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Narkomed Mobile Anesthesia System

1. hme 3 4 Breathing Pressure Monitoring rn 3 5 Respiratory Volume Monitoring 0 ce RR IH 3 n 3 5 Serial Interface ofensis Heth Gee Cha REESE 3 6 Section 4 Daily and Preuse Checkout Procedures Daily Checkout 4 3 Preuse Checkout 4 11 Section 5 Operating the Anesthesia Machine Gas Delivery System Operation 5 3 Anesthetic Vaporizer 5 4 Absorber System Operation 0 00 ccc ehh 5 7 Scavenger Interface 5 11 Anesthesia Ventilator Operation 000 ccc eee 5 12 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Section 6 Using the Monitoring System OVEIVIOW iai oues paie tuii ea enu oed rec rg ewe arae uice d dra ip dcs ages 6 3 Power On Screen 6 3 Monitor Screen and 6 4 Usirig the 6 cess ex
2. 9995123 System n Accessories Breathing Hose 22 mm 382 1 9995132 Breathing Bag Connector 4114312 Rubber Goods Set includes Y piece mask elbow 2 liter breathing bag two 22 mm corrugated hoses 32 long 1101071 Pediatric Rubber Goods Set includes Y piece mask elbow 0 5 liter breathing bag two 22 mm corrugated hoses 30 long 4114356 Newborn 9995001 Infant Fac em sk 12222 vds robe dogs r bea C dod 9995002 Adult 9995005 Gas Hose 22mm 22 1 9995123 Evacuation Accessories Hose 19mm 13 long 0 0 ees 9995213 Hose 19mm x 30 long leeeeeeeeeee ees 9995230 Scavenger 3 liter breathing bag 19 mm connection 9995430 Breathing 9995820 Bag Vaporizer O rings vaporizer mount lees 4114346 Dr ger Vapor 19 3 Bellows Adult Latex Free 4114102 Adult Latex Free Bellows Subassembly 4106930 001 Oxygen Oxygen Sensor 6850645 Monitorin Sensor Housing and Cable 4106363 Respiratory Flow Sensor 4115754 Volume
3. 2 17 Fresh Gas HOSS o FE e nM Ebr EI RORIS RO UAE 2 17 Breathing System Pressure Gauge 2 17 Pressure Sensing Hose Assembly 2 17 Manual Automatic Selector Valve 2 17 Adjustable Pressure Limiter APL Valve 2 17 Respiratory Volume Monitor Sensor 2 17 Oxygen ec uaa BUR 2 18 Positive End Expiratory Pressure PEEP Valve 2 18 Scavenger d 2 19 Anesthesia Ventilator 2 20 Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Table of Contents continued Power Supply System iiu ioris tonis cepa 2 22 System Power Switch 2 22 Circuit Breakers sse 2 22 Backup Battery System 2 23 System Interface Panel 2 24 Remote Display and Support Arm 2 24 Monitoring 2 25 Monitor Screen and Controls 2 25 Alarm Systemi 2 26 Alann DIS Pl AY 2 26 Alarm Annunciation en 2 27 Ventilation Alarms
4. 2 27 2 2 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Overview The Narkomed Mobile is a compact lightweight continuous flow anesthesia system Narkomed Mobile machines are equipped with a monitoring system and pneumatic circuitry for delivering gases and anesthetic vapor for adult and pediatric patients Figure 2 1 Narkomed Mobile Front View VENTILATOR oP00087 CONTROLS HANDLE DISPLAY ASSEMBLY FLOWMETER AUXILIARY OXYGEN FLOWMETER __ PRESSURE BELLOWS d GAUGES ULTRASONIC FLOW SENSOR VAPORIZER y SUPPORT ABSORBER E ERAME SYSTEM Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 3 2 4 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS The Narkomed Mobile consists of these major systems e gas delivery e vaporizer e absorber scavenger e ventilator e power supply system interface e monitoring alarms Figure 2 2 Narkomed Mobile Back View PIPELINE GAS INLET Dee CYLINDER YOKE ES 8 00086 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Gas Delivery System P
5. 5 15 Selecting the Bellows Drive Gas 5 16 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Gas Delivery System Operation 5 The Narkomed Mobile is a continuous flow anesthesia system with pneumatic circuitry for mixing and delivering fresh gas and anesthetic agent vapor The pneumatic system can deliver up to three gases oxygen nitrous oxide and air and one anesthetic agent simultaneously Adjusting the To adjust the gas flow asia 1 Turn the flow control knob located below the flowmeter tube for the gas you want to adjust Turning the valve knob counterclockwise increases flow Turning the knob clockwise decreases flow 2 As you adjust the flow control knob observe the flow rate Flow rate is indicated by the flowmeter scale reading at the center of the float Caution The oxygen flow cannot be completely shut off Do not force the oxygen flow control knob in an effort to shut off the minimum flow 150 x50 mL min Forcing the knob can damage the valve seat Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 5 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Using the To use the oxygen flush press the oxygen flush button located on the front Oxygen of the Narkomed Mobile This introduces an unmetered flow o
6. EE eS 6 10 Oxygen Monitoring dex cr Rr em e ke Reed dee por pane gore ya ears 6 12 Respiratory Volume 6 18 Breathing Pressure Monitoring llllilee RI I 3 ae 6 23 Section 7 Routine Maintenance and Cleaning M ETT 7 3 Routine Maintenance aee Rae egt Pd Un CR we 7 3 Removing Parts for Cleaning and Disinfection 7 9 Disassembling Parts for Cleaning and 7 14 General Guidelines for Cleaning and Disinfection llli 7 16 Reassembly Instructions 0 0 ce I hn 7 24 Section 8 Troubleshooting Absorber System Problem 8 2 Ventilator Problem Resolution 0 0 ccc ee hh n 8 4 Oxygen Monitoring Problem Resolution 8 5 Respiratory Volume Monitoring Problem 8 6 Breathing Pressure Monitoring Problem 8 6 Appendix Spare and Replacement Parts ii Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TAB
7. 1 5 Section 2 General Description S MC 2 3 Gas Delivery System hh 2 5 Anesthetic Vaporizer es carece E Wag eek RU dee EROR Rd e I Ro ie 2 14 Absorber System essi beer eR TE E AU eed EH URGE RR d RU d DR did 2 15 Scavenger System sss g magoa ete 2 19 Anesthesia Ventilator os er er e PR Euri Roe MOP AUD eae Mp ape BEM Ewe 2 20 Power Supply System ssssusselsesseelle ehh 2 22 System Interface Panel issaraen hh 2 24 Remote Display and Support 5 2 24 Monitoring System ache aq m re Me douce ree a aod Fer d je olg ioa OEC RON BOR CIR Ee 2 25 Alarmi System negare etie ike UE Ree Pc ida a ee e ed c o d AU dedi dvd 2 26 Section 3 Specifications General 3 2 Environmental eb ERAN aea dnbie ae vated of 3 2 xg e P 3 2 Gas Delivery System ossa ese eie ed a du kd b hace kd DR ped 3 3 MentlatoI stevie eee ecu RR I PEN Puedes EE RID UNE ERR QU RA NW wA RES 3 4 Absorber System c code obese x ex eee ea eked 3 4 Oxygen Monitoring
8. Chipped canister rim Replace canister Canister subassembly is loose Make sure the wing screws securing the canister assembly are tight Ruptured gauge diaphragm Replace gauge Absorbent is purple Ethyl violet indicator shows absorbent is exhausted Other indicators exhibit different color changes Replace with fresh absorbent High CO levels Depleted absorbent Replace with fresh absorbent Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 8 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Ventilator Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY Excessive PEEP Improperly adjusted ventilator relief valve Contact an authorized representative of Dr gerService Insufficient suction scavenger flow setting Increase suction scavenger flow valve PEEP valve active Decrease PEEP valve setting Inverse I E ratios Reset ratios Excessive suction scavenger flow Reduce suction scavenger flow rate Bellows won t reach tidal volume stop setting during expiration Frequency too high for selected tidal volume Decrease frequency Increase expiratory phase time Improperly adjusted ventilator relief valve Contact an authorized representative of Dr gerService Breathing system leak Repair leak Ventilator won t cycle Low oxygen supply pre
9. Turning the Apnea Pressure Alarm Off Turning the Apnea Pressure Alarm On 6 30 Figure 6 18 Sample Threshold Limit Settings 1 Threshold pressure alarm 2 Thus after partial breathing system limit correctly set to within X disconnection or leak small pressure 6 cm H 20 of peak pressure fluctuation does not cross threshold for alarm limit settings of 5 N pressure alarm limit Operator is through 20 cm H 20 warned of apnea condition 35 PEAK MEAN PEEP 1 Threshold pressure alarm c 2 Thus after partial breathing system limit incorrectly set 6 cm N disconnection or leak small pressure H20 below peak pressure fluctuation in system satisfies incorrectly set threshold pressure alarm limit Operator is not alerted of apnea condition 35 18 7 2 You can turn the apnea pressure alarm off only when the ventilator is off When the ventilator is on the alarm is automatically forced on to ensure notification of alarm conditions PEEP To turn off the apnea pressure alarm press the Breathing Pressure Off key Audio annunciation of the alarm is disabled and pressure alarm messages are erased from the display The LED next to the Breathing Pressure Off key lights to indicate that the apnea pressure alarm is disabled To turn on the apnea pressure alarm press the Breathing Pressure On key
10. Key Limit Low Label ALARM LOG SELECT EXIT Function Displays the Alarm Log a separate screen that lists cautions and warnings that have occurred Selects a parameter by highlighting it with a box Exits the Configure screen and returns to the Monitor screen Narkomed Mobile Operator s Manual When the Configure screen is displayed the system control keys function Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Changing Parameter Values High Limit Exiting the Configure Screen Follow this procedure for each parameter you want to change 1 Press the SELECT key until the variable you want to change is highlighted with a box 2 Press the up or down arrow key to increase or decrease the value of the highlighted variable To exit the Configure screen immediately press the EXIT key NOTE The monitoring system automatically exits the Configure screen if a minute passes and no keys are pressed When you exit the Configure screen the values displayed on the screen are saved The monitoring system uses these values until they are changed Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Using the Alarm Log If you miss a warning or caution message in the Alarm windo
11. 2 4 4 0 2 1 0 L min 100 mL min 760 mmHg _ 1 0 8 0 L min 5 FS Oxygen Auxiliary 0 10 L min 5 FS Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 3 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Ventilator 1 99 1 BPM in 1 BPM increments LE ratio Standard range 1 1 1 4 5 0 1 in increments of 0 5 Extended range 4 1 3 1 2 1 Inspiratory 10 100 L min uncalibrated Tidal 20 1500 mL 100 mL Pressure limit control adjustment range 15 120 cmH O Absorber System Inspiratory Mounting ring nut size M35x1 Valve A Hose 22 mm male Expiratory Mounting ring nut size M33 x 1 Valve Hose 22 mm male PEEP Valve Range approx 2 15 50 continuously adjustable APL Valve APL Valve Nominal low flow resistance 2 cmH 0 at 8 L min Hose 19 mm male Bag Mount Breathing Bag 1 22 mm male Oxygen Monitoring Dco 10 100 vol Os RR RE MER ERE
12. Unscrew and remove the ring nut around the valve dome on both valve Expiratory assemblies Valves 3 Separate the plastic dome dome gasket and valve disk from each valve body Figure 7 10 Disassembled Inspiratory and Expiratory Valves INSPIRATORY VALVE DOME PLUG PRESSURE SENSOR ADAPTER PART OF BREATHING PRESSURE HOSE ASSEMBLY 6 HE 2 RING INSPIRATORY VALVE DOME EXPIRATORY VALVE DOME EXPIRATORY VALVE BODY INSPIRATORY VALVE BODY VALVE MOUNT GASKET PEEP VALVE INSPIRATORY VALVE MOUNT OP00081 Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 15 RETURN THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Guidelines for Cleaning and Disinfection 7 16 The frequency level and need for disinfection of the Narkomed Mobile is determined by the user facility based on the conditions of use and hospital infection control policy Draeger Medical recommends using disposable patient breathing circuits that can be replaced after single use If disinfection is required first clean dry and then disinfect the Narkomed Mobile and its parts according to the guidelines provided in this chapter Determining the need and frequency of cleaning or disinfecting any particular component is the responsibility of the user facility These procedures should be performed according to procedures established by
13. cmH O Breathing 21 Perform a breathing and fresh gas delivery system pressure test This System Leak test detects leaks from the patient breathing system and fresh gas Test delivery system To perform the test a Close all flow control valves on the anesthesia machine b Turn the SYSTEM POWER switch to the STANDBY position Turn the vaporizer to 0 concentration d Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose Set the manual automatic selector valve to BAG f Close the APL valve by turning the knob fully clockwise to its stop position g Check that the breathing pressure gauge is on 0 h Attach the supplied test terminal to the breathing bag mount i Connectasphygmomanometer squeeze bulb available from Draeger Medical to the hose barb on the test terminal j Pump the squeeze bulb by hand until the breathing system pressure gauge indicates pressure of at least 50 cmH O not to exceed 80 cmH 0 k Observe the pressure drop at the breathing system pressure gauge When the pressure is at 50 cmH O begin counting seconds The pressure must not drop more than 20 cmH 0O in 30 seconds Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 4 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Scavenger System Verification 22 IN Verify the performance of the scavenger system To test negativ
14. etc that conduct oxygen or nitrous oxide within the machine For further information regarding safety precautions in the use of medical gases consult Compressed Gas Association pamphlet P 2 and appropriate sections of the National Fire Protection Association Standard 99 In circle systems the gas mixture in the patient circuit is not necessarily the same as that in the fresh gas flow This is particularly true at low fresh gas flow rates when the patient rebreathes a significant amount of previously exhaled gases It is important that the gas mixture in the patient circuit is monitored and that the fresh gas flow is adjusted to meet the requirements of the patient and to compensate for patient intake any system leakage or any gas drawn through sample lines and not returned Waste gas scavenging systems used with Draeger Medical absorber systems must have safety features to ensure that excessive subatmospheric pressure lower than 0 5 cmH O and excessive positive pressure higher than 10 cmH 0 are not possible at the connection point Because the vaporizer funnel filling system does not limit the type of agent poured into the vaporizer using an agent monitoring device is recommended to verify the agent Do not inhale anesthetic vapors while filling or draining the vaporizer Uncontrolled inhalation of anesthetic vapors is injurious to health Do not insert any additional components into or modify the anesthesia system after any
15. of reading or 0 01 L x breath rate wr whichever is greater Tidal Volume Display Range 0 01 2 01 L NOTE The standard bellows will deliver up to 1 5 L Resolution 22 3 4206 80 4404 0 01 L 10 of reading or 0 015 L whichever is greater Volume Apnea 1 0 02 L Respiratory Numeric display 2 99 BPM Rate Resolution 4i2 eeikd eat de aed 1 BPM cusa ue d ES 10 of reading or 1 BPM whichever is greater Exclusive of hose compliance Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 3 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Serial Interface Serial Ports WWD eek ec Rex AREE S EE S ee RS 232 422 Baud 300 38400 Parity e Ya XGA E YR Odd Even or None Data DH d C ach A 7 or 8 IUS I te TI lor2 ProtocolS cu eet eee Pat ee gu e RR RR Vitalink Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F 3 6 4 Daily RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CO
16. 1 vol Os AUT cs sw ER RN UR VERG RR I REA x3 vol Os When calibrated within 18 hrs and constant temperature and pressure Response time lsssseeeee es 25 sec T90 Z ro dr op D CLER CP Ped lt 0 1 vol Og month pan dofb seca ik de Opals PR RACER c 1 vol O4 8 hours Temperature error 8 of reading 15 40 Sensor service life gt 8 months at 25 C 50 relative humidity 50 gas mixture or 2 5000 hr 3 4 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Pressure Monitoring Numeric display 10 4125 cmH3O0 1 cmH 0 Accuracy 8 cmH5O0 or 10 of reading EP TEILTE whichever is greater Waveform display range full 0 100 cmH O Waveform resolution 1cmH30 Waveform accuracy 3 cmH 0O or 10 of reading CIT whichever is greater Waveform display scales 0 20 0 50 0 100 cmH O Respiratory Volume Monitoring Minute Display Range 0 1 50 0 L Volume Re soluti sx a aer ER 3e ORE ROS AUR deca 0 11 10
17. CONTENTS RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Part Number 4115139 001 Rev F Troubleshooting Table of Contents Absorber System Problem Resolution 8 2 Ventilator Problem Resolution 8 4 Oxygen Monitoring Problem Resolution 8 5 Respiratory Volume Monitoring Problem Resolution 8 6 Breathing Pressure Monitoring Problem Resolution 8 6 Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Absorber System Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY Erratic breathing system pressure gauge readings with gurgling sounds in equipment during AUTO mode Moisture accumulation in ventilator hose Switch to manual ventilation Remove ventilator hose from the back of the manual automatic selector valve block Drain hose reconnect and return to automatic ventilation Erratic breathing system pressure gauge readings with gurgling sounds in equipment during BAG mode Moisture accumulation in scavenger hose that leads from bottom of absorber pole to scavenger system Remove scavenger hose from bottom of absorber pole Drain hose and reconnect System has pressure but flow does not cycle correctly Misconnected hoses Check all hose connections according to the instruct
18. I E ratio setting Warning Using inverse I E ratios will introduce auto PEEP Use the inspiratory flow control knob to set the inspiratory flow in the range of 10 L min to 100 L min This setting controls the flow rate of gas into the bellows canister affecting the flow rate of gas delivered to the patient Because of patient circuit variables such as lung compliance fresh gas flow airway resistance and equipment compliance the flow gauge is labeled with nominal zones of LOW MEDIUM and HIGH Adjust the flow setting to a point where the ventilator bellows is fully compressed but not deformed at the end of the inspiratory phase of the breathing cycle The inspiratory flow control can be used to create an inspiratory plateau at the end of the inspiratory cycle and to affect the potential peak inspiratory pressure within the patient breathing system Always check the pressure indicated by the breathing system pressure gauge and waveform when adjusting the inspiratory flow control The pressure limit control located above the bellows canister is used to adjust the pressure limit over a scale labeled MIN 30 MAX see Figure 5 6 This control determines the maximum pressure that can be delivered by the ventilator during the inspiratory phase of the respiratory cycle Because of patient circuit variables the scale is only a reference The pressure should be read from the breathing system pressure gauge or the anesthesia machine s pressur
19. MONITOR WINDOW Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS e Alarm Window Displays up to six of the highest priority alarms Oxygen Monitor Window Displays the patient s oxygen concentration and the anesthesia machine s oxygen alarm limits Respiratory Volume Monitor Window Displays the patient s tidal volume respiratory rate breaths per minute and minute volume as well as the anesthesia machine s minute volume low alarm limit Breathing Pressure Monitor Window Displays the patient s peak airway pressure mean airway pressure and positive end expiratory pressure PEEP Breathing Pressure Trace Window Displays a trace or waveform of the patient s breathing pressure and the anesthesia machine s breathing pressure alarm limits to the left of the waveform Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Left Keypad You use the left keypad to initiate system wide monitoring functions Figure 6 4 Left Keypad Config OP87007 When the ventilator is off Standby turns off audible tones and message displays associated with the breathing pressure alarm and respiratory volume alarms until a valid breath is detected Silence Silences all audible alarm ER Alarms tones for 2 minutes Configure Disp
20. Monitoring Connector Hose Assembly 4114912 Accessories Flow 4114444 Transd cer S t 11 3 24 901 4114445 ORINE Det od cea otc dob aw edd 4115147 A 2 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Spare and Replacement Parts A Description S genie ecu ee urs asy auci Ex RUD m aru c n wie stu for aon Part Number Pressure Breathing Pressure Hose Assembly 4114281 Monitoring Accessories Scavenger Universal Scavenger 4114255 Pipeline Hose ASM N50 DISS Hand 101 4113712 010 Supply Hoses Hose ASM Air DISS Hand 101 4113713 010 Hose DISS 101 4113714 010 Other Adapter ASM Test 1 4104389 A 4110334 Cable Translator Adapter 4114359 Part Number 4115139 001 Rev Narkomed Mobile Operator s Manual A 3 RETURN TO THIS MANUAL S TABLE CONTENTS RETURN TO CD ROM TABLE OF CONTENTS RETURN TO THIS MANUAL S TABLE CONTENTS RETURN TO CD ROM TABLE OF CONTENTS RETURN TO THIS MANUAL S TABLE OF
21. ORC Verification Oxygen Flush Verification Fresh Gas Verification Part Number 4115139 001 Rev 11 12 13 14 15 16 p IN Vaporizer Verification a Check for sufficient supply of liquid anesthetic in the vaporizer Fill the vaporizer with liquid anesthetic to the maximum fill line b Make sure the cap is on the spout and the drain is completely closed c Make sure the handwheel is set to 0 d d Vapor handle is in the locked position IN Calibrate the oxygen monitor by exposing the sensor to ambient air and activate the calibration key See Operation Oxygen Monitoring Calibrating the Oxygen Sensor in Section 5 for more information a Place the oxygen sensor securely in the sensor mount Verify that the correct gas concentration is supplied to the anesthesia system from the pipeline and cylinder supplies c Close the cylinder supply and deplete the pressure from the system IN Check the oxygen failure protection device With all gases available on the machine set to a flow of about 4 L min close the oxygen supply by disconnecting the oxygen pipeline supply hose and closing the oxygen cylinder The flow of all other gases indicated by their flowmeters must decrease in proportion to the decrease in oxygen flow and eventually shut off N Check the function of the ORC With the nitrous oxide flow control valve open to a flow of 8 L min vary the oxygen flow with the oxygen flow control
22. TERMINAL 22MM HOSE EXPIRATORY HOSE TERMINAL AUTO BAG SELECTOR VALVE 2 LITER BREATHING BAG 22MM HOSE 30 Replace the 19 mm hoses and bag if a suction system is used that connect the APL valve and ventilator relief valve to the scavenger as illustrated on the following pages 31 Turn the System Switch on 32 Perform the Daily Checkout procedure provided in this manual before operating the machine Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 27 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 7 14 Replacing the 19 mm Hoses 1 of 2 VENTILATOR 7 RELIEF VALVE p 20 IN 19 MM SCAVENGER HOSE MAGENTA COUPLING EXHAUST SYSTEM 30 IN 19MM SCAVENGER HOSE MAGENTA COUPLING OP00100 7 28 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Figure 7 15 Replacing 19mm Hoses 2 of 2 VENTILATOR RELIEF VALVE 20 IN 19 MM SCAVENGER HOSE MAGENTA COUPLING OP00082 APL VALVE N MAGENTA BAND HOSPITAL SUCTION LINE 3 LITER RESERVOIR BAG MAGENTA COUPLING 30 IN 19MM SCAVENGER HOSE J MAGENTA COUPLING Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 29 RETURN TO THIS MANUAL S TABLE CONTENTS RETURN TO CD ROM TABLE OF
23. absorbent in the absorber system Make sure the absorber canister is filled with absorbent Consult the absorbent manufacturer s literature for information on what signs to expect when the absorbent is exhausted Draeger Medical recommends the use of Dr gerSorb Make sure that the color change represents the absorbent s true state of depletion and is not due to regeneration after a rest period Flushing the anesthesia machine continuously for at least one minute with 100 oxygen before the first case of the day is recommended If the anesthesia machine has been out of use or in storage replace the absorbent before using the machine Draeger Medical recommends establishing a routine schedule with a sufficient safety margin for replacing the absorbent Remove accumulated absorbent dust and water from the absorber dust cup WARNING Absorbent is caustic and is a strong eye skin and respiratory tract irritant When emptying the absorber dust cup take care not to spill is caustic contents NOTE When changing the absorbent take care not to chip or crack the absorbent canister Check the canister for signs of damage especially around the rim before reinstallation Close the vaporizer and flow control valves Check for free gas passage in the patient breathing system Wear a surgical mask to inhale and exhale through the breathing system each limb individually if possible Verify the unidirectional flow in each limb and then
24. checkout procedure is started Doing so can invalidate the checkout results and could affect the patient s safety There is a possible explosion hazard if the Narkomed Mobile is used in the presence of flammable anesthetics Although the Narkomed Mobile is designed to minimize the effects of ambient radio frequency interference machine functions may be adversely affected by the operation of electrosurgical equipment or shortwave or microwave diathermy equipment in the vicinity Communications with external equipment may be temporarily affected by electromagnetic interference due to the use of electrosurgical equipment Do not place sensitive electronic equipment on or adjacent to the display screen The vaporizer is specifically designed and calibrated for one particular anesthetic agent Do not fill a vaporizer with any other anesthetic Do not place more than 35 pounds on top of the Narkomed Mobile unit Always operate the Narkomed Mobile on a level surface Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Vaporizer Two vaporizer holders are located on the lower rear frame rail as shown in Storage the illustration Each holder will accommodate a single Dr ger Vapor unit For storing a Dr ger Vapor unit with a flat bottom a single foam cushion is used For Drager Vapor units that are not the flat bottom style three expose
25. electrical contacts in the sensor housing Replace the sensor housing cover and turn it clockwise until it is secure against the housing Push the tip of the sensor housing cover back into the breathing pressure sensor assembly Plug the oxygen sensor connector into the system interface panel Place the pressure gauge assembly on the gauge mount Be sure to keep the o ring with the pressure gauge assembly Turn the nut that connects the pressure gauge to the gauge mount clockwise Check the gauge needle s zero position and adjust it if necessary Replace the 22 mm hoses and other breathing circuit accessories as illustrated Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 25 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 7 12 Replacing 22 mm Hoses and Other Breathing Circuit Accessories 1 of 2 OP00233a VENTILATOR Y PIECE df di 22MM 2 CORRUGATED ELBOW HOSE NN Ew 32 IN LONG NX NSPIRATORY 2D VALVE i 22 NN CORRUGATED HOSE CPAN 22 IN LONG us 7 26 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Figure 7 13 Replacing 22 mm Hoses and Other Breathing Circuit Accessories 2 of 2 1 Y PIECE p VENTILATOR we i HOSE q if 22MM HOSE s INSPIRATORY HOSE
26. ensure that excessive subatmospheric pressure lower than 0 5 cmH 0 and excessive positive pressure higher than 10 cmH 0 are not possible at the connection point 2 18 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Scavenger System The scavenger interface is an exhaust collector manifold It is intended for use with suction vacuum or passive waste gas disposal systems The suction approach uses continuous suction to transfer the gas from the scavenger to the disposal system Passive systems rely on the pressure of the waste gas to convey the waste gas to the exhaust system This is a closed system that has one spring loaded valve for positive pressure relief and one for negative pressure relief Figure 2 10 Scavenger Interface VACUUM NEGATIVE POSITIVE RESSURE PRESSURERELIEF RELIEF VALVE VALVE N y 19MM INLET HOSE CONNECTION NEEDLE VALVE 19MM OUTLET HOSE CONNECTION ADJUSTMENT KNOB SHOWN DOTTED PASSIVE OR 3 0 LITER RESERVOIR BAG ACTIVE SUCTION HOSE BARB The exhaust collector manifold has two 19 mm male fittings to connect 19 mm hoses from the ventilator and absorber APL valve to the exhaust system The exhaust collector manifold connects to a suction waste gas disposal system with the hose barb An adjustable needle valve regulates the wa
27. flow at the Y piece during the inspiratory and expiratory phases Turn the SYSTEM POWER switch and ventilator power switch to their ON positions Place the manual automatic selector valve in the AUTO position Adjust the oxygen flow control valve to a 3 L min flow Set the ventilator frequency to 3 BPM the I E ratio to 1 2 and the tidal volume to about 1 liter Adjust the ventilator flow control to the maximum of the low zone on the flow gauge Occlude the patient side of the Y piece Fill the ventilator bellows by pressing the oxygen flush button Observe the breathing system pressure gauge as the ventilator cycles Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 4 15 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS The pressure gauge must indicate a pressure over 30 when the bellows completes its downward travel At the end of the expiratory phase when the bellows completes its upward travel the pressure should not exceed 3 cmH5O Verify the PEEP valve s performance Attach a breathing bag to the patient Y piece with an appropriate adapter such as a Draeger Medical combination mask elbow with a 22 mm male fitting for the breathing bag and 15 mm male fitting for the Y piece With the manual automatic selector valve in the AUTO position set the ventilator to the preferred frequency Then adjust the PEEP valve to different values and observe the breathing system pressu
28. flow control knob in an effort to shut off the minimum flow 150 50 mL min Forcing the knob can damage the valve seat Oxygen A manually operated self closing oxygen flush valve is located on the front Flush of the power supply area of the machine A bezel is mounted around the push button to prevent accidental engagement When pressed the valve delivers an unmetered oxygen flow of about 55 L mi directly to the fresh gas common outlet The SYSTEM POWER switch does not have to be on to use the oxygen flush Figure 2 6 O Flush Button OP00097 O2 FLUSH FRESH GAS X CONTROL OUTLET N FRESH GAS LOCKING BAR RELEASE TO LOCK PULL TO INSERT OR REMOVE HOSE FRESH GAS HOSE Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Ratio Controller Fresh Gas Outlet 15 mm Auxiliary Oxygen Flowmeter 2 12 The Oxygen Ratio Controller ORC is a pneumatic oxygen nitrous oxide interlock system that maintains a fresh gas oxygen concentration of 25 4 The ORC allows independent control of the oxygen and nitrous oxide flows The ORC proportionally limits the nitrous oxide flow whenever the selected oxygen and nitrous oxide flow control valve settings would otherwise result in a hypoxic fresh gas mixture For example if you open the nitrous oxide flow control valve excessively without m
29. gas is labeled at bottom of the flowtube Each flowmeter has a float indicator To determine the flow rate read the flowmeter scale at the center of the float Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Figure 2 5 Flowmeter and Indicator Float 9 P 00213 P 8 D 5 INDICATOR FLOAT Minimum The oxygen dispensing system has a calibrated bypass flow of Oxygen Flow 150 50 mL min at 50 psi pipeline pressure that delivers this flow of oxygen even if the oxygen flow control valve is fully closed 2 10 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS p Flow Control A valve located below each flowmeter tube is used to adjust the gas flow Valves Turning the valve knob counterclockwise increases flow Turning the knob clockwise decreases flow zero stop prevents damage to the flow control valve seats If necessary an authorized representative of Drager Service can readjust the stop Each flow control knob is identified by its color code and chemical symbol The oxygen flow control valve is also touch coded with a deeply fluted knob Each knob has a guard to prevent accidental adjustment to gas flow Caution The oxygen flow cannot be completely shut off Do not force the oxygen
30. machine Figure 5 3 Absorber System PRESSURE 4 p SENSOR ADAPTER lt BREATHING SYSTEM PRESSURE GAUGE ABSORBENT CANISTER EXPIRATORY VALVE PEEP VALVE OP00079 The absorber system includes e an inspiratory valve and an expiratory valve absorber canister and dust cup abreathing system pressure gauge apressure sensing hose assembly fresh gas hose manual automatic ventilation selector valve e an adjustable pressure limiter APL valve respiratory volume sensor oxygen concentration sensor e a positive end expiratory pressure PEEP valve Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual OXYGEN SENSOR INSPIRATORY VALVE FRESHGAS HOSE APL VALVE MANUAL AUTO SELECTOR VALVE BREATHING BAG FITTING ABSORBER MOUNTING STUD ABSORBER POLE 5 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Using the Manual Automatic Selector Valve 5 8 The absorber system handles spontaneous manually assisted or automatic ventilation The preferred mode of operation is selected with the manual automatic selector valve Warning Waste gas scavenging systems used with Draeger Medical absorber systems must have safety features to ensure that excessive subatmospheric pressure lower than 0 5 cmH3O and excessive positive pressure higher than 10 cmH 0 are not possible at the connection point The manual automatic sele
31. not to spill its caustic contents NOTE When changing the absorbent take care not to chip or crack the absorbent canister Check the canister for signs of damage especially along the rim before reinstallation Close the vaporizer and all gas flow sources Check for free gas passage in the patient breathing system Wear a surgical mask to inhale and exhale through the breathing system each limb individually if possible Verify the unidirectional flow in each limb and then reconnect the tubing Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS t APL Valve 20 IN Check the APL valve to be sure it can relieve excess gas from the Verification breathing system into the scavenger system To check the APL valve s flow resistance a Set the manual automatic selector valve to BAG b Setthe PEEP valve to its minimum position c Remove the bag from the bag mount d Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm hose e Completely open the APL valve by turning the control knob fully counterclockwise to its stop position f Turn the SYSTEM POWER switch to ON g Open the oxygen flow control valve to a flow of 8 L min h Occlude the bag mount opening and watch for a pressure increase on the breathing system pressure gauge This pressure increase must not exceed
32. or partial disconnection occurs when the Limit threshold pressure alarm limit is set significantly lower than the peak Guidelines pressure continued positive pressure ventilation can produce a pressure fluctuation great enough to exceed the threshold and thereby satisfy the alarm yet not great enough to provide adequate ventilation To address the problem the Advisory message THRESHOLD LOW appears in the Alarm window when either of the following conditions occurs e The sensed peak pressure exceeds the set threshold by more than 6 cmH50 at threshold pressure alarm limit settings of 5 20 cmH 0 e The sensed peak pressure exceeds the set threshold by more than 8 cmH 0 at threshold pressure alarm limit settings of 21 29 cmH 0 Note The threshold setting may be affected when the ventilator is turned on or off If you turn the ventilator off while the threshold is set to a value greater than 15 cmH 0 the setting is changed to 15 cmH O If the threshold is set lower than 15 cmH5O when the ventilator is turned off the threshold retains its setting When the ventilator is turned back on the threshold is restored to its previous set value Sample Figure 6 18 illustrates the effects of correct and incorrect settings of the Threshold threshold pressure alarm limit Limit Settings Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 29 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS
33. screws Perform the absorber portion of the daily checkout procedure provided in the Daily Checkout section to verify proper reassembly Replacingthe Replace the oxygen sensor capsule when its sensor is depleted because a Oxygen depleted sensor cannot correctly analyze oxygen concentrations Sensor Capsule 1 Turn the SYSTEM POWER switch to STANDBY 2 Remove the oxygen sensor housing from the inspiratory valve dome It is a press fit 9 Unscrew the cover from the sensor housing and remove the sensor capsule 4 Install the replacement sensor in the housing Verify that the copper rings on the capsule mate with the electrical contacts in the sensor housing 5 Wait 15 minutes to let the sensor capsule stabilize to ambient air If you do not wait calibration the next step will not be successful 6 Restore power to the machine and calibrate the oxygen sensor This procedure is provided in Using the Monitoring System Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Figure 7 2 Disassembled Oxygen Sensor f O2 SENSOR P HOUSING SENSOR m CAPSULE SENSOR a a CORD CONNECTOR SENSOR HOUSING PRESSURE Bes ROVER SENSOR ADAPTER ins INSTALLED IN INSPIRATORY VALVE DOME OP00091 Clearing Depending on the conditions of use and the environment condensation can Condensa accumulate in t
34. the sensor s output against a range of acceptable output voltages There are three possible causes for deviation from within this range Exhausted sensor If the sensor s capacity is exhausted its output voltage will not meet the required minimum e Incorrect calibration environment If the sensor is exposed to an excessive oxygen during calibration the sensor s output will be above or below the acceptable output range e Improper waiting If the proper waiting period is not allowed for a new sensor or for a sensor removed from the sensor housing the sensor s output may be above or below the acceptable output range If a sensor error condition is detected during monitoring the Advisory message REPLACE 2 CELL appears in the Alarm window and operation continues Try to recalibrate the sensor if the message remains replace the sensor cell The Advisory message CAL O2 SENSOR appears in the Alarm window in the following instances the oxygen sensor enters a noncalibrated state the Narkomed Mobile is unable to calibrate the oxygen sensor more than 18 hours have elapsed since the last calibration Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS SERVICE VENT MON Advisory If the Narkomed Mobile detects an internal electronic failure that would prevent proper operation the Advisory message SERVICE VENT MON appears in the Alarm window If this h
35. the user facility following the specific instructions provided by the manufacturer of the equipment or agent used For additional information about infection control practice refer to the APIC Guideline for Selection and Use of Disinfectants This guideline was developed by the Association for Professionals in Infection Control and Epidemiology Inc and published in AJIC Vol 24 No 4 pp 313 342 August 1996 The following table of recommended disinfection methods for the Narkomed Mobile was adapted from the APIC Guideline for Selection and Use of Disinfectants Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS A Heat sterilization autoclaving including steam or hot air use manufacturer s recommendations Table 11 Disinfection Methods Part Exterior Painted Plated and Plastic Surfaces Corrugated Breathing Hoses Mask Elbow and Breathing Bag Y Piece and Face Mask Ventilator Bellows Ventilator Bellows Bottom Assembly Oxygen Sensor Capsule Oxygen Sensor Housing Oxygen Sensor Housing Cover Breathing Pressure Sensor Adapter and Hose Assembly Inspiratory Expiratory Valves PEEP Ultrasonic Flow Sensor Housing and Transducers Ultrasonic Flow Sensor Electronics Housing and Cable Breathing System Pressure Gauge Absorber Canister Assembly and D
36. the valve mount Replace the canister assembly in the absorber assembly and tighten the two wing nuts that secure the canister assembly to the absorber Replace the dust cup making sure the o ring is in place Place the absorber mounting stud on the absorber pole Loosely tighten the upper set screw to lock the assembly to the absorber pole Loosen the lower wing screw to raise the absorber system to the preferred height Tighten the wing screw to hold the absorber at that height Loosen the upper wing screw and rotate the absorber system to the preferred position Tighten the upper wing screw to hold the absorber in position Warning Do not pinch or kink the fresh gas hose leading from the fresh gas outlet to the absorber Connect the fresh gas hose to the fresh gas outlet on the machine Replace the PEEP valve Make sure the gasket is in place over the absorber pipe before installing the PEEP valve and tightening the retaining ring Replace the expiratory valve Make sure the gasket is in place over the PEEP valve connection before turning the expiratory valve retaining ring clockwise until it is secure Reassemble the ultrasonic flow sensor Press the transducers into their ports on the flow housing Ensure that the three o rings on each transducer are not damaged and are properly seated Slide the flow housing transducer assembly into the electronics housing Be sure that it clicks into place Narkomed Mobile Operator s M
37. valve The nitrous oxide flow indicated on the nitrous oxide flowmeter must automatically vary in response to the adjustment of the oxygen flow control valve The ORC must maintain a fresh gas oxygen nitrous oxide flow ratio of at least 2196 oxygen N Check the oxygen flush a Press the oxygen flush button and listen for an audible gas flow sound accompanied by a marked increase in oxygen concentration in the breathing system b Check the delivered oxygen concentration Repeatedly flush the patient breathing system by pressing the oxygen flush button Close all the other flow control valves The oxygen measurement display area should indicate 97 to 100 oxygen concentration IN Make sure the handwheel is set to 0 Open the oxygen flow control valve to an 8 L min flow and close all other flow control valves Sniff the gas coming from the fresh gas common outlet There should be no noticeable odor Narkomed Mobile Operator s Manual 4 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Absorber System Verification 17 IN To check the absorber system 18 19 a Check the hose connections in the breathing system b Make sure the fresh gas hose of the breathing system is securely connected to the fresh gas outlet c Make sure a 22 mm patient breathing circuit is connected between the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor d Make s
38. warning caution and advisory alarms associated with respiratory volume monitoring The Narkomed Mobile continuously monitors the expiratory flow in the patient breathing system By processing the expiratory flow pattern the monitor can determine whether a valid breath has occurred A valid breath has a tidal volume of 20 mL or greater Note During some breathing system disconnects when the ventilator is in use the ventilator s dynamics may cause a small volume of gas to be drawn through the expiratory valve and the ultrasonic flow sensor Because of the enhanced sensitivity of the flow sensor this volume may be detected as a valid breath However the disconnect will still be detected by the airway pressure monitor which is always on and can not be turned off when the ventilator is in use When the ventilator is on e f 15 seconds pass and valid breath is not detected the Caution message APNEA VOLUME appears in the Alarm window and an intermittent audible alarm sounds e additional 15 seconds pass 30 seconds total and a valid breath is not detected the Caution message APNEA VOLUME is upgraded to a Warning in the Alarm window and a continuously repeating audible alarm sounds Narkomed Mobile Operator s Manual 6 21 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS MINUTE VOLUME LOW Caution REVERSE FLOW Advisory VOL SENSOR DISC Advisory VOL ALARMS STBY Advi
39. BAG Turn the APL valve fully counterclockwise Verify that the suction waste gas disposal system is active Open the scavenger needle valve enough to allow typical suction through the scavenger Close all flow control valves on the anesthesia machine Occlude the absorber breathing bag mount At this point the breathing pressure gauge should indicate a negligible negative pressure no lower than 1 0 cmH O To test positive pressure relief a Bm m Connect a 19 mm scavenger hose to the ventilator relief valve and the scavenger interface Connect a 19 mm scavenger hose between the APL valve and the scavenger interface Connect the 3 0 liter reservoir bag to the reservoir bag terminal Connect the scavenger to the suction waste gas disposal system Short circuit the absorber s inspiratory and expiratory valves with a 22 mm breathing hose Set the absorber s manual automatic selector valve to BAG Turn the APL valve fully counterclockwise Verify that the suction waste gas disposal system is active Turn the PEEP valve control knob fully counterclockwise to its lowest setting Turn the scavenger needle valve fully counterclockwise Push the flush button to inflate the scavenger reservoir bag Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Manual and Automatic Ventilation Systems n t should
40. Before each case perform the preuse checkout procedures and check the following 1 Make sure the drain valve is closed and the locking lever is in the locked position 5 4 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS gt 2 Set the handwheel to 0 zero point interlock and make sure the button is engaged Then press the 0 button and turn the handwheel to 0 and engage the button Wait 5 seconds for the pressure to equalize Figure 5 2 Locking Lever Open Handwheel Moved to Zero LOCKING LEVER LOCKED LOCKING LEVER UNLOCKED N HANDWHEEL OP00330 3 Fill the vaporizer to the maximum fill line 4 Tighten the filler sealing plug Turning the To turn the vaporizer on Vaporizer On Adjust the fresh gas flow 2 Turn the vaporizer handwheel to the preferred anesthetic concentration Do not set the handwheel between 0 and 0 2 volume concentration This part of the handwheel actuates the on off switch and cannot be calibrated Note Verify that the scavenger system to collect and remove vented gas from the operating room is properly functioning Turning the To turn the vaporizer off turn the vaporizer handwheel to 0 zero point Vaporizer Off interlock and make sure the button engages Do not interrupt the fresh gas flow until the vaporizer is turned off Note Drain the anesthetic agent if th
41. CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Drager medical A Drager and Siemens Company Draeger Medical Inc 3135 Quarry Road Telford PA 18969 Tel 215 721 5404 800 462 7566 Fax 215 721 9561 Web www draegermedical com Printed in the U S A
42. ETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Table of Contents continued Preuse Checkout Procedure 4 11 Reserve Power Verification 4 11 Absorber System Verification 4 11 Valve 4 12 Breathing System Leak Test 4 13 Scavenger System sss 4 14 Manual and Automatic Ventilation Systems 4 15 MONTON e ERR 4 16 System iaceret 4 16 Final POSION c 4 16 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS t Daily Checkout Procedure Initial Setup and Verification System Software Diagnostics Battery Power Verification Emergency Ventilation Equipment Verification Before operating the Narkomed Mobile the following checkout procedure must be performed to make sure the machine is ready for use This is a recommended procedure Follow your institution s policies for specific checkout procedures If the anesthesia system fails any procedures identified by an important note symbol do not use the machine Contact an authorized representative of Dr gerService for inspection of the unit Note Do not in
43. LE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 1 Safety Summary Table of Contents Operator s Responsibility for Patient Safety 1 2 Limitation of 1 3 RESIICUON E 1 3 Copyright a n 1 3 Trademark Notices esses 1 3 BIETe ENIM 1 4 Recommendations nnen nn nnne 1 4 Purpose of This Manual 1 4 Symbol Definition eese 1 5 Warnings and Cautions i i te been ot Hine e thia xb eh 1 5 Warnings 1 6 Moving the cence esadsccnereescnsicesscercecenans 1 6 i eer ILLE 1 8 Vaporizer Storage 1 9 Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS M Operator s Responsibility for Patient Safety Draeger Medical anesthesia products are designed to provide the greatest degree of patient safety that is practically and technologically feasible The design of the equipment the accompanying literature and the labeling on the equipment take into consideration that the purchase and use of the equipment are restricted to trained professionals and that certain inherent characteristics of the equipment are known to the tra
44. MM OUTLET NEEDLE VALVE ADJUSTMENT KNOB HOSE CONNECTION SHOWN DOTTED PASSIVE OR 3 0 LITER RESERVOIR BAG ACTIVE SUCTION 7 HOSE BARB 6 Place the filter back into the cap making sure that it lays flat against the inside of the cap 7 Reinstall the cap on the scavenger body making sure that the filter is properly seated 8 Perform the scavenger interface portion of the daily checkout procedure provided in this manual Note If your facility requires a disinfection process for the scavenger interface and hoses remove the scavenger and all 19 mm hoses Refer back to the cleaning instructions under Scavenger Maintenance for disassembly instructions Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Removing Parts for Cleaning and Disinfection 1 2 Turn the SYSTEM POWER switch to STANDBY Disconnect the 22 mm breathing circuit hoses between the ventilator and the absorber and from the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor Remove the Y piece mask and mask elbow from the hoses Disconnect the 19 mm scavenger hoses from the APL valve and the ventilator relief valve While supporting the bottom of the assembly loosen the two wing nuts located below the ventilator bellows canister until the assembly releases from the canister Figure 7 5 Removing the Ventilator Bell
45. Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Using the APL Valve 5 The valve relieves excess gas from the breathing circuit into the scavenger system during spontaneous or manual ventilation The APL valve expels excess gas containing expired carbon dioxide before it contacts the absorbent which extends the life of the absorbent Turning the APL valve knob clockwise increases the flow resistance into the scavenging system Complete clockwise rotation eliminates all flow through the valve Turning the knob counterclockwise decreases the flow resistance In addition to regulating the amount of waste gas flow adjusting the APL valve also affects the patient peak inspiratory pressure during manual ventilation Turning the APL valve knob counterclockwise reduces the valve s flow resistance and lowers the peak inspiratory pressure Turning the APL valve knob clockwise increases the valve s flow resistance and raises the peak inspiratory pressure However a variety of additional factors such as fresh gas flow rate and the method used to squeeze the breathing bag also affect patient peak inspiratory pressure during manual ventilation During spontaneous ventilation the APL valve control knob must be fully open turned fully counterclockwise to minimize mechanical resistance to patient exhalation Figure 5 4 APL Valve APL VALVE N CONTR
46. NTENTS and Preuse Checkout Procedures Part Number 4115139 001 Rev F Table of Contents Daily Checkout Procedure 4 3 Initial Setup and Verification 4 3 System Software Diagnostics 4 3 Battery Power Verification 4 3 Emergency Ventilation Equipment Verification 4 3 High Pressure System Verification 4 4 Pipeline Supply System Verification 4 4 System Gas Circuit Verification 4 4 Low Pressure System Verification 4 5 Oxygen Monitor Calibration 4 5 OFPD Verification Me C 4 5 ORG VeritiGallDl iicet tuts 4 5 Oxygen Flush Verification cie t 4 5 Fresh Gas Verification 4 5 Absorber System Verification 4 6 APL Valve Verification xi ern eno Lieu brin eu 4 7 Breathing System Leak Test 4 7 Scavenger System Verification 4 8 Manual and Automatic Ventilation Systems 4 9 L epiq 4 10 System FluSh Re 4 10 Final POSION 222 4 10 Narkomed Mobile Operator s Manual R
47. Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Pressure Alarm Messages APNEA PRESSURE Warning Caution VENT PRESSURE HI Warning SUB ATM PRESSURE Warning Part Number 4115139 001 Rev The LED next to the Breathing Pressure On key lights to indicate that the apnea pressure alarm is enabled Note You cannot turn on the apnea pressure alarm during power up It is automatically forced off to prevent nuisance alarms during patient setup The following list contains all warning caution and advisory alarms associated with breathing pressure monitoring When the ventilator is on e Ifthe measured breathing pressure remains below the threshold pressure alarm limit for more than 15 seconds the Caution message APNEA PRESSURE appears in the Alarm window and an intermittent audible alarm sounds e Ifthe breathing pressure remains below the threshold pressure for an additional 15 seconds 30 seconds total the Caution message APNEA PRESSURE is upgraded to a Warning in the Alarm window and a continuously repeating audible alarm sounds During the Warning condition numeric data remains on the display as long as the monitor detects a peak pressure at least 10 cmH50 greater than PEEP pressure When this pressure difference drops and remains below 10 cmH50 for more than 60 seconds the numeric data is cleare
48. OL KNOB 0 00089 gravity loaded check valve within the valve prevents gas flow from the scavenging system into the breathing system For instance during spontaneous ventilation when patient inspiratory effort produces a negative pressure on the breathing circuit side of the check valve the valve closes and prevents gas from the scavenger system from entering the breathing Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 5 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Using the PEEP Valve 5 10 circuit Also the check valve minimum opening pressure of about 1 cmH O enables the breathing bag to reinflate before the valve opens Warning To minimize mechanical resistance to the patient s exhalation during spontaneous breathing the APL valve s control knob must be turned fully counterclockwise For manually assisted or manually controlled ventilation APL valve resistance must be increased as needed by turning the APL valve control knob clockwise The absorber system regulates positive end expiratory pressure PEEP through the PEEP valve The PEEP valve is located on the absorber downstream of the breathing system pressure gauge As a result the pressure gauge reading includes PEEP Its integral design also prevents accidents that are possible with accessory PEEP valves such as inadvertent reversal and misplacement in the inspiratory limb Turning the PEE
49. P control knob clockwise increases PEEP and turning the knob counterclockwise reduces PEEP The actual PEEP in the system is indicated on the absorber pressure gauge at the end of exhalation and can be adjusted from about 2 15 cmH O Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 5 Scavenger Interface Operation The scavenger interface is an exhaust collector manifold It is intended for use with suction vacuum or passive waste gas disposal systems The suction approach uses continuous suction to transfer the gas from the scavenger to the disposal system Passive systems rely on the pressure of the waste gas to convey the waste gas to the exhaust system This is a closed system that has one spring loaded valve for positive pressure relief and one for negative pressure relief Figure 5 5 Scavenger Interface VACUUM NEGATIVE gt POSITIVE RESSURE PRESSURE RELIEF N 7 RELIEF VALVE VALVE N iA 19MM INLET HOSE CONNECTION OP00088 NEEDLE VALVE ADJUSTMENT KNOB SHOWN DOTTED 19MM OUTLET HOSE CONNECTION PASSIVE OR 3 0 LITER RESERVOIR M c BAG ACTIVE E HOSE BARB Warning The scavenger interface for suction systems requires proper adjustment for safe operation The needle valve regulates the waste gas exhaust flow During a case the needle valve must be readjusted as needed Needle valve ad
50. R ADAPTER INSPIRATORY VALVE DOME QUICK CONNECT a FITTING 10 Turn the nut that connects the pressure gauge to the gauge mount to the absorber assembly counterclockwise 11 Lift the pressure gauge assembly off the gauge mount Be sure to keep the o ring with the pressure gauge assembly Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 7 8 Removing the Breathing Pressure Gauge BREATHING PRESSURE GAUGE OP00229 12 Disconnect the flow sensor cable from the system interface panel 13 Remove the connector hose assembly between the expiratory valve and the ultrasonic flow sensor by turning the ring nut counterclockwise 14 Lift the flow sensor off the bracket 15 Turn the expiratory valve counterclockwise until it can be removed from the assembly Take care not to lose the gasket that fits between the expiratory valve and the PEEP valve 16 Remove the PEEP valve by turning the retaining ring counterclockwise Take care not to lose the gasket 7 12 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Figure 7 9 Removing the Expiratory Valve and Ultrasonic Flow Sensor SENSOR p REMOTE DISPLAY BREATHING PRESSURE HOSE SENSOR PLUG ULTRASONIC FLOW J SENSOR EXPIRA
51. RESSURE MONITOR WINDOW Breathing Pressure Trace Window This large window on the left displays a breathing pressure trace or waveform the left of the waveform in small type are the pressure high and threshold pressure alarm limits Breathing Pressure Monitor Window This small window on the right contains numerical breathing pressure measurements Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 23 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing The Breathing Pressure Monitor window contains breathing pressure Pressure measurements expressed in units of cmH3O Monitor Window Figure 6 14 Breathing Pressure Monitor Window OP87015 PEAK BREATHING PRESSURE MEAN _ BREATHING PRESSURE POSITIVE END EXPIRATORY PRESSURE PEAK Breathing Pressure The highest instantaneous pressure value for each breath MEAN Breathing Pressure The average of all the instantaneous pressure values recorded during each breath e PEEP Positive End Expiratory Pressure The breathing pressure at the end of exhalation During apneic conditions the pressure monitor displays numeric information as long as it detects a peak pressure at least 10 cmH O greater than PEEP pressure When this pressure difference drops below 10 cmH O the numeric information remains 1 minute lo
52. RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Drager medical A Drager and Siemens Company Operator s Instruction Manual Part Number 4115139 001 Rev F Date 30 January 2004 2004 Draeger Medical Inc Narkomed Mobile Anesthesia System WARNING For a full understanding of the performance characteristics of this anesthesia machine the user should carefully read this manual before operating RETURN TO THIS MANUAL S TABLE CONTENTS RETURN TO CD ROM TABLE OF CONTENTS RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Contents Section 1 Safety Summary Operator s Responsibility for Patient Safety liliis 1 2 Limitation of Liability net eee ea e e m Ge b RR e RR Tem REOR RUE EROR DC e 1 3 ROSHICHON eben b C EU e er aga ed ER ed CERE RUP ete eats 1 3 COD VIG IM Ta Sd eee ate eed Suo i id Mua eaten 1 3 Trademark Notices ere Rex Ux RUE oe eee 1 3 DISCIANMNEN ees RE 1 4 Recommendations eee reet p hed ERU d epe he PM te obo eed 1 4 Purpose of This Marital 2e rr eren tte Rte tena t e i ie RO 1 4 Symbol Definitlon 12 zi ute reat re eor dined eR RAP e rece d Me TOP E RR D 1 5 Warnings and
53. S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Respiratory Volume Display Information about the patient s respiratory volume is presented in the Respiratory Volume Monitor window in the middle of the monitor display From left to right numerical values are shown in large type for tidal volume respiratory rate and minute volume At the extreme right in small type is the minute volume low alarm limit Figure 6 11 Respiratory Volume Monitor Window OP87012 MINUTE VOLUME MEASUREMENT l min TID VOL MIN VOL 0 35 10 35 2 0 M b MINUTE VOLUME ALARM LIMIT TIDAL VOLUME BREATHING RATE MEASUREMENT 1 MEASUREMENT breaths min Tidal Volume Measurement TID VOL Displays the volume for each valid breath at least 20 mL If the monitor does not detect a valid breath within 30 seconds the display area goes blank Breathing Rate Measurement BPM Shows the number of breaths during the previous minute of respiration If the BPM display is blank a full minute of respiration has not occurred Minute Volume Measurement MIN VOL Continuously displays the volume of exhaled gas accumulated during the previous minute of respiration A blank MIN VOL display area indicates that a full one minute history of exhaled volume is not available Minute Volume Alarm Limit Indicates the volume below which an alarm condition occurs Part Number 4115139 001 Rev F Narkomed Mobile Operator s Ma
54. TORY VALVE EXPIRATORY HOSE TERMINAL VALVE RETAINING NUT ABSORBER FLOW SENSOR ASSEMBLY BRACKET PEEP VALVE OP00099 17 Remove the absorbent from the absorber canister Refer back to Routine Maintenance Replacing the Absorbent in this chapter for instructions Warning Absorbent is caustic and a strong irritant to the eyes skin and respiratory tract When removing the absorbent take care not to spill its caustic contents 18 Disconnect the fresh gas hose from the fresh gas outlet 19 Loosen the wing screw to release the absorber from the absorber pole Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 20 Exercising care lift the absorber off the pole Note If the user facility mandates disinfection for the scavenger interface and hoses remove the scavenger hoses and bag if used as described in the following steps 21 Remove the 19 mm scavenger hoses from the scavenger interface 22 If a passive scavenger system is used disconnect the exhaust system hose from the scavenger If a suction scavenger system was used disconnect the suction hose and remove the 3 liter reservoir bag from the scavenger 23 Slide the scavenger interface up the slide mount until it is free of the frame Disassembling Parts for Cleaning and Disinfection Disassem bling the Oxygen Sensor Ass ly Disass
55. The anesthesia machine s SYSTEM POWER switch located at the bottom of the flowmeter housing must be set to ON for the ventilator to function The ventilator power switch controls the pneumatic and electrical power to the ventilator In the OFF position the FREQUENCY and I E RATIO displays remain lighted but the ventilator will not function The ON position activates the ventilator The monitoring system s volume and pressure alarms are automatically enabled when the power switch is in the ON position The tidal volume is adjusted using a self locking knob located above the bellows assembly The control knob positions a stop within the bellows canister that limits the upward travel of the bellows and sets the maximum tidal volume of gas delivered to the patient adjust the tidal volume press the self locking knob in so it can turn then set the tidal volume by the setting indicator on the bellows chamber scale marked 200 1400 mL The tidal volume can be adjusted for volumes between 20 and 1500 mL 100mL Smaller tidal volumes can be adjusted by setting the pointer below the 200 mL marking on the bellows chamber Larger tidal volumes can be selected by setting the pointer above the 1400 mL calibration As in any volume preset anesthesia ventilator the actual tidal volume delivered to the patient s lungs may differ from the preset volume at the bellows due to the compliance of the breathing system and fresh gas flow To accurately
56. URN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS t Symbol Definition The following symbols appear on the label on the back of the Narkomed Mobile unit CAUTION Refer to accompanying documents before N operating equipment Refer servicing to a qualified technical service representative CAUTION Risk of electric shock do not remove cover Degree of protection against electric shock Type B The following symbols appear on the shipping container of the Narkomed Mobile unit WARNING This end up WARNING Handle with care WARNING Keep dry oe WARNING Minimum and maximum storage temperatures Warnings and Cautions This manual contains warning and caution statements about the Narkomed Mobile unit e Warning statements provide important information that if ignored could lead directly to personal injury e Caution statements provide important information that if ignored could lead directly to equipment damage and indirectly to personal injury Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 1 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS M Warnings Moving the Unit 1 6 The instruction manual provides important information about patient and operator safety Anyone involved with the setup operation or maintenance of the Narkomed Mobile anesthesia system must be thoroughly familiar with this ins
57. US PRES appears in the Alarm window and an intermittent audible alarm sounds When the measured breathing pressure drops below the threshold pressure alarm limit alarm annunciation ceases Any time that the monitor measures a PEEP of 26 cmH 0 or greater the Caution message PEEP gt 25 appears in the Alarm window and an intermittent audible alarm sounds Alarm annunciation ceases when the measured PEEP drops below 26 cmH3O Also an APNEA or CONTINUING PRESSURE alarm condition will clear this alarm condition The Advisory message THRESHOLD LOW appears in the Alarm window any time the sensed peak pressure exceeds the threshold pressure alarm limit by more than 6 cmH5O at threshold pressure alarm limit settings of 5 20 cmH 0 or by more than 8 cmH 0 at threshold pressure alarm limit settings of 21 29 cmH5O Setting the threshold pressure alarm limit at 30 cmH5O disables the THRESHOLD LOW advisory Any time the monitor measures a PEEP of 5 cmH5O or greater the Advisory message PEEP gt 4 appears in the Alarm window When the measured PEEP drops below 5 the Advisory message 15 cleared from the display Any time that the apnea pressure alarm threshold pressure alarm limit has been set to Standby the Advisory message APNEA PALM STBY appears in the Alarm window If the Narkomed Mobile detects an internal electronic failure that would prevent proper operation the Advisory message SERVICE VENT MON appears in the Alarm wi
58. aking a corresponding increase in the oxygen flow control valve setting the flow of nitrous oxide will not increase even though its flow control valve setting was greatly increased Similarly if you decrease the oxygen flow without also decreasing the nitrous oxide flow the nitrous oxide flow will automatically drop in proportion to the oxygen flow Warning In circle systems the gas mixture in the patient circuit is not necessarily the same as that in the fresh gas flow This is particularly true at low fresh gas flow rates when the patient rebreathes a significant amount of previously exhaled gases It is important that the gas mixture in the patient circuit is monitored and that the fresh gas flow is adjusted to meet the requirements of the patient and to compensate for patient intake any system leakage or any gas drawn through sample lines and not returned The fresh gas outlet Figure 2 7 on page 2 13 delivers the fresh gas mixture consisting of oxygen nitrous oxide and air and vapors of a liquid anesthetic to the patient breathing system The outlet is located on the front of the anesthesia machine The 15 mm cylindrical female fitting accepts a 15 mm male fitting on the absorber fresh gas hose The male fitting slides into a retaining slot in the spring loaded safety locking bar to prevent inadvertent disconnection of the fresh gas hose The 15 mm male fitting on the fresh gas hose is unique to Draeger Medical design and should no
59. ambient air exposure hold the sensor away from any open part of the breathing system With the sensor exposed only to room air press the Cal key Calibration begins View the monitor screens to track progress of the calibration During calibration the LED next to the Cal key lights and the label CAL appears in the Oxygen Monitor window Following successful calibration the currently sensed oxygen concentration appears in the Oxygen Monitor window If the calibration was not successful the Oxygen Monitor window is blank See Unsuccessful Calibration in this section for further information Typically calibration lasts less than 30 seconds However the time may vary depending on the amount of oxygen the sensor was exposed to before calibration Oxygen Typical Calibration Exposure Time 21 10 seconds gt 21 up to 50 seconds When the Narkomed Mobile successfully completes the calibration pull the inspiratory valve dome plug and reinsert the sensor assembly Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Unsucessful Calibration Part Number 4115139 001 Rev If at the end of the calibration period if the Oxygen Monitor window is blank the calibration was not successful This condition is also indicated by the CAL O2 SENSOR Advisory message in the Alarm window An unsuccessful calibration can b
60. ance and patient condition to simple direct contact between operator and patient direct observation of clinical signs The responsibility for the selection of the best level of patient monitoring belongs solely to the equipment operator To this extent the manufacturer Draeger Medical disclaims responsibility for the adequacy of the monitoring package selected for use with the anesthesia system However Draeger Medical is available for consultation to discuss monitoring options for different applications 1 2 Narkomed Mobile Operators Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Limitation of Liability Restriction Copyright Draeger Medical s liability whether arising from or related to the manufacture and sale of the products their installation demonstration sales representation use performance or otherwise including any liability based upon Draeger Medical s product warranty is subject to and limited to the exclusive terms of Draeger Medical s limited warranty whether based upon breach of warranty or any other cause of action whatsoever regardless of any fault attributable to Draeger Medical and regardless of the form of action including without limitation breach of warranty negligence strict liability or otherwise Draeger Medical shall in no event be liable for any special incidental or consequential damages including loss of prof
61. anual 2 27 RETURN TO THIS MANUAL S TABLE CONTENTS RETURN TO CD ROM TABLE OF CONTENTS RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 3 Specifications Table of Contents 3 2 ipii 3 2 icr m 3 2 Operating rr 3 2 Electrical mere 3 2 Main Power Supply sicccccicccenecsantcecendenansasanntecanthecteeamseets 3 2 Backup Battery A 3 2 Gas Delivery System 3 3 Cylinder Gas Pressure 3 3 Flowmeter Accuracy at 20 C and 760 mmHg 3 3 Ventilator 3 4 Absorber System ducens totes tds 3 4 Inspiratory Valve 2 2 3 4 Expiratory iie rx ru cili 3 4 PEEP 3 4 APL ri CC 3 4 re te n 3 4 Oxygen Monitoring eti tob tag eral endet apio tnde 3 4 Breathing Pressure Monitoring 3 5 Respiratory Volume Monitoring 3 5 Minute VolUMe m M 3 5 Tidal Volume c 3 5 Respiratory Rate ct 3 5 Serial Interface set ce ceca esse ennai 3 6 Serial Ports qe 3 6 Part Number 4115139 001 Rev F Narkomed Mobile Operat
62. anual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 15 16 17 18 19 20 21 22 23 24 25 26 2T 28 29 7 Note If the flow housing transducer assembly does not fit easily into the electronics housing make sure the flow housing is facing the right direction Compare the direction to the illustration on the electronics housing The index pin on the electronics housing should align with the hole in the flow housing Slide the flow sensor onto the bracket Connect the patient hose to the expiratory hose terminal on the flow sensor Install the connector hose assembly between the flow sensor and the expiratory valve and secure it by turning the ring nut clockwise Connect the sensor cable to the volume sensor receptacle on the system interface panel Replace the pressure gauge Place the pressure gauge assembly on the gauge mount making sure that the o ring is in place Turn the knurled ring nut clockwise until it is secure Check the gauge s zero position and adjust it if necessary Press the pressure sensor adapter and hose assembly into the inspiratory valve dome Connect the quick connecting fitting to the pressure gauge Connect the breathing pressure pilot line connector to the system interface panel Place the oxygen sensor back into the oxygen sensor housing Verify that the rings on the capsule face the
63. aporizer is off the handwheels is set to zero b the vaporizer is filled to the maximum fill line c Vaporizer properly locked into position d the APL valve is open fully counterclockwise the manual automatic selector is set to BAG f allflowmeters indicate 0 or minimum g the breathing system is ready to use the bag is in place and all hoses are connected properly Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS t Preuse Checkout Procedure Reserve Power Verification Absorber System Verification Perform the following abbreviated checkout procedure when the Narkomed Mobile is used in successive cases It may be performed only after the initial daily checkout procedure given in Section 3 was performed This is a recommended procedure Follow your institution s policies regarding specific checkout procedures If the anesthesia system fails any procedures identified by an important note symbol IN do not use the machine Contact an authorized representative of Dr gerService for inspection of the unit NOTE Do not insert any additional components into or modify the anesthesia system after the checkout procedure is started 1 IN Check the reserve battery power Turn the SYSTEM POWER switch to the ON position Remove the power cable from the outlet Press the BATTERY TEST button located to the left of the SYSTEM POWER
64. appens contact an authorized representative of Dr gerService Respiratory Volume Monitoring 6 18 Respiratory volume is measured by an ultrasonic flow sensor which is attached to the expiratory valve and mounted to the top of the absorber assembly The ultrasonic flow sensor has two transducers that measure the time of flight of ultrasonic pulses transmitted upstream and downstream in the respiratory flow path The difference in the time of flight is used to determine the velocity and the flow rate of gas through the patient circuit The flow sensor output is converted to meaningful readings for minute volume tidal volume and respiratory rate displays Warning The ultrasonic flow sensor can be used with all normal anesthetic gases except oxygen helium heliox Incorrect flow measurements will result if heliox is used Caution Although the Narkomed Mobile is designed to minimize the effects of ambient radio frequency interference the functioning of the respiratory volume monitor may be adversely affected by the operation of electrosurgical equipment or short wave or microwave diathermy equipment in the vicinity Note Sudden irregular expiratory flow may cause erratic tidal volume and respiratory rate displays To avoid such erroneous measurements defer reading the display until a full minute has elapsed after the irregular flow has stopped Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL
65. ation Warning Caution Caution can be higher or lower than the concentration set on the handwheel Be sure to fill the vaporizer in an upright position Filling the vaporizer in a tilted position can cause overfilling Overfilling causes the anesthetic concentration rate to be higher or lower than the handwheel setting Handle the vaporizer with care Do not drop carry by the handwheel sealing plugs or locking lever Damage to the vaporizer will result Ensure that the Vapor 19 3 handle is in the locked position prior to use Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Absorber System A single canister system absorbs exhaled carbon dioxide in the rebreathing circuit of the anesthesia machine Figure 2 9 Absorber System PRESSURE p OXYGEN SENSOR SENSOR ADAPTER N e INSPIRATORY VALVE BREATHING SYSTEM FRESHGAS PRESSURE HOSE GAUGE APL VALVE ABSORBENT CANISTER EXPIRATORY VALVE MANUAL AUTO SELECTOR VALVE BREATHING PEEP VALVE BAG FITTING OP00079 J 9 7 ABSORBER MOUNTING STUD ABSORBER LO POLE The absorber system is equipped to accommodate sensors to monitor oxygen concentration tidal volume respiratory minute volume pressure and respiratory frequency The PEEP valve regulates positive end expiratory pressure in the patient breathing circuit The ab
66. ault to a value within the range of 0 2 liters to 10 0 liters Follow these steps to adjust the minute volume low alarm limit 1 Press the Breathing Volume Low Limit key A box is drawn around the minute volume low alarm limit 2 Press the up arrow or down arrow key to increase or decrease the highlighted alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different alarm Limit key The new value is saved as the alarm limit Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Turning Respiratory Volume Alarms Off Turning Respiratory Volume Alarms On Respiratory Volume Alarm Messages APNEA VOLUME Warning Caution Part Number 4115139 001 Rev To turn off the respiratory volume alarms press the Breathing Volume Off key The alarms stop sounding and their messages are erased from the display In addition the LED next to the Breathing Volume Off key lights to indicate the Off condition To turn on the respiratory volume alarms press the Breathing Volume On key The LED next to the Breathing Volume On key lights to indicate that the volume alarms are enabled Note You cannot turn on volume alarms during power up They are automatically forced off to prevent nuisance alarms during patient setup The following list contains all
67. called thymol which evaporates more slowly than halothane and collects in the vaporizer Over time thymol may decompose into compounds that affect the wick material and turn the halothane yellow If you see particles in the sight glass of a halothane vaporizer or if the halothane turns yellow rinse the vaporizer chamber with fresh halothane as follows 1 Drain the discolored halothane from the vaporizer 2 Fill the vaporizer with fresh halothane up to the maximum level then drain completely 3 Dispose of the drained halothane in accordance with standard practices at your facility Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the Scavenger Interface Cleaning and Disinfecting the Scavenger Hoses and Bag Part Number 4115139 001 Rev F pe For comprehensive information about filling and draining the vaporizer refer to the Dr ger Vapor 19 n Anesthetic Vaporizer Instructions for Use Clean the vaporizer exterior with a soft lint free cloth moistened with mild detergent and water Follow up with a 7096 to 9096 diluted solution of ethyl or isopropyl alcohol or sodium hypochlorite 5 2 household bleach at 1 500 dilution 100 ppm chlorine Do not sterilize the vaporizer If the user facility requires disinfection an EtO process can be used after cleaning Refer back to the cleaning inst
68. chine s alarms on a central alarm display On status indicates that the anesthesia machine s Alarm window will continue to display alarms as usual An Off status indicates that the anesthesia machine s Alarm window will not display alarms instead alarms will be displayed on the other product s central alarm display When you start the anesthesia machine it uses the values that were established the last time the machine was configured You can view or change these values on the Configure screen Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Displaying the Configure Screen Under standing the Keys 6 8 To display the Configure screen press the Config key which is located on the left keypad The Configure screen replaces the standard Monitor screen You must begin configuration within 1 minute or the Monitor screen will replace the Configure screen Figure 6 6 Configure Screen ALARM WINDOW CONFIGURE 4 SCREEN WARNING CAUTION ADVISORY INSP O2 LOW SUB ATM PRESSURE AC BATTERY FAIL 02 SUPPLY LOW SERVICE VENT MON PORT A ERROR CONFIGURE SCREEN TRACE SPEED ALARM VOLUME TIME DATE DISPLAY ALARMS SLOW 11 10 18 JUN 1996 ALARM LOG SELECT EXIT OP87009 KEY LABELS according to the labels on the screen
69. ctor control knob must be positioned properly for either the ventilator bellows or the breathing bag to be properly engaged in the breathing circuit Turn the knob counterclockwise for the BAG setting Turn the knob to the clockwise for the AUTO setting The settings are labeled on the control knob The current setting appears near the top Set the knob to BAG for spontaneous breathing or manually assisted ventilation Set the knob to AUTO for automatic ventilation Selecting the ventilator AUTO pathway removes the APL valve and the breathing bag from the active gas pathway of the absorber When the system is set in the automatic mode excess gas is relieved from the breathing circuit through a relief valve mounted on the ventilator bellows Selecting BAG eliminates the ventilator and its relief valve from the active gas pathway and includes the APL valve and breathing bag In this mode the breathing bag acts as a passive reservoir for breathing gases and the patient s thoracic movements drive the gases through the breathing circuit When breathing is manually assisted the breathing bag contains breathing gases and functions as the sole means of driving them through the breathing circuit when the bag is squeezed Warning Do not use the anesthesia machine if The pins in the I E valves or valve body ies are bent damaged or missing The valve disks are missing or damaged The valve seat is damaged Narkomed Mobile Operator s
70. d When the ventilator is off The Caution condition does not occur until 30 seconds have elapsed The Warning condition does not occur until 60 seconds have elapsed If the measured breathing pressure exceeds the high pressure limit the Warning message VENT PRESSURE HI appears in the Alarm window and a continuously repeating audible alarm sounds This alarm condition is cleared when the measured breathing pressure drops below the high pressure alarm limit However the alarm message is extended for 5 seconds to allow for a momentary high pressure condition If the measured breathing pressure falls below 10 cmH O the Warning message SUB ATM PRESSURE appears in the Alarm window and a continuously repeating audible alarm sounds This alarm condition is cleared when the sensed pressure rises above 10 cmH5O However the alarm message is extended for 5 seconds to allow the recognition of a momentary subatmospheric pressure condition Narkomed Mobile Operator s Manual 6 31 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS CONTINUOU S PRES Warning PEEP gt 25 Caution THRESHOLD LOW Advisory PEEP gt 4 Advisory APNEA P ALM STBY Advisory SERVICE VENT MON Advisory 6 32 If the measured breathing pressure remains above the threshold pressure alarm limit for more than 15 seconds the breathing pressure display area is cleared the Warning message CONTINUO
71. d the yoke s gas inlet When attaching a cylinder make sure that only one washer is installed between the cylinder and the yoke gas inlet Using multiple washers can compromise the pin indexed safety system Be sure to verify the integrity of both index pins when installing a new cylinder Warning Make sure the cylinder yoke has two intact index pins each time the cylinder is replaced Use only one cylinder gasket Using more than one gasket can cause cylinder gas leakage and compromise the pin indexed safety system The cylinder attached to the hanger yoke must contain the proper gas at the recommended pressures outlined in the table below Any cylinder that contains less than the recommended minimum shown in the table should be replaced with a new full cylinder GAS PSI FULL PSI MIN Oxygen 19007 1000 Nitrous Oxide 745 600 Indicated pressure is for an E size cylinder at 70 F 21 C T Due to differences in manufacture s specifications and topping off during refill of E type cylinders a full cylinder can be as high as 2015 psi Within the cylinder gas circuit are the cylinder pressure gauges These gauges are labeled and color coded on the flowmeter housing When a cylinder valve is opened the associated pressure gauge indicates the gas pressure in that cylinder Pressure is indicated in psi and kPa The indicated pressure is proportional to the gas content of the cylinder Narkomed Mobile Operat
72. d Mobile Operator s Instruction Manual 4115139 Absorbent DragerSorb 10 liter canister ccccccccccecsessssneececeeeeserseaees 6750801 Absorber System Gasket Canister Top arrecare erkese ieia ai aii 4105848 Sereen Canister su EEEE 1100022 Canister includes bottom gasket 4105851 Breathing Pressure Gauge Assembly 4114290 Dome Expiratory Valve without port r M 2109230 Dome Inspiratory Valve with sensor port H 4108829 Plug Assembly for inspiratory valve dome with Sade E A E 4106387 Valve Assembly Inspiratory with ported dome assembly and plug assembly esee 4112773 001 Valve Assembly Expiratory 4112150 Gasket valve 2109281 Gasket flat washer inspiratory or expiratory Valve TITRE LINT TT 1101690 P st TON CHR FREUEN CHAR 4114094 O ring 335 EPDM dust cup fitting esses 4114167 Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS A Spare and Replacement Parts Part Number Breathing Breathing Hose 22 mm x 28 1
73. d pads on the bottom of the unit you will need to place an additional foam cushion in the holder There are two additional foam cushions supplied with the machine and are located in the drawer Figure 1 2 Vaporizer Storage Locations 5000045 ADDITIONAL FOAM PAD IF NEEDED VAPORIZER HOLDERS Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 1 9 RETURN TO THIS MANUAL S TABLE CONTENTS RETURN TO CD ROM TABLE OF CONTENTS RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description Part Number 4115139 001 Rev Table of Contents e S Rt 2 3 Gas Delivery System 2 5 Piping Hoses and Fittings 2 5 Oxygen Supply Pressure Failure Protection Device 2 9 Flowmeters sssseeenennenen menn 2 9 Minimum Oxygen Flow 2 10 Oxygen Flush seeesssssseeeerenerennnn 2 11 Oxygen Ratio Controller 2 12 Fresh Gas Outlet 15 mm 2 12 Auxiliary Oxygen Flowmeter 2 12 Anesthetic Vaporizer 1 o pied cop Id 2 14 Absorber System M M 2 15 Inspiratory and Expiratory Valves 2 16 A TEE 2 17
74. drive gas Figure 2 12 on page 2 21 The ventilator will not function properly if this pressure drops below 32 psi Electrical power is supplied by the AC power source or in event of AC power failure by the backup battery A fully charged battery can power the ventilator for at least 90 minutes 2 20 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 2 12 Drive Gas Selector Switch DRIVE GAS um A 9 SELECTOR SWITCH OP00078 E N VENTILATOR 4 FLOWMETER HOUSING The anesthesia ventilator is designed for use with a Draeger Medical absorber with a manual automatic selector valve This valve is for selecting either the breathing bag using the adjustable pressure limiter APL valve for manual ventilation or the ventilator bellows for automatic ventilation During automatic ventilation the manual automatic selector valve isolates the absorber s breathing bag and APL valve from the breathing system To compensate for the continuous introduction of fresh gas into the breathing system the ventilator has a relief valve mounted behind the bellows chamber When the bellows is completely filled any excess gas in the system is released to the scavenging system through the ventilator relief valve As in any ascending bellows the force
75. e absorber s manual automatic selector valve to AUTO Turn the PEEP valve control knob fully counterclockwise to its lowest setting Open the oxygen flow control valve to a flow of 10 L min and occlude the 19 mm scavenger terminal labeled EXHAUST After the ventilator bellows inflates the flow of oxygen exits the system through the positive pressure safety relief valve At this point the absorber system s breathing pressure gauge must indicate a pressure of less than 5 cmH20 23 IN Test the ventilator a Check for proper pressure and flow at the Y piece during the inspiratory and expiratory phases Turn the SYSTEM POWER switch and ventilator power switch to their ON positions Place the manual automatic selector valve in the AUTO position Adjust the oxygen flow control valve to a 3 L min flow Set the ventilator frequency to 3 BPM the I E ratio to 1 2 and the tidal volume to about 1 liter Adjust the ventilator flow control to the maximum of the low zone on the flow gauge Occlude the patient side of the Y piece Fill the ventilator bellows by pressing the oxygen flush button Observe the breathing system pressure gauge as the ventilator cycles Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 4 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Monitors 24 25 System Flush 26 Final Position 27 The pressure gauge must indicate a pressure over 30 cmHy O wh
76. e caused by several conditions Cause Solution Sensor was exposed to an excessively lean or excessively rich oxygen calibration mixture Make sure that the sensor is exposed to room air only for the entire calibration period Sensor was exposed to a constantly changing calibration mixture Make sure that the sensor is exposed to room air only for the entire calibration period Sensor did not receive the proper waiting period If the sensor capsule was removed from the sensor assembly a waiting period equal to the time that the capsule spent outside the sensor assembly up to one week is necessary prior to calibration New sensors require a 15 minute waiting period Sensor is exhausted If the oxygen sensor has decayed beyond its useful service life see the Specifications section of the manual replace the decayed sensor with a new sensor and allow the proper waiting period Sensor failure If there is too great a difference between the outputs of the two sensor halves replace the failed sensor with a new sensor and allow the proper waiting period prior to calibration Sensor is disconnected When the sensor is disconnected the display area is blank and the message 02 SENSOR DISC appears in the Alarm window If this happens reconnect the sensor cord to the OXYGEN SENSOR interface beneath the rear panel of the ventilator box and try to calibrate the oxygen sens
77. e inspiratory valve dome Information about the oxygen analysis is presented in the Oxygen Monitor window at the top right of the monitor display The numerical value for inspiratory oxygen concentration is shown in large type To the right of this figure in small type are the high and low oxygen concentration alarm limits Figure 6 8 Oxygen Monitor Window OP87010 j INSPIRATORY OXYGEN CONCENTRATION OXYGEN 7 HIGH OXYGEN CONCENTRATION ALARM LIMIT LOW OXYGEN CONCENTRATION ALARM LIMIT Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS You use the oxygen monitor control keys and the arrow keys on the right Monitor keypad to set oxygen concentration alarm limits and calibrate the oxygen Controls sensor The oxygen monitor control keys are located next to the Oxygen Monitor window Figure 6 9 Oxygen Monitoring Control Keys HIGH OXYGEN Oxygen CALIBRATION CONCENTRATION uin Low KEY ALARM LIMIT KEY T Limit Limit LOW OXYGEN CONCENTRATION ALARM LIMIT KEY 4 ARROW OP87011 v KEYS Setting Alarm Limits High Low At power up the oxygen high and low alarm limits are automatically set to Limit Limit their system defaults You can adjust these limits within specified ranges Valid settings for the ala
78. e monitoring system When the pressure limit control is turned fully counterclockwise the peak inspiratory pressure is less than or equal to 15 cmH53O When the control is turned fully clockwise the peak inspiratory pressure is less than or equal to 120 cmH30 Narkomed Mobile Operator s Manual 5 15 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Selecting the Bellows Drive Gas 5 16 A toggle switch located on the side of the flowmeter housing is for selecting the bellows drive gas To select oxygen as the drive gas move the switch to the position To select air as the drive gas move the switch to the AIR position Figure 5 7 Drive Gas Selector Switch DRIVE GAS SELECTOR SWITCH OP00078 EN En NX 8 VENTILATOR Ei a AIR 4 privecas i FLOWMETER HOUSING Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Using the Monitoring System Part Number 4115139 001 Rev F Table of Contents 6 3 xc clasnESII IM m 6 3 Monitor Screen and Controls 6 4 Monitor Screen E 6 4 Lett Keypad RENE 6 6 Right Keypad eR 6 7 Configuring the Anesthesia Mach
79. e pressure relief a b Bom n m Connect a 19 mm scavenger hose to the ventilator relief valve and the scavenger interface Connect a 19 mm scavenger hose between the APL valve and the scavenger interface Connect the 3 0 liter reservoir bag to the reservoir bag terminal Connect the scavenger to the suction waste gas disposal system Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose Set the absorber s manual automatic selector valve to BAG Turn the APL valve fully counterclockwise Verify that the suction waste gas disposal system is active Open the scavenger needle valve enough to allow typical suction through the scavenger Close all flow control valves on the anesthesia machine Occlude the absorber breathing bag mount At this point the breathing pressure gauge should indicate a negligible negative pressure no lower than 1 0 cmH O To test positive pressure relief a Bm m Connect a 19 mm scavenger hose to the ventilator relief valve and the scavenger interface Connect a 19 mm scavenger hose between the APL valve and the scavenger interface Connect the 3 0 liter reservoir bag to the reservoir bag terminal Connect the scavenger to the suction waste gas disposal system Short circuit the absorber s inspiratory and expiratory valves with a 22 mm breathing hose Set the absorber s manual automatic selector valve
80. e vaporizer will not be used for longer than six months or if the vaporizer will be removed from the anesthesia machine Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 5 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS s Filling the Vaporizer During a Case 5 6 Be extremely careful when filling the vaporizer during a case The vaporizing chamber is pressurized when fresh gas is flowing and the vaporizer is turned on To safely add anesthetic agent while the machine is in use depressurize the vaporizer by setting the handwheel to 0 zero point interlock Make sure the button engages in the locked position Allow at least 5 seconds for the vaporizing chamber to depressurize then add the anesthetic agent Warning The vaporizer handwheel must be set to 0 zero point interlock before the vaporizer can be filled If the vaporizer is not depressurized before unsealing the filling spout liquid anesthetic can gush out Warning Because the vaporizer funnel filling system does not limit the type of agent poured into the vaporizer using an agent monitoring device is recommended to verify the agent Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Absorber System Operation 5 A single canister system absorbs exhaled carbon dioxide in the rebreathing circuit of the anesthesia
81. ecting the Y Piece and Mask 7 19 Cleaning and Disinfecting the Ventilator Bellows 7 19 Cleaning and Disinfecting the Ventilator Bellows Bottom Assembly 7 19 Cleaning and Disinfecting the Oxygen Sensor Capsule 7 20 Cleaning and Disinfecting Oxygen Sensor Housing 7 20 Cleaning and Disinfecting Oxygen Sensor Housing Cover 7 20 Cleaning and Disinfecting the Breathing Pressure Sensor Adapter and Hose PASSOIMI DIY seeds 7 20 Cleaning and Disinfecting the Inspiratory and Expiratory Valves 7 20 Cleaning and Disinfecting the PEEP Valve 7 21 Cleaning Disinfecting Ultrasonic Flow Sensor Housing and Transducers 7 21 Cleaning Disinfecting Ultrasonic Flow Sensor Electronics Housing Cable 7 21 Cleaning and Disinfecting the Breathing System Pressure Gauge 7 21 Cleaning and Disinfecting the Absorber Canister Assembly and Dust Cup 7 21 Cleaning and Disinfecting the Absorber Assembly 7 22 Cleaning and Disinfecting the Vaporizer Exterior 7 22 Cleaning and Disinfecting the Scavenger Interface 7 23 Cleaning and Disinfecting the Scavenge
82. ed on the flow housing transducer assembly When the volume alarms have been set to Standby the Advisory message VOL ALARMS STBY appears in the Alarm window If the Narkomed Mobile detects an internal electronic failure that would prevent proper operation the Advisory message SERVICE VENT MON appears in the Alarm window If this happens contact an authorized representative of Dr gerService Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S RETURN TO CD ROM TABLE OF CONTENTS TABLE OF CONTENTS Breathing Pressure Monitoring Breathing pressure is measured with a solid state pressure transducer that can sense pressure at the inspiratory valve Draeger Medical disagrees with the idea of relying on pressure monitoring to detect a blocked breathing circuit Carbon dioxide monitoring and respiratory flow monitoring provide superior detection of blocked breathing paths when compared to pressure monitoring which detects such conditions only in some instances Draeger Medical pressure monitors are therefore not promoted for detection of blocked breathing paths Breathing Information about the patient s breathing pressure is presented in two Pressure windows at the bottom of the monitor display Monitoring Displays Figure 6 13 Breathing Pressure Monitor and Trace Window OP87017 35 PEAK 18 MEAN PEEP BREATHING PRESSURE TRACE WINDOW BREATHING P
83. ee cloth with the appropriate cleanser before applying it to the machine e Wipe any spills and cleanser off the equipment surfaces immediately Clean painted plated and plastic surfaces of the Narkomed Mobile with a soft lint free cloth moistened with mild detergent and water Follow up with a 70 to 9096 diluted solution of ethyl or isopropyl alcohol or sodium hypochlorite 5 2 household bleach at 1 500 dilution 100 ppm chlorine Note Draeger Medical makes no claims about the efficacy of these agents or this method of cleaning for infection control Consult your hospital s infection control officer or epidemiologist Contact with oxygen ether mineral or vegetable oils phenols cresois terpenes hydrocarbon solvents chlorinated hydrocarbons esters or oxidizing acids hastens the deterioration process for rubber goods Check the hoses mask elbow and breathing bag often for signs of deterioration including swelling tackiness or cracking Replace the affected parts when any of these conditions are evident Thoroughly clean rubber goods with mild alkali detergent and water before disinfecting them Then thoroughly rinse them with water to remove all detergent To prevent water spots use distilled or demineralized water Avoid using hard bristle brushes that can cause damage Manufacturers of rubber goods recommend that reusable rubber goods be soaked in a liquid disinfection agent Always follow the agent manufacturer s in
84. em bling the Ventilator Bellows Ass ly Disassem bling the Flow Housing Transducer Ass ly The following parts must be further disassembled for thorough cleaning and disinfection oxygen sensor assembly e ventilator bellows assembly respiratory flow sensor housing transducer assembly e inspiratory expiratory valves Unscrew the cover from the sensor housing and remove the sensor capsule Take care not to drop the sensor housed inside The sensor is not connected to the housing Remove the bellows from the ventilator bottom assembly by unscrewing it in a counterclockwise direction until it is released Unscrew the knurled ring nut around the ventilator relief valve and pull the relief valve dome and pilot line away from the relief valve body Caution Take special care not to change the position of the adjustment lock ring on the ventilator relief valve dome Do not attempt to loosen the knurled relief valve ring nut by twisting the pilot line hose barb 1 Press down on the lever under the flow housing and pull the flow housing transducer assembly out of the electronics housing 2 Pull both transducers out of the flow housing Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Disassem 1 Remove the inspiratory valve from the absorber dome by turning it bling the counterclockwise Inspirato an ry 2
85. en Sensor Housing Cleaning and Disinfecting Oxygen Sensor Housing Cover Cleaning and Disinfecting the Breathing Pressure Sensor Adapter and Hose Assembly Cleaning and Disinfecting the Inspiratory and Expiratory Valves 7 20 Wipe the oxygen sensor capsule with a soft lint free cloth moistened with mild detergent and water Make sure the capsule is dry before replacing it Caution Do not immerse or autoclave the oxygen sensor capsule After cleaning the capsule perform an EtO process at a temperature not exceeding 50 C Aerate the sensor according to the manufacturer s instructions The oxygen sensor housing can be immersed for cleaning and disinfection Use mild detergent and water for cleaning For disinfection follow up with either sodium hypochlorite 5 2 household bleach 1 500 dilution 100 ppm free chlorine or 70 to 90 ethyl or isopropyl alcohol The oxygen sensor housing cover can be immersed or wiped during cleaning and disinfection Use mild detergent and water for cleaning For disinfection follow up with a 2 glutaraldehyde based formulation wet pasteurization at 70 for 30 minutes or an EtO process Clean the assembly with a mild detergent and water applied with a soft lint free cloth Rinse the assembly with water Dry the assembly thoroughly for example with a tube drying device Caution Do not autoclave the breathing pressure sensor adapter and hose assembly Use a 2 glutara
86. en the bellows completes its downward travel The pressure should not exceed 2 at the end of the expiratory phase when the bellows completes its upward travel b Verify the PEEP valve s performance Attach a breathing bag to the patient Y piece with an appropriate adapter such as a Draeger Medical combination mask elbow with a 22 mm male fitting for the breathing bag and 15 mm male fitting for the Y piece With the manual automatic selector in the AUTO position set the ventilator to the preferred frequency Then adjust the PEEP valve to different values and observe the breathing system pressure gauge to verify performance Turn the PEEP valve control knob fully counterclockwise to its lowest setting after the test is completed Check the alarm limit settings The monitor alarm limits are automatically set to a default configuration when the SYSTEM POWER switch is turned on Check these settings and adjust them if necessary Alarm limits can be adjusted at the beginning of or during a procedure Also make sure that any external monitors if any are connected properly and that the alarms sound through the anesthesia machine s central audio annunciator Test the alarm functions for all monitors Simulate alarm conditions and check for appropriate alarm signals Flush the system for at least one minute with 100 oxygen by pressing the oxygen flush button When the daily checkout procedure is complete verify that a the v
87. ent backflow leakage into the atmosphere when supply hoses are not connected or backflow into the attached supply hoses when the cylinder is used Each pipeline connection is equipped with a filter to prevent foreign material from entering the internal gas piping Pipeline gases should be supplied at 50 55 psi Pipeline pressure gauges for oxygen air and nitrous oxide are standard These gauges are labeled and color coded for their respective gases on the flowmeter shield The gauges are located directly below their corresponding flowmeters and flow control valves Pressure is indicated in psi and kPa The pressure gauge and flowmeter arrangements are shown in Figure 2 4 on page 2 7 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Figure 2 4 Flowmeter and Pressure Gauge Assembly OP00211 AUXILIARY 02 FLOW TUBE FLOWMETER l min _ FLOW CONTROL PA VALVE P P A FLOW GUARD KNOB PIPELINE PRESSURE GAUGE N20 in PIPELINE PRESSURE N20 CYLINDER GAUGE 02 PRESSURE GAUGE PIPELINE PRESSURE 02 CYLINDER GAUGE AIR PRESSURE GAUGE When the machine is connected to an active pipeline supply each gauge should indicate 50 55 psi A deviation from within this range indicates that the pipeline gas supply system is improperly adjusted and can adversely af
88. er is restored The battery charging system charges the battery any time the power cord is connected to an active AC power source The charger can recharge a fully discharged battery in about 12 hours If the machine is getting AC power but the battery voltage level is low due to a problem with the battery charging circuit or similar hardware malfunction the Advisory message RESERVE BATT LOW is displayed These events signal backup battery system activation The Caution message AC POWER FAIL is displayed Athree pulse pattern audio alarm sounds every 30 seconds These alarms signify that about 90 minutes of backup battery power remains from the time the alarm is activated if the battery was fully charged All monitoring functions continue to operate using the battery for power When the battery reserve approaches depletion after an AC power loss the Caution message AC BATTERY FAIL is displayed This alarm signifies that about 10 minutes of backup battery power remains from the time the message is activated The gas supply system remains operative Because the ventilator is inoperative when battery power is cut off you must perform manual ventilation by bag The machine cannot provide monitoring or alarm functions until AC power is restored Note If the power cord is not plugged into an active AC outlet for a period of 30 days or more the backup battery can become depleted Plugging the power cord into an active AC outlet fo
89. exit through the positive pressure relief valve The pressure gauge should indicate pressure less than 10 0 cmH5O Open the oxygen flow control valve to a flow of 8 L min Occlude the absorber breathing bag terminal The oxygen flow Adjust the scavenger needle valve to a proper initial setting To test the scavenger interface for passive systems a Make sure a 19 mm scavenger hose is connected between the ventilator relief valve and the scavenger interface Make sure a 19 mm scavenger hose is connected between the APL valve and the scavenger interface Make sure a 19 mm scavenger hose is connected between the bottom scavenger interface and the hospital exhaust system Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose Set the absorber s manual automatic selector valve to AUTO Turn the PEEP valve control knob fully counterclockwise to its lowest setting Open the oxygen flow control valve to a flow of 10 L min and occlude the 19 mm scavenger terminal After the ventilator bellows inflates the flow of oxygen exits the system through the positive pressure safety relief valve At this point the absorber system s breathing pressure gauge must indicate a pressure of less than 10 cmH O 8 N Test the ventilator a Check for proper pressure and
90. f pure oxygen Flush into the breathing circuit at a rate of about 55 L min Figure 5 1 Oxygen Flush Button Put cubo O2 FLUSH LU CONTROL 1 FRESH GAS OUTLET FRESH GAS LOCKING BAR RELEASE LOCK PULL TO INSERT OR REMOVE HOSE FRESH GAS HOSE Anesthetic Vaporizer Operation The Dr ger Vapor 19 3 adds an anesthetic gas to the fresh gas stream by producing a precisely metered amount of the vapor of a particular liquid anesthetic The vaporizer is installed in the fresh gas line upstream of the patient breathing system semi closed semi open system Refer to the Dr ger Vapor 19 n Anesthetic Vaporizer Instructions for Use for detailed information about operating the vaporizer Warning The vaporizer must not be connected downstream of the fresh gas outlet of the anesthesia machine For low flow fresh gas flows lower than 250 mL min or closed system anesthesia breathing circuit concentrations may differ considerably from the vaporizer setting When performing anesthesia with low flow or closed system techniques it is essential to monitor inspiratory and expiratory anesthesia concentration oxygen concentration expiratory volume and airway pressure in the circuit Warning Be sure to fill the vaporizer in an upright position Filling the vaporizer in a tilted position can cause overfilling Overfilling causes the anesthetic concentration rate to be higher or lower than the handwheel setting
91. fect operation A fluctuating pipeline supply pressure for example would cause a corresponding fluctuation of the gas flow delivered from that pipeline An excessively low pipeline pressure can activate the O5 and 0 cylinders and deplete their contents if the cylinder valve is left in the open position Caution To ensure gas supplies are adequate pipeline pressure gauges should show steady pressures of 50 55 psi Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cylinder Gas Entry Cylinder Pressure Gauge 2 8 The Narkomed Mobile is equipped with a two cylinder hanger yoke assembly The standard combination is one O2 cylinder and one N20 cylinder A factory installed option for the mounting of two O2 cylinders is available If this option is installed the appropriate color coding scheme and cylinder pin index safety sytems will show this difference To prevent a cylinder from being improperly connected the yoke is labeled color coded and keyed for oxygen and nitrous oxide cylinders using the pin indexed safety system A filter in the yoke prevents foreign material from entering the internal gas piping check valve in the yoke prevents leakage into the atmosphere when a cylinder is not mounted on the yoke If a cylinder is not mounted to the yoke the attached yoke plug should be placed between the yoke bolt an
92. for the oxygen and nitrous oxide cylinders GAS PSI FULL PSI MIN Oxygen 1900 1000 Nitrous Oxide 745 600 Indicated pressure is for an E size cylinder at 70 F 21 C T Due to differences in manufacture s specifications and topping off during refill of E type cylinders a full cylinder can be as high as 2015 PSI Pipeline 9 IN Pipeline Supply Verification Supply System Verification b Connect the appropriate pipeline supply hoses to the pipeline inlet connectors a Inspect the supply hoses for cracks or wear c Check for sufficient pipeline pressure readings for each gas on the pipeline pressure gauges located below the flow control valves The pressure for each gas must be between 50 55 psi Open the flow control valve for each gas over the full range The pressure indicated at the pipeline pressure gauge must not decrease more than 5 psi d Verify that the correct gases are supplied to the anesthesia machine inlets System Gas 10 N Check the flowmeters Adjust the flow control knob for each gas and Circuit verify the proper operation of the corresponding flowmeters The float Verification must move freely over the full range of each flowmeter 4 4 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Low Pressure System Verification Oxygen Monitor Calibration OFPD Verification
93. furnished for informational use only and is subject to change without notice Draeger Medical Inc assumes no responsibility or liability for any errors or inaccuracies that may appear in this manual Recommendations In the interest of patient safety Draeger Medical strongly advocates the use of an oxygen analyzer pressure monitor and either a volume monitor or an end tidal monitor in the breathing circuit at all times Because of the sophisticated nature of Draeger Medical anesthesia equipment and its critical importance in the operating room setting it is highly recommended that only appropriately trained and experienced professionals be permitted to service and maintain this equipment Contact an authorized representative of DragerService for service of this equipment Draeger Medical also recommends that its anesthesia equipment be serviced at three month intervals Periodic Manufacturer s Service Agreements are available for equipment manufactured by Draeger Medical For further information concerning these agreements contact Dr gerService at 800 543 5047 Purpose of This Manual This manual provides operating instructions for the Narkomed Mobile Anesthesia System It is intended for use by trained clinical professionals familiar with accepted medical procedures practices and terminology used in delivery of anesthesia and patient monitoring 1 4 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RET
94. he flow sensor housing Moderate amounts of condensation tion from the should not affect operation Excessive condensation can result in erratic or Flow Sensor total loss of flow measurement To remove condensation 1 Remove the connector hose assembly between the flow sensor and expiratory valve by turning the ring nut counterclockwise 2 Remove the patient hose from the expiratory hose terminal on the flow sensor Lift the flow sensor off the bracket Press down on the lever under the flow housing and remove the flow housing transducer assembly from the electronics housing 5 Pull both transducers out of the flow housing 7 6 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Figure 7 3 Disassembled Flow Sensor ELECTRONICS gt HOUSING OP00302 INDEX PIN SENSOR CABLE LEVER J FLOW TRANSDUCER 2X 4 HOUSING 6 Tip and shake the flow housing to release fluid trapped in the housing 7 Make sure that all large droplets are cleared from the transducer ports 8 Patthe transducers dry with a soft lint free cloth 9 Press the transducers back into their ports in the flow housing 10 Slide the electronics housing over the flow housing transducer assembly Be sure that it clicks into place Note If the transducer flow housing assembly does not fit easily into the electronics housing make s
95. he green LED power on indicator illuminates Figure 2 13 System Power Supply POWER APPLIED INDICATOR SYSTEM POWER SWITCH BATTERY TEST BUTTON BATTERY TEST INDICATOR OP00098 X Circuit The electrical system has two magnetic circuit breakers to protect machine Breakers functions primary AC power input and backup battery power The circuit breakers are located on the lower part of the power supply in the back of the machine A circuit breaker is in its normal closed position when the plunger is flush with the surface of its base A circuit breaker is open tripped when its plunger extends beyond its base If a breaker is tripped the cause must be found and corrected before using the anesthesia system 2 22 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Backup Battery System Machine Functions on Backup Battery Power Battery Test Indicator and Button pu The backup battery system consists of a rechargeable battery and a built in battery charging system The backup battery system automatically provides power with no delay during the period between line power failure and activation of an emergency generator during a power outage It also provides power if the cord is accidentally unplugged during a case The system automatically switches back to AC power and recharges its battery when pow
96. hree pulse tone pattern that is repeated every 30 seconds Advisories single tone or no sound at all depending on the urgency of the advisory The alarm sounds only for the highest priority currently active alarm condition Tones for lower priority alarm conditions are temporarily suppressed eliminate simultaneous alarms If the primary speaker fails the Advisory message SERVICE SPEAKER appears in the Alarm window When the system power switch is turned ON the volume and pressure apnea alarms default to Standby to allow machine setup without sounding alarms An interlock with the ventilator ensures that when the ventilator is turned on the alarms are enabled You can also enable the alarms individually using the keypad When the ventilator is turned off e Ifthe pressure apnea threshold was greater than 15 cmH5O when the ventilator was turned off the threshold setting is changed to 15 cmH 0 If the pressure apnea threshold was less than 15 cmH O when the ventilator was turned off the threshold retains its setting The Cautions and Warnings associated with apnea alarms change from activation after 15 and 30 seconds of apnea to 30 and 60 seconds respectively When the ventilator is turned back on the pressure apnea threshold is restored to its previous set value and the apnea alarms revert to activation after 15 seconds Caution and 30 seconds Warning of apnea Part Number 4115139 001 Rev F Narkomed Mobile Operator s M
97. iates calibration but Oxygen Monitor window is blank at end of calibration period Sensor is exposed to incorrect oxygen concentration Sensor exposed to constantly changing calibration mixture Expose sensor to room air for 21 calibration Sensor capsule was removed from housing for a prolonged period Allow a waiting period equal to duration of capsule removal New capsule not given proper waiting period Allow a 15 minute waiting period Exhausted or defective sensor capsule Replace sensor capsule Allow a 15 minute waiting period O2 SENSOR DISC message appears in Alarm window during monitoring Defective sensor housing and cable Replace housing cable assembly Sensor cord is disconnected Insert sensor cord connector into Oxygen Sensor receptacle in the system interface panel Part Number 4115139 001 Rev Narkomed Mobile Operator s Manual 8 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Respiratory Volume Monitoring Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY Blank display area One full minute has not elapsed for Minute Volume and Respiratory Rate since respiration began Wait one minute to read display Apnea condition Correct apnea condition Ensure sensor is properly connected to the expiratory valve Blank display area VOL SENSOR DISC alarm message in Alarm window Se
98. ile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Gas Delivery System Pipeline inlet connections DISS male ANSI 57 1 1977 Pipeline inlet pressure 50 55 psi 345 380 kPa Oe 0 Air Pipeline gauge accuracy x3 psi 0 25 psi TT x2 psi 25 75 psi O X x3 psi 75 100 psi Cylinder Pin indexed hanger yoke ANSI CGA V 1 1987 Over pressure 1 95 psi 655 kPa Fresh gas common 15 mm female Fresh gas oxygen concentration 25 4 Oxygen flush flow 55 x10 L min Minimum oxygen flow at 50 psi pipeline pressure 150 50 mL min Low oxygen supply pressure alarm 34 40 psi Cylinder gauge x90 psi 0 750 psi 60 psi 750 2250 psi x90 psi 2250 8000 psi Cylinder Gas Oxygen 1900 psi 13100 kPa E size cylinder at 70 F 21 C P Nitrous Oxide 745 psi 5130 kPa E size cylinder at 70 F 21 Flowmeter Oxygen Nitrous Oxide Air Accuracy at Dual Tapered 0 8 L min 0 1 0 2 L min 50 mL min 20 Cand
99. imize the potential for channeling In channeling gas flows through the canister along the path of least resistance The gas depletes the efficiency of the absorbent along this route bypassing absorbent in other areas of the absorber Draeger Medical recommends the use of Dr gerSorb for the absorber system A removable cup at the bottom of the absorber canister assembly collects absorbent dust and excess moisture that can cause increased flow resistance in the system The fresh gas hose is connected to the upper absorber dome This flexible hose delivers fresh gas to the breathing system It has a 15 mm male fitting designed to fit the Draeger Medical fresh gas outlet and must not be replaced by another manufacturer s fitting The absorber system has a pressure gauge for quick visual readings of breathing circuit pressure The gauge is marked for measurements from 20 to 80 cmH O in increments of 2 The pressure gauge line is connected to the absorber at the pressure sensing adapter Warning Frequent observation of the breathing system pressure gauge is mandatory to ensure adequate pressure buildup and relief regardless of the mode of operation Pressure is monitored at the absorber A pilot line connects the anesthesia system pressure monitoring and alarm system The manual automatic selector valve has two position control knob for selecting gas pathways for automatic or manually assisted ventilation Turning the knob cloc
100. ine 6 7 Displaying the Configure Screen 6 8 Understanding the Keys 6 8 Changing Parameter Values 6 9 Exiting the Configure Screen 6 9 Using the Alarm Log 25 5 ierra iR pre EE He pa ro EEvPreuS Eus 6 10 Displaying the Alarm Log 6 10 Clearing tne Alarm Log 6 10 Exiting the Alarm Log 20 6 11 Setting Alarms to Standby 6 11 Silencing Alarms P 6 11 Oxygen Monitoring 6 12 Oxygen Monitoring Display 6 12 Oxygen Monitor Controls 6 13 Setting Alarm Limits sioe a ene ee 6 13 Calibrating the Oxygen Sensor 6 14 Unsucessful Calibration 6 15 Oxygen Alarm Messages 6 17 Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Table of Contents continued Respiratory Volume Monitoring 6 18 Respiratory Volume Display 6 19 Respirat
101. ined operator Instructions warnings and caution statements are limited therefore to the specifics of the Draeger Medical design This publication excludes references to hazards that are obvious to a medical professional to the consequences of product misuse and to potentially adverse effects in patients with abnormal conditions Product modification or misuse can be dangerous Draeger Medical disclaims all liability for the consequences of product alterations or modifications as well as for the consequences that might result from the combination of Draeger Medical products with products supplied by other manufacturers if such a combination is not endorsed by Draeger Medical The operator of the anesthesia system must recognize that the means of monitoring and discovering hazardous conditions are specific to the composition of the system and the various components of the system It is the operator and not the various manufacturers or suppliers of components who has control over the final composition and arrangement of the anesthesia system used in the operating room Therefore the responsibility for choosing the appropriate safety monitoring devices rests with the operator and user of the equipment Patient safety may be achieved through a variety of different means depending on the institutional procedures the preference of the operator and the application of the system These means range from electronic surveillance of equipment perform
102. ion 5 3 Adjusting the Gas FIOW ot aeneis 5 3 Using the Oxygen Flush ius i eerie pacte nba bin 5 4 Anesthetic Vaporizer Operation 5 4 Turning the Vaporizer On iiic tenebre ue SE bekbn pees 5 5 Turning the Vaporizer 5 5 Filling the Vaporizer During Case 5 6 Absorber System Operation 5 7 Using the Manual Automatic Selector Valve 5 8 Using the APL Valve 5 9 Using the PEEP Valve 5 10 Scavenger Interface Operation 5 11 Needle Valve Adjustment for Suction Systems 5 12 Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Table of Contents continued Anesthesia Ventilator Operation 5 12 Activating the Ventilator 5 14 Using the Ventilator On Off Control 5 14 Adjusting the Tidal Volume eene 5 14 Setting the Respiratory Frequency 5 15 Setting the Inspiratory Expiratory I E Phase Time Ratio 5 15 Setting the Inspiratory Flow Rate 5 15 Setting the Inspiratory Pressure Limit
103. ions provided in this manual System is over pressurized PEEP valve is on when no PEEP is required Turn the PEEP valve off APL valve resistance is set too high Adjust APL valve counterclockwise Automatic ventilation malfunction Switch to manual ventilation Ventilator relief valve adjustment set incorrectly Contact an authorized representative of DragerService to adjust ventilator relief valve 8 2 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 8 PROBLEM POSSIBLE CAUSE REMEDY Failure of system to pressurize properly or sudden loss of pressure Low fresh gas supply Increase fresh gas supply Occluded fresh gas supply Inspect hose Restore free flow Disconnection of fresh gas hose Check and secure fresh gas hose connection Manual automatic selector valve improperly positioned Correct manual automatic selector valve position Disconnected hose Check all breathing system hoses Reconnect loose hoses Leaking hose Check integrity of all breathing system hoses APL valve resistance is set too low Adjust APL valve clockwise to required pressure Loose unidirectional valve or fitting Check unidirectional valves and all joints and fittings for tightness All gaskets and O rings must be in place
104. iping Hoses and Fittings Color Coding Part Number 4115139 001 Rev The pneumatic system can simultaneously deliver up to three gases and one anesthetic agent Gas is supplied to the system through pipelines and cylinders Pipeline connections for oxygen air and nitrous oxide are standard Gas cylinder yokes for one oxygen and one nitrous oxide cylinder connection are provided As a factory installed option these gas cylinder connections can be configured for two oxygen cylinders Pipeline connectors and the gas cylinder yokes are located on the back of the anesthesia machine Figure 2 3 Gas Delivery Connections 00085 PIPELINE GAS SUPPLY CONNECTIONS AR 6 CYLINDER YOKES_ __ Each connection valve gauge and flowmeter is labeled and color coded for the appropriate gas as shown in the table below GAS SYSTEM COLOR CODING GAS MARKING COLOR Air AIR Yellow Nitrous Oxide N20 Blue Oxygen O2 Green Narkomed Mobile Operator s Manual 2 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Pipeline Gas Entry Pipeline Pressure Gauges 2 6 Gas from the pipeline supply enters the system through hoses connected to indexed pipeline inlets The indexed connector system reduces the risk of delivering the wrong gas to a patient by preventing incorrect connection of gas lines The inlets have check valves that prev
105. its whether or not foreseeable and even if Draeger Medical has been advised of the possibility of such loss or damage Draeger Medical disclaims any liability arising from a combination of its product with products from another manufacturer if the combination has not been endorsed by Draeger Medical Buyer understands that the remedies noted in Draeger Medical s limited warranty are its sole and exclusive remedies Furthermore buyer acknowledges that the consideration for the products equipment and parts sold reflects the allocation of risk and the limitations of liability referenced herein Federal law restricts this device to sale by or on the order of a physician Copyright 2004 by Draeger Medical Inc All rights reserved No part of this publication may be reproduced transmitted transcribed or stored in a retrieval system in any form or by any means electronic or mechanical including photocopying and recording without written permission of Draeger Medical Inc Trademark Notices Datagrip Dr gerService Narkomed Narkomed GS ORM Quality Service For Life Vigilance Audit Vitalert and Vitalink are registered trademarks of Draeger Medical Inc All other products or name brands are trademarks of their respective owners Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 1 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS M Disclaimer The content of this manual is
106. justment depends on several factors including the fresh gas flow rate and type of suction disposal system Warning The positive pressure relief valve must be inspected and cleaned if necessary at six month intervals Warning Waste gases vented through the positive pressure relief valve enter the operating room Properly adjusting the needle valve keeps such venting to a minimum Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 5 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Needle Valve 1 Attach breathing hoses and a Y piece to the absorber system Attach a breathing bag to the Y piece using an appropriate adapter such Systems as a Draeger Medical combination mask elbow with a 15 mm male fitting for the Y piece and a 22 mm male fitting for the breathing bag 3 Set the manual automatic selector valve to AUTO and set the ventilator to the preferred frequency 4 Adjust the 5 flow control valve to the expected total flow of all gases Verify that the suction disposal system is active Watch the scavenger reservoir bag as the oxygen flow passes through the scavenger The bag should not overextend or collapse 7 Adjust the needle valve to provide either more or less suction Anesthesia Ventilator Operation The anesthesia ventilator is a volume preset time cycled pressure limited ventilator with electronic timing pneumatic circuitry and independent cont
107. kwise sets the system to AUTO Turning the knob counterclockwise sets the system to BAG The APL valve relieves excess gas from the breathing circuit into the scavenger system The APL valve expels excess gas containing expired carbon dioxide before it contacts the absorbent which extends the life of the absorbent The respiratory volume sensor is an ultrasonic flow sensor that monitors tidal volume respiratory minute volume and respiratory frequency Narkomed Mobile Operator s Manual 2 17 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS The oxygen sensor analyzes oxygen concentration in the patient circuit The Sensor sensor mounts in the port at the top of the pressure sensor adapter which is connected to a port in the inspiratory valve dome A plug for closing off the port when an oxygen sensor is not in place is tethered on the absorber system Draeger Medical strongly advocates using an oxygen concentration sensor in the patient circuit Positive End The PEEP valve regulates the positive end expiratory pressure in the Expiratory patient breathing circuit PEEP is increased by turning the knob clockwise Pressure and diminished by turning the knob counterclockwise The adjustment PEEP Valve range is about 2 to 15 cmH5O The pressure gauge reading includes the PEEP Warning Waste gas scavenging systems used with Draeger Medical absorber systems must have safety features to
108. lays the Configure screen where you can set system parameters such as the time date and alarm volume You also enter the Alarm Log by way of the Configure Screen Config These functions are described in detail later in this section 6 6 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Right Keypad Configuring the Anesthesia Machine You use the right keypad to perform functions associated with a specific monitor These functions are described in the following sections Oxygen Monitoring Respiratory Volume Monitoring and Breathing Pressure Monitoring Figure 6 5 Right Keypad Oxygen N r High Limit imi Breathing Volume Liters fw Limit Breathing P Limit OP87008 4 You can configure the following parameters on the Narkomed Mobile Trace Speed Speed of the breathing pressure waveform trace either FAST or SLOW e Alarm Volume Volume of annunciated alarms Current Time The current hour and minute in 24 hour format hour minute Current Date The current day month and year Display Alarms On Off status of the anesthesia machine s Alarm window The Display Alarms parameter is configurable only when the anesthesia machine is connected to another Narkomed product that can display the anesthesia ma
109. ldehyde based formulation to disinfect the assembly Rinse with distilled or sterilized water to prevent contamination by tap water organisms Wet pasteurization or a cold cycle EtO procedure can also be used Follow the manufacturer s guidelines for proper aeration The inspiratory and expiratory valves come into contact with the patient s breath The oxygen sensor and breathing pressure sensor assembly must be removed and the valves disassembled for thorough cleaning and disinfecting Clean these parts with soft lint free cloth moistened with mild alkali detergent and water Dry the parts before reassembling The valve assemblies can be immersed in a 2 glutaraldehyde based solution wet pasteurized gas disinfected or autoclaved at a temperature not exceeding 121 C The valve disks can also be autoclaved in certain instances but should not be autoclaved routinely Be careful while handling the valve disks Improper handling can damage them After cleaning or disinfecting the inspiratory or expiratory valve assembly verify that the valve disk and all internal pins are undamaged and that the valve disks are correctly reinstalled Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the PEEP Valve Cleaning Disinfecting Ultrasonic Flow Sensor Housing and Transducers Cleaning Disinfecting Ultrasonic Flow Se
110. lect either the breathing bag and adjustable pressure limiter APL valve for manual ventilation or the ventilator bellows for automatic ventilation During automatic ventilation the manual automatic selector valve isolates the absorber s APL valve from the breathing system To compensate for the continuous introduction of fresh gas into the breathing system the ventilator incorporates a relief valve mounted behind the bellows chamber Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 5 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Activating the Ventilator Using the Ventilator On Off Control Adjusting the Tidal Volume 5 14 When the bellows is completely filled any excess gas in the system is released to the scavenging system through the ventilator relief valve As in any ascending bellows the force needed to overcome gravity acting on the bellows causes a positive end expiratory pressure PEEP within the breathing system The PEEP is approximately 2 cmH3O The monitoring system s breathing pressure and expiratory flow waveform displays can be used as an aid in adjusting the ventilator and establishing alarm criteria Warning Regardless of the indications of any alarm or monitoring device patient chest movement shall be the primary indication of a securely connected properly ventilated patient The ventilator is activated by using the ventilator on off control
111. les to push or pull the unit The anesthesia machine should only be moved by people who are physically capable of handling the weight Take special care that the machine does not tip when moving up or down ramps and across thresholds 1 e door thresholds elevator entrances etc The Narkomed Mobile patient breathing system must not be used in conjunction with any additional components that establish a flow direction Hoses and bags attached to the 22 mm hose terminals of the inspiratory valve expiratory valve ventilator hose connect and breathing bag mount must comply with current ANSI standards Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS t Figure 1 1 Narkomed Mobile Showing Handle Locations HANDLE ROTATE MONITOR SIDE ix INTO PARKED POSITION ut HANDLE REAR ROTATE ABSORBER ELEVATE SLIGHTLY AND INSERT INTO BRACKET OPENING FOR PARKED POSITION OP00104 Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 1 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cautions 1 8 Oil and grease may combine explosively with oxygen or nitrous oxide For this reason oil and grease must never come in contact with pipelines cylinders cylinder valves gauges fittings
112. long this route bypassing absorbent in the other areas of the absorber Warning Absorbent is caustic and is a strong irritant to the eyes skin and respiratory tract When replacing the absorbent take care not to spill its caustic contents Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 7 1 Disassembled Canister Assembly TOP ABSORBER GASKET CANISTER CANISTER GASKET e E DUST CUP 7 O RING DUST CUP OP00094 7 4 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS To replace the absorbent 1 2 3 4 5 Loosen the canister release screws Remove the canister from the absorber system Empty the contents of the canister into an appropriate refuse container Check the canister to make sure it is not chipped or cracked Taking care not to chip or crack the canister add new absorbent e When using absorbent prepacks remove all packaging materials some have clear plastic wrappers and place a prepack into the canister When using loose absorbent fill the canister to the fill line Do not overfill Center the canister on the gasket of the bottom dome Unscrew and empty the dust cup if loose absorbent is present and replace the dust cup Tighten the canister release
113. lve to BAG Close the APL valve by turning the knob fully clockwise to its stop position g Check that the breathing pressure gauge is on 0 h Attach the supplied test terminal to the breathing bag mount i Connect sphygmomanometer squeeze bulb available from Draeger Medical to the hose barb on the test terminal j Pump the squeeze bulb by hand until the breathing system pressure gauge indicates pressure of at least 50 cmH5O not to exceed 80 cmH30 k Observe the pressure drop at the breathing system pressure gauge When the pressure is at 50 cmH50O begin counting seconds Thirty seconds or longer are needed for a pressure drop from 50 30 cmH 0 Part Number 4115139 001 Rev Narkomed Mobile Operator s Manual 4 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Scavenger System 7 N Verify the performance of the scavenger system To test negative pressure relief a b Bom n m Connect a 19 mm scavenger hose to the ventilator relief valve and the scavenger interface Connect a 19 mm scavenger hose between the APL valve and the scavenger interface Connect the 3 0 liter reservoir bag to the reservoir bag terminal Connect the scavenger to the suction waste gas disposal system Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose Set the absorber s manual automatic selector valve to
114. m limits turn the apnea threshold pressure alarm off or on Monitor and automatically set the threshold pressure The breathing pressure Controls monitor control keys are located next to the Breathing Pressure Monitor window Figure 6 17 Breathing Pressure Monitor Control Keys OP87014 PRESSURE Pd ALARM fr zu ON KEY PRESSURE HIGH ALARM a Um ALARM LIMIT KEY High Y Limit f 7 ___ ARROW fX KEYS THRESHOLD Z J PRESSURE ALARM LIMIT KEY THRESHOLD PRESSURE AUTO SET KEY 6 26 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Setting the Pressure High Alarm Limit High Limit Setting the Threshold Pressure Alarm Limit The pressure high alarm limit is automatically set to 50 0 at power up You can change this limit to any value from 30 120 cmH 0 as long as it is greater than the threshold pressure alarm limit To adjust the pressure high alarm limit follow these steps 1 Press the Breathing Pressure High Limit key A box is drawn around the pressure high alarm limit 2 Press the up arrow or down arrow key to increase or decrease the pressure high alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different Alarm Limit key The new val
115. minutes or until alarm conditions have been cleared for 10 seconds Note All continuous audible alarms are automatically silenced for 2 minutes following power up During this period the occurrence of a new alarm produces a non repeating tone pattern appropriate for that alarm s level of urgency Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Monitoring Oxygen Monitoring Display Inspiratory oxygen concentration is measured with a dual galvanic cell sensor which is attached to the inspiratory valve dome The sensor contains two independent electrochemical cells or sensor halves When the sensor takes in oxygen an electrochemical reaction occurs within each cell The oxygen monitor reads the voltage produced in each cell computes an average for the two cells and translates the average into an oxygen concentration measurement Caution Never remove an oxygen sensor from its housing except to replace it If a sensor is removed from its housing you must do the following before continuing normal operations e Reinstall the sensor in the housing Wait for a period equal to the time that the sensor spent outside the housing e Calibrate the sensor Note When the machine is not in use remove the oxygen sensor assembly from the inspiratory valve dome and insert the inspiratory valve dome plug into th
116. ndow If this happens contact an authorized representative of Dr gerService Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning Table of Contents 9177 1471 7 3 Routine Maintenance e 7 3 Replacing the Absorbent 7 3 Replacing the Oxygen Sensor Capsule 7 5 Clearing Condensation from the Flow Sensor 7 6 Scavenger Interface Maintenance 7 8 Removing Parts for Cleaning and Disinfection 7 9 Disassembling Parts for Cleaning and Disinfection 7 14 Disassembling the Oxygen Sensor Ass y 7 14 Disassembling the Ventilator Bellows Ass y 7 14 Disassembling the Flow Housing Transducer 55 7 14 Disassembling the Inspiratory and Expiratory Valves 7 15 Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Table of Contents continued General Guidelines for Cleaning and Disinfection 7 16 Cleaning Disinfecting Exterior Surfaces 7 18 Cleaning WDisinfecting Corrugated Breathing Hoses Mask Elbow and Bag 7 18 Cleaning and Disinf
117. needed to overcome gravity acting on the bellows causes a positive end expiratory pressure PEEP within the breathing system For the Narkomed Mobile the PEEP is approximately 2 cmH3O The pressure limit control is used to set the peak inspiratory pressure produced by the ventilator to limit the maximum pressure to the patient The pressure limit control can also improve ventilation for patients with reduced lung compliance neonatal pediatric patients and patients with adult respiratory distress syndrome Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 21 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Power Supply System The Narkomed Mobile has a central power supply for the ventilator alarm system and monitoring system When in use the Narkomed Mobile must be plugged into an active AC outlet Do not use cheater plugs The term cheater plug implies any and all electrical plugs or other devices that can inhibit or prohibit the proper grounding of the anesthesia machine System The SYSTEM POWER switch is located at the front of the power supply It Power Switch has two positions ON and STANDBY In the ON position the gas pneumatic and electric power circuits are actuated In the STANDBY position the switch shuts down the fresh gas supply the monitoring system and all electrical power to the machine except the battery charging circuit When power is on t
118. nger and then disappears Breathing The Breathing Pressure Trace window displays the breathing pressure Pressure waveform and the pressure high and threshold pressure alarm limits Trace Pressure measurements are displayed in units of and are Window automatically scaled from 0 20 0 50 or 0 100 cmH 0 If the scale changes the positions of the waveform and alarm limits also change relative to the new scale The window below has a scale of 0 20 0 6 24 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 6 15 Breathing Pressure Trace Window INSPIRATORY PEAK INSPIRATORY FLOW RATE PAUSE SLOPE 1 PRESSURE A HIGH ALARM N Ti LIMIT M THRESHOLD PRESSURE APNEA ALARM LIMIT N PEEP OP87016 The peak of the waveform corresponds to the peak pressure The slope of the trace as it rises toward the peak pressure is correlated with the inspiratory flow rate the steeper the slope the higher the flow rate The amount of pressure that the baseline is raised from zero corresponds to the patient s positive end expiratory pressure PEEP e The length of the plateau from peak pressure to the decrease in pressure corresponding to expiration is equivalent to the length of the inspiratory pause if present e The horizontal dotted line on the
119. nsor Electronics Housing Cable Cleaning and Disinfecting the Breathing System Pressure Gauge Cleaning and Disinfecting the Absorber Canister Assembly and Dust Cup Part Number 4115139 001 Rev 7 Set the PEEP valve to the minimum setting Wipe the PEEP valve with a soft lint free cloth moistened with mild detergent and water Follow up with a distilled water rinse Caution The PEEP valve cannot withstand immersion or the heat and pressure of autoclaving Do not disassemble the PEEP valve itself for cleaning or disinfection The PEEP valve can be disinfected with an EtO process followed by appropriate aeration Follow the Manufacturer s instructions Wash the flow housing and transducers with mild detergent and water Fol low with a distilled water rinse These components can be immersed The flow housing and transducers can be autoclaved at a temperature not exceeding 121 C Follow the manufacturer s instructions for the process Allow the transducers to normalize for 30 minutes under room ambient con ditions before using them Wipe the electronics housing and sensor cable with a clean soft cloth moist ened with mild detergent and water Take care not to allow any fluid to access the interior of the electronics housing The electronics housing and sensor cable can be wiped with a clean soft lint free cloth moistened with a 70 to 90 diluted solution of ethyl or iso propyl alcohol or sodium hypochlori
120. nsor cord disconnected Reconnect sensor cable to the interface panel on the anesthesia machine Sensor fault Replace sensor assembly Electronics housing is not properly seated on flow housing transducer assembly Reseat electronics housing on flow sensor transducer assembly and ensure it is locked in place REVERSE FLOW alarm message in Alarm window Leak between sensor and expiratory valve Check connector hose Expiratory valve not closing completely during inspiration Check expiratory valve disc and pins Clean repair or replace expiratory valve Defective sensor Replace sensor assembly Breathing Pressure Monitoring Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY No pressure readout in display area during ventilation Breathing pressure hose assembly not connected properly Make sure the assembly is properly connected Hose is blocked or kinked Make sure that assembly is free of obstructions Erratic readings Condensation accumulation in the hose Drain and reconnect breathing pressure hose assembly PEEP valve setting Adjust PEEP valve 8 6 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Spare and Replacement Parts Replacement Parts and Spares Description Part Number Documentation Narkome
121. nual 6 19 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Respiratory Volume Monitor Controls Setting the Minute Volume Low Alarm Limit Low Limit 6 20 You use the respiratory volume monitor control keys and the arrow keys on the right keypad to set the minute volume low alarm limit and to turn the volume alarms on and off The respiratory volume monitor control keys are located next to the Respiratory Volume Monitor window Figure 6 12 Respiratory Volume Monitor Control Keys LOW MINUTE T _ VOLUME VOLUME RAI ALARMS ALARM LIMIT KEY Y OFF KEY VOLUME ALARMS ON KEY ARROW v KEYS OP87013 L J Fixed alarms are provided for low tidal volume apnea volume low minute volume and reverse flow through the sensor While the ventilator is on apnea volume alarms are generated at 15 seconds Caution and 30 seconds Warning if the respiratory volume monitor does not sense a valid breath While the ventilator is off these alarms are generated at 30 seconds Caution and 60 seconds Warning The Narkomed Mobile s volume alarms are automatically enabled when the ventilator power switch is turned to the ON position A disconnected or damaged sensor causes a sensor failure alarm If the low minute volume falls below the minute volume low alarm limit an alarm condition occurs The alarm limit is automatically set to a default of 1 0 liter at power up You can change the def
122. o keys are pressed When you exit the Alarm Log you return to the Monitor screen When the ventilator is off you can use the Stby key to turn off audible tones and message displays associated with the breathing pressure alarm and respiratory volume alarms The alarms remain in this standby condition until the monitor detects a valid breath Note If the ventilator is on setting alarms to standby has no effect on the pressure alarm The pressure alarm cannot be turned off when the ventilator is on To set alarms to standby press the All Stby key The LED next to the All Stby key lights to indicate the standby condition You can silence all audible alarm tones for 2 minutes while retaining the alarm message display on the monitor To silence alarm tones for 2 minutes press the Silence Alarms key The LED next to the Silence Alarms key lights and remains lit for the duration of the silence period Pressing the Silence Alarms key while the LED is lit restarts the 2 minute silence period If a new alarm condition occurs during the silence period a single tone pattern sounds corresponding to the priority of the alarm After the silence period one of the following occurs e fno alarm conditions are active audio annunciation reverts to normal e Warning or Caution conditions are active the tone associated with the highest existing alarm condition sounds The alarm continues to sound once every minute for up to 3
123. obile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Alarm Messages INSP O2LOW Warning INSP O2 HIGH Advisory O2 SENSOR DISC Advisory REPLACE O2 CELL Advisory CAL O2 SENSOR Advisory Part Number 4115139 001 Rev The following list contains all warning caution and advisory alarms associated with oxygen monitoring The Narkomed Mobile continuously compares the current inspiratory oxygen percentage with the preset low oxygen alarm limit If the measured oxygen concentration falls below the low alarm limit the Warning message INSP O2 LOW appears in the Alarm window and a continuous audible alarm sounds If the measured inspiratory oxygen concentration exceeds the preset high alarm limit the Advisory message INSP O2 HIGH appears in the Alarm window and a single tone audible alarm sounds If the oxygen sensor cord becomes disconnected or is damaged enough to cause an open circuit the Advisory message O2 SENSOR DISC appears in the Alarm window and a single tone audible alarm sounds During oxygen sensor calibration and monitoring the Narkomed Mobile checks for a difference between the outputs of the two sensor channels If the difference exceeds a predetermined percentage the Advisory message REPLACE O2 CELL appears in the Alarm window During oxygen sensor calibration the Narkomed Mobile also checks
124. on each valve prevent connecting a valve to the wrong vent Warning Do not use the anesthesia machine if e a pin in the valve domes or valve body is bent damaged or missing e the valve disks are missing or damaged the valve seat is damaged The inspiratory valve dome is equipped with a pressure sensor adapter This adapter contains a port for the pressure sensor hose assembly The oxygen concentration sensor fits on top of the pressure sensor adapter A cap is tethered to the absorber for plugging into the inspiratory valve dome when the oxygen sensor and pressure sensor hose assembly are not in place Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Canister Dust Cup Fresh Gas Hose Breathing System Pressure Gauge Pressure Sensing Hose Assembly Manual Automatic Selector Valve Adjustable Pressure Limiter APL Valve Respiratory Volume Monitor Sensor Part Number 4115139 001 Rev pu The absorber system has a transparent plastic canister that houses the absorbent The absorbent soda lime or barium hydroxide lime is available in either loose granular form or in a prepacked cartridge When using loose absorbent do not fill above the maximum fill level line located about a quarter inch from the top of the canister The clearance and the ratio of canister diameter to screen opening min
125. or again Narkomed Mobile Operator s Manual 6 15 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS If the oxygen sensor is improperly calibrated it can cause inaccurate measurements When a calibration gas mixture is excessively rich or lean in oxygen the Narkomed Mobile will not complete an attempted calibration however if the calibration gas is rich or lean but is within certain limits the Narkomed Mobile will complete the calibration As a result when displaying sensor measurements the Narkomed Mobile displays an oxygen percentage either greater or less than the actual oxygen percentage Therefore make sure that the sensor is exposed only to room air during the entire calibration period The following figure illustrates the relationship between the calibration mixture and the accuracy of oxygen measurement Figure 6 10 Relationship Between Calibration Mixture and Oxygen Measurement Accuracy 100 90 VA At calibration sensor exposed 80 to lt 21 O2 Thus displayed O2 a d will be higher than actual O2 ae 70 VA N 60 lt x 5 50 x O a c 2 30 Correct calibration of room air 2196 O2 for entire calibration period Displayed O2 actual O2 20 m At calibration sensor exposed 10 f to gt 21 O2 Thus displayed O2 2 will be lower than actual O2 f OP10098A ACTUAL O2 PERCENTAGE Narkomed M
126. or s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Anesthesia machine dimensions approx W SH XD oss ee eens Pee 23 x 53 x 24 inches Anesthesia machine Weight 163 lbs Environmental Storage 346 ph bale Be ebb ETE VSE RETER 20 60 C Humidity 10 90 relative humidity noncondensing Barometric Pressure 787 523 mmHg Operating Temperature 0 0 cc Rhe 10 35 C Humidity 30 70 relative humidity noncondensing Barometric Pressure 787 528 mmHg Electrical Equipment class UL 2601 Class 1 Type B continuous operation IPXO Leakage 300 microamps UL 2601 Ground 0 1 ohm 60 Hz source Dielectric withstand gt 1500 VAC UL 2601 Chassis resistance between any metallic point and ground pin on power cord 0 1 ohm Main Power Primary input voltage acceptable range 100 240 VAC 50 60 Hz Suppl Primary input lt 2 5 amps 50 60 Hz Backup Type Rer Sealed Lead Acid 12 VDC 3 4 Ah Battery Charging time lt 12 hours Reserve power time from full 90 min 3 2 Narkomed Mob
127. or s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Supply Pressure Failure Protection Device Flowmeters 2 The oxygen failure protection device OFPD is a pneumatically operated valve that protects the patient in the event of partial or complete loss of oxygen pressure The valves are located in the internal supply lines for all gases except oxygen The gas pressure in the oxygen supply line controls the valves When the oxygen pressure is adequate the valves remain open with an unrestricted gas flow Oxygen pressure loss causes the valves to close proportionally to the loss of pressure As a result OFPD controlled gases can be restricted or shut down in response to loss of oxygen pressure Gas flow reductions are indicated on the flowmeter When the oxygen supply from the pipeline or cylinder pressure drops below about 37 psi an O2 SUPPLY LOW Caution message appears in the Alarm window on the monitor anintermittent alarm sounds Note If only one source of oxygen supply pressure either the cylinder or pipeline fails and the other source maintains proper supply pressure in the oxygen supply lines the OFPD and the alarm are not activated The individual flowmeters for each gas are located directly above their corresponding flow control valves The flowmeters indicate the delivered flow rate of each gas in the fresh gas mixture The specific
128. ory Volume Monitor Controls 6 20 Setting the Minute Volume Low Alarm Limit 6 20 Turning Respiratory Volume Alarms Off 6 21 Turning Respiratory Volume Alarms On 6 21 Respiratory Volume Alarm Messages 6 21 Breathing Pressure Monitoring 6 23 Breathing Pressure Monitoring Displays 6 23 Breathing Pressure Monitor Window 6 24 Breathing Pressure Trace Window 6 24 Breathing Pressure Monitor Controls 6 26 Setting the Pressure High Alarm Limit 6 27 Setting the Threshold Pressure Alarm Limit 6 27 Manually Setting the Threshold Limit 6 28 Automatically Setting the Threshold Limit 6 28 Turning the Apnea Pressure Alarm 6 30 Turning the Apnea Pressure Alarm On 6 30 Breathing Pressure Alarm Messages 6 31 6 2 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Overview In addition to monitoring clinical parameters the Narkomed Mobile performs diagnostic self tests eve
129. ow manufacturer s instructions for these procedures Caution Do not autoclave face masks Autoclaving causes rapid deterioration of face mask cushions The Y piece and mask can be disinfected by wiping or immersion with glutaraldehyde based formulations EtO and wet pasteurization processes can also be used The ventilator bellows and its bottom assembly are the only ventilator components that come in contact with the patient s breath Refer back to Cleaning and Disinfecting Exterior Surfaces for instructions on cleaning and disinfecting the surface of the ventilator bellows canister Clean the bellows with a soft lint free cloth moistened with mild alkali detergent and water followed by a distilled water rinse Let the bellows drip dry After cleaning use wet pasteurization at 70 for 30 minutes a 2 gluteraldehyde based solution or an EtO process to disinfect the ventilator bellows Follow manufacturer s guidelines for these procedures Clean the ventilator bellows bottom assembly with a soft lint free cloth moistened with mild detergent and water followed by a distilled water rinse Allow the assembly to drip dry After cleaning use an EtO process for disinfection Follow manufacturer s guidelines Narkomed Mobile Operator s Manual 7 19 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the Oxygen Sensor Capsule Cleaning and Disinfecting Oxyg
130. ows Assembly Part Number 4115139 001 Rev OP00093 o ES Zu Be BELLOWS S Bd p CANISTER NA T x m ge A E 7 BELLOWS 4 PILOT LINE RELIEF VALVE BODY WINGNUT 2X Disconnect the oxygen sensor connector from the system interface panel Separate the oxygen sensor housing from the breathing pressure sensor adapter It is a press fit 7 9 Narkomed Mobile Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 7 6 Removing the Oxygen Sensor OXYGEN SENSOR O2 SENSOR Ps HOUSING 2 A SENSOR Ju x CAPSULE SENSOR FC CORD B CONNECTOR j _ i we 7 SENSOR HOUSING PRESSURE COVER SENSOR ADAPTER INSTALLED IN INSPIRATORY VALVE DOME OP00091 7 Disconnect the breathing pressure sensor quick connect fitting from the system interface panel Disconnect the quick connect fitting from the pressure gauge Separate the pressure sensor adapter from the inspiratory valve dome It is a press fit Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Figure 7 7 Removing the Breathing Pressure Sensor OP00216 2 BREATHING PRESSURE A QUICK CONNECT A FITTING N LT y BREATHING PRESSURE PILOT LINE PRESSURE SENSO
131. r Hoses and Bag 7 23 Reassembly Instructions 7 24 7 2 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Overview This section outlines procedures for maintaining and cleaning the Narkomed Mobile Routine Maintenance Replacing the Absorbent Routine maintenance must be performed regularly to ensure safe and effective operation Regularly check the condition of the absorbent and the overall condition of the machine power cord hoses and breathing bag When the carbon dioxide absorbent in the absorber system is exhausted it must be replaced Refer to the manufacturer s instructions for the signs to expect when the absorbent is exhausted Draeger Medical recommends the use of DragerSorb If the machine has been out of use or in storage replace the absorbent before using the machine Draeger Medical recommends establishing a routine schedule with a sufficient safety margin for replacing absorbent When using loose absorbent do not fill above the maximum fill level line located about a quarter inch from the top of the canister The clearance and the ratio of canister diameter to screen opening minimize the potential for channeling In channeling gas flows through the canister along the path of least resistance The gas depletes the efficiency of the absorbent a
132. r about 12 hours will recharge a depleted battery The battery test button and indicator located near the system power switch are used to determine the backup battery status Figure 2 13 on page 2 22 A detailed testing procedure is included in the checkout procedures in this manual Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 23 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS System Interface Panel The system interface panel has receptacles for the remote display oxygen sensor cord the breathing pressure pilot line and the respiratory volume sensor cord The panel is located on the display side of the anesthesia machine near the top of the housing Figure 2 14 System Interface Receptacles REMOTE BREATHING DISPLAY b PRESSURE INTERFACE MONITOR INTERFACE VOLUME SENSOR OP00083 REMOTE DISPLAY BREATHING P4 2 PRESSURE Pa OXYGEN ie SENSOR FROM ULTRASONIC OXYGEN ANALYZER FLOW SENSOR INTERFACE Remote Display and Support Arm The remote display monitor screen and controls is mounted on the absorber side of the machine The display can be adjusted up or down to place it in the most convenient position The support arm below the monitor screen supports an external patient monitor 2 24 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Monitoring Sy
133. re gauge to verify performance Turn the PEEP valve control knob fully counterclockwise to its lowest setting after the test is completed Monitor 9 Check the alarm limit settings The monitor alarm limits set automatically to a default configuration when the SYSTEM POWER switch is turned on Check these settings and adjust them if necessary Alarm limits may be adjusted at the beginning of or during a procedure Also make sure that any external monitors are connected properly and that the alarms sound through the anesthesia machine s central audio annunciator 10 N Test the alarm functions of all monitors Simulate alarm conditions and check for appropriate alarm signals System Flush 11 Flush the system with 100 oxygen by pressing the oxygen flush button Final Position 12 At the completion of the checkout procedure verify that a Roc the vaporizer is off handwheel is set to zero the vaporizer is filled to the maximum fill line the APL Valve is open fully counterclockwise the manual automatic switch is set to BAG all flowmeters indicate 0 or minimum the patient suction level is adequate the breathing system is ready to use bag is in place and all hoses connected are properly Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 5 Operating the Anesthesia Machine Table of Contents Gas Delivery System Operat
134. reconnect the tubing IN Check the APL valve The APL valve must be capable of relieving excess gas from the breathing system into the scavenger system To check the APL valve s flow resistance a Setthe manual automatic selector valve to BAG Remove the bag from the bag mount c Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm hose d Completely open the APL valve by turning the control knob fully counterclockwise to its stop position e Turn the SYSTEM POWER switch to ON Open the oxygen flow control valve to a flow of 8 L min g Occlude the bag mount opening and watch for a pressure increase on the breathing system pressure gauge This pressure increase must not exceed 3 cmH50 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing System Leak Test t 6 Perform a breathing and fresh gas delivery system pressure test This test detects leaks from the patient breathing system and fresh gas delivery system To perform the test a Close all flow control valves on the anesthesia machine b Turn the SYSTEM POWER switch to the STANDBY position c Turn the vaporizers to 096 concentration d Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose e Set the manual automatic selector va
135. rify that backup ventilation equipment is available and functional Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 4 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS High 8 IN Check the oxygen and nitrous oxide cylinder supplies Pressure System Verification b Close the both cylinder valves and remove the cylinders from the yoke Verify that there is one cylinder gasket and there are two index pins at each cylinder mounting point Verify that the cylinders match the yoke label Replace the cylinders a Disconnect all pipeline gas supply hoses and drain the system c Open the oxygen cylinder and check the cylinder pressure gauge A full oxygen cylinder registers about 1900 psi Replace any cylinder with pressure less than 1000 psi To check for a high pressure leak close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure With the oxygen cylinder closed press the oxygen flush button on the front of the anesthesia machine Hold the button in until the pressure gauges indicate no pressure d Open the nitrous oxide cylinder and check the cylinder pressure gauge full oxygen cylinder registers about 745 psi Replace any cylinder with pressure less than 600 psi To check for a high pressure leak close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure The full and minimum pressures
136. rm limits and their system defaults are shown in the following table Alarm Limit Default Valid Settings High 10096 19 100 must be greater than low alarm limit Low 3096 18 99 must be less than high alarm limit Follow these steps to change the high or low alarm limit 1 Press the Oxygen High Limit or Low Limit key depending on which alarm limit you want to change box is drawn around the selected alarm limit 2 Press the up arrow or down arrow key to increase or decrease the highlighted alarm limit 3 Tosave the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different alarm Limit key The new value is saved as the alarm limit Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Calibrating the Oxygen Sensor 6 14 To calibrate the oxygen sensor correctly make sure it is exposed only to room air during the entire calibration period You should calibrate the oxygen sensor as part of the daily preoperative setup of the anesthesia equipment 1 Remove the sensor assembly from the inspiratory valve dome and close off the dome with the inspiratory valve dome plug Do not disassemble the sensor assembly further Expose the sensor to ambient air only 2196 oxygen concentration and allow it to stabilize for several minutes To ensure an
137. rols for frequency inspiratory to expiratory I E ratio inspiratory flow rate tidal volume and inspiratory pressure limit 5 12 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 5 6 Anesthesia Ventilator Components and Controls RATIO CONTROL N c FLOW GAUGE de INSPIRATORY RATIO DISPLAY N FLOW CONTROL EXTENDED RANGE ACCESS cox FREQUENCY CONTROL FREQUENCY DISPLAY INSPIRATORY PRESSURE LIMIT VENTILATOR ON OFF CONTROL OP00096 TIDAL VOLUME CONTROL BELLOWS CANISTER PRESSURE LIMIT CONTROL TIDAL VOLUME SETTING INDICATOR BREATHING CIRCUIT CONNECTOR Pneumatic power bellows drive gas to the ventilator is supplied through the hospital pipeline supply or through reserve cylinders on the anesthesia machine switch on the side of the machine allows the use of either oxygen or air as the drive gas The ventilator will not function if this pressure drops below 32 psi Electrical power is supplied by the Narkomed Mobile s AC power source or in event of AC power failure by the backup battery A fully charged battery can power the ventilator for at least 90 minutes The anesthesia ventilator is designed for use with a Draeger Medical absorber system which incorporates a manual automatic selector valve This valve allows you to se
138. ructions provided under the Routine Maintenance section in this chapter If the user facility requires disinfection refer back to the instructions provided in Cleaning and Disinfecting Corrugated Breathing Hoses Mask Elbow and Bag to select a compatible process Check the hoses frequently for signs of deterioration including swelling tackiness or cracking Replace the affected parts when any of these conditions are evident Narkomed Mobile Operator s Manual 7 23 M RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Reassembly Instructions Make sure all parts are completely dry and adequately aerated before reassembling the machine after cleaning and disinfection procedures 7 24 1 10 11 12 13 Reassemble the ventilator bellows assembly Fit the relief valve dome onto the relief valve body and tighten the knurled ring nut Place the ventilator bellows on the bellows bottom assembly and turn it in a clockwise direction Replace the bellows assembly Fit the bellows assembly into the ventilator bellows canister and tighten the two wing nuts Reassemble the inspiratory and expiratory valves by replacing the valve disk and dome gasket in the valve body then replacing the dome and ring nut Turn the ring nut counterclockwise to tighten Replace the inspiratory valve assembly and gasket on the valve mount of the absorber dome Turn the valve assembly clockwise to secure it to
139. ry time the machine is turned on After the initial power on screen appears the Monitor screen is displayed This section of the manual describes these screens and explains how to establish general monitoring settings Power On Screen When you turn the SYSTEM POWER switch ON the Narkomed Mobile performs extensive self tests on its internal hardware As these diagnostics are performed each test and its result appear on the screen The result PASS or FAIL indicates the status of the tested component Figure 6 1 Power On Screen COPYRIGHT NAD INC VERSION SOFTWARE ID DIAGNOSTIC TESTS FIRMWARE PASS RAM PASS VIDEO PASS AID CONVERTER PASS AUDIO PRIMARY PASS BACKUP PASS SERIAL I O PASS CLOCK PASS NON VOLATILE MEMORY PASS FUNCTIONAL OP00215 At the end of the self diagnostics one of three possible conclusions to the self tests is posted on the screen FUNCTIONAL The monitoring system is in satisfactory operational order After a brief delay the Monitor screen appears CONDITIONALLY A noncritical fault was detected such as a speaker FUNCTIONAL failure The Narkomed Mobile may be used but an authorized representative of Dr gerService should be notified to correct the problem When you are ready to resume operation press any key on the keypad NONFUNCTIONAL 4A serious fault was detected and operation of the monitor is inhibited Do not use the machine Immediately notify an authorized represen
140. sert any additional components into or modify the anesthesia system after the checkout procedure is started Enter the serial number of the anesthesia machine The serial number is located on the leg of the transport trolley assembly Make sure there is a valid inspection sticker on the back of the machine indicating that the anesthesia machine was serviced and inspected by an authorized representative of DragerService Verify that a cylinder wrench is tethered next to the cylinder yoke If the anesthesia machine is not already plugged in connect the electrical power cable to an active AC outlet that accepts and properly grounds the power cable Do not use cheater plugs The term cheater plug implies any and all electrical plugs or other devices that can inhibit or prohibit the proper grounding of the anesthesia machine N Turn the SYSTEM POWER switch to the ON position Wait for the machine to complete its diagnostic checks Make sure the system is functional IN Check the reserve battery power Remove the power cable from the outlet Press the BATTERY TEST button The green indicator must light Plug the power cable back into the electrical outlet NOTE This test assumes that the anesthesia machine has been plugged in for 12 hours The battery charging system works only when the machine is connected to an active AC power source The charging system takes about 12 hours to charge a fully discharged battery ya IN Ve
141. set the tidal volume refer to the tidal and minute volume measurements The position of the tidal volume indicator can be calibrated for a specific combination of fresh gas flow and equipment compliance by an authorized representative of Dr gerService Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Setting the Respiratory Frequency Setting the Inspiratory Expiratory EE Phase Time Ratio Setting the Inspiratory Flow Rate Setting the Inspiratory Pressure Limit Part Number 4115139 001 Rev Use the frequency control knob to set the respiratory frequency from 1 to 99 breaths per minute BPM in 1 BPM increments Clockwise rotation of the control knob increases the frequency setting while counterclockwise rotation decreases the frequency setting Use the ratio control knob to set the inspiratory expiratory I E phase time ratio The standard range of ratios is from 1 1 through 1 4 5 adjustable in increments of 0 5 An extended range of ratios is also available that allows the setting of inverse I E ratios The specific extended range settings are 4 1 3 1 and 2 1 The extended range settings are accessible by pressing the EXTENDED RANGE switch while rotating the I E ratio control knob Clockwise rotation of the control knob increases the I E ratio setting while counterclockwise rotation decreases the
142. sorber system handles spontaneous manually assisted or automatic ventilation The preferred mode of operation is selected with the manual automatic selector valve The AUTO position of the valve enables automatic ventilation The BAG position enables Manual Spontaneous ventilation Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 15 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Inspiratory and Expiratory Valves 2 16 The absorber system includes aninspiratory valve and an expiratory valve e an absorber canister and dust cup abreathing system pressure gauge apressure sensing hose assembly fresh gas hose manual automatic ventilation selector valve anadjustable pressure limiter APL valve respiratory volume sensor oxygen concentration sensor e a positive end expiratory pressure PEEP valve The inspiratory and expiratory valves control the gas flow direction in the absorber system The valves are unidirectional meaning they permit gas flow in one direction only e The inspiratory valve allows gas to flow toward the patient only without backflow to the absorber The expiratory valve allows gas to flow to the absorber only with no backflow to the patient The valves are not interchangeable They must be connected to the correct mounts to ensure proper flow direction through the absorber system Different size mounting threads
143. sory SERVICE VENT MON Advisory 6 22 When the ventilator is off The Caution condition does not occur until 30 seconds have elapsed The Warning condition does not occur until 60 seconds have elapsed During apneic conditions the respiratory volume measurements disappear after 30 seconds When a valid breath is detected alarm annunciation ceases and a tidal volume measurement appears in the display window However a full minute of respiratory activity must be registered before the minute volume and respiratory rate appear Note You can disable volume related alarms by pressing the Breathing Volume Off key Whenever the Narkomed Mobile measures a minute volume less than the low minute volume alarm limit the Caution message MINUTE VOLUME LOW appears in the Alarm window and an intermittent audible alarm sounds If a reverse flow in excess of 20 mL is detected the Advisory message REVERSE FLOW appears in the Alarm window and a single tone audible alarm sounds A forward flow greater than 20 mL clears the alarm condition The REVERSE FLOW alarm message remains on the screen for 5 seconds after the resumption of forward flow to allow for recognition of an intermittent reverse flow condition The VOL SENSOR DISC appears in the Alarm window if the respiratory volume sensor cable is not properly connected to the interface panel if there is an internal sensor fault or if the electronics housing is not properly seat
144. ssure Provide sufficient oxygen supply pressure Bellows won t compress during inspiration Absorber manual automatic selector valve in BAG position Place selector valve in AUTO position Inspiratory flow control setting on ventilator too low Increase inspiratory flow control setting Frequency too high Decrease frequency 8 4 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 8 Oxygen Monitoring Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY Display area remains blank when a reading is expected CAL O2 SENSOR message in Alarm window Needs calibration Perform proper calibration Remove sensor assembly from breathing circuit Make sure sensor is exposed to room air only Then press the Cal key O analyzer fails to retain calibration Alarm message CAL O2 SENSOR appears in Alarm window Backup memory power not available Check battery circuit breaker Allow backup battery to recharge and recalibrate the analyzer Hardware malfunction Contact an authorized representative of Dr gerService Pressing Cal does not initiate calibration Sensor is disconnected Insert sensor cord connector into Oxygen Sensor receptacle in the system interface panel Sensor cord is damaged Replace housing cord assembly Pressing Cal init
145. ssure Threshold key A box is drawn around the threshold pressure alarm limit 2 Press the up arrow or down arrow key to increase or decrease the threshold pressure alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different Alarm Limit key The new value is saved and displayed as the threshold pressure alarm limit If the alarm limit is on or below the upper limit of the scale a marker appears next to the alarm limit and a dotted line extends from the alarm limit horizontally across the scale You can have the monitoring system automatically set the threshold pressure alarm limit to an optimum value based on the current peak pressure To automatically set the threshold pressure alarm limit press and then release the Breathing Pressure Auto Set key The LED next to the Breathing Pressure Auto Set key lights briefly when you press it The threshold pressure limit is automatically set 4 cmH5O below the current peak pressure measurement to a minimum of 5 cmH5O and a maximum of 30 cmH50 If the alarm limit is on or below the upper limit of the scale a marker appears next to the alarm limit and a dotted line extends from the alarm limit horizontally across the scale Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Threshold If a breathing system leak
146. ste gas exhaust flow A 3 0 liter reservoir bag contains the excess waste gas This system accommodates a variety of waste gas flow rates from the patient breathing system A 19 mm hose connects to the fitting below the hose barb for passive exhaust systems A relief valve guards against excessive pressure build up if the exhaust hose is restricted Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 19 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Anesthesia Ventilator The anesthesia ventilator is a volume preset time cycled pressure limited ventilator with electronic timing pneumatic circuitry and independent controls for frequency inspiratory to expiratory I E ratio inspiratory flow rate tidal volume and inspiratory pressure limiting Figure 2 11 Anesthesia Ventilator Assembly RATIO CONTROL N FLOW GAUGE INSPIRATORY RATIO DISPLAY NON N FLOW CONTROL EXTENDED RANGE ACCESS FREQUENCY CONTROL FREQUENCY DISPLAY VENTILATOR ON OFF CONTROL TIDAL VOLUME CONTROL OP00096 BELLOWS CANISTER PRESSURE LIMIT CONTROL TIDAL VOLUME SETTING INDICATOR BREATHING CIRCUIT CONNECTOR Pneumatic power bellows drive gas to the ventilator is supplied through the hospital pipeline supply or through the cylinder A switch on the right side of the housing is used to select either oxygen or air as the
147. stem The monitoring system integrates the functions of the electronic monitors and organizes information from these monitors on the monitor screen The Narkomed Mobile monitors oxygen concentration breathing pressure respiratory volume oxygen supply pressure system status Monitor monitoring data and alarm messages are displayed on the monitor Screen and screen Use the control keys on either side of the screen to establish Controls monitoring settings With the left keypad you can control system wide settings such as alarm annunciation and monitor configuration With the right keypad you can control settings for specific monitors oxygen concentration breathing pressure and respiratory volume Figure 2 15 Monitor Screen and Controls OP87005 r WARNING INSP 02 LOW 7 Config SUB ATM PRESSURE OXYGEN Oxygen s CAUTION BATTERY FAIL 100 High Low 02 SUPPLY LOW s Limit ADVISORY SERVICE VENT MON PORT AERROR Breathing TID VOL BPM MIN VOL Low on a 0 35 10 3 5 LI 29 Breathing 35 N Alarms VAI MEAN PEEP LEFT MONITOR _ RIGHT SCREEN KEYPAD Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 25 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Alarm System Alarms are organized in
148. structions for use Caution Disinfectants containing phenol or phenyl compounds destroy rubber goods Latex and rubber goods treated with disinfectants having a quaternary ammonium base will be damaged if subsequently autoclaved Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the Y Piece and Mask Cleaning and Disinfecting the Ventilator Bellows Cleaning and Disinfecting the Ventilator Bellows Bottom Assembly Part Number 4115139 001 Rev Use 2 glutaraldehyde based formulations for more than 20 minutes or wet pasteurization at 70 for 30 minutes after detergent cleaning Thoroughly rinse the corrugated hoses mask elbow and breathing bag after contact with chemicals Use sterilized water to prevent contamination by tap water organisms Thoroughly dry rubber goods before returning them to service The corrugated hoses mask elbow and breathing bag can be autoclaved at 121 However such temperatures accelerate the natural aging of rubber goods Autoclaved rubber goods can also harden over time as a result of the loss of softeners Exposure to ozone or ultraviolet light also accelerates the natural aging of rubber goods Reusable rubber goods can also be disinfected with ethylene oxide After EtO processing properly aerate rubber goods before returning them to service Always foll
149. switch The green indicator to the right of the test button must illuminate Plug the power cable back into the electrical outlet NOTE This test assumes that the anesthesia machine has been plugged in for 12 hours The battery charging system works only when the machine is connected to an active AC power source The charging system takes about 12 hours to charge a fully discharged battery 2 IN To check the absorber system a Check the hose connections in the breathing system b Make sure the fresh gas hose of the breathing system is securely connected to the fresh gas outlet c Make sure a 22 mm patient breathing circuit is connected between the inspiratory valve and expiratory hose terminal on the ultrasonic flow sensor d Make sure a 22 mm breathing hose is connected between the ventilator hose terminal and the manual automatic selector valve breathing hose terminal e Make sure a breathing bag of proper capacity and appropriate construction is connected to the breathing bag terminal of the breathing system f Make sure the breathing pressure hose assembly is properly connected to the pressure sensor adapter and the system interface panel g Make sure the oxygen sensor and respiratory volume sensor are properly installed Part Number 4115139 001 Rev Narkomed Mobile Operator s Manual 4 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS APL Valve 3 5 N Check the
150. t be replaced by a hose from any other manufacturer For the delivery of a metered flow of pure oxygen for example delivery of oxygen through a nasal cannula an auxiliary oxygen flowmeter is mounted on the left side of the flowmeter bank Figure 2 6 on page 2 11 This flowmeter can be used when the machine is turned off Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 Figure 2 7 Fresh Gas Outlet OP00097 A d esu 5 22 FRESH GAS BN O2 FLUSH CONTROL OUTLET X E E 4 m 2 Pd d d pes FRESH GAS LOCKING BAR RELEASE TO LOCK PULL TO INSERT OR REMOVE HOSE FRESH GAS HOSE Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 2 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Anesthetic Vaporizer The Narkomed Mobile is equipped with a Dr ger Vapor 19 3 vaporizer This vaporizer enriches fresh gas with precisely metered vapor of liquid anesthetic agent The vapor is inserted into the fresh gas line It is connected between the fresh gas metering unit and the fresh gas outlet 2 14 Figure 2 8 Dr ger Vapor 19 3 Vaporizer OP00329 INLET VALVE FILLING SPOUT MAX FILL LINE SIGHT GLASS N DRAIN VALVE MIN FILL LINE Warning If the wrong anesthetic is used the delivered concentr
151. tative of Dr gerService to correct the problem Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Monitor Screen and Controls Following a successful power up monitoring information is displayed on the Monitor screen The control keys to the left and right of this screen allow you to establish monitoring settings Monitor Screen 6 4 Figure 6 2 Monitor Screen and Controls OP87005 Config WARNING INSP 02 LOW SUB ATM PRESSURE CAUTION BATTERY FAIL O02 SUPPLY LOW ADVISORY SERVICE VENT MON PORT A ERROR OXYGEN Oxygen 100 High Low 4b Limit Limit Breathing Volume TID VOL BPM MIN VOL 3 5 0 35 10 PEAK MEAN PEEP LEFT MONITOR L RIGHT KEYPAD SCREEN KEYPAD The Monitor screen displays information in five separate windows Figure 6 3 Monitor Screen Window Locations ALARM WINDOW OXYGEN MONITOR WINDOW WARNING INSP 2 LOW SUB ATM PRESSURE OXYGEN Pide CAUTION AC BATTERY FAIL 3 2 100 O2 SUPPLY LOW ADVISORY SERVICE VENT PORT A ERROR TID VOL BPM MIN VOL 0 35 10 35 m m A 2 0 VOLUME 35 PEAK MONITOR WINDOW BREATHING PRESSURE TRACE WINDOW Narkomed Mobile Operator s Manual BREATHING PRESSURE
152. te 5 2 household bleach at 1 500 dilu tion 100 ppm chlorine Note North American makes no claims about the efficacy of these agents or this method of cleaning for infection control Consult your hospital s infection control officer or epidemiologist Wipe the pressure gauge assembly with a soft lint free cloth moistened with mild detergent and water Dry the assembly before reinstalling The gauge can be disinfected with ethylene oxide gas followed by appropriate aeration Follow the manufacturer s instructions Caution The breathing system pressure gauge cannot withstand immersion or the heat and pressure of autoclaving Refer to the instructions provided earlier in this chapter under the heading Replacing the Absorbent for instructions on removing the absorbent canister assemblies from the absorber Clean the canister frequently Remove used absorbent and clean absorbent residues for the canister and gasket surfaces Check the dust cup periodically Empty and clean it when necessary Warning Absorbent is caustic Avoid contact with the skin and eyes Narkomed Mobile Operator s Manual 7 21 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the Absorber Assembly Cleaning and Disinfecting the Vaporizer Exterior 7 22 After removing the canister assemblies and dust cup from the absorber system wash these parts with mild alkali detergent and wa
153. ter The canister assembly and dust cup can be immersed or wiped with a soft lint free cloth Allow the parts to dry Several methods can be used for disinfection Wet pasteurization autoclaving and immersion or wiping with 2 glutaraldehyde based solution are all acceptable If an EtO process is used make sure the parts are properly aerated before returning them to service Turn the APL valve control knob fully counterclockwise before cleaning or disinfecting the absorber system After cleaning use wet pasteurization at 70 for 30 minutes to disinfect the absorber system assembly The assembly can be autoclaved at a temperature not exceeding 121 or an EtO procedure can also be used Follow manufacturer s guidelines Refer to the Dr ger Vapor 19 3 Anesthetic Vaporizer Instructions for Use for complete information about the vaporizer Warning Water and other liquids with the exception of the appropriate anesthetic that enter the vaporizer chamber can cause injury to the patient or form corrosive products that affect the function of the vaporizer Caution Do not immerse the vaporizer or allow water or any other liquid to enter the fill or drain ports or fresh gas inlet or outlet ports Any vaporizer suspected of contamination with water or any other liquid must be returned to Dr gerService for a complete overhaul Additional care must be taken with halothane vaporizers Halothane contains a stabilization additive
154. to BAG Turn the APL valve fully counterclockwise Verify that the suction waste gas disposal system is active Turn the PEEP valve control knob fully counterclockwise to its lowest setting Turn the scavenger needle valve fully counterclockwise Push the flush button to inflate the scavenger reservoir bag Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Manual and Automatic Ventilation Systems n t should exit through the positive pressure relief valve The pressure gauge should indicate pressure less than 10 cmH50O Open the oxygen flow control valve to a flow of 8 L min Occlude the absorber breathing bag terminal The oxygen flow Adjust the scavenger needle valve to a proper initial setting To test the scavenger interface for passive systems a Make sure a 19 mm scavenger hose is connected between the ventilator relief valve and the scavenger interface Make sure a 19 mm scavenger hose is connected between the APL valve and the scavenger interface Make sure a 19 mm scavenger hose is connected between the bottom scavenger interface and the hospital exhaust system Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose Set th
155. to three categories depending on the urgency of the alarm condition Warnings The highest priority alarms requiring an immediate response Cautions Second priority alarms requiring a prompt response Advisories The lowest priority alarms requiring the operator s awareness Visual and audible notification announce the most urgent conditions Alarm Messages for active alarm conditions appear in the Alarm window at the top Display of the monitor screen Messages are displayed for up to six of the highest priority active alarm conditions Any additional lower priority active alarm conditions are retained in the monitor s memory Messages for these lower priority conditions are displayed when the higher priority alarm conditions are resolved and their messages are removed from the display Figure 2 16 Alarm Window Display ALARM WINDOW WARNING INSP O2 LOW SUB ATM PRESSURE CAUTION BATTERY FAIL O2 SUPPLY LOW ADVISORY SERVICE VENT MON PORT A ERROR OP87001 2 26 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Alarm Annunciation Ventilation Alarms Each alarm category has a specific audible signal Warnings A three pulse tone pattern that is initially repeated every few seconds in a series of descending volumes and then constantly at full volume until the alarm condition is resolved Cautions A t
156. truction manual This anesthesia system will not respond automatically to certain changes in patient condition operator error or failure of components The system is designed to be operated under the constant surveillance and control of a qualified operator Constant surveillance is necessary to ensure patient safety Do not attach third party components to the anesthesia machine ventilator or breathing system except for certain approved exceptions These devices may affect the safe operation of the anesthesia machine Contact Dr gerService at 800 543 504 for further information Prior to moving the Narkomed Mobile unit the following functions must be performed 1 Disconnect the power cord from the mains and store properly 2 Disconnect all gas supply lines from the wall supply Ensure that these supply lines are not in a position to interfere with the movement of the machine 3 Make sure the Vaporizer has been placed in the 0 position Remove and store the Vaporizer in the vaporizer holding area located on the base of the unit For more detailed information on storing the Vaporizer refer to Vaporizer Storage on page 1 9 Move the monitor to its parked position 4 Move the absorber system to its parked position 5 Unlock the caster brakes located on the two front wheels of the unit Before moving the assembled anesthesia machine remove all monitors from the top shelf of the machine and use only the machine hand
157. ue is saved and displayed as the pressure high alarm limit If the alarm limit is on or below the upper limit of the scale a marker appears next to the alarm limit The threshold pressure alarm limit defines the level below which an apneic alarm condition exists When the patient s breathing pressure falls below the threshold limit a message appears in the Alarm window and an audible alarm sounds The threshold pressure alarm limit is automatically set to 12 cmH O at power up The setting can be changed to any value from 5 30 cmH 0 as long as it is less than the pressure high alarm limit You can change the alarm limit manually to a value you select or have the system set it automatically to an optimum value based on the current peak pressure Warning The threshold pressure alarm limit should be as close as possible to the sensed peak pressure without exceeding it For details see Threshold Limit Guidelines and Sample Threshold Limit Settings in this section Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 27 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Manually Setting the Threshold Limit Automati cally Setting the Threshold Limit 6 28 To set the threshold pressure alarm limit manually follow these steps Remember that the value must be within the range of 5 30 cmH O and less than the pressure high alarm limit 1 Press the Breathing Pre
158. ure a 22 mm breathing hose is connected between the ventilator hose terminal and the manual automatic selector valve breathing hose terminal e Make sure a breathing bag of proper capacity and appropriate construction is connected to the breathing bag terminal of the breathing system f Make sure the breathing pressure hose assembly is properly connected between the pressure sensor adapter and the system interface panel g Make sure the oxygen sensor and respiratory volume sensor are properly installed IN Make sure the absorber canister is filled with absorbent Consult the absorbent manufacturer s literature for information on what signs to expect when the absorbent is exhausted Draeger Medical recommends the use of Dr gerSorb Make sure that the color change represents the absorbent s true state of depletion and is not due to regeneration after a rest period Flushing the anesthesia machine continuously for at least one minute with 100 oxygen before the first case of the day is recommended If the anesthesia machine has been out of use or in storage replace the absorbent before using the machine Draeger Medical recommends establishing a routine schedule with a sufficient safety margin for replacing the absorbent Remove accumulated absorbent dust and water from the absorber dust cup WARNING Absorbent is caustic and is a strong eye skin and respiratory tract irritant When emptying the absorber dust cup take care
159. ure the flow housing is facing the right direction Compare the direction to the illustration on the electronics housing The index pin on the electronics housing should align with the hole in the flow housing 11 Slide the flow sensor onto the bracket 12 Connect the patient hose to the expiratory hose terminal on the flow sensor 13 Install the connector hose assembly between the flow sensor and the expiratory valve and secure it by turning the ring nut clockwise Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 7 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Scavenger Interface Maintenance 7 8 Draeger Medical recommends routine maintenance for the scavenger interface and attachments Follow this procedure every 6 months Wipe the scavenger body with a soft lint free cloth moistened with mild detergent and water 2 Inspect all scavenger hoses for signs of wear and deterioration Replace any worn hoses Remove the filter valve cap by pulling it off the scavenger Inspect the filter in the cap If necessary remove the filter from the cap for cleaning Brush any accumulated lint or dust off the filter The filter can be further cleaned with a low flow of clean air or oxygen Figure 7 4 Removing the Scavenger Filter Valve Cap VACUUM NEGATIVE p POSITIVE RESSURE PRESSURE RELIEF RELIEF VALVE VALVE OP00088 Y 19MM INLET HOSE CONNECTION 19
160. ust Cup Absorber Assembly Vaporizer Exterior Scavenger Interface does not normally need disinfection Corrugated Scavenger Hoses and Breathing Bag does not normally need disinfection Ethylene oxide gas use manufacturer s recommendations C Glutaraldehyde based formulations 296 D E T Part Number 4115139 001 Rev Wet pasteurization at 70 C for 30 minutes after detergent cleaning Sodium hypochlorite 5 2 household bleach 1 500 dilution 100 ppm free chlorine Ethyl or isopropyl alcohol 70 to 90 Narkomed Mobile Operator s Manual 7 7 17 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning Disi nfecting Exterior Surfaces Cleaning Disi nfecting Corrugated Breathing Hoses Mask Elbow and Bag 7 18 Caution To avoid damaging the Narkomed Mobile e Do not use Betadine Povodine Sagrotan Mucocit acetone ketone xylene or anesthetic agents for cleaning e Dilute cleaning agents before use by strictly following the manufacturer s instructions Do not use abrasives such as steel wool liquid abrasives or powder abrasives on the machine Do not let any liquid enter the interior of the machine e Do not submerge any part of the system unless specifically instructed to do so in this manual Do not pour or spray liquid directly on the machine during cleaning Always moisten a soft lint fr
161. w you can look for it in the Alarm Log It contains up to 100 of the most recent warning and caution messages When there are more than 100 warnings and cautions the oldest message is deleted to make room for the newest Displaying Follow this procedure to display the Alarm Log the Alarm Log ewm 1 From the Monitor screen press the Config key onfig ponts The Configure screen is displayed 2 From the Configure screen press the ALARM LOG key Imi The Alarm Log appears with the first warning or caution that occurred at the top of the list 9 Ifthe list extends beyond the page scroll forward by pressing the down arrow key and scroll backward by pressing the up arrow key Figure 6 7 Alarm Log Screen OP87029 CLEAR LOG ALARM LOG TIME MESSAGE 12 49 INSP O2 LOW 14 03 APNEA PRESSURE 14 03 APNEA VOLUME 14 03 APNEA PRESSURE 14 03 APNEA VOLUME 14 03 MINUTE VOLUME LO EXIT Clearing the Alarm Log To delete all of the messages from the Alarm Log press the CLEAR LOG Limit key The messages are permanently deleted from the LOG 6 10 Narkomed Mobile Operator s Manual Part Number 4115139 001 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Exiting the Alarm Log Setting Alarms to Standby Silencing Alarms a To exit the Alarm Log immediately press the EXIT key Note The monitoring system automatically exits the Alarm Log if a minute passes and n
162. waveform and the adjacent marker on the Y axis both represent the threshold pressure apnea alarm limit The horizontal dotted line is always displayed but the marker on the Y axis appears only when the threshold pressure alarm limit is less than or equal to the top of the scale set by the system There is a marker in the illustration above because the threshold pressure alarm limit 12 is less than the top of the scale 20 cmH 0 The pressure high alarm limit is denoted by a marker on the Y axis only when it is less than or equal to the top of the scale set by the system In Figure 15 the pressure high alarm limit 35 is greater than the top of the scale 20 cmH 0 When a high alarm limit marker is displayed its appearance depends on whether the pressure high alarm limit is less than or equal to the top of the scale The following examples illustrate the difference in appearance Note that a threshold pressure alarm limit marker is also displayed in these examples Part Number 4115139 001 Rev F Narkomed Mobile Operator s Manual 6 25 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figure 6 16 Trace Markers HORIZONTAL STEP LIKE MARKER MARKER PRESSURE HIGH ALARM PRESSURE HIGH ALARM LIMIT TOP OF SCALE LIMIT TOP OF SCALE SCALE 0 50 cmH20 87020 Breathing You use the breathing pressure monitor control keys to set breathing Pressure pressure alar

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