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
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)
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
• 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.
7
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.
8
10. Set the unit to STANDBY by pressing and holding
the ON/STANDBY touch-switch. This switch has
approximately a 2-second delay before allowing
the unit to be set to STANDBY. You must hold the
switch in for the 2-seconds before the unit will be
set to STANDBY.
2.6 DUAL CUFF OPERATION
Operation of the unit is identical to single cuff operation
(see Section 2.5) except for the following points:
1. Both dual port cuffs are connected at the bottom of
the unit.
2. Deflation of one cuff will not be permitted while the
other is inflating.
3. When inflating a second cuff with the other cuff
already inflated, the unit will continuously check the
original cuff to ensure that the pressure is within
allowable limits. The unit will stop its inflation and
maintain the original cuff to within 10 mm Hg of the
set point before returning to the inflating cuff. This
ensures that at least one cuff maintains occlusion
at all times. If there is a significant leak in the original cuff, this feature could cause the inflation rate of
the subsequent cuff to be longer and perhaps even
cause the 30-second inflation alarm to sound.
4. At the end of the procedure one cuff, either the
MAIN or SECOND CUFF, may be deflated by
pressing the appropriate deflate touch-switch without the Bier Block Safety Lock Out feature interrupting. When attempting to deflate the other cuff, an
alarm code “CUFF” “DEFL” will appear. Release the
deflate touch-switch and within 5 seconds of the
alarm discontinuing, press the deflate touch-switch
again. Immediately upon cuff deflation, the cuff
should be removed from the patient. After the
cuff has been fully deflated and removed from
the patient, the unit can be set to STANDBY.
2.7 BIER BLOCK CUFF OPERATION, (IVRA)
Review Sections 2.5 and 2.6, SINGLE CUFF OPERATION
and DUAL CUFF OPERATION.
1. The following are suggested cuff connections:
a. The proximal cuff connected to the red outlined
MAIN CUFF connectors, using the white/red
cuff tubing;
b. The distal cuff connected to the blue outlined
SECOND CUFF connectors, using the
white/blue cuff tubing.
2. Follow the cuff inflation sequence adopted by your
institution or requested by the surgeon.
3. Deflation of a cuff is not possible while the other is
inflating.
4. At the end of the procedure one cuff, either the
MAIN or SECOND CUFF, may be deflated by
pressing the appropriate deflate touch-switch without the Bier Block Safety Lock Out feature interrupting. When attempting to deflate the other cuff, an
alarm code “CUFF” “DEFL” will appear. Release the
deflate touch-switch and within 5 seconds of the
alarm discontinuing, press the deflate touch-switch
again. Immediately upon cuff deflation, the cuff
should be removed from the patient. After the
cuff has been fully deflated and removed from
the patient, the unit can be set to STANDBY.
2.8 ALARM CONDITIONS
There are a number of conditions for which the A.T.S.
2000 Tourniquet will produce a visual and/or audible alarm.
Those conditions, indications and appropriate actions are
shown in Table 2.1. The appropriate actions indicated are
based on the most probable causes and should only be
used as a guide. Other causes of alarm conditions may
indicate a need for other actions.
In addition to the conditions shown in Table 2.1, it is conceivable that a malfunction could occur for which the indications are unintelligible and unpredictable. It is very likely
that the valves will be disabled causing the system to hold
cuff pressure. It is also likely that a high pitched tone will
sound under these conditions.
Most audible alarm tones may be silenced for 30 seconds
by depressing the Alarm Silence switch. The light in the
Alarm Silence switch will normally remain lit until the condition that created the alarm has been corrected. At the end
of the silenced period, tones will be re-enabled. Depressing
the Alarm Silence switch will cause the alarm tone to be
silenced again.
It is possible for more than one alarm condition to be present. In that event, the unit will announce the alarm conditions in sequence. The operator should identify the causes
of the alarms and act on the condition that presents the
most significant risk to the patient first. Note that the Alarm
Silence switch will silence the audible tones associated with
multiple alarm conditions in the same manner that it does
for single alarm conditions.
To minimize nuisance pressure alarms that can be caused
by vigorous movement of the patient’s limbs, a 1.5 second delay has been designed into the tone generator. The
Alarm Silence light will still turn on during the 1.5 second
period.
Under certain conditions, such as when a FAIL indication
appears in the TIME display or the information that appears in the TIME and PRESSURE display is unintelligible,
the operator should conclude that a hardware failure has
occurred, rendering the unit unusable. The appropriate
action is to set the unit to STANDBY by pressing and holding the ON/STANDBY touch-switch until the unit is set to
STANDBY. Since this removes power from the internal
instrument circuitry and all instrument functions, commands to the valves and pump will cease. This should
cause the cuff to hold pressure (in the absence of
leaks). Clamp the cuff lines with hemostats and replace the
tourniquet. FAIL conditions can only be reset by setting the
unit to STANDBY. In the event that a FAIL shutdown was
caused by transient condition, it may be possible to resume
normal operation by setting the unit to STANDBY then back
on again. Please read the special CAUTION note in Section
2.5
2.8.1 PRESSURE ALARMS
A pressure alarm “LO-P” will occur when the pressure in
a cuff is more than 15 mm Hg from the pressure set point.
A cuff can have a leak that is substantial but which the unit
can compensate for by continual pumping and maintain cuff
pressure within the 15 mm Hg set point window. This type
of leak could be due to a pin hole in a cuff bladder, or loose
pneumatic/hose fitting(s). This type of leak could progress
into a total failure of a cuff if not corrected. The operator is
alerted to a substantial leak by “LEAK” in the cuff pressure
display. Should a “LEAK” be detected, all connections must
9
be checked for leaks and fixed and/or replaced.
Table 2.1 Alarm Conditions
CONDITION
AUDIBLE
TONE
PRESSURE
DISPLAY
TIME
DISPLAY
ALARM
SILENCE
LIGHTAPPROPRIATE ACTION/REMARKS
CUFF PRESSURE LOW:
15 mm Hg or more below
desired set point
STEADY
HIGH
PITCH
LO-P LITThis condition is generally caused by a leak
in the system, or a hose occlusion. All lines
and connections should be checked.
CUFF PRESSURE HIGH:
15 mm Hg or more above
desired set point
STEADY
HIGH
PITCH
HI-PLITNormally caused by transient conditions
such as patient movement, controller
overshoot, or hose occlusion. This
condition, for an extended period, would
indicate a hardware failure and the
A.T.S. 2000 should be replaced.
CUFF SIDE LEAK:
A sustained leak exists that
may affect the cuff pressure.
STEADY
HIGH
PITCH
LEAKLITA substantial leak has been present for
more than 9 seconds.
RESERVOIR LEAK:
An internal leak exists that
may affect the reservoir
pressure.
STEADY
HIGH
PITCH
RES LEAKLITA substantial leak has been detected
which may indicate a leak has occurred
between the manifold and pump/reservoir.
INFLATION TIME IN
EXCESS OF SETTING
STEADY
HIGH
PITCH
TIME UPLITSurgeon should be warned of time up
condition. On the advice of the surgeon‚
time should be set to a new value.
LOW BATTERY VOLTAGESTEADY
HIGH
PITCH
BAT LOW
PLUG IN
LITUnit needs to be connected to A/C (~)
power.
CUFF PRESSURIZED
DURING POWER UP:
This will occur if, for
example, the unit is turned
off and back on without
deflating the cuff.
STEADY
HIGH
PITCH
CUFFINFLLITIf a cuff pressure is 50 mm Hg or greater
at the time that the ON/STANDBY touchswitch is set to ON, the system assumes
that a procedure is in progress. It adopts
the sensed pressure of the cuff(s) as the
new cuff set point and sounds the alarm
to notify the operator that it has done so.
The operator should immediately check the
pressure set point to see if it needs to be
reset to a different value.
CUFF NOT DEFLATEDSTEADY
HIGH
PITCH
CUFF
NOT
DEFL
LIT
NOTE: In addition to the conditions shown, it is conceivable that a malfunction could occur for which the indicators are unintelligible or
unpredictable. It is very likely that the valves will be disabled causing the system to hold cuff pressure. It is also likely that a high pitched tone
will be sounded under these conditions. The operator should conclude that a hardware failure has occurred rendering the unit unusable. The
appropriate action in such an event is to turn the unit off by pressing and holding the ON/STANDBY touch-switch until the unit turns off. Another
tourniquet system should be brought in and cuff hoses must be clamped off prior to changing units.
Pressure in the deflated cuff is a non-zero
value. Check for kinks in hose(s). If alarm
persists, disconnect hose(s) from cuff. If
attempting to set the unit to STANDBY,
ensure that cuff is fully deflated and has
been removed from the patient.
10
Table 2.2 Hardware Malfunction Codes
PRESSURE
DISPLAY
TIME
DISPLAY
AUDIBLE TONEALARM
SILENCE
LIGHT
MEANING OF INDICATIONS
AMPFAILSTEADY HIGH
PITCH
LITAMPLIFIER OUT OF RANGE.
BAT LOWPLUG INSTEADY HIGH
PITCH
LITBATTERY VOLTAGE TOO LOW TO
ENSURE RELIABLE OPERATION.
BATFAILSTEADY HIGH
PITCH
LITBATTERY DEFECTIVE OR TOO LOW TO
USE.
CALMFAILSTEADY HIGH
PITCH
LITMAIN CUFF OUT OF CALIBRATION OR
“CAL” VALVE MALFUNCTION.
CAL2FAILSTEADY HIGH
PITCH
LITSECOND CUFF OUT OF CALIBRATION
OR “CAL” VALVE MALFUNCTION.
CALRFAILSTEADY HIGH
PITCH
LITRESERVOIR OUT OF CALIBRATION OR
“CAL” VALVE MALFUNCTION.
MATHFAILSTEADY HIGH
PITCH
LITRESULT OF A MATH OPERATION WAS
OUT OF RANGE.
ROMFAILSTEADY HIGH
PITCH
LITMICROPROCESSOR FAILED A “ROM”
MEMORY CHECK.
RAMFAILSTEADY HIGH
PITCH
LITMICROPROCESSOR FAILED A “RAM”
MEMORY CHECK.
VALVFAILSTEADY HIGH
PITCH
LITAN IMPROPER VALVE COMBINATION
OCCURRED.
WDTFAILSTEADY HIGH
PITCH
LITWINDOWING WATCHDOG SYSTEM
DETECTED A MALFUNCTION.
11
SECTION 3.0
A.T.S. 2000 TOURNIQUET SYSTEM
MAINTENANCE
3.1 GENERAL MAINTENANCE INFORMATION
While the A.T.S. 2000 Tourniquet has been designed and
manufactured to high industry standards, it is recommended that periodic inspection and calibration be performed to
ensure continual safe and effective operation. This section
contains information to assist in that effort as well as serve
as a guide to expediting unscheduled maintenance.
This unit is organized into easily accessible modular assemblies for ease of service. The major subassemblies of
the unit are shown in Fig. 3 through 10.
3.2 GENERAL THEORY OF OPERATION
Refer to Block Diagram (Fig. 3).
The A.T.S. 2000 Tourniquet is a microprocessor controlled
automatic tourniquet. The microprocessor takes inputs from
various switches, the A/D converter, and memory, then
uses this information to generate commands to the outputs
(valves, pump, displays, alarm circuitry) to regulate cuff
pressure. The pump and the eight valves control the inflation, deflation, and regulation of the tourniquet cuff(s).
The main and second cuffs are connected to the pump via
a reservoir and manifold. There are eight valves mounted to
the manifold to control the inflation, regulation, and deflation, four valves for each cuff. The cuff valves are further
divided as slow and fast inflate, as well as slow and fast
deflate valves. When a cuff is inflating, the fast inflate valve
opens to pressurize the cuff quickly. When the cuff is deflating, the fast deflate valve opens to remove pressure quickly.
The slow inflate and slow deflate valves are used to regulate the pressure during cuff regulation. Please note that
block diagram Fig. 3 shows all valves in their off (no power)
condition. In the event of a power failure or if the unit enters
a failure mode, power to the valves will be removed and all
of the valves will close which will prevent internal leaks.
The three pressure transducers, main cuff, second cuff, and
reservoir, are connected to the A/D converter via high precision amplification circuitry. The digitized pressure signals
are used by the microprocessor to regulate the pressure in
the cuff(s) as well as in the reservoir. The condition of the
pump, transducers reference, +15 volts, and safety monitor
voltages are periodically checked for proper voltage levels.
The battery condition is checked during power up for proper
connection, i.e., broken wire or blown battery fuse. The unit
can alarm when the battery voltage becomes low during a
loss of AC (~) power or during patient transport.
The Windowing Watch Dog Circuit (Safety Processor) is a
hardware circuit that monitors the timing signal generated
by the microprocessor as well as valve states and system
modes. Should any abnormality exist, indicating a problem
with either the microprocessor, software, or valves, the
safety processor will remove power to all eight valves. This
means the valves will all close, flag the microprocessor of
the error and turn the alarm light and speaker on. If the microprocessor is able, a message will be displayed indicating
the failure.
CAUTION: BE SURE THAT THE UNIT IS SET TO STANDBY AND THE POWER PLUG IS UNPLUGGED BEFORE
DISASSEMBLY.
CAUTION: MANY OF THE PARTS ON THE CPU AND
POWER SUPPLY PRINTED BOARDS ARE STATIC SENSITIVE. TAKE APPROPRIATE PRECAUTIONS WHEN
SERVICING THESE BOARDS.
To gain access to all internal parts, first remove the four
rubber feet from the bottom of the unit. Remove the I.V. pole
clamp knob, and the 2 screws from the top back of the unit,
and then slide the back cover away from the front.See Fig.
4–7.
To access the power supply and CPU boards, remove the
3 screws from the bottom of the chassis, just behind the
battery compartment‚ along with the 2 screws from the front
top chassis. By removing these 5 screws, the chassis will
be divided into two halves for clear and easy access. See
Fig. 8–10.
3.4 PERIODIC MAINTENANCE
Test and inspect as per this section at least every 6 months.
3.4.1 CLEANING
The exterior of the unit may be cleaned with a cloth that
has been dampened (not dripping) with a mild detergent.
The interior of the unit may be vacuumed or blown out as
required. The exterior of the cuff hoses may be cleaned
using a mild detergent solution or with alcohol. The interior
of the cuff hoses should not be cleaned. Tourniquet cuffs
should be cleaned in accordance with their cuff package
insert instructions.
3.4.2 INSPECTION
The unit should be inspected at regular intervals. It is
recommended that a visual inspection be performed by
a qualified technician at least every 6 months. Inspection
points are:
• Obvious internal or external damage;
• Condition of the power cord;
• Condition of hoses (both internal and external cuff connection hoses);
• Accumulation of dust or dirt within the unit;
• Mating integrity of internal connectors;
• Integrity of battery fuse mounted on the CPU printed
circuit board;
• Security of the EPROM (U15) and safety processor
(U10). See Fig. 11 for location;
• Integrity of the pump filters;
• Tightness of the pump mount.
3.4.3 FUNCTIONAL AND CALIBRATION CHECKS
It is recommended that the functional and calibration
checks described in Section 2.2 be performed at least once
a quarter.
3.3 ACCESS TO PARTS
12
3.4.4 CALIBRATION
CALIBRATION SHOULD BE PERFORMED EVERY 6
MONTHS, OR AFTER ANY UNSCHEDULED MAINTENANCE.
Calibration of the A.T.S. 2000 Tourniquet consists of a
series of set-points from which the microprocessor can
calculate the correct pressure readings by linearizing the
pressure from the set-point voltages. These set-points are
made by pressurizing the individual transducers to a predetermined pressure then allowing the microprocessor to read
the voltages at those pressures (set-points). The set-point
voltages are stored in nonvolatile memory and used whenever pressure is calculated.
The unit software contains an instruction set for the Calibration Mode that is independent of the normal operating
software. To enter the Calibration Mode, turn the unit on,
then press and hold the Second Pressure Increase (+) and
Decrease (–) touch-switches until “CUFF” “CAL” is displayed.
EQUIPMENT REQUIRED:
A. Calibration connecting hose
B. Calibrated mm Hg pressure meter
C. Adjustable pressure source, 0 to 700 mm Hg
Caution: The following steps must be taken in the exact
order to calibrate the unit. Failure to do so may result in
incorrect pressure readings while the unit is in operation.
1. Connect the calibration connecting hose, pressure
gauge and adjustable pressure source as shown in Fig.
1.
2. Turn the unit on and enter the Calibration Mode.
3. Set the zero point in the main cuff by pressing the Main
Cuff “INFLATE” and “DEFLATE” touch-switches at the
same time. A tone will be heard letting you know that
the zero point has been entered.
4. Set the zero point in the second cuff by pressing the
Second Cuff “INFLATE” and “DEFLATE” touch-switches
at the same time. A tone will be heard letting you know
that the zero point has been entered.
NOTE: Steps 3 and 4 must be performed with the Calibration Connecting Hose disconnected from both Cuff Sense
Ports.
5. Adjust the main cuff set point by pressing the Main Cuff
Time (+) touch-switch once. The Main Cuff Time display
should be showing 50.
6. Adjust the second cuff set point by pressing the Second
Cuff Time (+) touch-switch once. The Second Cuff Time
display should be showing 50.
7. Insert the main cuff line with connector into the Main
Cuff Sense Port. See Fig. 1.
8. Insert the second cuff line with connector into the Second Cuff Sense Port. See Fig. 1.
9. Apply 50 mm Hg of pressure to the input ports.
10. Set the 50 mm Hg point in the main cuff by pressing the
main cuff “INFLATE” and “DEFLATE” touch-switches
at the same time. A tone will be heard letting you know
that the 50 mm Hg has been entered.
11. Set the 50 mm Hg point in the second cuff by pressing the second cuff “INFLATE” and “DEFLATE” touchswitches at the same time.
12. Repeat steps 5–11 for set points of 250 and 475.
13. Remove source pressure then disconnect the calibration connecting hose from both sense ports.
14. Return the set points to zero by pressing the time (–)
touch-switch 3 times for each cuff.
15. Press the second cuff pressure (+) and (–) touchswitches at the same time to move into reservoir calibration. The second pressure display should be showing “RES”.
16. Set the zero point in the reservoir by pressing the main
cuff “INFLATE” and “DEFLATE” touch-switches at the
same time. A tone will be heard letting you know that
the zero point has been entered.
17. Adjust the reservoir set point by pressing the main cuff
time (+) touch-switch once. The main cuff time display
should be showing 250.
18. Insert the main cuff line with connector into the Main
Cuff Reservoir sense port. The Main Cuff Reservoir sense port is the leftmost port on the main cuff.
See Fig. 1.
19. Insert the second cuff line with connector into the
Second Cuff Reservoir sense port. The Second Cuff
Reservoir sense port is the leftmost port on the
second cuff. See Fig. 1.
20. Apply 250 mm Hg of pressure to the reservoir sense
ports.
21. Set the 250 mm Hg set point in the reservoir by pressing the main cuff “INFLATE” and “DEFLATE” touchswitches at the same time. A tone will be heard letting
you know that the 250 mm Hg point has been entered.
22. Repeat steps 20 and 21 for 475 and 700 mm Hg pressure set points.
23. Remove source pressure then disconnect the calibration connecting hose from both sense ports.
24. Return the reservoir set point to zero by pressing the
Main Cuff Time (–) touch-switch 3 times.
25. Press the Second Cuff Pressure (+) and (–) touchswitches at the same time. The Main and Second Pressure displays should be showing “CAL” “DONE”.
NOTE: THE “CAL” “DONE” MUST BE DISPLAYED BEFORE TURNING THE UNIT OFF. THE NEW SET POINTS
WILL NOT BE SAVED IF POWER IS REMOVED BEFORE
“CAL” “DONE” IS DISPLAYED.
26. Set unit to STANDBY at the ON/STANDBY (I/O) touchswitch. Remember, this switch has approximately a
2-second delay before allowing the unit to be set to
STANDBY, so you must hold the touch-switch in.
27. Restart the unit. We recommend that you check your
calibration by following the steps in Section 2.2 step 5
“Calibration Check”.
3.4.5 LEAK TESTING
The A.T.S. 2000 Tourniquet is capable of keeping a cuff with
a substantial leak inflated. Naturally it is desirable to keep
plumbing leaks to an absolute minimum. For this reason,
a check for significant leakage is recommended at regular
intervals as well as following any service procedure.
After verifying the operation of the A.T.S. 2000 Tourniquet
per Section 2.2, connect two 24 in. (61 cm) (or larger) cuffs
which are known to be leak free to the A.T.S. 2000 Tourniquet System. Adjust both cuff set points to 475 mm Hg. Ensure that all external connections are tight. Inflate the main
and second cuffs and allow the pressure to stabilize. At this
point, the unit must be set to STANDBY. Under normal use,
the unit
13
cannot be set to STANDBY with a non-zero pressure value
displayed in the cuff(s). However for leak testing purposes, a bypass feature has been incorporated. Press the
ON/STANDBY touch-switch until the alarm message
“CUFF” “NOT” “DEFL” appears. Release the ON/STANDBY
touch-switch and within 5 seconds of the alarm discontinuing, press and hold the ON/STANDBY switch again. The
switch must be held in for an additional 10 seconds before
the unit will be set to STANDBY.
NOTE: During the 10 seconds, the alarm will continue to
sound a high pitch tone, the alarm silence lamp will be lit
and the alarm message “CUFF” “NOT” “DEFL” will be displayed. The alarm cannot be silenced by the alarm silence
switch.
After 10 minutes, turn the unit back on. Operation will
resume under cuff inflated start-up conditions (see section 2.5 part 3 for explanation). Cancel the alarm using the
ALARM SILENCE push-button. Display both main and second pressure points be activating either PRESSURE touchswitch and view the current (New) pressure set point. The
set point is always displayed with an asterisk in the far left
position. The current set point for either cuff should be at
least 400 mm Hg or more. Values less than this should be
traced and corrected. The first connection to check should
be the connections of the cuffs. Different cuffs and/or cuff
hoses may be tried to determine if the leak is internal or
external of the unit.
3.4.6 BATTERY VOLTAGE AND BATTERY SERVICE
NOTE: This section assumes that the unit has been
plugged in and the battery charging for at least 24 hours.
The rear case must be removed to measure battery voltage. See Section 3.3 ACCESS TO PARTS and be sure to
follow cautionary statements.
A. Battery Voltage Check
Be sure the unit is unplugged. Attach a volt meter to the
battery plug (P6 on the CPU board). The battery voltage
should not be lower than 24 volts while in this off state. If,
after 1 minute, the voltage reads less than 24 volts, the
integrity of the batteries should be suspect and they should
be replaced.
B. Battery Service
The two 12-volt sealed lead acid batteries are charged using the latest lead acid charging technology. The charging
circuit is active anytime the unit is plugged into an acceptable
AC (~) outlet and the batteries are installed. The charger
automatically sequences through several charge states
based on the battery voltage and charging current conditions. Based on a charger test, the best charge mode is
selected. No maintenance is required of the battery charging circuit.
The life of the batteries depends on the type of service
and the storage method. Battery replacement will need to
be more frequent with continued cycles of deep discharge
and/or storage in a high temperature environment. Infrequent short-term use of the batteries and storage in a
room-temperature environment will result in maximum life.
It is recommended that the batteries in the A.T.S. 2000 be
replaced annually. The A.T.S. 2000 should be connected to ~ power 24 hours before initial use.
The A.T.S. 2000 Tourniquet is designed with several specific
self-test features to assist in fault isolation. These features
are designed to show a message in PRESSURE and TIME
displays. The meaning of these messages are delineated in
Tables 2.1 and 2.2.
Another mode of failure that might occur is where the high
pitched tone occurs that cannot be silenced by the ALARM
SILENCE push-button. The valves and pump will be disabled‚ which seals off the cuff(s) to prevent pressure loss.
The displays may show random characters. Should this
occur, the Watch Dog Timer circuit of the safety processor
has detected a problem. The microprocessor may not be
executing reliable instructions and is not able to display the
correct failure message. This failure mode, and all others
giving a “FAIL” message, might be cleared by cycling the
ON/STANDBY touch-switch.
The calibration error message (CALM, CAL2 or CALR) may
be due to faulty circuitry or may simply indicate the need
for calibration. The Watch Dog Timer (WDT) error message
may be due to a faulty Watch Dog Timer circuit or improper
microprocessor timing.
3.6 EXPECTED TEST POINT READINGS
To expedite unscheduled maintenance, Table 3.1, Expected Test Point Readings, has been incorporated into this
manual. This table, as well as Table 3.2, Troubleshooting,
should give a qualified technician a good starting point from
which to locate and repair most problems that could occur
during the life of the unit.
3.7 TROUBLESHOOTING GUIDE
To aid in unscheduled maintenance, Table 3.2 delineates a
number of possible malfunctions that could occur with the
unit. The most likely causes are shown for each symptom.
While it is not practical to enumerate every conceivable
malfunction and all possible causes, the table will assist in
isolating the most common problems.
Expected readings on both the CPU and power supply
boards are shown in Table 3.1. All measurements are to be
made at room temperature with the cuffs disconnected, and
the unit connected to AC (~) power. All voltage measurements are with respect to ground and are to be made with
the unit on.
3.5 UNSCHEDULED MAINTENANCE
14
Table 3.1 Expected Test Point Readings
Power Suppl
y
Board
Normal ReadingToleranceConditions/Comments
TP1V Common+/-50 mV Bulk Supply Common
TP2+27 V +/-2 V Main supply for entire system
CPU BoardNormal ReadingToleranceConditions/Comments
TP1+/-2 V
TP2+26 V +/-2 V V_ON voltage. Energized when unit is ON.
TP3+26 V +/-2 V 24 V nominal if ~ (AC) present.
TP40.0 V
+26 V
+/-50 mV
+/-2 V
0.0 V when unit is ON. 26 V when unit
is OFF.
TP66 V +/-2 V ~ (AC) signal if speaker is sounding.
TP85 V +/-0.5 V 5 V supply for battery charging logic.
TP9V Common+/-50 mV Bulk Supply Common.
TP105 V
26 V
+/-0.5 V
+/-2 V
5 V when pneumatics are NOT enabled.
26 V when pneumatics ARE enabled.
TP115 V +/-0.5 V 5 V Supply
TP125 V
0 V
+/-0.5 V
+/-50 mV
5 V Nominal.
0 V when depressing
ON/STANDBY switch on membrane panel.
TP13V Common+/-50 mV Bulk Supply Common.
TP144.5 V
0 V
+/-1 V
+/-50 mV
0 V if Safety Circuit is enabled and alarm
condition exists.
TP154.5 V +/-1 V At power up, this TP will be held low until
approximately 0.2 seconds after TP11
reaches 5 V Ensures microprocessor has
reset properly.
TP1632.768 kHzSquare wave.
TP174.5 V +/-1 V 0 V indicates problem with valve(s) or
valve driver circuit.
TP20V Common+/-50 mV Bulk Supply Common.
TP2212 V +/-1 V 12 V for audio amplifier.
TP234.1 V +/-0.1 V 4.1 V Transducer reference voltage.
TP245 V +/-0.5 V 5 V A to D supply voltage
TP27V Common+/-50 mV Bulk Supply Common.
TP30V Common+/-50 mV
TP315 V +/-0.5 V 5 V for ON/STANDBY switch logic.
Bulk Supply Common.
+27 V
Main supply for entire system
15
Table 3.2 Troubleshooting
SYMPTOMPOSSIBLE CAUSESCHECK TEST POINTS
1. Cuff(s) will not inflate.a) Touch-Switch Panel connector not
properly plugged into P9.
b) Tubing inside unit may be pinched or
improperly connected.
c) Valve(s) stuck.
d) Pump not properly plugged into P10.
2. Cuff(s) will not deflate.a) Touch-Switch Panel connector not
properly plugged into P9.
b) Deflate touch-switch not depressed long
enough.
c) Valve(s) stuck.
d) Deflation on one cuff will not be
permitted if in Bier Block procedure.
Deflate touch-switch must be depressed
within 5 seconds after “CUFF” “NOT”
“DEFL” message appears.
3. No ~ Indicator light.
Unit still runs.
a) Unit not plugged into wall outlet.
b) No power at wall outlet.
c) Bulk Supply harness
loose/disconnected at P2 or P3.
d) Blown Fuses(s).
4. Alarm Silence Switch not
working.
a) Connector not properly plugged into P1.
b) Broken wire.
c) Non-silenceable alarm (hardware failure).
d) Faulty switch.
5. Safety Circuit Failure.a) 32 kHz clock not working correctly.TP16 (CPU Board)
6. No sound from speaker.a) No output from audio amp U1.
b) No output from CPU.
c) Faulty 12 volt supply.
TP6 (CPU Board)
TP22 (CPU Board)
7. Alarm Light does not turn on.a) Alarm lamp burned out.
c) Broken wire.
To aid in unscheduled maintenance, the following list
delineates a number of possible malfunctions that could
occur with the unit. The most likely causes are shown for
each symptom. While it is not practical to enumerate every
conceivable malfunction and all possible causes, this list in
conjunction with the attached schematics will be of assistance in isolating the most common problems.
Expected reading on the CPU and Power Supply boards
are shown in Table 3.1. The measurements are to be made
at room temperature with the cuffs disconnected, and the
unit plugged in. All voltage measurements are with respect
to ground unless otherwise noted.
CAUTION: HIGH VOLTAGE ELECTRICAL HAZARD. HIGH
VOLTAGE WILL BE PRESENT ON THE POWER INPUT
MODULE AND POWER SUPPLY BOARD.
ALL SERVICE WORK MUST BE DONE BY QUALIFIED
TECHNICIANS.
16
Table 3.2 Troubleshooting (continued)
SYMPTOMPOSSIBLE CAUSESCHECK TEST POINTS
8. Unit turns on and gives tones
but no displays are present.
a) Faulty 5 V display voltage (+V)TP11 (Power Supply Board)
9. “AMP” “FAIL” at start up.a) Faulty 15 V supply.
b) Faulty A to D supply voltage.
c) Transducers reference voltage.
d) Too high main supply.
TP25 (CPU Board)
TP24; 4.1 V (CPU Board)
TP21; 0.25 V (CPU Board)
TP23; 4.1 V (CPU Board)
TP2 (Power Supply Board)
10. No Main Cuff pressurea) Transducer amplifier not working.*TP26; Voltage will vary with
pressure. 0.25 to 4 V (CPU Board)
11. No Second Cuff pressure
reading.
a) Transducer amplifier not working.TP28; Voltage will vary with
pressure. 0.25 to 4 V
12. Pump does not stop running.a) Internal leak in hose or hose fittings.
b) Leak in valve manifold.
c) Transducer not working.
*TP29; Voltage will vary with
pressure. 0.25 to 4 V (CPU Board)
Power Entry Module
62-1184-001-00Gray Power Cord
62-1192-001-00
Bulk Power Supply
Harness
The following is a list of field replacement parts that can be
ordered from Zimmer. To obtain parts or additional information regarding your unit, write or phone:
MAIL: Zimmer Orthopaedic Surgical Products
200 West Ohio Avenue
Dover, Ohio 44622 U.S.A.
PHONE: 330-343-8801 or
800-321-5533
You can also contact your local Zimmer distributor. To ensure prompt service, please include the following information with your order:
Model Number
Serial Number
Description of Part
Part Number (If known)
Quantity Desired
Shipping Address
Shipping Means (If any)
18
Recommended Accessories and Kits
REFDescription
60-2000-102A.T.S. 2000 Tourniquet System (with A.T.S. Cylindrical Cuffs) with Hoses
60-2000-103A.T.S. 2000 Tourniquet System (with A.T.S. Cylindrical Cuffs) with Hoses,
Tourniquet Stand and Basket
60-2000-104A.T.S. Tourniquet System (without Cuffs) with Hoses, Tourniquet Stand
and Basket
60-4022-001Tourniquet Stand (includes Base and Pole)
60-1908-001Tourniquet Accessory Basket
A.T.S. Cylindrical Cuffs, Dual Ports, Single Bladder:
60-7500-0018 in. (20 cm) x 3.125 in. (7.0 cm)
60-7500-00212 in. (30 cm) x 4.125 in. (10.5 cm)
60-7500-00318 in. (46 cm) x 4.125 in. (10.5 cm)
60-7500-00424 in. (61 cm) x 4.125 in. (10.5 cm)
60-7500-00530 in. (76 cm) x 4.125 in. (10.5 cm)
60-7500-00634 in. (86 cm) x 4.125 in. (10.5 cm)
60-7500-00742 in. (107 cm) x 4.125 in. (10.5 cm)
60-7555-00112 in. (30 cm) x 5.5 in. (14.0 cm)
60-7555-00218 in. (46 cm) x 5.5 in. (14.0 cm)
60-7555-00324 in. (61 cm) x 5.5 in. (14.0 cm)
Zimmer Sterile Disposable Tourniquet Cuffs with Positive Locking
Connectors, Dual Port, Single Bladder (sterile packed in a box of 10
with attached sterile tubing on each cuff):
60-7070-1018 in. (20 cm) x 2.75 in. (7.0 cm)
60-7070-10212 in. (30 cm) x 3.5 in. (7.6 cm)
60-7070-10318 in. (46 cm) x 4 in. (10.2 cm)
60-7070-10424 in. (61 cm) x 4 in. (10.2 cm)
60-7070-10530 in. (76 cm) x 4 in. (10.2 cm)
60-7070-10634 in. (86 cm) x 4 in. (10.2 cm)
60-7070-10742 in. (107 cm) x 4 in.
Z imm e r Sterile Disposable Tourniquet Cuffs with Positive Locking
Connectors, Dual Port, Dual Bladder (sterile packed in a box of 10
with attached sterile tubing on each cuff):
60-7080-10112 in. (30 cm) x 5.5 in. (14.0 cm)
60-7080-10218 in. (46 cm) x 5.5 in. (14.0 cm)
60-7080-10324 in. (61 cm) x 5.5 in. (14.0 cm)
Zim m er Sterile Disposable Esmarch Bandages
(sterile packed in boxes of 20):
60-2694-0013 in. (8 cm) x 9 feet (3 m)
60-2694-0024 in. (10 cm) x 9 feet (3 m)
60-2694-0036 in. (15 cm) x 9 feet (3 m)
60-2694-0043 in. (8 cm) x 12 feet (4 m)
60-2694-0054 in. (10 cm) x 12 feet (4 m)
60-2694-0066 in. (15 cm) x 12 feet (4 m)
A.T. S . Low Pressure Cuffs, Dual Port, Single Bladder:
60-7400-001Cylindrical Arm Cuff
60-7400-002Contour Arm Cuff
60-7400-003Contour Thigh Cuff
60-7400-004Lower Leg Cuff
A.T. S .
Low Pressure Cuff, Dual Port, Dual Bladder:
60-7400-010Cylindrical Arm IVRA Cuff
60-7400-011Contour Arm IVRA Cuff
60-4017-001A.T.S. Dual Hose, Blue/White
60-4018-001A.T.S. Dual Hose, Red/White
3.9 STORAGE
The A.T.S. 2000 Tourniquet System has an operating tem-
perature range of 50°F to 100°F (10°C to 38°C).
The following are environmental conditions for transportation and storage:
A. Ambient temperature range 1°F to 149°F (–17°C to 65°C)
B. Relative humidity range .................................10% to 80%
C. Atmospheric pressure range .......... 500 hPA to 1060 hPA
20
1
Main and Second Calibration Setup Assembly
A. Reservoir Sense Ports
B. Main Cuff Sense Port
C. Second Cuff Sense Port
D. Calibration Hose Assembly
E. Calibrated mmHg Pressure Meter minimum range of 0 to 700 mmHg
F. Pressure Regulator 0 to 700 mmHg minimum
G. Pressure Source, minimum of 700 mmHg
21
2
F
C
D
H
B
E
K
G
I
Controls, Indicators & Connectors
A. ON/STANDBY (I/O) Touch-Switch
B. PRESSURE SETTING Touch-Switches
C. TIME SETTING Touch-Switches
D. INFLATE/DEFLATE Touch-Switches
E. ALARM SILENCE Switch
F. PRESSURE Displays
G. TIME Displays
H. AC Indicator Light
I. Quick Reference Cards
J. Cuff Connectors
K. Pole Clamp
A
J
22
3
Block Diagram
23
45
Removing Chassis from Rear Case
1. Remove Pole Clamp knob
67
Removing Chassis from Rear Case
2. Remove Rear Cover Screws
Removing Chassis from Rear Case
3. Remove 4 Feet and Screws
Removing Chassis from Rear Case
4. Slide Front and Rear Covers Apart
24
89
Separating Chassis
1. Remove top 2 screws
10
Separating Chassis
2. Remove Recessed Bottom 3 screws
Separating Chassis
3. Access to all components
25
11
CPU Board
26
12
Power Supply Board
27
Warnings, Cautions, and Symbol Definitions
(See Fig. 17.)
Power “OFF” for a part of equipment
Power “ON” connected to the mains
Type B equipment
Alternating Current
Protective earth ground
Direct Current
Refer to instruction manual
Electrical Hazard
Year of manufacture
Replace fuse as marked
Conformity Marking of the Council of the
European Community (TÜV Product Service,
Munich, Germany)
UL Classification Mark Medical Equipment
With Respect to Electric Shock, Fire, and Mechanical Hazards Only, In Accordance with UL
60601-1, CAN/CSA C22.2 No. 601.1, and IEC
60601-1
SYMBOL DEFINITION:
LATEX FREE This product does not contain natural rubber latex.
28
17
MEDICAL EQUIPMENT
WITH RESPECT TO ELECTRIC SHOCK,
FIRE, AND MECHANICAL HAZARDS
ONLY, IN ACCORDANCE WITH
UL 60601-1, CAN/CSA C22.2
NO. 601.1, AND IEC 60601-1
Label 62-8000-025-00
WARNING: A.T.S. ® WILL NOT DEFLATE CUFF IN “STANDBY” MODE.