance test.

YES

or CLEAR to indicate

, as appropriate, to indicate whether or not there is water in the humidifier.

ALERT

to begin

ALERT

, an

FAILURE

to begin

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How to run Short Self Test (SST)

Table 3-1: SST test sequence (cont)

Test step Function Comments

Compliance Calibration (cont)

3.5 SST Results

The individual SST test results, and the overall SST outcome.

ALERT

You can override an can determine with certainty that the defect in the ventilator or related component cannot create a hazard for the patient, or add to the risks that may arise from other hazards.

ventilator uses four status categories to characterize the

840

The system displays the compliance of the patient circuit.

The system prompts you to unblock the patient wye.

reported for an individual test if you

ALERT

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

ALERT

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

5 Press

, improper

the patient wye.

complete the SST test sequence.

ALERT

FAILURE

NOTE:

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.

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How to run Short Self Test (SST)

FAILURE

OP 3

When the system declares a

FAILURE

for an individual test in the SST sequence, the ventilator enters the SVO state. When a ventilator experiences a

FAILURE

, immediately remove the equipment from clinical use until qualified service personnel have completed and verified the necessary repairs.

OVERRIDDEN

is a final status of the overall SST outcome and indicates that you used the override feature when the system reported an the test with an

PASS

is the final status of the overall SST outcome in which no

PASS

condition. (The ventilator must have ended

ALERT

condition.)

ALERT

alerts or failures were detected.

Refer to Table 3-2 and Table 3-3 to learn how to interpret and respond to each of these SST status categories.

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How to run Short Self Test (SST)

3.5.1 How to interpret individual SST test results

SST reports a test result status for each of the individual tests. Use Table 3-2 to interpret SST test results and to determine how to respond.

Table 3-2: Individual SST test results

If the test status is:

PASSED

ALERT

FAILURE

It means: Do this:

The system did not detect a fault for the

You do not need to do anything, unless you are prompted by the ventilator.

individual test.

The test result is not ideal, but is not

When the system prompts you, touch one of these buttons, then press ACCEPT:

critical. If SST is in progress, it

EXIT SST

halts further testing and prompts you to make a decision.

A critical problem has been detected, and

RESTART SST

REPEAT

Touch one of these buttons, then press

ACCEPT: SST cannot complete until the ventilator

EXIT SST

passes the failed test.

RESTART SST

Discontinue SST

Repeat SST from the beginning

Proceed to the next test

Repeat the test

Discontinue SST

Repeat SST from the beginning

REPEAT

840 Ventilator System Operator’s Manual 4-070088-00 Rev. F (10/06)

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How to run Short Self Test (SST)

3.5.2 SST outcomes

When SST has completed all of the tests, use Table 3-3 to determine how to proceed.

Table 3-3: Overall SST outcomes

OP 3

If the SST outcome is:

PASSED

ALERT

It means: Do this:

All tests passed. Touch one of these buttons, then press

ACCEPT:

Exit SST and begin normal ventilation

Repeat SST from the beginning

Discontinue SST

One or more faults were detected. If you can determine with certainty that this

EXIT SST

RESTART SST

Touch one of these buttons, then press ACCEPT:

EXIT SST

cannot create a hazard for the patient, or add to the risks which may arise from other hazards, you can choose to override the ALERT status and authorize ventilation.

RESTART SST

OVERRIDE

Repeat SST from the beginning

Press ACCEPT to override the ALERT, as allowed by your institution’s protocol. Touch EXIT SST, then press ACCEPT to begin normal ventilation.

FAILURE

One or more critical faults were detected. The ventilator enters the SVO state and cannot be used for

Restart SST with a different patient circuit. Touch one of these buttons, then press ACCEPT:

EXIT SST

Discontinue SST

normal ventilation until SST passes. Service is required.

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RESTART SST

Press ACCEPT to repeat SST from the beginning. If the failure persists, contact qualified service personnel.

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HAPTER

How to use the 840 ventilator

Chapter 4 tells you:

• How the ventilator user interface is structured

• How to start up the ventilator for a new or previous patient

• How to change main settings

• How to change other settings

• How to set the humidification type, expiratory sensitivity, and disconnect sensitivity

• How to enable or disable the oxygen sensor

• How to select and set the variable that remains constant when the breath rate setting is changed

• How to set the alarm limits

• How to perform inspiratory and expiratory pause maneuvers

• How to interpret inspiratory pause maneuver displays

• How to use Non-invasive ventilation (NIV)

NOTE:

DualView

The you touch the screen. To avoid a DEVICE ALERT alarm, do not place any foreign substances or objects on the screen.

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touch screens use light beams to detect where

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4.1 Structure of user interface

The following buttons are available on the upper and lower touch screens. These buttons appear across the bottom portion of each of the two touch screens.

Upper screen

How to use the 840 ventilator

Display More patient graphics

vent setup (vent type, mode, breath types, trigger type, settings)

data (e.g. O2%,

I END

Diagnostic code log (system diagnostic, system information, EST/SST diagnostic logs)

VENT

SETUP

)

Current/proposed apnea setup

Alarm log Active alarms (time, event, urgency, alarm, analysis)

Operational time log (compressor, ventilator hours)

Lower screen

APNEA SETUP

Communication setup (printer/DCI, baud rate, data bits, parity mode)

SST result log

ALARM SETUP

Current/proposed alarm settings

Ventilator configuration (revisions, serial numbers, part numbers, installed options)

Time/date change

Other screens

Test summary (time, date, outcome of SST, EST)

Other screensCurrent/proposed

More settings (humidification type,

sensor enable/

disable, disconnect sensitivity, humidifie volume)

Figure 4-1. Touch screen user interface

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How to use the 840 ventilator

4.2 Patient setup

Warning

Always complete the patient setup before you attach a patient to the ventilator. If you attach a patient before the setup procedure is complete, the ventilator issues a procedure error and initiates the safety ventilation mode.

When you turn on the ventilator, the ventilator automatically runs POST (Power On Self Test). After POST passes, the system displays the screen. The prompt area, located in the lower right corner of the lower screen, contains setup instructions.

Ventilator Startup

OP 4

screen (see Figure 4-2) on the lower

Figure 4-2. Ventilator Startup screen

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How to use the 840 ventilator

4.2.1 How to ventilate with most recent control parameters

To continue ventilation with the most recent ventilator control parameters, touch

Same Patient

and press

. Ventilation does not begin until a patient is connected. A flashing reminder arrow prompts you to consider the previous Tube I.D. and Tube Type if the prior Spontaneous Type used these parameters.

4.2.2 How to ventilate with new control parameters

Refer to Table A-12 in Appendix A for the descriptions, ranges, resolutions, accuracies, and new patient values of the available ventilator control parameters.

1Touch the

New Patient

parameters for patient ventilation.

2Touch the

(ideal body weight) button, then turn the knob

IBW

to adjust the IBW. The proposed value is highlighted.

Warning

Always enter the IBW that is appropriate for the patient. The system uses the patient’s IBW to automatically set certain values, alarm limits, and parameter boundary limits for several initial parameters. (The IBW values that correlate with patient height are listed in Table 4-1 and Table 4-2.)

button to select new ventilator control

3 Touch

the

CONTINUE.

CONTINUE

If you want to return to the

RESTART

button.

4 The system displays the

(You must touch the

button will display.)

Ventilator Startup

New Patient Settings

button first before

IBW

screen, touch the

screen with the following buttons, and uses the rotary knob or drop-down menus to display the available selections.

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OP 4

Vent Type

•

INVASIVE

Determines the ventilation type

— conventional ventilation using either

endotracheal (ET) or tracheostomy (trach) tubes

•

non-invasive

NIV (

ventilation using full-face masks,

) —

nasal masks, infant nasal prongs, or uncuffed ET tubes (see Section 4.12 for specific information on how to use NIV)

Determines the type and sequence of breath delivery

Mode

•

(Assist/Control)

A/C

•

(Synchronous Intermittent Mandatory Ventilation)

SIMV

SPONT

BILEVEL

(Spontaneous)

(available only with

BiLevel

software option

when Vent Type is INVASIVE)

Mandatory Type:

Determines the type of mandatory breath

control

•

(Pressure Control)

•

(Volume Control)

• VC+ (Volume Control Plus available only with

Ventilation Plus (VV+

) software option when

Volume

Vent Type

INVASIVE)

(If the selected

Mode

SPONT

, the

Mandatory Type

applies to

manual inspirations only.)

Determines type of support for

Spontaneous Type

spontaneous breaths

•

(Pressure Support)

•

(Tube Compensation available only with

software

option when Vent Type is INVASIVE)

•

(Volume Support available only with

VV+

software

option when Vent Type is INVASIVE)

•

(Proportional Assist available only with

PAV+

software option when Vent Type is INVASIVE)

•

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NONE

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(If the selected

Mode

A/C,

the

Spontaneous Type

button

does not appear.)

Determines the method used to detect patient

Trigger Type

inspiratory effort

•

•V-

(Pressure) (not available when Vent Type is NIV or

TRIG

when using the

(Flow)

TRIG

NeoMode

option)

Touch the button and turn the knob to adjust the desired settings. When you complete your settings changes, touch

CONTINUE

5The final

New Patient Settings

screen appears. Touch the button of each parameter you want to change, then turn the knob to select its value. To cancel this change, press the cancel all changes and start over, touch the

CLEAR

RESTART

NOTE:

The ventilator control parameter you are setting may be dependent upon other ventilator settings that determine its boundaries. Refer to the prompt area on the lower GUI screen (Figure 1-2) for more information.

6 Press

to put all of your ventilation control settings into effect. Normal ventilation begins once a patient is connected.

7The

Apnea Setup

screen appears. Apnea settings are automatically determined based on IBW, circuit type, and mandatory breath type, but you can change them. If you change any apnea settings, press

to apply.

Although you are not required to change or confirm apnea settings, you should verify that they are appropriate for the patient prior to ventilation.

8 Press the

ALARM SETUP

limit settings on the

button to review the current alarm

Alarm Settings

screen. Ensure that they are appropriate for the patient. To change any limit, touch the button and turn the knob. To cancel, touch

ALARM

. To apply the settings, press the

PROPOSED

key.

key. To

button.

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OP 4-6