Zimmer A.T.S. 2000 User manual
Operator
& Service Manual
A.T.S.™ 2000
TOURNIQUET SYSTEM
REF 60-2000-101-00
LIMITED ONE YEAR WARRANTY (U.S.A. only)
SCOPE OF WARRANTY
Zimmer, Inc. warrants the Product (A.T.S.™ 2000 Tourniquet System) for one year from date of purchase. During the warranty period, Zimmer will repair or replace, at its option, any product which is defective in materials or workmanship or
which fails to meet the published specification for that model. This Limited Warranty is made only to the original purchaser
of the product and is non-transferable. The remedies described in the Limited Warranty are the exclusive remedies for
breach of warranty. THIS WARRANTY SHALL NOT APPLY TO ANY PRODUCT WHICH HAS BEEN ALTERED OR
MODIFIED IN ANY WAY, OR WHICH HAS BEEN SUBJECTED TO MISUSE OR ABUSE.
DISCLAIMER OF IMPLIED WARRANTIES
The foregoing Express Limited Warranty is given in lieu of any and all other express or implied warranties. ZIMMER
MAKES NO OTHER WARRANTIES INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS
FOR A PARTICULAR PURPOSE.
LIMITATION OF REMEDIES
In no case shall Zimmer, Inc. be liable for any special incidental or consequential damages whether based on breach of
warranty or other legal theory. Some states do not allow limitations on warranties or on remedies for breach in certain
transactions. In such states, the limits in this paragraph and the preceding paragraph do not apply.
WARRANTY CLAIMS
In the event of a warranty claim within the warranty period please take the following steps:
1. Notify Customer Service Department, Zimmer Orthopaedic Surgical Products at 800-348-2759 or contact your local
Zimmer representative. Please provide details about the nature of the problem and include the product serial number.
Upon receipt of this information, Zimmer will provide a date for service or a return shipping authorization.
2. Upon receipt of the shipping authorization, forward the equipment, freight prepaid, to the location specified in the shipping authorization.
Your compliance with these steps will help assure that you receive prompt warranty service for your product.
WARRANTY (OUTSIDE U.S.A.)
Please contact your local Zimmer Representative for warranty information.
Unit Serial Number ________________
TABLE OF CONTENTS
A.T.S. 2000 TOURNIQUET SYSTEM
SECTION TITLE PAGE
1.0 GENERAL INFORMATION
1.1 Features .....................................................................................3
1.2 Specifications .............................................................................3
1.3 Intended Use ............................................................................4
1.4 Contraindications ......................................................................4
1.5 Precautions in Use .....................................................................4
1.6 Adverse Effects ..........................................................................5
2.0 INSTALLATION AND OPERATING INSTRUCTIONS
2.1 Initial Inspection .........................................................................5
2.2 Functional and Calibration Check ............................................. 5
2.3 Installation ..................................................................................6
2.3.1 Pressure and Time Default Selections ...................................... 6
2.3.2 Volume Selection ...................................................................... 7
2.4 Controls, Indicators, and Connectors ........................................7
2.5 Single Cuff Operation ...............................................................8
2.6 Dual Cuff Operation ..................................................................9
2.7 Bier Block Cuff Operation, (IVRA) .............................................9
2.8 Alarm Conditions ......................................................................9
2.8.1 Pressure Alarms .......................................................................9
3.0 MAINTENANCE
3.1 General Maintenance Information ...........................................12
3.2 General Theory of Operation ..................................................12
3.3 Access to Parts ....................................................................... 12
3.4 Periodic Maintenance .............................................................12
3.4.1 Cleaning ..................................................................................12
3.4.2 Inspection ...............................................................................12
3.4.3 Functional and Calibration Checks .........................................12
3.4.4 Calibration ...............................................................................13
3.4.5 Leak Testing ............................................................................ 13
3.4.6 Battery Voltage and Battery Service .......................................14
3.5 Unscheduled Maintenance ..................................................... 14
3.6 Expected Test Point Readings ................................................ 14
1
SECTION TITLE PAGE
3.7 Troubleshooting Guide ............................................................14
3.8 Replacement Parts .................................................................. 18
3.9 Storage ................................................................................... 20
FIGURE TITLE PAGE
1 Main and Second Calibration Setup Assembly ........................21
2 Controls, Indicators & Connectors ..........................................22
3 Block Diagram .........................................................................23
4–7 Removing Chassis From Rear Case .......................................24
8–10 Separating Chassis .................................................................25
11 CPU Board ...............................................................................26
12 Power Supply Board ............................................................... 27
13 CPU Schematic Sheet 1 of 3 ................................... ENCLOSED
14 CPU Schematic Sheet 2 of 3 .................................. ENCLOSED
15 CPU Schematic Sheet 3 of 3 .................................. ENCLOSED
16 Power Supply Schematic ........................................ ENCLOSED
17 Warnings, Cautions, and Symbol Definitions .....................28, 29
TABLE TITLE PAGE
2.1 Alarm Conditions ....................................................................10
2.2 Hardware Malfunction Codes .................................................11
3.1 Expected Test Point Readings ................................................ 15
3.2 Troubleshooting ......................................................................16
2
ENGLISH
SECTION 1.0
A.T.S. 2000 TOURNIQUET SYSTEM*
GENERAL INFORMATION
*U.S. Patents B1 4,469,099; 4,548,198; 5,556,415; 5,607,447; 5,855,589
1.1 FEATURES
The A.T.S. 2000 Tourniquet System is an automatic, micro-
processor-based pneumatic tourniquet system. Its features
include:
• The ability to independently control and monitor two
cuffs in a Bier Block or bilateral procedure.
• Microprocessor control for improved reliability and to
help prevent loss of occlusion during Bier Block cuff
switching.
• Dual line tubing and dual port cuffs to facilitate monitoring of cuff pressure from one line as well as supplying
air to pressurize the cuff via the other.
• A built-in battery charger.
• Precision pressure transducers in conjunction with a
microprocessor-based control system.
• Time and pressure defaults that can be customized to
fit user preference.
• Built-in inflation time alarm system to alert the operating room staff when the anticipated cuff inflation time
has been reached. This system also provides a convenient means to monitor and record total inflation time.
• Large, bright LED displays for easy viewing from
a distance.
• High output pump for increased inflation rate.
• Internal reservoir for increased inflation rate.
• Self-testing of alarm tones, displays, system calibration,
and certain portions of the hardware and software each
time the unit is turned on. In addition, some self-testing
occurs continuously during normal operation.
• Multiple audible and visual alarms to alert the user
of abnormal conditions: detects pressure not within
acceptable limits, time alarm, low battery voltage,
hardware failure. For certain types of equipment malfunctions, the unit will also display error messages for
certain equipment malfunctions that identify the cause
of error, thus reducing fault isolation time.
• Easily accessible Quick Reference Cards containing
general use instructions and help codes.
• Alarm silence switch permits silencing of most alarm
tones for 30 seconds.
• Adjustable alarm volume (medium to high tone).
• Simple calibration that may be performed without disassembly.
• Modular construction for easy maintenance and repair.
• Portable and designed for tabletop or tourniquet stand
mounting.
1.2 SPECIFICATIONS
Line Voltage Range:
90–240 V~, 50/60 Hz, auto switching
Line Current:
670 mA RMS @ 120 V~
Input Power:
53 Watts Typical
AC Indicator Light:
Green LED
Battery Type:
2 Rechargeable, 12 V sealed lead acid, 2.3 Amp hours
Battery Discharge Time:
Unit will operate on battery power for 60 minutes minimum
with fully charged batteries.
Battery Recharge Time:
24 hours (Maximum)
Unit should be plugged in 24 hours before initial use.
Power Cord:
Type SJT, AWG 16, 14 ft. (4.27 m)
Power Plug:
Hospital grade, 3 prong straight blade, 15 Amp
Line Protection:
2 time delayed 1.0 Amp 250 volt fuses
Cuff Pressure Range:
50–475 mm Hg
Pressure Accuracy:
±3 mm Hg (50–475 mm Hg)
Pressure Regulation:
±4 mm Hg of set point
(10 second average under non-transient conditions without
external leaks)
Maximum Pressures:
475 mm Hg cuffs
700 mm Hg reservoir
Time Alarm Set Ranges:
0–240 minutes; 1 minute increments
Timer Accuracy:
0.25% ±1 second
Internal Diagnostics:
Program, memory, watchdog timer, transducer calibration,
improper valve actuation.
SIZE:
Height:
12.75 in. (32.4 cm)
Width:
10 in. (25.4 cm)
Depth:
10.5 in. (26.7 cm) (including clamp)
Weight:
19.8 lbs (9 kg)
3
CONTROLS:
On/Standby Switch:
Applies power to unit / sets unit to STANDBY
Pressure Touch-Switches:
Increase or decrease pressure set points.
Time Touch-Switches:
Increase or decrease the time alarm set points.
Cuff Touch-Switches:
Control inflation or deflation of the main cuff and/or second cuff.
Alarm Silence Switch:
Allows operator to manually silence certain alarms for
30 seconds.
DISPLAYS:
Pressure:
Red 14 segment light emitting diodes (LED)
Time:
Red 14 segment light emitting diodes (LED)
AC Indicator Light:
Green LED
UL 60601-1 Classification:
Class I and Internally Powered, Type B, continuous operation. Use ordinary protection against ingression of liquids.
Not for use with flammable anesthetic or gases.
The A.T.S. 2000 Tourniquet System complies with EMC
criteria set forth in IEC 60601-1-2.
1.3 INTENDED USE
The A.T.S. 2000 Tourniquet System is intended to be used
by qualified medical professionals to temporarily occlude
blood flow in a patient’s extremities during surgical procedures on those extremities. Tourniquets have been found
useful in producing a bloodless operation field in surgical
procedures involving the extremities including:
• Reduction of certain fractures
• Kirschner wire removal
• Tumor and cyst excisions
• Subcutaneous fasciotomy
• Nerve injuries
• Tendon repair
• Bone grafts
• Total wrist joint replacement
• Replacement of joints of the fingers
• Knee joint replacements
• Amputations
• Replantations
WARNING: Do not use tourniquet cuffs to control the distal
flow of CO2 or any other gases used as distention media.
Tourniquet cuffs have not been evaluated for safety or effectiveness in controlling gas flow beyond the surgical site
during arthroscopic insufflation procedures. Possible effects
of using a tourniquet cuff in this manner include serious
subcutaneous emphysema proximal to the cuff.
1.4 CONTRAINDICATIONS
The medical literature lists the following as possible contraindications. However, in every case, the final decision
whether to use a tourniquet rests with the attending physician.
• Open fractures of the leg
• Post-traumatic lengthy hand reconstruction
• Severe crushing injuries
• Elbow surgery (where there is concomitant excess
swelling)
• Severe hypertension
• Skin grafts in which all bleeding points must be readily
distinguished
• Compromised vascular circulation, e.g., peripheral
artery disease
• Diabetes mellitus
• The presence of sickle cell disease is a relative contraindication. (See PRECAUTIONS IN USE.)
A tourniquet should also be avoided in patients who are
undergoing secondary or delayed procedures after immobilization.
1.5 PRECAUTIONS IN USE
• The tourniquet system must be kept well calibrated and
in operable condition. Accessories should be checked
regularly for leaks and other defects.
• The tourniquet cuff should never be punctured. There-
fore, towel clips used near the system must be handled
with special care. Cuffs with inner rubber bladders
must be completely enclosed by the outer envelope to
preclude ballooning and possible rupture of the bladder.
Cleaning and assembly instructions of the cuff manufacturer should be followed carefully.
• Do not use an elastic bandage for exsanguination in
cases where this will cause bacteria, exotoxins, or malignant cells to spread to the general circulation, or
where it could dislodge thromboemboli that may have
formed in the vessels.
• The tourniquet cuff must be applied in the proper location on the limb, for a “safe” period of time, and within
an appropriate pressure range. Never apply a tourniquet over the area of the peroneal nerve or over the
knee or ankle. Do not readjust an already inflated cuff
by rotating it because this produces shearing forces
which may damage the underlying tissue.
• Prolonged ischemia may lead to temporary or permanent damage to tissues, blood vessels, and nerves.
Tourniquet paralysis may result from excessive pressure. Insufficient pressure may result in passive congestion of the limb with possible irreversible functional
loss. Prolonged tourniquet time can also produce
changes in the coagulability of the blood with increased
clotting time.
• Inflation should be done rapidly to occlude arteries and
veins as near simultaneously as possible.
• Careful and complete exsanguination reportedly prolongs pain free tourniquet time and improves the quality
of IVRA (Bier Block anesthesia). In the presence of infection and painful fractures, after the patient has been
in a cast, and in amputations because of malignant
tumors, exsanguination before tourniquet application
may be done without the use of an elastic bandage by
elevating the limb for 3 to 5 minutes.
4
• In case of failure, the tourniquet cuff must be fully deflated and the limb exsanguinated again before reinflation. Reinflation over blood-filled vasculature may lead
to intravascular thrombosis.
• Tourniquet users must be familiar with the inflation-
deflation sequence when using a dual-cuff tourniquet,
or two tourniquet cuffs together for IVRA (Bier Block
anesthesia), so that the wrong tourniquet will not be
released accidentally.
• Test for hemoglobin type and level before using a
tourniquet on patients with sickle-cell anemia. When the
tourniquet is used for these patients, the limb should be
carefully exsanguinated and the PO2 and pH should be
closely monitored.
• Select the proper cuff size to allow for an overlap of
about 3 to 6 inches (7.6 to 15.2 cm). Too much overlap
may cause cuff rolling and telescoping, and may lead
to undesired pressure distribution on the limb. The
skin under the tourniquet cuff must be protected from
mechanical injury by smooth, wrinkle-free application
of the cuff. If the tourniquet cuff is applied over any
material that may shed loose fibers (such as Webril) the
fibers may become embedded in the contact closures
and reduce their effectiveness. As an under padding, a
section of stockinette may be used. The deflated cuff
and any underlying bandages should be completely removed as soon as tourniquet pressure
is released. After the cuff has been fully deflated
and removed from the patient, the unit can be set
to STANDBY. Even the slightest impedance of venous
return may lead to congestion and pooling of blood in
the operative field.
• If skin preparations are used preoperatively, they
should not be allowed to flow and collect under the cuff
where they may cause chemical burns.
• Whenever the tourniquet cuff pressure is released, the
wound should be protected from blood surging back by
applying pressure dressings and, if necessary, elevating the limb. Transient pain upon tourniquet pressure
release can be lessened by elevation of the limb. If
full color does not return within 3 to 4 minutes after
release, the limb should be placed in a position slightly
below body level.
• Whenever Intravenous Regional Anesthesia (IVRA, a
Bier Block anesthesia) is used, it is recommended that
the tourniquet remain inflated for at least 20 minutes
from the time of injection.
1.6 ADVERSE EFFECTS
A dull aching pain (tourniquet pain) may develop throughout the limb
following use.
Pathophysiologic changes due to pressure, hypoxia, hypercarbia,
and acidosis of the tissues occur and become significant after about
1 1/2 hours of tourniquet use. Symptoms of tourniquet paralysis are
motor paralysis and loss of sense of touch, pressure, and proprioceptive responses.
Intraoperative bleeding may be caused:
1. By the slight impeding effect exerted by an unpressurized cuff
(and its padding, if used), which prevents venous return at the
beginning of the operation.
2. By blood remaining in the limb because of insufficient exsanguination.
3. By inadequate tourniquet pressure (between systolic and
diastolic blood pressure of the patient), or slow inflation and deflation, all of which allow arterial blood to enter while preventing
venous return.
4. By blood entering through the nutrient vessels of the long
bones, such as the humerus.
SECTION 2.0
A.T.S. 2000 TOURNIQUET SYSTEM
INSTALLATION & OPERATING
INSTRUCTIONS
2.1 INITIAL INSPECTION
Unpack the A.T.S. 2000 Tourniquet upon receipt and
inspect the unit for any obvious damage that may have occurred during shipment. We recommend that this inspection
be performed by a qualified biomedical engineer or other
person thoroughly familiar with electronic medical devices.
If the unit is damaged, notify the carrier and your Zimmer
representative immediately. If the initial inspection results
are satisfactory, a functional and calibration check should
be performed.
2.2 FUNCTIONAL AND CALIBRATION CHECK
The unit shall produce the results explained in the following steps, exactly as indicated. Failure to do so indicates
that the device is not to be used until necessary repairs are
made.
1. Connect the power plug to the power entry module on
the back of the unit, then plug the unit into a source of
power compatible with the unit’s power rating.
a) Observe that the ~ (AC) indicator is on.
b) Unit should be connected to A/C power 24
hours before initial use.
2. Turn the unit on by pressing the ON/STANDBY (I/O)
touch-switch and observe the following:
a) A series of zeros and asterisks appear on the
PRESSURE and TIME displays;
b) The unit emits three tones; high, medium, low;
c) The word “SELF” appears in the main PRESSURE
display and the word “TEST” appears in the main
TIME display;
d) The word “VER” appears in the second PRES-
SURE display and the software version number
appears in the second TIME display;
e) The Alarm Silence Switch illuminates;
f ) The word “CAL” appears in both PRESSURE dis-
plays;
g) The PRESSURE and TIME displays all read zeros.
3. Test the PRESSURE set point system as follows:
a) Press and hold the main PRESSURE INCREASE
(+) or DECREASE (–) touch-switch;
b) The PRESSURE display reads “*250”, the default
pressure set point, for approximately 1.5 seconds;
c) The main PRESSURE display increases (or de-
creases) by units of one until reaching a multiple of
5. Then the main PRESSURE display increases (or
decreases) by units of 5 to a maximum of 475 (or a
minimum of 0), thus altering the pressure set point;
d) Releasing the touch-switch causes the sensed
pressure of “0” to be displayed;
e) Once again, press the main PRESSURE IN-
CREASE (or DECREASE) touch-switch; the main
PRESSURE display should read the last setting
from step c (above);
f) Release the main PRESSURE touch-switch;
g) Repeat steps a through f above for the second
PRESSURE display functional check.
5
b) The main TIME display reads “*60”, the default
pressure set point, for approximately 1.5 seconds;
c) The main TIME display increases (or decreases)
by units of one until reaching a multiple of 5. Then
the main TIME display increases (or decreases) by
units of 5 to a maximum of 240 (or a minimum of
0), thus altering the time set point;
d) Release the touch-switch. This should cause the
actual time of “0” to be displayed;
e) Once again, press the main TIME INCREASE (or
DECREASE) touch-switch; the main TIME display
should read the last setting from step c (above);
f) Release the main TIME touch-switch;
g) Repeat steps a through f above for the second
TIME display functional check.
Notes for steps 3 & 4:
1. Anytime an asterisk (*) is displayed in the left dis-
play digit, the data being displayed is its set point.
2. The default factory set point for pressure is 250 mm
Hg.
3. The default factory set point for time is 60 minutes.
5. Calibration Check
Note: During the power-up diagnostic self-test described
above, the unit, which must hold a tolerance of ± 3 mm Hg,
will test calibration. Should an out of calibration condition
be detected, the unit will display “AMP” “FAIL” in the PRESSURE and TIME displays. Even though the unit completes
this check during power-up, the following quantitative check
is recommended at regular intervals.
a) Set the unit to STANDBY by pressing and holding
the ON/STANDBY (I/O) touch-switch. Note that the
unit will not be set to STANDBY immediately. The
ON/STANDBY touch-switch has a 2-second delay
built in to help prevent accidental turn off.
b) Wait approximately 10 seconds, then turn the unit
back on by pressing the ON/STANDBY (I/O) touch-
switch. Press and hold the second PRESSURE
(+) and (–) touch-switches until “CUFF” “CAL” is
displayed.
c) Connect a calibrated pressure meter, with a mini-
mum range of 0 to 700 mm Hg, to the Calibration
Hose Assembly. See Fig. 1.
d) Connect a pressure source capable of supplying
(at minimum) 700 mm Hg of pressure. See Fig. 1.
e) Insert the second cuff line with connector into the
Second Cuff sense port. See Fig. 1.
f) Insert the main cuff line with connector into the
Main Cuff sense port. See Fig. 1.
g) Apply 50 mm Hg of pressure to the cuff sense
ports. The displays should each read 50 ±3 mm Hg.
h) Increase the pressure to 250 mm Hg. Again, the
displays should each read 250 ±3 mm Hg.
i) Repeat step h (above) for 475 mm Hg.
j) Remove the main and second cuff line from the cuff
sense ports.
k) Press and hold the second PRESSURE (+) and
(–) touch-switches until “RES” is displayed in the
second PRESSURE display. The main PRESSURE
display should be reading 0 ±3 mm Hg.
l) Insert the main cuff line with connector and second
cuff line with connector into the reservoir sense
ports. See Fig. 1.
m) Apply 250 mm Hg of pressure to the reservoir
sense ports. The display should read 250 ±3 mm
Hg.
n) Repeat step m for 475 mm Hg and 700 mm Hg.
o) Remove pressure as well as the main and second
cuff line with connectors from the unit.
p) Set the unit to STANDBY by pressing and holding
the ON/STANDBY (I/O) touch-switch.
NOTE: During the calibration check, if any reading is off
by more than 3 mm Hg, the unit must be calibrated. See
CALIBRATION in MAINTENANCE Section 3.
6. Under Pressure Alarm Check
Create a leak in the main cuff while it is inflated. Make the
leak large enough that even though the unit will be attempting to maintain pressure, the pressure still falls more than
15 mm Hg below set point. Observe:
a) The Main PRESSURE display window indicates
low pressure by “LO-P”.
b) The Alarm Silence Switch illuminates.
c) After approximately 1 second, an audible tone will
sound announcing the low pressure condition. This
delay is used to preclude nuisance alarms.
d) Stop the leak and observe that the pressure re-
turns to within limits, the audible tone ends, and the
Alarm Silence Switch light extinguishes.
Repeat the above procedures for the second cuff.
2.3 INSTALLATION
The A.T.S. 2000 Tourniquet is designed to be mounted on
a table top or tourniquet stand (REF 60-4022-001). The
adjustment range of the pole clamp on the right side of the
unit will accommodate pole diameters of 0.5 to 1.5 inches
(1.25 to 3.8 cm). Caution: Do not hang articles on the tourniquet stand which are not related to tourniquet use.
Inspect and ensure that the correct fuse drawer with appropriately rated fuses is present. 100–120 V uses the grey
fuse drawer with 1.0 A time delay fuses. 220–240 V uses
the black fuse drawer with 500 mA time delay fuses.
Connect the power cord of the unit to a properly polarized
and grounded power source whose voltage and frequency
characteristics are compatible with those listed on the
nameplate of the unit.
The A.T.S. 2000 Tourniquet is now ready for use.
2.3.1 PRESSURE AND TIME DEFAULT
SELECTIONS
An operator may want to modify the start up default pressure of 250 mm Hg and the default time of 60 minutes for
one or both cuffs.
The following steps will allow a user to customize the default settings for both cuffs.
1. Prior to any cuff inflation, set the cuff target pres-
sure and the maximum inflation time to the new
desired default values.
2. Press the main cuff PRESSURE (+) and (–) touch-
switches simultaneously and hold until an audible
tone is sounded, indicating that the new default
values have been stored. The display should also
read “UP” “DATE”.
The new pressure and time defaults will be written to nonvolatile storage and will provide the default pressure and
6
2.3.2 VOLUME SELECTION
An operator may want to change the speaker volume setting from the default value of 2.
The following steps will allow a user to customize the
speaker volume default.
1. Prior to any cuff inflation, set the speaker volume
by pressing and holding the second cuff PRESSURE (+) and (–) touch-switches simultaneously.
Hold until “VOL” is displayed in the second cuff
PRESSURE display.
2. Adjust the volume to the desired level by pressing
the second cuff TIME (+) or (–) touch-switches.
The (+) increases volume while the (–) decreases
volume. The volume can be set from 1 to 4, with 1
being the lowest volume.
3. Exit the volume mode by pressing the second cuff
PRESSURE (+) and (–) touch-switches simultaneously. The new speaker volume setting will be written to nonvolatile storage and used as the default
setting.
2.4 CONTROLS, INDICATORS, AND CONNECTORS
Refer to Fig. 2 for the locations of the unit’s controls, indicators, and connectors. Their primary functions are:
1. ON/STANDBY (I/O) touch-switch
Turns the unit on or sets the unit to STANDBY. This
switch has approximately a 2-second time delay.
When setting the unit to STANDBY, this switch must
be held in for the 2-second duration. This helps prevent the unit from being accidentally set to STANDBY.
This switch will not set the unit to STANDBY when the
cuff pressure is at a non-zero value. Ensure cuffs
are fully deflated and have been removed from
the patient prior to setting the unit to STANDBY.
Note: During STANDBY, power to the A.T.S. 2000 instrument and all instrument functions (i.e. inflation,
deflation, etc) are off but power continues to supply
the battery charging circuitry anytime
~ (AC) power is present.
2. PRESSURE SETTING Touch-Switches
a) The MAIN CUFF controls, indicators and connec-
tors operate the main cuff. The SECOND CUFF
controls, indicators and connectors operate the
second cuff. To view the current pressure setting,
depress either pressure setting touch-switch (+) or
(–). The PRESSURE display will display the pressure setting with an asterisk (*) in the far leftmost
digit. The asterisk helps the operator identify that
the data displayed is the set point data, not the actual sensed pressure. This is helpful when needing
to view the set point data during a procedure.
b) To change the pressure setting, depress and hold
the increase (+) or decrease (–) touch-switch
until the desired setting is reached. The setting
will change in 1 mm Hg increments for the first
5 counts or until reaching a multiple of 5, then in
increments of 5 until the touch-switch is released or
the limits (0 and 475) are reached.
3. TIME SETTING Touch-Switches
a) To view the current time setting, depress either time
setting touch-switch (+) or (–). The TIME display
will display the time setting with an asterisk in the
far left digit. The asterisk helps the operator identify
that the data being displayed is the set point data,
not the actual elapsed time. This is helpful when
viewing the setpoint data during a procedure.
b) To change the time setting, depress and hold the
increase (+) or decrease (–) touch-switch until the
desired setting is reached. The setting will change
in 1 minute increments for the first 5 counts or until
reaching a multiple of 5, then in increments of 5 until the touch-switch is released, or the limits (0 and
240) are reached.
c) The accumulated inflation time may be reset to
zero by depressing the TIME increase (+) and decrease (-) touch-switches simultaneously for 2-seconds. This enables the unit to be used for multiple
procedures at the same pressure setting without
setting the unit to STANDBY (and thus erasing the
selected pressure set point if other than the default
is used.)
4. INFLATE/DEFLATE Touch-Switches
Inflation or deflation of the cuff(s) is accomplished by
depressing the appropriate touch-switch. For greater
safety, the deflate touch-switch has a delay and, therefore, must be held for 1.5 seconds before the unit will
allow a cuff to deflate.
Note: It is not possible to deflate one cuff while the
other cuff is inflating.
5. ALARM SILENCE SWITCH
This push-button switch will light when any of a number
of alarm conditions exist. The audible tone associated with most of these alarms may be silenced for 30
seconds by depressing this switch. The push-button will
remain lighted until the alarm condition is corrected.
Note: In general, when an alarm sounds because of an
internal circuit malfunction, the tone cannot be silenced
by this switch.
6. PRESSURE DISPLAYS
During normal operation with no touch-switches being
depressed, the displays will show the pressure sensed
in the cuff(s) over the range of 0 to 475 mm Hg. At
other times, depending on alarm conditions and touchswitches, these displays may communicate other information such as alarm messages or pressure set point.
The pressure set point may be viewed on the displays
when the PRESSURE SETTING touch-switches are
operated in accordance with point 2 above.
7. TIME DISPLAYS
During normal operation, with no touch-switches being
depressed, the displays will show the inflation time of
the cuff(s) in 1-minute increments, up to a maximum of
240 minutes. At other times, depending on alarm conditions and touch-switches, these displays may communicate other information such as alarm messages
or time set point. The time set point may be viewed on
the displays when the TIME SETTING touch-switches
are operated in accordance with point 3 above. If the
inflation time has exceeded the time alarm setting, the
display will flash between inflation time and “TIME” “UP”
message.
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8. AC INDICATOR LIGHT
Identifies that the unit is plugged into an ~ (AC) power
source. The unit is operating on battery if this light is
not illuminated.
9. QUICK REFERENCE CARDS
Pull-out cards that contain general use instructions and
help codes.
10. CUFF CONNECTORS
Ports to connect hoses to cuff(s).
11. POLE CLAMP
Adjustable clamp to mount the unit on a tourniquet
stand.
2.5 SINGLE CUFF OPERATION
1. Connect the power cord to an electrical power
source that is compatible with the ratings listed on
the nameplate of the unit.
2. Connect a dual port cuff to the unit at the main cuff
connectors.
3. Press the ON/STANDBY touch-switch to turn the
unit on. The unit will execute a self-check diagnostic test as described in Section 2.2 of this manual.
Successful completion of the self-check indicates
the unit is ready for use.
CAUTION: If either cuff is pressurized to 50 mm Hg
or more during power-up, the A.T.S. 2000 Tourni-
quet will declare it an abnormal start-up sequence.
It will assume that a surgical procedure is in process, and will adopt pressures sensed in each cuff
as the new set point. It will automatically go into the
regulate mode on the cuff(s) which had the excess
pressure. To alert the operator of this condition, the
unit will sound a high pitch tone and illuminate the
Alarm Silence Switch Light. The operator should
immediately check the pressure set point and readjust to the proper set point if necessary. The alarm
will be cleared as soon as the set point is examined.
4. The default settings for cuff pressure and time are
retrieved from the nonvolatile storage during power
up. These values may be changed prior to cuff
inflation by following Section 2.4 step 2b.
For each patient, tourniquet pressure should be set
to the minimum effective pressure. The minimum
effective pressure should be determined by factors such as: whether the cuff is to be applied to
an upper or lower limb; whether the limb is normal,
hypertrophied, or obese; the patient’s preoperative
systolic pressure; and the maximum anticipated
rise in systolic pressure during the procedure.
5. Prepare the patient in accordance with your established procedures and cuff manufacturer’s instructions. The precautions of Section 1 and the following are offered as a guide to assist in
this process.
In most cases a tourniquet cuff should be applied
to the widest part of the limb to allow as much
tissue as possible to lie between the cuff and any
nerves or vascular structures susceptible to damage. The optimum positions are the upper arm and
the proximal third of the thigh. In certain cases of
forefoot surgery, the tourniquet cuff can be applied
around the calf or to the area proximal to the malleoli. For emergency surgery of the hand, a suf-
ficiently small tourniquet can be fitted around the
wrist.
Apply a leak-free tourniquet cuff smoothly without
wrinkles. The valve port and hose connections
should be placed so that the hose will not be
kinked when the limb is positioned for surgery. The
limb is then prepared and draped for surgery. The
viability of the skin and deeper tissues should be
established prior to exsanguination of the limb and
tourniquet inflation.
Exsanguinate the limb by elevating it for a minimum
of 2 minutes and wrapping it, distal to proximal,
using an Esmarch, Martin, or elastic bandage. The
bandage should come up approximately to 1 in.
(2.5 cm) from the edge of the tourniquet cuff. The
elastic bandage is removed following inflation of the
cuff. If regional anesthesia is being used, the anesthetic agent or nerve block is then administered.
The tourniquet time depends greatly on the
patient’s anatomy, age, and absence of vascular
disease. The surgeon will determine: 1. when the
tourniquet is to be inflated; 2. to what pressure; 3.
for how long; 4. whether to allow for intermittent
aeration of tissues by deflating the cuff for 10 to
15 minutes; 5. at what point in the operation the
tourniquet should be released. In many operating
rooms, it is customary to prominently note the time
of inflation, and to warn the surgeon after a certain
time has elapsed. This will allow the surgeon to assess the need for further tourniquet time.
There is a general agreement that, for reasonably
healthy adults, about 1 1/2 hours is safe and 2
hours should not be exceeded without releasing the
tourniquet to allow the underlying tissue to breathe.
During this time, the limb should be elevated about
60 degrees, and steady pressure should be applied
to the incision with sterile dressing.
Under optimum conditions, the tourniquet cuff can
be kept inflated until the final compression dressings are in place. Postoperative swelling is then
kept to a minimum.
6. The cuff is inflated by pressing the MAIN CUFF
INFLATE touch-switch. The unit will pressurize the
main cuff to the preset pressure and start the inflation clock. If the unit cannot pressurize the
cuff to within 15 mm Hg of the set point in less then
30 seconds, a pressure alarm will be sounded. See
Section 2.8 for information about possible alarm
conditions.
7. At the end of the procedure, deflate the cuff by
pressing the MAIN CUFF DEFLATE touch-switch.
The PRESSURE display will show the deflation of
the cuff, and the inflation clock will stop. Record the
elapsed time if desired.
8. Remove the tourniquet cuff and any underlying
bandages immediately following final deflation.
The time of tourniquet cuff removal should be noted, and circulation of the limb should be checked.
9. The time clock display(s) may be reset to zero without turning the unit off. This would enable the unit to
be used for multiple procedures without turning the
unit off (and thus erasing the selected pressure set
point if other than the default is used). see Section
2.4 step 3c.
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