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ZAN300 CO Diffusion

1. 4 1 2 2 2 Select Medication Selecting this icon or pressing the F3 key selects the medication for the next stage The medication and dose given to the patient can be selected from the current medications entered into the system The user has the choice to correct the medication for the current stage or to define the medication of the next stage On the left hand side of the window the user is able to select the test stage This can either be a Pre stage without medication a NaCl stage a dose of a provocation protocol or a bronchodilator Post Stage For a dose the user needs to first select a protocol from the list It is also possible to create a new protocol see below As soon as a protocol is chosen the possible doses of this protocol are shown in the list box on the right hand side If the dialogue box is opened during a provocation protocol the protocol in use and the next dose are selected automatically Again the user has a choice to create edit see below or delete doses On the bottom right hand side of the window the user is shown how to do the provocation to get to the selected dose This includes concentration nebuliser and count of nebulisations For the count of nebulisations the computer calculates the difference between the target dose and the dose currently in the lung 0 if not cumulative For bronchodilators it is possible to either select none of the medications in the list box or one of those li
2. Additional Patient Data Vali H Station Treating Doctor Referng Doctor Smoking Habits CigDay Annotations 3 My Computer When the required fields have been completed select the Enter key to save this data 2 5 Measurement Mode Once the input of Patient data is complete measurements can be performed on the active patient Select the Measure button from the menu or press M to display the measurement mode screen A Fluss F volumen EE Select the required test PO 1 Rhino Note The options available on this menu will vary according to the installed components and hardware 2 5 1 Symbol Definitions before a Measurement Cancel the measurement Shutter test Zero the flow sensor Patient must not breath into the flow sensor zoom in zoom out choose medication es identify current user Notes display the incentive graphs With each click the incentive graph changes to a new selection Start measurement Select the measurement programme using the mouse or the arrow keys gt The programme is selected when the corresponding field is displayed in red The measurement programme starts either when you click on the selected field again or by pressing the Enter key Refer to the corresponding chapters for explanation of the particular measurement programme INSPIRING RESPIRATORY
3. Cancel The hardware configuration allows you to reset the zeroing point of the flow sensor and configure the set up of the device from a filter mouthpiece perspective Your system components Curent measuring system amp Results 102231 4 o Teste Flow Volume This allows you to set the Results Ex T parameters you want to see rig after the test is performed from Results ty both the expired and inspired Ane results and the order of the Aonde results displayed on the screen You can set the Automatic option which allows you to automatically save the results of each test In this way you can concentrate on the patient instead of having to push the enter key to save the trace at the end of the test W Automatic Procedure Start after breath ef YiSpire INSPIRING RESPIRATORY HEALTH Finally the tick box allows you to remove the ability to split the inspired and expired portion of the loop Under the Hyper Responsive set up you can configure the timer for the bronchial challenge program The timer is helpful for the user to do the provocations and after a defined time period keep the cumulative effect of the medication According to ATS ERS provocations should be performed every 5 minutes The test timers allow the defining of up to three time points after the provocation that the efforts should be performed The ATS ERS recommends that these
4. German law MPG 0535 The number describes the institute which performed the CE certification In this example it is the Eurocat GmbH institute in Darmstadt If necessary nSpire Health GmbH is able to present the corresponding documents which allow application of this symbol on the device Typical Product Label ZAN 800 ECG 12V 0c max 12W The serial number is defined as The 1 number is the year The 4 means 2004 for example Ser Nr 4800472 0535 ZAIN Eesen eo 0 D 97723 Oberthulba favit Numbers 2 4 define the product code 800 in this example J Safety Maintenance Ser INSPIRING RESPIRATORY HEALTH 9 7 Maintenance Information A8 2 1 Gas Container Valves Caution Do not open the valve to the absolute ending and leave it in this position The valve might be blocked irreversibly by the internal pressure of the container Always take AN one half turn back when the opening end has been reached 9 7 1 Pressure Reducer Pressure reducers need periodical maintenance Please refer to the manufacturers manual for the correct maintenance intervals 9 7 2 Flow Sensor Lifetime The Flow Sensor is directly exposed to the patients breath disinfective agents and a permanent change of humidity and temperature That makes it impossible to guarantee a minimum lifetime The typical lifetime of a Flow Sensor is about 5 years according to customer reports Calibration Calibration is reco
5. 4 5 7 Performing PEmax and Plmax Measurement 4 5 7 1 P0 1max and Pimax To measure PO 1max and Plmax the patient is asked to exhale as deeply as possible Fi gt During deep exhalation select the Plmax icon 3 gt The device will automatically interrupt the flow after the beginning of the next inhalation for 2 sec and records the pressure at the mouth gt The patient is asked to inhale during this time to inhale as powerfully as possible gt Repeat this manoeuvre at least 3 times to obtain acceptable results Important Between each Plmax interruption wait for a minimum 5 tidal breaths to give the patient a rest 4 6 5 1 PEmax The PEmax manoeuvre is inverse to the Plmax manoeuvre The patient starts with maximum inhalation max gt During deep inhalation select the PEmax icon 4 gt The device will automatically interrupt the flow after the beginning of the next exhalation for ca 2 sec and records the pressure at the mouth gt The patient is asked to exhale as powerfully as possible gt Repeat this manoeuvre 3 times or more Important This test should be repeated after a short pause of minimum 5 tidal breaths to give the patient a rest YiSpir P0 1 PEm INSPIRING RESPIRATORY HEALTH essen P0 1 Funktions Anal lyse yon Atempumpe und Atem Antrieb EPERERA 4 5 7 2 Additional recommendations In most cases the patient is a little nervous before the measurement and breat
6. Select this icon or press the F12 key to check that results meet ERS ATS 2005 Standards Click the go icon to start the test Select this icon or press the F1 key to display a dialogue box to enter comments Select this icon or press the F2 key to define the user Select this icon or press the F3 key to select the medication Select this icon or press the F8 key to print one or more templates Select this icon or press the Enter key to save the measurement and exit the module The 3D icon switches to view graphic in 3D the magnifying glass icons zoom in and out First the SVC Test is performed Please refer to the SVC Chapter for detailed information MP 7 Combined SVC F V Measuremer INSPIRING RESPIRATORY HEALTH Directly after the slow inspiration the forced expiration is performed Please look for detailed information in the F V chapter 4 3 2 Airway Resistance Measurement ROCC Spirome trie FluB olumen oo Woe eh ce ta sn se aT hy Ae lt n aR If your ZAN device is equipped with a valve shutter the respiratory flow can be interrupted during tidal breathing by pressing the space bar during a spirometry measurement If the pressure that was caused during the interruption is measured and divided by the flow that was caused after opening the valve the flow resistance can be measured The last five measured interruptions will be analysed and displayed in the list of re
7. pire INSPIRING RESPIRATORY HEALTH 8 1 5 11 Disabled Options If you use the edit file option a html file is opened in the Notepad editor Modify report File description File ErgoSpiro Value Table Ergot zim OK Cancel Edit file dialogue fej Ergo1 ztm Editor J f lolx Datei Bearbeiten Format lt ZANTYPE Report Preset gt lt DOCTYPE HTML PUBLIC w3C DTD HTML 3 2 EN gt lt ZAN ID INCLUDE REF MScript itm 56 gt lt ZAN ID INCLUDE REF header itm gt lt H ZAN ID INCLUDE REF Zergo itm gt lt TITLE gt Test Report lt ZAN ID DATA_DATE gt lt ZAN ID DATA_TIME gt lt TITLE gt lt HEAD gt lt BODY LEFTMARGIN 20 TOPMARGIN 0 gt lt ZAN ID INCLUDE REF ZANDat itm lt ZAN ID INCLUDE REF styles itm lt BASEFONT SIZE 2 gt lt ZAN ID INCLUDE REF person itm PEF IDE LANGUAGE VBScript gt k panpata BA N lt FONT SIZE 5 gt lt CENTER gt ErgoSpirometry Value Table lt CENTER gt lt FONT gt lt script LANGUAGE VBScript gt les Dim ValueTable ValueTab le Array 340 1 310 309 338 302 305 373 315 306 307 314 313 DoT imeTab leHeader ValueTab le document write iris document write Res DoTimeTable Valyetable 60 0 2 document write lt HR document write Load DorimeTab 1c Valuerable 60 3 4 document write lt HR gt document write Recovery DoTimeTable ValueTable 60 4 0 Notepad with a raw template file open
8. Curves over exhaled volume Number of sampling points Style ofthe step curves Add another parameter FEC Remove selected parameter KotH Position as of maximum 65 Colour of the curve dark green IW Reference curve flight green Stat OLCO maneuver Manually C This measurement only f The program recognizes the exhalation Always Occlusion time s C This measurement only 12 f Always cancel The Curves over exhaled volume allows to select the style and colour to be modified To add a new curve to the display pick a curve from the drop down list right from the Add another parameter and press the button To remove a particular curve from the display select the curve from the drop down list right from the Remove selected parameter and press the button The sections Start DLCO manoeuvre and Occlusion time have the option to be effective for the next measurement only This measurement only or permanently Always 4 Sp re CO Diffusion and Residual Vi INSPIRING RESPIRATORY HEALTH 4 7 2 2 3 The Measurement Screen The Measurement screen looks very similar to the master screen There s a different menu a timer is displayed and instructions are given in the centre of the screen as guidance 4 7 2 2 3 1 Structure pily Please perform T normal tidal breathing volume time graph instruction 4 7 2 2 3 2 The Menu The menu of the measureme
9. HIS Interface Path E Browse Waiting Room T Enable Path AWAR TEN Browse Options M Show HIS Patient and visit Humber Guen for patients through HIS Cancel 8 2 Device Settings System Messgerat Beenden Default The Device setting shows the following options Tie ZAN 600 External ef Yispire Setup Customizing The 8 2 1 Default Device Select your default device using this dialogue box The default device must always be the main device of the system E g select ZAN100 when using a ZAN100USB device a ZAN 100 8 2 2 Device specific settings Select the port where your ZAN100 device is connected to With the ZAN 100 USB it is always the USB port Please do not change settings in the Device segment These settings should be changed by qualified personal only Please refer to you dealer or the ZAN service if you need to make changes here Spiro F V toggles the display of the Flow Volume chart between portrait and landscape 8 2 3 External Devices Select the type of external device The device is activated when you change the type in the drop down box from none to a different value This will also activate the associated port dialogue box Select the port where your external device is connected to INSPIRING R 42 Default Device x ESPIRATORY HEALTH Default Device C None f ZAN 100 i ZAN 300 C ZAN 400 ZAN 500
10. ji 1 i y p a S SEs s pow wig 3 i yo BERS E gt S S o L Messung mM 2 3 ERGEBNISSE B x Sal Mitel Sal bax H M2 Max Neg Max TLeofHb mmol kFa min 10 09 108 107 12 20 11 55 3 820 33 KeolHb mmolkPa min l 1 55 1 55 100 1 68 1 67 Oo 128 23 t cliff s 12 98 0 9 31 15 80 70 1354 45 TLC I 6 50 710 109 7 44 7 3 2 6S 12 VA TI 6 93 0 TIT 715 20 63 12 FAC I 327 365 112 392 422 jg 3 4 RY I 1 92 248 129 297 239 20 209 30 IVC CH4 I 462 0 447 492 10 4 46 i FAC TLC 53 52 g5 53 44 1 458 10 AVATLE 2 30 35 116 40 33 J48 3 20 TLC fs I 6 50 742 113 7 82 747 4 BB 15 VA Fs N 7 15 0 7 65 7 30 5 65 15 FAC fs I 326 367 115 4 31 337 22 393 4 RY Fs I 1 92 270 141 335 254 24 22 34 FACTLC fa 2 53 53 101 55 45 48 59 7 RVATLE fs 2 30 37 122 43 J4 21 3 23 The average value of all selected efforts is displayed Right clicking on a dot corresponding to an effort places a red cross over the dot and removes that effort from the average calculation Right clicking also removes the red cross A left mouse click on the dot will display the graph of that effort re Chapt P ki CO Diffusion and Residual Vc INSPIRING RESPIRATORY HEALTH 4 7 2 4 3 Editing the Results The regression lines for evaluation of the diffusion capacity and the residual volume are computed with numeric methods Depending on the structure of the curves the resulting line may diffe
11. 4 7 2 2 2 CO Diffusion Set up F5 The dialogue is organised in four sections Volumes modify the volume to be discarded before sampling and the volume to be sampled for measurement Curves over exhaled volume Add remove or modify the display style of the displayed curves Start DLCO manoeuvre select the starting mode for the measurement Occlusion time determine the time the shutter keeps closed to let the testgas diffuse Chapte CO Diffusion and Residual Volu INSPIRING RESPIRATORY HEALTH Select this icon or press the F2 key to change the user Select this icon or press the Enter key to start the measurement Select this icon or press the F3 key to select the medication Select this icon or press the F4 key to define type of mouthpiece and filter Deadspace Select this icon or press the key to decrease scale Select this icon or press the F5 key to enter Set up Select this icon or press the F4 key to start the inert gas edit mode Fast Space Select this icon or press the F6 key to toggle result window Select this icon or press the F9 key to save the entry Pressing the F5 key or pushing the a button opens the CO diffusion test set up dialogue This dialogue allows to change the display and a few test parameters to be modified either for the next following test or permanently Discarded volume ml sample volume ml fl 750
12. Spire NSPIRING RESPIRATORY HEALTH ZAN300 CO Diffusion Operations Manual Part Number 5001003ENG Version Revision A YAspire ZAN300 CO Diffu INSPIRING RESPIRATORY HEALTH Disclaimer Information in this manual is subject to change without notice and does not represent a commitment on the part of nSpire Health The software described in this document is furnished under a license agreement The software may be used or copied only in accordance with the terms of the agreement It is against the law to copy the software on any medium except as specifically allowed in the license or nondisclosure agreement No part of this manual may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying and recording for any purpose without the express written permission of nSpire Health The software is provided as is without warranty of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular purpose Some states do not allow the exclusion of implied warranties so the above exclusion may not apply to you This warranty gives you specific legal rights and you may also have other rights which vary from state to State nSpire Health does not warrant that the functions contained in the system will meet your requirements or that the operation of the system will be uninterrupted or error free In no
13. equipment electric shock protection is provided by 3 wire power cord earth ground and additional external earth ground as described However the following precautions must be observed for auxiliary equipment a Connect the power cord for each individual component to a wall source b Do not connect extension cords to the system c Do not use multiple power strips and only use the power strip that is supplied by nSpire Health d Operate the hardware device only when the power cords are plugged into U grounded outlets 3 hole outlets e Unplug the power cords prior to servicing the equipment f Computer monitor printer and testing unit are components fit for use within the patient environment provided external grounding has been implemented as per instructions g The User Operator must not touch any non medical device that is any device other than the testing unit and the test subject at the same time h The ZAN hardware ZAN100 USB has been tested and meets the latest EMC requirements for immunity and emissions of IEC 60601 1 2 However electromagnetic interference may still be encountered If the device is behaving erratically due to electromagnetic interference contact nSpire Health customer support Do not connect items that are not specified as part of the ZAN hardware ZAN 100 j Do not operate the ZAN hardware ZAN300 CO Diffusion System or other system components on any voltage other than that specified
14. Ea LESC EN E Spirometry for CV test Ry 10 0 Gas battle closed Cancel measurement Enter operator PR Increase scale more We Decrease scale less details details Enter comments Select medication B Show hide numeric results Save end and print out window measurement Save and end measurement 4 8 5 2 Meaning of the curves In the left hand graph the spirometry and inert gas curve are plotted against time The vertical blue dotted line indicates the time when the CV starts The graph on the right shows the inert gas curve plotted against expired volume Additionally four auxiliary lines cursors are displayed which can be moved by dragging them with the mouse The position of these four cursors is automatically calculated and generally they do not need to be moved Both cursors Phase III start and Phase III end border phase III the plateau phase A regression line shown as a black dashed line is calculated to describe the data bound in phase Ill A regression line is similarly plotted to describe phase IV the data bound by Phase IV start and Phase IV end The start of the closing volume is at the intersection of the two regression lines 2 Pa Spi re O Closing Volume INSPIRING RESPIRATORY HEALTH If the program cannot calculate a regression line or if the gradient of phase IV is lower than the one of phase Ill the closing vol
15. IMPORTANT When the patient maximally expires they must push hard to empty their lungs If they do not the typical CV bend will not be evident The thick shaded bar in the left part of the screen indicates 90 100 of the vital capacity determined in the spirometry performed on the same day or if no spirometry has been measured it indicates 90 100 of the patient s predicted VC It also suggests an appropriate rate of inspiration Expiratory flow rate indicator Closing Yolume Single Breath N2 Wash Out Method S der Thomas eleme Eje Spirometry for C test 215 x A A a C 0 10 20 30 40 40 D 2 3 5 6 7 60 1 S der Thomas SVC ref 5 58 Gas bottle closed IMPORTANT The patient must push hard to empty their lungs at the end of each expiration If not the typical CV bend will be missing In the diagram on the right the concentration of inert gas N or CH3 is plotted against expired volume The small waves as shown in the figure are attributable to the heart beat and are normal 10 Once the patient has completed the final expiration to RV they should return to normal breathing or come away from the mouthpiece 11 The program will automatically move to the analysis mode Che pte 2 Yispire INSPIRING RESPIRATORY HEALTH 4 8 5 The CV program after the measurement Closing Yolume Single Breath N2 Wash Out Method S der Thomas a oj xj oo mim
16. If the automatic mode is selected in the set up after the predetermined number of breaths the computer instructs you to expire maximally The patient should be encouraged to exhale slowly for as long as possible w DA Please go on expiring Pt a When the lungs are completely empty the computer will instruct you to perform a deep steady inhalation During this procedure the plateau slide bar gives an excellent indication of whether or not the patient is close to the end of their breath Plateau INSPIRING RESPIRATORY HEALTH Please inspire maximal ST a At the end of the inhalation the patient can return to normal tidal breathing roy Please breathe normally TE Gl If a test is available for online comparison two lines will show the corresponding vital capacity The first manoeuvre that touches or crosses a line moves both lines so that the curve will not cross this line By having this visual help during the test the user can easily determine whether the effort is reproducible with respect to the online comparison Additional VC manoeuvres can be performed when the patient is rested and ready Once sufficient manoeuvres have been made press B end the test and display the results The following screen will be displayed at the end of the test lt i Chapte 4 Spire SVC Measur INSPIRING RESPIRATORY HEALTH el ALAx Pre test Parameter
17. Patent Headline Reports Frotocols Pred Formulas i Printer Service screen HL Demo mode Set up window with open drop down menu 8 1 5 3 Report Selection Dialogue This dialogue has two different functions 1 Select a report for editing 2 Organise the print options reports list Three listboxes are in the dialogue window 1 Measurement 2 Selected reports 3 Ignored reports In the leftmost listbox all installed measurement methods are displayed If you select one of the measurements the corresponding list of installed reports for this method is displayed The list can be divided in an active part selected reports and a passive part ignored reports Only active reports are displayed in the print options and can be selected during the measurement Use the arrow keys to move a report from the selected to the ignored list and vice versa as well as to move a particular report to another vertical position in the selected list In the print selection the reports appear in exactly this order so it is possible to move more reports used most often into top positions for easier handling No report template will be deleted They only remain disabled in the ignored list until they are needed Setup Customizing INSPIRING RESPIRATORY HEALTH MEE Measurement Selected reports Ignored reports Body BGA Spiro F V CO Diffusion BGA Bodypleth z Exercise BGA Pre Post FRC BGA Hyperr x FY BGA Hyp
18. This edit option is not intended to be used by unauthorised personnel Please do not use this option It will be disabled and removed in the next version When you try to use the New report option you will always get a template file not defined error message Setup Customizing The INSPIRING RESPIRATORY HEALTH YiSpire ZAN Report Editor S x Measurement Selected reports Ignored reports Attention AN Template file not defined Modify New report OK Cancel This option has been disabled and will be removed in the next version Please do not use this option 8 1 6 Reference Value Editor You can define the use of the reference value tables of different authors according to your demands Mireference value authors i x Authors not taken into account Selected authors Measurements D Stein es below 17 Y Aex Quanjer 1971 NN SpiroErgo Wasserman 1994 Jones 1988 Taussig LM van der Ent Godfrey Uldry und Fitting Thoray 1995 NAustria Stam Rotterdam Knudson 1976 Spanien Bass Feb 1973 Vol 63 Restore defaults New author New formula Cancel Add an author with New Author and a new equation with New Formula You can also change the order in which the associated table is used To activate and deactivate a particular table use the arrow buttons on the left o he Yispire 8 1 7 Printer Configuration This dialogue box is used to define the pr
19. VE Factor lat 0 System Software Insta INSPIRING RESPIRATORY HEALTH CTT x Enter text for report headlines Font Bold After the Installation the Protocol Header B o m SOOP pepe ue Schlimpthoter Str 14 Om os Enter your practice or clinic data as desired 037723 Obethaba Si Tel 09736 8181 0 Fax 09736 8181 20 fe To store these data click on lt Save gt __ Cancel Note These data can be changed at any time using the Set up option Flow sensor calibration 7AN100 BetterFlow only Please enter the calibration code of Your Flow Sensor A Next you will be prompted to enter the CAL A A Code of the mounted flow sensor You find the cal code on a sticker on top of the frontal rim of the sensor You find a two character code Enter the two characters and press OK eZee Note The Cal code must be checked on every change of the flow sensor Change the settings using the option Calibration and the ch apter Volume calibration LI x Ci Please connect the device to your computer If not already done you are prompted to connect the devices to the PC and press OK System Software Ir INSPIRING RESPIRATORY HEALTH i settinas iojxi System Messger t Beenden ZAN 100 Device Type Akku unit C Typel Type ll Flowsensor C Type ll When the ZAN Settings window pops up you Type Ila Ib can configure settings of the s
20. be taken to not block the holes The O rings should be covered with a thin layer of Vaseline accessories to make them slide easily 5 7 Disinfection And Cleaning The Bodychamber ZAN 500 Caution There is no protection of the electronics against incoming water or liquids A 5 7 1 Cleaning The Camber And the Glass Panes The cabin can be cleaned with ordinary cleansers Use soft tissues or leather and wipe with hot soapy water Make sure the fabric is not wet but moist and moisture will not get inside the device If moisture gets inside the device it can cause severe damage to the sensors and electronics Do not use aggressive cleansing agents 5 7 2 Maintaining the Rubber Gasket Of The Door Never clean the rubber gaskets with aggressive cleansers To avoid early ageing of the rubber it is strongly recommended to at least once per month apply talcum powder to the gasket or use the special rubber maintenance stick which is available from your dealer Visible and cutting cracks of the rubber will influence the seal of the chamber Recalibrate the chamber for control and call the ZAN service to replace the rubber gasket if necessary 5 7 3 Disinfection Of Parts of the Chamber Which Are In Contact With The Patient Use disinfection tissues or spray for disinfection after each patient Ventilate properly to avoid irritation to the next patient 5 8 Cleaning The ZAN Electronic Modules Warning The ZAN Electronic modules ar
21. k All flammable materials must be kept away from the equipment and No Smoking signs must be prominently displayed in the testing area Oil and grease must be kept away from oxygen equipment m Oxygen approved regulators must be used for Os tanks n The equipment is a Type IIA device that requires the use of a 3 wire Type cord set INSPIRING RESPIRATORY HEALTH Warning For Denmark it is extremely important not to use the Schuko CEE 7 7 plug it will mate with the Danish socket AN but it will not be grounded This may result in serious safety hazards o According to good hygiene practices filters and or mouthpieces that came into direct contact with the subject s mouth or aerosolised droplets from the subject s effort should not be touched Dispose of filters and mouthpieces as ordinary waste or as specified by your institution Labelling Glossary Glossary of Common ISO Symbols Item for single use do not use High Voltage more than once Acceptable Ambient Temperature Range Indicates the upper and lower temperatures allowed for transport and storage This symbol indicates that the user must read and understand all instructions and warnings prior to use Indicates the date by which the product must be used in the format Year Month Date e g 2005 02 19 Protective earth ground Type B Equipment Equipment providing a particular degree of protection against electric shock particul
22. the flow in one tube of the nose is compared to the pressure of the second tube Connect a new disposable nasal adapter to the internal tubing There are different sizes available Please choose the one which fits the best in the nostril Nasal adapter connected to the tubing 2 YiSpire INSPIRING RESPIRATORY HEALTH The mask is connected to the flow sensor and the tubing is connected to the pressure sensor on the back of the Flowhandy The patient breathes with a closed mouth Again the flow and pressure are recorded Placing the nasal adapter in the other nostril allows measurement of the second side of the nose This method is especially suited to children Important Because the mask integrates nose AND mouth it is important that the patient keeps the mouth shut and only breathes through the nose 4 6 1 2 Posterior Measurement Performing the posterior measurement the patient will also breathe through a mask but the nose is not blocked The pressure is measured in the mouth while the patient breathes through the nose To differentiate between the two nostrils one can be blocked after the other to get results for each The patient takes the internal tubing between his lips Use a new adapter tip for each patient Make sure that the patient holds the tip firmly between his her lips and the breath will only flow through his her nose Important After the measurement all contaminated parts like olives olive hold
23. 1 During the nitrogen wash out method the patient must first expire to residual volume RV At this time the alveoli of the closing volume are open and contain the normal concentration of approximately 77 nitrogen Nz Next the patient breathes in to total lung capacity TLC and fills his her lungs with 100 oxygen Os In all of the patient s alveoli the concentration of No is slightly diluted by the addition of the O2 When the alveoli of the CV close the normal alveoli will remain open and the N contained in these alveoli will continue to be diluted by the Oo At the end of the inspiration there is a relatively low concentration of No in normal alveoli and a relatively high concentration of N in alveoli of the CV Finally the patient expires to RV At first the air from the normal areas of the lungs which have a low N concentration is exhaled Then at the CV the alveoli of the CV open and the Ne concentration increases relatively abruptly this corresponds to an upwards bend in the inert gas N2 concentration curve 2 Methane CH or helium He is used by ZAN for the bolus method since the lungs normally contain no CH or He First the patient must empty his her lungs by expiring to RV and after doing so must then inspire to TLC During this maximal inspiration of room air the system delivers a bolus of inert gas at a high concentration 0 3 CH4 During this test all alveoli will initially contain a high concentratio
24. C ZAN 600 C ZAN 700 C ZAN 800 Cancel x Device Type Akku unit C Type i Type ll Flowsensor Type ll Type lla llb External Devices A Cancel x Ergometer Type Port none OFF z Treadmill Type Port IV Confirm start of belt none BP Monitor Ergometer Part lin Ergometer OFF fort Go BP Monitor Treadmill Part none x OFF 7 Pulseoxymeter Port none OFF v F Use ZAN Analog Box Cancel Setup Customizing The INSPIRING RESPIRATORY HEALTH After selecting the port you can set up the corresponding port configuration by clicking on the port configuration button This dialogue allows you to define necessary parameters like baud rate data format parity and stop bits for a serial port for example Please refer to the manual of the external device to find the correct settings Stopbits E Ca Cancel 1 1 1 On line support nSpire Health uses the remote control software PC Visit for on line support PC Visit is not active during normal work and needs to be started on demand To invoke PC Visit select the corresponding item from the Settings Menu like shown below ZAN Settings im e a x system Device Exit E Version PC Yisit For more information refer to the product documentaion of PC Visit A Safety
25. INSPIRING RESPIRATORY HEALTH 4 5 6 Performing the P0 1 Measurement in the MEASURE menu Start measurement by selecting the P0 1 Symbols IE Screen Before Measurement Messen P0 1 Funktions Analyse yon Atempumpe und Atem Antrieb CJ ukol a g xe E SS Ee 0 05 0 10 0 15 0 20 ZNormal Juergen oo o Symbol Definitions S esc Stop the measurement and exit the Fe Define the user programme z Ea Demonstrate the shutter Fa Enter comments Enter Start the measurement FAL 0 m2 Reset the zero point Patient must not breathe through the sensor ap anil a Select a medication Note During resetting the zero point the patient must NOT breathe through the sensor After reset the patient applies the nose clip and forms a tight seal with his her lips around the mouthpiece INSPIRING RESPIRATORY HEALTH aR gt Start the volume recording by selecting the Enter icon or pressing the enter key gt The patient breathes normally gt During tidal breath the measurement is started by randomly selecting the PO 1 a Symbol 2 gt The device will automatically interrupt the flow 120ms after the beginning of the next inhalation and records the mouth pressure Messen P0 1 Funktions Analyse von Atempumpe und Atem Antrieb Pletel S11 el After every 2 4 tidal breaths this manoeuvre is repeated at least 5 times Cnirea spire 4 P0 1 PEmax INSPIRING RESPIRATORY HEALTH
26. If you have selected a directory that contains an older ZAN version the set up will suggest you make a backup Clicking on Yes will store the older ZAN installation at C ZANOLD ZAN lt Date gt lt Time gt ef YiSspire System Software insta Clicking on No will permanently delete the older ZAN installation as well as the archive and the new version will be installed INSPIRING RESPIRATORY HEALTH InstallShield Wizard Choose Destination Location Select folder where Setup will install files Setup will install ZAN in the following folder To install to this folder click Next To install to a different folder click Browse and select another folder F Backup Do you want to save the old ZAN programme NO WILL DESTROY IRREVOCABLY i Browse lt Back Cancel If you have an Internet Explorer Version that is older than the version 6 0 you are prompted to update It is recommended to install Internet Explorer 6 0 or a newer version Only in DEMO MODE If you are installing the DEMO software select the ZAN Option measuring device you want to install Caution If you selected a main device all options will also be chosen Therefore also click on the H symbol on the left next to the relevant option InstallShield Wizard Select Components Choose the components Setup will install Select the components you want to install and clear the components you do not want to instal
27. MM DD YYYY it must be corrected to continue Note If all Tab forms are in use use the Archive option to free one 2 2 1 Input Formats Family Name All letters The first 3 letters are used for an automatic ID number First name All letters The first 3 letters are used for an automatic ID number Date of birth MM DD YYYY Month Day Year Leading 0 does not have to be entered but the slashes between the dates are required The input of century or millennium can be left out if the patient s age is below 100 Caution If the cursor does not leave the input field it is likely the input format is wrong This happens frequently in the date of birth field but check all data fields for format errors anyway W vipi re Once all fields are completed the record can be saved using the save button Caution If the cursor jumps into the ID No field this indicates that the automatically determined ID No has already been assigned to another patient As patient data must A N be differentiated the ID No must be modified manually Press the save button again amp a The patient s name will appear at the top of the index card The system is now ready to begin testing H X lt i hap lis ul User inte 2 3 Modifying Patient Data From the measurements screen click the Patient button to open the patient data field for the current patient Once the patient file is open the Change button will becom
28. Maintenance Service INSPIRING RESPIRATORY HEALTH 9 Safety Maintenance Service 9 1 General Security Information We explicitly declare that the regulations in this manual are according to the MPG and the DIN EN 60601 1 The particular regulations are not part of this manual Use of devices and software is exclusively reserved for medical diagnostic and therapeutical purposes Only trained and experienced personal should be allowed to use the devices on patients If there is damage to a part or system due to misuse VDE protection is broken In this case disconnect the device from any external power and contact your ZAN service before any further use nSpire Health GmbH takes responsibility for security and reliability of the device only if Caution A All changes extensions repair or other work is done exclusively by authorised personnel of the nSpire Health GmbH Electrical installations of the room in which the device is operated conforms to VDE 0107 Operation of the device is done according to the instructions in the manuals The instructions in the technical description have been observed carefully Never operate medical devices of nSpire Health GmbH in an environment which is endangered by explosions Never extend cables or tubes without the explicit permission of nSpire Health GmbH In case of damage of current carrying parts or parts which have to carry weight set the equipment out of order discon
29. cables amp l tubes computer keyboard mouse table amp mouse calibration pumpe computer unit l transport roll with locking device front view we 4 measuring head mouse table Tee CO supply breathing apparatus without blocking magnet CO gas supply tube from pressure cylinder shutter cable to accuswitch System Descr koal Rear view with cover Rear view of measuring head ioe INSPIRING RESPIRATORY HEALTH stand holder with set screw monitor colour printer pressure controller of CO storage bottle Tube connection onat the pressure reducer By pressing the blue ring and simultaneously pulling the tube the tube can easily be disconnected in unpressurised condition FlowHandy connection for mouth pressure sensor gas suction to measuring device arm of the stand USB cable from FlowHandy to PC INSPIRING RESPIRATORY HEALTH mouthpiece amp filter breathing apparatus without blocking magnet Side view The figure shows a normal breathing apparatus for use as a standalone version For the CO diffusion option of the ZAN Body Plethysmograph another breathing apparatus with blocking magnet is used The two components are not interchangeable vent button on the breathing apparatus The hand operated button is located on the rear side of the breathing apparatus it is integrated into the black cove
30. efforts be performed at 30 and 90 seconds respectively i x Proyexgation Each m g 4 2 13 Animation Programme Select this icon F or F8 to display the animation programme With each click the animation selection changes The animation programmes are meant to motivate patients especially children to help perform a maximum effort for example to make all the balloons burst Co Note With each click on the F4 icon the animation selection changes EEN Please breathe normally TS Flow Volume M INSPIRING RESPIRATORY HEALTH Additional animation selections follow To finish the measurement and display the results press the 4 3 Combined SVC and F V Measurement INSPIRING RESPIRATORY HEALTH 4 3 1 Combined SVC and F V Measurement Window before Measurement Selecting the icon in the MEASURE mode enables the measurement of SVC as well as F V measurement with one single procedure 15 x 20 PA Pre test Parameter Unit Ref 4 3 1 1 Symbol Definitions Select this icon or press the ESC CANCEL Erce key to stop the measurement and exit the programme Select this icon or press the L key REF to select a reference value from another test for comparison to enter the test set up 2 e Select this icon or press the F9 key Select this icon or press the F7 key to print a single test result
31. event will nSpire Health be liable to you for any damages including any lost profits lost savings or other incidental or consequential damages arising out of the use or inability to use such system even if nSpire Health or an authorised nSpire Health dealer or distributor has been advised of the possibility of such damages or for any claim by any other party In the event you should have any claim whether based on the license agreement express or implied warranty or otherwise you agree to accept refund of your money in full satisfaction of your claim Some states do not allow the limitation or exclusion or liability for incidental or consequential damages so the above limitation or exclusion may not apply to you Copyright 2006 nSpire Health www nspirehealth com Manufactured for nSpire Health Inc Tel 1 800 574 7374 1830 lefthand Circle Email sales nspirehealth com Longmont Colorado 80501 USA Authorized Representative nSpire Health Ltd Tel 44 0 1992 526 300 Unit 10 Hartforde Court Email info nspirehealth com John Tate Road Hertford SG13 7NW U K nSpire Health GmbH Tel 49 097 36 8181 17 Schlimpfhofer Strasse 14 49 097 36 8181 27 D 97723 Oberthulba Email zan nspirehealth com Germany X VY pire ZAN300 CO Diffu INSPIRING RESPIRATORY HEALTH Dear Customer Thank you for purchasing the Flow Handy ZAN300 CO Diffusion System The product complies with the newest state of technical devel
32. hot steam autoclave and ethylenoxid 5 4 1 5 Nasal Tips Nasal tips can be sterilised in 121 C hot steam autoclave and ethylenoxid TFA AILMNKR ALAAN PNINLL a ddd d AT mM a L Al FAAI AAI Alf A f AIN SIII C 9 I CIAN 1 A LIT N A wT EN L Z AA WY U U U J L J U D U I O da IL IN U U U U JO LW NNA AA Yispire Disinfection Maint INSPIRING RESPIRATORY HEALTH 5 4 1 6 Nasal Adapter Nasal adapters can be sterilised in 121 C hot steam autoclave and ethylenoxid 5 4 1 7 KoKo Moe Filter Filters have to be disposed of after use They are single patient use For replacement use only ZAN certified filters 5 4 1 8 Olive Holder Olive holders can be sterilised in 121 C hot steam autoclave and ethylenoxid 5 4 1 9 Adapter Adapters can be sterilised in 121 C hot steam autoclave and ethylenoxid 5 4 1 10 Cleaning and Disinfecting the Breathing Mask Caution Breathing mask must be disinfected after every patient We strongly advice you to follow the instructions of the manufacturer of the mask which can be found in the original packing Yispire a Disinfection Maintel INSPIRING RESPIRATORY HEALTH 5 4 2 Disinfecting The Flow Sensor Caution The flow sensors can be exposed to a maximum temperature of 140 F or 60 C during disinfection Higher temperatures could destroy the variable diaphragm on the inside of A N the tube T
33. i POT TiTY 0 20 0 46 232 kPa s l PO1 PO1 max 5 9 172 2 X x Z Normal Juergen PO1 Plma 3 Z 74 Ta R Selecting the E Icon or pressing the F6 key toggles the results window on and off The content of the results window can be configured by double clicking on the results window This leads into the parameter selection window where parameters can be selected to be displayed in the results window for future tests The selection can be changed at any time Spire 4 4 6 Post Processing A mouse Click in one of the three sub windows opens a small post processing window The post processing windows of all three sub windows are almost the same A function is performed by clicking on the appropriate symbol INSPIRING RESPIRATORY HEALTH BSE Uz gt Click on or to change the scale gt Up arrow and Down arrow icons manually change Plmax value of the measurement set gt left arrow and right arrow icons selects a PO 1max value manually gt selecting the K icon deactivates the selected PO 1 curve gt Using the F1 and F2 keys allows manual determination of a PEmax value of the measurement 4 4 7 Co operation lt is hard to determine if the patient co operates fully It is up to the technician to carefully observe the patient and motivate him her to obtain accurate results Important The patient must try to inhale to maximum after his her maximum exhalation A P0 1 PEmax F INSP
34. or the arrow keys and start it by pressing the lt ENTER gt key 3 1 Volume Calibration iene Disinfection and use of the flow sensors can change the mechanical quality of the plastic membrane which is situated on the inside of the flow sensor The elasticity of the membrane fades and the difference in pressure in front of and behind the membrane will increase This will affect the accuracy of the results To ensure optimum quality of measurements at any time a calibration of the system can be performed with the optional available calibration syringe Calibration of the Flow Sensor should be done at least after 50 Disinfections or it should be sent to ZAN for a service If this is not possible replace the flow sensor with a new one Using filters can reduce the number of necessary disinfections because the filter protects the flow sensor from contamination as well as the filter protects the patient from contamination through the device Performing Volume Calibration Make sure the flow sensor including the adapter is attached tightly to the calibration syringe Verify that the piston of the syringe is completely inserted The syringe volume 1 000L in this case can be changed by selecting the F4 icon To start recording press Enter and begin to pump steadily A well defined and constant volume of air is pumped through the flow sensor To ensure an identical volume is provided in
35. rey A nough FA efforts meet the ATS criteria see if efforts conform to quality Effort 1 FVC not within the range for reproducability standards a Flow Volume Measut INSPIRING RESPIRATORY HEALTH 4 2 12 Set up By clicking on the A icon you enter the test Set up Menu There are five sections of the Set up menu Demo Set up General Set up Hardware Set up Test Set up and Hyper Responsiveness Set up The Demo Set up mode is for sales purpose only and should not be connected to the computer Setup O OOOO hh hl ERN 8888 I Dena mode Flow Volume M Record mode Results Ex Configure Results tn Configure Automatic Configure Online comparison Configure Io FA ie R Instructions English Adjust zero Device configuration p Hppenesponsveness Timer Configure amp Empty C NaCl The General Set up mode allows you to set up an automatic sequence for example if you always want to perform 3 FVC tests in a row you can simply set up the sequence as shown below I Sequence active Seino a The Set up online comparison dialogue allows you to configure result comparisons Please see the dialogue box below for comparison options Flow Volume Meas INSPIRING RESPIRATORY HEALTH Setup online comparison x Compare to F nothing C Best C Reference Best Reference Best dominant C Reference Best Reference dominant
36. she will be moved backwards The place behind the treadmill should therefore be free from any objects equipment We recommend placing padding on the walls behind the treadmill Depending on the patients condition a special safety belt might be necessary to prevent the patient from falling On any malfunction such as a power failure the patient must leave the treadmill immediately because some treadmills accelerate on recovery skipping the normal start programme and this may cause the patient to fall off Also a sudden stop of the band must be avoided because it could make the patient fall onto or over the front of the treadmill Read the safety information by the treadmill manufacturer carefully 7ispire Chapt Safety Maintenance INSPIRING RESPIRATORY HEALTH 9 6 Symbol Definitions lf a part or product is marked with this symbol it is compliant to DIN EN 60601 1 Type BF lf a part or product is marked with this symbol it is compliant to DIN EN 60601 1 Type B If a part or product is marked with this symbol it is compliant to DIN EN 60601 1 Type BF with additional defibrillator protection This means the device is isolated from the mains and has a built in protection against over voltage Caution Read the accompanied manuals device of protection class Il IPXO Not protected against liquid om protective conductor connector C This product is compliant to regulations for medical products 93 42 EWG and
37. the areas for phase III and IV and thus the value of CV manually 2 Yispire 4 8 7 The CV program in the display mode multiple measurement You can compare up to five CV measurements f ay When displaying several measurements the operator icon F will not be shown The remaining icons are the same as those displayed when viewing a single measurement Closing Yolume Single Breath N2 Wash Out Method S der Thomas The spirometry volume time graphs have been replaced by bar graphs of the individual measurements Each bar graph is aligned to TLC The inert gas traces and the respective regression lines of the individual measurements are overlayed and the colours will correspond to those in the bar graphs The cursors cannot be moved manually Disinfection Mainten INSPIRING RESPIRATORY HEALTH 5 Disinfection and Maintenance 5 1 General Disinfection and Maintenance Recommendations All parts of the ZAN equipment which can get contaminated by the patients breath are designed for simple and complete disinfection Caution A Important To avoid infections in connection with medical devices directly contaminable parts have to be disinfected after each patient Disinfection must be carried out at low temperature 140 F or 60 C maximum e g with cold disinfectants cold gas or plasma disinfection If you choose an antiseptic solution you have to make sure that it does not contain high c
38. viruses bacteria dust and other contaminating substances The use of a filter disposable single use between mouthpiece and flow sensor guaranties optimum security for the patient concerning infection protection Note Although the filters are very effective better then 99 they can not replace disinfection of the parts of the devices Flow sensor and the parts of the shutter described below should be disinfected at least once per day even if filters are used with every patient There is no difference in the way parts have to be cleaned and disinfected when filters are in use AARC Clinical Practice Guideline Spirometry 1996 Update reprinted from Respiratory Care Vol 41 No 7 pp 629 636 1996 gt American Journal of Respiratory and Critical Care Medicine Vol 152 No 6 pp 2188 2189 December 1995 7G ire INSPIRING RESPIRATORY HEALTH 5 4 Disinfection Of Particular Components 5 4 1 Small Parts And Materials All parts that may be sterilised may also be cleaned using a chemotechnical disinfection in an RDG device 5 4 1 1 Paper Mouthpiece Cardboard mouthpieces are disposed of after use They are single patient use 5 4 1 2 Nose clips Nose clips can be sterilised in 121 C hot steam autoclave and ethylenoxid 5 4 1 3 Plastic Mouthpiece Plastic Mouthpieces can be sterilised in 121 C hot steam autoclave and ethylenoxid 5 4 1 4 Bite Mouthpiece Bite Mouthpieces can be sterilised in 121 C
39. 0 After saving the calibration results some devices will still prompt you to enter the ambient conditions B Se ee Please adjust them and save them by clicking on the Save button If the Cancel button is selected the existing values will be used As mentioned before the absolute pressure is needed here not the pressure at sealevel To help you to input the right values ZAN offers you an additional so called environment module which provides the necessary data by clicking the use BTPS checkbox 3 2 Mouth Pressure Calibration U Mouth pressure calibration is performed using EeP mmp the shutter A pressure transducer is employed to measure pressures inside the flow sensor ae U The mouth pressure measurement is achieved directly and is therefore generally stable for a long time The accuracy of the mouth pressure transducer can be checked by using an appropriate pressure manometer maximum 50mbar and Please connect the U Tube to the pressure sensor through an access panel on the front of the device Note Mouth pressure calibration should be performed during the measuring system inspection which should be performed at least once a year S pire INSPIRING RESPIRATORY HEALTH To calibrate the mouth pressure transducer click on the mouth pressure symbol resembling a U tube manometer in the calibration window Calibrations are performed by introducing an accurate 10 mbar pres
40. 300 and FRC ZAN310 FRC Helium Options Caution The ZAN300 as well as the ZAN 310 FRC Helium must use the specially designed ZAN system desk for safe operation AN Extension of any tube will cause inaccurate results during measurement and is therefore strictly forbidden Tubes for CO diffusion and FRC measurement must not be bent Avoid sudden major changes of environmental parameters such as temperature for example This will create faulty measurement and could damage the analysers 9 2 4 ZAN600 USB Caution The ZAN600 USB may only be used in connection with devices which comply at least with the DIN EN 60950 Norm and have a valid CE certification The devices must not be operated in an environment which is endangered by explosions The ZAN600 USB must be operated with the original power supply or with the built in power supply of the ZAN system desk which complies with DIN EN 60601 1 9 2 5 ZAN 800 ECG Caution The ZAN800 ECG may only be used in connection with devices which comply at least with the DIN EN 60950 Norm and have a valid CE certification The devices must not be operated in an environment which is endangered by explosions The ZAN800 ECG must be operated with the original plug in power supply which is DIN EN 60601 certified The ZAN800 ECG must be cleaned and disinfected in accordance to the instructions of the user manual The user is responsible for the correct application Safety Maintenance S
41. 5 years can be expected under normal conditions and if properly used Caution The ZAN600 USB is a medical measurement device built according to strict legal regulations of the German MPG Chapter 5 of the regulations demands regular supervision of the measurement precision nSpire Health GmbH recommends supervision by either nSpire Health GmbH or another authorised institution once a year In addition the user is also advised to follow the regulations concerning correct usage and proper handling Maintenance A service at nSpire Health GmbH includes tests of the following parameters e Leaks e Mechanical condition e Measurement precision e Data communication e Linearity The customer will receive a written test report with all results of the service from nSpire Health GmbH The customer is also able to check mechanical conditions and connectivities as well as calibrate the system with the Calibration Syringe using special testgas which is available from nSpire Health GmbH ispire chai Safety Maintenance Service INSPIRING RESPIRATORY HEALTH 9 7 8 ZAN 800 ECG Lifetime The lifetime of the ZAN 800 ECG system depends on usage mechanical strain and maintenance Under normal conditions a lifetime of more than 8 years may be expected Maintenance The ZAN 800 ECG is a medical measurement device built according to strict legal regulations of the German MPG Chapter 5 of the regulations demands regular supervision
42. 8 1 5 8 Select a Results Graphic Type Clicking on the right graphic element opens the results graphic types selection The behaviour is the same as in the measurement graphics Bitte W hlen x Cancel Available graphic types wef Yispire INSPIRING RESPIRATORY HEALTH 8 1 5 9 Editing a Table Below the graphics area the tables area begins A table is divided into a caption and the table itself The caption is displayed on the left of the table body To edit a caption of a table click on the requested caption and the edit dialogue pops up Please enter new Tert Spirometry Flow olurme Dialog1 x OK Peers ee eeeenaeeneeeneaeaeeeaeesenaeenenenens Cancel Schriftart Use the Schriftart button to select a font Use OK to activate the changes or Cancel to leave the content unchanged Diao r eee ZAN Meblger te GmbH DATA Oberthulba Schiimptheferstr 14 Tel O2796 8151 Fax 08736 5151 20 2 ErgoSpire Karl D ZTro 170 cm 74 ieg sale 25 01 12 S2Y Test S10 20007 11 11h Spiromety Flow Wo bone parameter uzit gwd vale pmi Y l 72 473 117 rc 1 21 4 117 FY Cer 8 ja FEV 1 46 4 Ba 175 FEWE z SaN 103 FES Schriftgrabe 108 FEF z 114 WE i WE 1 1 WE Werte iid i 134 Resictarce oe w RA Wt kin F9 450 Wohmnes Ta 3 06 111 TLE j 5 23 iiz WD 233 Bi 2E 146 TFIWILE k ii 14 BTL Va 55 139 Comment When you click into the table the system offers
43. 9 10 1 Limited Warranty The warranty covers defective materials and manufacturing for one year Within this time nSpire will replace or repair defective parts or products at no charge except shipping costs 9 10 2 Exclusions The warranty does not cover damages caused by the following reasons Negligent handling Improper maintenance Third party software or hardware connections Unauthorised changes or abuse Neglecting storage regulations Operation outside of the allowed environmental conditions Incorrect voltage Mechanical damage of the Flow Sensor Use of unpermitted disinfection agents Hardware damage caused by software The warranty starts on the day of delivery to the customer 9 10 3 Terms Of Warranty The given Warranty exclusive There will be no other warranty or extensions to this warranty neither written nor verbally given Every other warranty concerning common quality or aptitude is also limited to a one year period some states do not allow the limitation or exclusion or liability for incidental or consequential damages so the above limitation or exclusion may not apply to you 9 10 4 Maintenance within the warranty period The devices must be shipped in original packaging to avoid damage during transportation The customer is responsible for damages caused during shipping due to improper packaging X pire Yop Waste Management Recycling INSPIRING RESPIRATORY HEALTH 10 Wa
44. DAN AA M LL s Z ANIRAA U WTTIIQION 62 IA Sf AINSUU GU USI yn cl O VU TU WITING A LMI NOII UY VITIUSIUVI OV IU i L VU GUY TFUUILEINUAL SA INSPIRING RESPIRATORY HEALTH 4 6 2 2 Using A Mask Flowhandy ZAN 100 USB Put the Mask 2 on the Flowhandy ZAN 100 USB 1 Connect the Nasal adapter 3 with the tubing to the Flowhandy ZAN 100 USB 1 Connect the tubing to pressure sensor of the Flowhandy ZAN 100 USB le a 4 6 3 The Rhinomanometry Window before Measuremen ee Start the measurement by either selecting equipment You will then see this window amp Rhinomanometrie ele Slol lelal lt a Normal Juergen Symbol Definitions 2 Yispire INSPIRING RESPIRATORY HEALTH Cancel measurement Select medication L_ Ir al Hie FR 0 reset zero patient must not Define user breathe through the 5 M2 Sensors LS Zoom in gi Enter remarks M b Zoom out as Start measuring the left part k Start measuring the right of the nose part of the nose gt 4 6 4 Performing Rhinomanometry Note Before starting the test the patient should clean his nose properly in order to obtain reproducible results Usually rhinomanometry does not require special co operation from the patient Sometimes the depth of the breath has to be adapted gt gt Clickon or will start measurement of the right or left nose You will see this hint Plea
45. H 8 1 5 4 Editing the Report The first option is to change the description of the report displayed in the listbox and the print selections Modify report File description File fboay1 ztm Edit file Cancel Press OK to save the changes made in the File Description text box or Cancel to abort the process The Edit file button can be used to enter a basic file editor to review the internal template file The Report Designer Window appears on the screen Dialog AN Mefgerite GmbH BATTS Oberthulba Schiimpthoferstr 14 Tel 09736 2181 0 Fax 09730 8181 20 Z ErgoSpire Karl Mt 2 IVobiiid 170 cm M hg mae 25 01 iMi Y Tet 2 11 20007 11 11h PREF Spiromety Flor vobnne parameter unit pmd Fale Shere Wit 1 392 866 55 117 Ic i 421 434 iif Fuar 1 156 8 Tz FEW i 467 Sa 135 FEY Tw i 31 baai 103 FEYiFV2 ka 1 Be 105 FEF Is 1032 118 114 HEF25 its Bay F 1iz EFA lis L75 Tz MEF ifs 2753 3ili iid MEF25 73 li 437 AI 124 ae RAWiot kPalts 03 a 325 EA Wt kfar 0553 oP 440 ue Be Toa 276 36 111 TLE i 5 10 5 23 iz YE 2 45 EW 196 20 i TIWILE Ti 1 Ti 1H EWTLO ti 40 55 134 Camment Report Layout Template 6 ire y P Setup Customizing The INSPIRING RESPIRATORY HEALTH 8 1 5 5 Modifying the Header To edit the Header use the mouse pointer to click into the header area A dialogue pops up which allows you to change the particular lines in the header Reporeneaereator x Ent
46. HEALTH during a Measurement delete previous recordings and go on with the measurement delete FV loop on screen Shutter test Zero the flow sensor Patient must not breathe into the flow sensor Activate Shutter for Rocc test save and terminate INSPIRING RESPIRATORY HEALTH Once the measurement is completed all tests can be reviewed compared and printed under the View mode by clicking the View button or pressing the V key 2 5 2 Symbol Definitions automatically select best curve print report on screen a change pre post assignment B show tests from the first on print report change position provocation test optional enter remarks delete measurement show more tests gt 10 2 5 3 Review measurements of the day Fluss Volumen After selecting the measurement type all measurements of this type taken on this day are displayed Ehina Click on the appropriate field to select one or more from the list M 99 and display them on the screen ee INSPIRING RESPIRATORY HEALTH 2 5 4 Displaying Archived Measurements To view measurements performed previously week month or year on the same patient access the archive folder with the Archive button or by e SS Sa SS Py 2 pressing the key _ hed bo be d i gt E E 20 05 2206 25 08 27 09 20 11 t 12 2 Archived measurements are displayed in fields 1 ne a a any a e a 10 labelled with the date on which t
47. Health cannot be held responsible for possible problems INSPIRING RESPIRATORY HEALTH InstallShield Wizard License Agreement Please read the following license agreement carefully Press the PAGE DOWN key to see the rest of the agreement Licensed Copies 1 IMPORTANT READ CAREFULLY This End User License Agreement EULA is a legal agreement between you either an individual or a single entity and ZAN Messger te GmbH for the ZAN Messger te GmbH software product identified above which includes computer software and may include associated media printed materials and online or electronic documentation Product An amendment or addendum to this EULA may accompany the Product YOU AGREE TO BE BOUND BY THE TERMS OF THIS EULA BY INSTALLING COPYING OR OTHERWISE USING THE PRODUCT IF YOU DO Do you accept all the terms of the preceding License Agreement If you choose No the setup will close To install ZAN you must accept this agreement InstallShield Wizard Please enter the license number of the software License number 1 1 1 is Demo Mode License number lt Back Cancel InstallShield Wizard Choose Destination Location Select folder where Setup will install files Setup will install ZAN in the following folder To install to this folder click Next To install to a different folder click Browse and select another folder Destination Folder CAZAN Browse lt Back Cancel
48. IRING RESPIRATORY HEALTH eee wa hw RAPS Kt aes Pra e SY JE IE if 4 5 P0 1 P0 1max Pimax and PEmax Caution To perform this test the shutter unit must be connected properly to the Flowhandy ZAN100 USB Refer to chapter 1 for more information Note These tests depend on good co operation of the patient It is important to explain every aspect of the test to the patient BEFORE the test starts and make sure the patient is willing to co operate 4 5 1 Definitions PO 1 is the pressure measured at the mouth 100ms after inhalation starts during a tidal breath manoeuvre This pressure represents the effort that the patient has to make in order to breathe normally PO 1max is the pressure measured at the mouth 100ms after inhalation starts after a maximum exhalation manoeuvre Plmax is the maximum pressure of inhalation which the patient can cause PEmax is the maximum pressure of exhalation which the patient can cause PO1max and Plmax require an identical breathing manoeuvre and will be measured simultaneously 4 5 2 Measuring PO 1 gt The patient breathes normally gt During exhalation click on the corresponding symbol to start the measurement gt When the next inhalation starts the respiratory flow will be interrupted for 120ms The pressure is registered 100 ms after inhalation starts The pressure represents the effort a patient can make during normal breathing 4 5 3 Measuring P0 1max gt The
49. PONENTS ccccsecccsecececccscseuscceuccescsececeeeceescseeseeeceuseseseseeceusesenes 111 5 5 DISINFECTION OF THE ONE WAY VALVE CO DIFFUSION OPTION ONLY sccccseceeeecceeseceeneceeeeceees 115 5 6 DISINFECTION OF THE ERGO FLOW SENSOR ZAN 600 680 ONLY ccccccceeecceeecseeecsceesceeesseeessees 115 5 7 DISINFECTION AND CLEANING THE BODYCHAMBER ZAN 500 c ccccscccceesccesscceecceeecseensseeseseeeseees 117 5 8 CLEANING THE ZAN ELECTRONIC MODULES cccccccccsecccssccecceecceseceeceesccesececeseeeceuseseesseeeceusesenes 117 5 9 DISINFECTING AND CLEANING MEDICAL PRODUCTS OF OTHER MANUFACTURERS cseccesceescesseesees 118 5 10 CLEANING AND DISINFECTION OF PARTS IN THE ENVIRONMENT OF THE PATIENT 0 c0eccceesceeseeeces 118 5 11 CLEANING THE COMPUTER EQUIPMENT cscccscccsccssccscccsccsccsccesccsccsscesccscesscescescesceescenseesccusceness 118 TROUBLESHOOTING orasan E ra 119 6 1 OENE RAL P OBLE M ea E E E AE EEE R 119 6 2 BODY PLETHYSMOGRAPH PROBLEMS wisi vise senscsevdvaciviecsseessectasdvevawoeebsedtevevewsvenesdedtevsvent vers a eiii ii 120 6 3 TOS ON P OBIE M aE EEE E E E biadlaciesaatsersnteins 121 6 4 ERGOMETER PROBLEMS ixstsstacccnscaunessinthsoniexcieunno budiecsonsteurisuannthasicanseunwatanevancewstuniaasshtaaidendeanasbaneeusesndencvesanes 122 6 5 SPRO ERGOMETR goal 20113 12H ee re ee nr ne eee eee 123 SOFTWARE ENSTALLA TION sasvivcscccasescesctisciccncsiosascrissicetessasessiaistorni
50. RY HEALTH After modification the result can be viewed using the Preview button This opens the MS Internet Explorer window showing the new content of this template Note The changes are not visible in the designer window The designer window acts like a big graphical menu and is designed just to select items to be edited or modified To see how the editing impacts the layout you need to use the preview button Note Please select the appropriate font size in you MS Internet Explorer To close the designer window use the Close icon x in the upper right corner A verification dialogue will pop up to ask you if the changes should be stored permanently or not This dialogue will only appear if changes have been made to the template 8 1 5 2 Invoking the Report Designer From the main menu select Set up by either pressing ALT S or clicking the button with the mouse Fatient Select the Set up with ALT S or a mouse click This opens the Set up window From the menu select the drop down list System In this list you find the item Reports Move the mouse cursor over the Reports entry and the Protocols subitem pops up Click on Protocols to invoke the Report Selection dialogue ZAN300 CO Diffusion 13 oOo CO I OD N U Q 3 Z O O1 O O h O O GO m z G D Setup Customizing The INSPIRING RESPIRATORY HEALTH lo x ZAN Settings System Device Exit F Licence Language Database
51. Unit Ref Best Effort 1 Effort 2 Ref GRef Ref C 482 2 gt 479 99 gt 479 29 IC 3 32 3 19 96 3 09 93 3 29 99 ERV 147 2 160 08 IRV TY The efforts are colour coded and the tabular data is shown at the bottom of the screen You can choose to view the graphics as a volume time trace or as a bar graph by clicking the bar graph symbol on the right hand side of the screen To zoom in and out use the magnifying glass icons The computer automatically selects the best effort to be reported for this stage This is shown by the highlighted coloured dot You can change the computer decision by left clicking on a different coloured dot ATS ERS have provided criteria for the acceptance of the test The computer will automatically determine whether the criteria for acceptance are met If an effort is not acceptable this is shown by a red cross over the corresponding coloured dot To remove the effort from the selection process right click on the coloured dot The fulfilment of ATS criteria is also visualised by the result table Green and red dots show for each parameter that is defined by ATS whether the criteria were met or not This includes the criteria for acceptance as well as those for reproducibility only shown when more than one effort performed The result window also has a column called Best This column shows the results that are reported for this stage The results of t
52. aptor Cancel Default shutter options Select a component Select a component ZAN FlowSensor Type llb ZAN FlowSensor Type lla Without Shutter ZAN Shutter j ZAN Shutter with demand Pneumo valve valve ErgoSensor Save multiple configurations for easy selection by pressing the New button i Remove Ok Cancel 4 1 3 Performing SVC Testing Select this icon located at the right hand side of the screen to start the measurement 4 1 4 Symbol Definition Select this icon or press the ESC key to end the test without saving Select this icon or press the Enter key to save the measurement and exit Select this icon or press the space key to save the measurement and start a new measurement The volume trace is displayed on the graph as a blue line and scrolls from left to right The patient should use a nose clip and form a tight seal around the mouthpiece with his or her lips The patient should breathe normally through the mouthpiece The following example is an Ex In manoeuvre These have the same structure but with inhalation instead of exhalation t y If the trace is unsatisfactory the measurement can be re started by pressing the F3 key This deletes the results and continues the measurement INSPIRING RESPIRATORY HEALTH Please breathe normally al a To determine the tidal volume the patient should breathe normally through the mouthpiece
53. arly regarding allowable Heavy weight leakage current and reliability of the protective earth connection if present Alternating current Fragile Direct current Keep Dry International Standard CEI IEC 417P Graphical symbols for use on equipment first edition 1973 X amp YiSpire ZAN300 CO D INSPIRING RESPIRATORY HEALTH Glossary of Common ISO Symbols Transport and storage humidity conditions Power on This symbol indicates that this Class IIA equipment complies with the guidelines concerning medical Power off devices 93 42 EEC of the council from 14 Jun 1993 This symbol indicates that the associated jack is for a USB Universal Serial Bus connection A ieee gt a amp a goes a if uE i E E E ve aly i Table of Contents 1 8 GENERAL INFORMATION ON ZAN300 CO DIFFUSION cccccsssccsssccssscccscccssccccsccccscccccscccceceee 3 1 1 TE OIE Wy AIRE oE EAA AEEA O O EEE AET EA A TAE E AEE A 4 tz Ry D DEEE sas ners weer oc E NEA ce bat pcs ent nee aati E A A EE A A onset pa ean A E A E AT 5 1 3 THEFLOWHANDY ZAN 100 USB ssssssssccsscccsccavecteccacedavepasnsdeetesedausstenteadindcuvacdtensvedacveewernevsdeaiucdsanaveencebeons 9 1 4 THE ZAN 260 SYSTEM TROLLEY ssssssesssesssesssesssesssessstsersssrsserseessersseessetsseessereseessersscesscesserssersserssere 10 1 5 SPECIAL INSTRUCTIONS FOR USE sccsnsusicasncacevevacuotennesncdusinasavasanwnagaviendupheasme
54. ary because the mechanical quality of the membrane could be influenced Warning To avoid infections in connection with the flow sensor it must be disinfected after each patient AN Always consider the recommendations from the disinfectant manufacturers concerning concentration purpose and reaction time gt The inside of the flow sensor must neither be rinsed with a direct jet of water out of the pipe nor must it be cleaned or touched by mechanical tools This could damage the sensitive plastic orifice and disturb the correct measuring function gt The flow sensor must be carefully dried after disinfection Before use you have to make sure that there is no more water in the holes gt If necessary blow out the holes with compressed air Hint Compressed air in sprayers for medical purposes is available from your dealer Caution The flow sensors can be exposed to a maximum temperature of 140 F or 60 C during disinfection Higher temperatures could destroy the variable diaphragm on the inside of N the tube a E Chapt Disinfection Maintenance INSPIRING RESPIRATORY HEALTH Hint The pressure ring does not need to be disinfected Only pressure is detected at the orifices of the Flow Sensor and no breath flows into or out of the openings back or forth Transport of germs and viruses or infection of a patient is impossible through this path We recommend cleaning the pressure ring regularly with wipe disinfection Care must
55. assword if you try to access or edit such parameters you will be asked to enter your password with the following dialogue box Password required x Enter password Change password ES New password Re enter new password Cancel Enter the correct password and click on the OK button The factory setting for the password is Lufu entered without the The entry is case sensitive Click on the Change Password check box to change the password To avoid typing errors the password must be entered twice The new password is active after you leave the dialogue box by wef Yispire Setup Customizing The INSPIRING RESPIRATORY HEALTH clicking the OK button If you want to discard the changes and stay with the old password leave the dialogue box by pressing the Cancel button 8 1 1 Language To activate German English French or Spanish language settings 8 1 2 Database In paragraph Id No the format of the patients ID is determined In the paragraph Database the user can define the folder were the patient archive has to be stored Paragraph Search Results defines the number of patients displayed in the main window as a result of the Search Patient request CT x r Select System Language English Cancel C Deutsch Fran ais r Units C Height cm Weight kg Date Day Month Year Height inch Weight Ib
56. ation The latest detected calibration factors are saved and used by the software We recommend calibrating the bodyplethysmograph once per day Please refer to the corresponding manual chapter Calibration for details Caution nSpire Health GmbH recommends a service of the system by nSpire Service i Dept once a year The customer will receive a written test report with all results of the service and the calibration values from nSpire Health GmbH 9 7 5 CO Diffusion Option ZAN300 Lifetime The lifetime of the CO Diffusion option is limited by the CO CH4 analyser Depending on how often it is switched on and off it lasts between 3 to 6 years Another wearing part is the suction pump The manufacturer guarantees a minimum of 3000 working hours Since the pump is only working while the CO diffusion measurement is running which last about 1 minute the pump will last approx 120 000 measurements Calibration A calibration of the CO diffusion option is not necessary if the device is sent in to nSpire maintenance for a service at regular intervals Warning nSpire Health GmbH strongly recommends a service of the CO diffusion option by nSpire once a year The customer will receive a written test report with all results of the service and the calibration values from nSpire Health GmbH Yispire on Safety Maintenance Se INSPIRING RESPIRATORY HEALTH 9 7 6 FRC Helium Option ZAN310 Lifetime The lifeti
57. bCO value carbonmonoxide blocked fraction of Hb can be entered for more detailed evaluation HbCO is respected in the calculation of the predicted values yi re Ch apte 4 P CO Diffusion and Residual INSPIRING RESPIRATORY HEALTH 4 7 2 5 Important Information The user should ensure that the patient keeps their lips tightly sealed around the mouthpiece and uses a nose clip throughout the test Caution The patient must not try to breathe in or out against the shutter This may cause the results to be under or overestimated Important Patients who have consumed alcohol should not be tested The methane analyser is also sensitive to alcohol N A methane concentration trace changing with the same frequency as the tidal volume is characteristic of a patient in whom alcohol is a constituent gas of their expiration Caution Remember to allow sufficient time between tests for inhaled gases to be washed out Testing too soon after the previous test will affect the results The concentrations of carbon monoxide and methane used in the CO diffusion measurement are very small 0 3 and the equipment extremely sensitive so the measurement should be performed with due care Correct technique is important 10 I C m n d rt gt P CO Diffusion and Residual Vol i INSPIRING RESPIRATORY HEALTH 4 7 3 Addendum 4 7 3 1 Parameter Definitions Diffusion Capacity Rate of transfer of In a single breath the test gas or T
58. chnical description Office equipment according to DIN EN 60950 is not the same as medical equipment according to DIN EN 60601 therefore a minimum distance of 1 5 m between the patient and the device which does not follow DIN EN 60601 1 is required E g The medical device Flowhandy ZAN100 USB is in accordance with DIN EN 60601 1 but the PC is only DIN EN 60950 The Minimum distance between the patient and the PC must be at least 1 5 m while there is no need to keep distance between the Flowhandy ZAN100 USB and the patient If this is not possible because of reasons such as small rooms etc we strongly recommend the use of a ZAN system desk which provides indirect coupling for the complete equipment and fulfils the necessary requirements according to the medical product law 9 2 2 ZAN500 Body Box Caution A The ZAN500 Body Box requires the ZAN system desk for safe and legal operation Do not pull the door downwards while it is open This could cause the whole chamber to fall over The patient must know how to open the door of the chamber from inside by his herself Never leave the patient alone inside the chamber without supervision All connections and cables between the chamber and the system desk are purposefully short so as to avoid stumbling over them Make sure all staff are aware of the cables to avoid any accidents Yispire chapi Safety Maintenance Se INSPIRING RESPIRATORY HEALTH 9 2 3 CO Diffusion ZAN
59. city may be impaired by mechanisms that are different to those affecting FEV It can also be used to estimate maximum ventilation in cardio pulmonary exercise testing MVV is measured by getting the patient to breathe in and out as rapidly and as deeply as possible for a specified time It is similar to heavy panting To obtain accurate results only begin recording the measurement once the desired breathing pattern has been achieved 4 4 1 How to perform the MVV Measurement Selecting the icon in the MEASURE mode enables the measurement of MVV and will lead you to the measurement window Z Mormal Juergen Symbol Definitions stop Stop measurement and exit the o Select medication ESC programme a Find Zero Define User P2 OF CS M gt m Zoomin Add Remarks ce Zoom out Start Measurement Spire 4 4 2 Performing a MVV Measurement he Select this icon Enter or press the Enter key to start the measurement INSPIRING RESPIRATORY HEALTH On the screen the recording is displayed as a yellow line The patient should place their lips around the mouthpiece forming a tight seal and breathe normally The patient should be instructed to begin breathing as rapidly and as deeply as possible The recommended frequency is 30 minute he Start measurement by selecting the Enter icon again Note Itis important that the patient continues to breathe maximally throughout the recording phase The measurement shou
60. cseats rive teetacreserstnstastnereiseiesiedentions 124 7 1 INSTALLATION cenna E E E E EOE 124 7 2 INSTALLATION OF THE ZAN GPI 3 XX SOFTWARE cccccseccsscccseccecccscccseceesceescseeceeeceeseseeeseeceusesenes 124 13 MODIFYING REINSTALLING OR DELETING THE SOFTWARE ccccccccescccsecceccescceseceeeceuseseseseeeceusesenes 132 SET UP CUSTOMISING THE SET UP ccccssscccsssscccsscccccssccccsscccccsscccccsccccccscccccsscccccssseccesccccseess 135 se YiSpire 8 1 SYSTEM SET UP 8 2 DEVICE SETTINGS sciscehscrectedetsonesdaddciemasucteenetaadeansitedessnaosudteunsesdhonctsadasuarosslnemeabaddianeseudsanstcndcsmeredewenwobehiemessudt 150 9 SAFETY MAINTENANCE SERVICE scsissssscsssssssssssssssssccsssossssssovcsosssscsossssosssssssosssssssssssosisossosssssssssss 153 9 1 GENERAL SECURITY INFORMATION iiniicnpnissnsoin ica a aaas iadaaa aae iR Aarand 153 9 2 DEVICE SPECIFIC SECURITY INFORMATION c csccsccsscsscsccsccsccsccsscescescessessesscsscescessessescesccuscescescenss 154 9 3 USING CUSTOMER SUPPLIED EQUIPMENT ccccscccssccscccssccesccesccesccusccesccesceusceusccesceesseesceeeseusceusceeess 156 9 4 C ONNE TIRO TO CBS eee acsaeteaacntassaeeesenaiecastincet ee uaae foeeasaesees asesdecadsaaeneausaadscantausesutendenedsagaeecstedescoseuaeaeseer 157 9 5 SPECIAL PRECAUTIONS WITH TREADMILLS cccccccccssccscccssccesccesccessccusccesccessceusceesccescceesseesceeseceuesens 157 9 6 SYMBOL DEFINITIONS s lt ss
61. dal breathing Please perform normal tidal breathing The screen returns from the measurement screen to the master screen and shows the graphical results of the measurement Numerical results may be displayed by pressing F6 Click on the a button or press the F9 key to save the results Caution During breath hold the patient should be encouraged not to breathe in or out against the shutter but to relax against it so as not to alter the intrathoracic pressure and N pulmonary haemodynamics because this will affect the results 4 7 2 4 Results The results will be displayed graphically and numerically From this view the editing of the gas concentration result lines can be done Fast Space The description on how this is done follows below 4 7 2 4 1 Graphical Display of the Results The standard view of the results is the graphical display The left half of the window shows the volume methane and carbon monoxide traces in different colours INSPIRING RESPIRATORY HEALTH sloj xi In the right part of the window is the volume concentration graph showing the computed lung subdivisions and a graphical representation of TLCO and KCO ZAN300 CO Diffusion 95 167 Part No 5001003ENG A INSPIRING RESPIRATORY HEALTH Selecting the buttons or pressing the F6 key invokes the numeric display of the results or hides it if it is already visible ae i T 7 E FEIR j
62. ding down the left mouse button To illustrate the line was selected with the mouse it is shown as a thicker green line a AlAx Pre test Parameter Unit Ref ERY 147 3 IRV 4 1 7 Parameter Selection To alter the parameters displayed in the results table open the set up function using the Eh mon INSPIRING RESPIRATORY HEALTH LI ix Ton eee 10224 IC Ry e TV 1 1 ce From the All Measurements list you can select the parameters you want to view in the results table These parameters will be inserted into the Selected Measurements list 4 1 7 1 Symbol Definition T Moves the selected parameter into the ee Removes the selected parameter from Selected Measurements list right the Selected Measurements list right window window Moves the parameter up or down in the 5 Selected Measurements list right window 4 1 8 Viewing Measurements In the View mode all measurements or only selected ones can be viewed Parameter Unit Ref 2 ERV 147 2 ey YiSpire INSPIRING RESPIRATORY HEALTH The software has two different views in which it can show the test results The first is the Effort View This view shows all efforts of one stage and allows the user to correct efforts by the use of tangents to determine the effort that represents the stage The second view is the Slot View This v
63. dll Cancel System Software Insti INSPIRING RESPIRATORY HEALTH Only with Option RHINOMANOMETRY Rhinomanometry x During the install you will be asked if the Rhinomanometry will be performed with olives or with a mask Select the components you want to install clear the components you do not want to install Check the appropriate box and press Click Next ta continue ial AE The Installation continues M Type Olives InstallShield Back Cancel Only with ZAN600 and Option ECG In case the ECG option has been purchased at this time the installation process branches to the Spacelabs Cardio direct installation Please refer to the original manual for detailed information about the installation procedure ioi System Device Exit x Next dialog in the standard oe A NT installation procedure is the Create Paent Id Hi automaticaly d atabase d ial og ue Create Patient Id Nr incrementally 001 002 003 Enter Patient Id Nr manually Database Folder ARCHIV Browse Waiting Room Enable WARTEN Search Results Number of persons displayed in the Select Patient list 30 Cancel After finishing the database dialogue several device settings dialogues pop up depending on your license All settings made here can be changed during normal operation using the Set Up option in the main menu ZAN300 A ZAN 300 Device C Ty
64. dvaeubaeuvieaneediuedeadasssaswstvaeasacwnncas 11 1 6 MONTE COV IVINS STONING caasa EE ie nator visussainci O EEEE E E 11 1 7 HYGIENE sonnin E E EA 11 1 8 SPECIAL ACTIONS BEFORE DAILY STARTING UP cccccccccsecceeccescsececeeuceeusceeceeuceeseseseceeceuscsueseeceuesenes 12 USER TINT GRR AGB cccescesccccscccscseccccecveesceascceseaseccceedacceusccctesesccnevesseeneceeneceeconsxaaseouseseseseneeereenecassorseasenomuannes 13 2 1 ACTIVATING THE PROGRAMME sarctrecxscatitiuawesiwdcosenocinpneaiearssehioeiuten ied nsehenld weniedaadncieerentseuet sack eanisens 13 22 ATTEN NUR E E E E E EE EEN 14 pee MODIFYING PATIENT DATA wsssssintivnerensnaccedndapmoceicesnsonnieenossudessadbadarnorsievanepeadinnedsedvasantadasinesassssussedixoasandiors 16 2 4 ENTERING ADDITIONAL PATIENT DATA OPTIONAL cccccceeccesesccseccccscccesescesecsuecseeseseesessesessuseseeeuss 16 ZO AIA RUIN OI acts stn ea rE vee onto w es te cr tied ea ane ees od cc eed stew eee nee eo 17 2 6 PTS FA TG sensro aa gato oo tinea EE EA OOE OEE EEs 23 24 FDDITION AL FUNCTION oc aiiinar cusecsivennsehvewenstarnneates exaweuneaseionuheh nablendeupavlieaatiesnntessdaniseehelespntsadaevanataveeacaxseuaeaetens 24 ATI A TTN caters acess secs sc cesta ccc se asics cteecuaeeeiagse cess scstnrcscsueceicatsvecicveccesisussesciebecsekestcstseidisecstissesera ic 27 3 1 VOLUME L ALIBRATION daa ae ica ceascicianc ainina iN EA E E R 27 3 2 MOUTH PRESSURE CALIBRATION cccccscccseccescccseceecceucces
65. e The CO diffusion measurement programme is invoked by two clicks on the CO Diff button E ZAN GPI 3 00 Before the programme starts the analysers must be flushed and calibrated During this time the user sees the messages below in the centre of the screen i Jnitialisation of Gas Analyser ZAN300 CO Diffusion 91 167 Part No 5001003ENG A 2 Yispire INSPIRING RESPIRATORY HEALTH After initialisation the flow sensor must be adjusted to zero A warning message is displayed during this time 0U Ofin Shoe Erost Muster aadlorre m br gol CS S E ML fel wm A Dp ihm IS at Attention Zero Adjust Please t breath Caution The patient must not breathe at the mouthpiece while the flow sensor is adjusted A The system is ready when the Zero Adjust message disappears 4 7 2 3 2 Preparation During the test the patient is guided by the system with a sequence of instructions This makes the execution of the test easier The directions are displayed in a coloured window in the middle of the screen zE Select the 1 button to start the test Please perform normal tidal breathing Direction Please perform normal tidal breathing Chapte CO Diffusion and Residual Vo INSPIRING RESPIRATORY HEALTH The measurement begins with regular tidal breathing If the breathing trace is too erratic clicking on the button or pressing the F3 key re
66. e available Click this gt to enable changes to the patient data file After the desired changes have been made to the data select the Save button Note Archived data can also be modified in this way 2 4 Entering Additional Patient Data Optional This option can be selected to add additional patient data for each patient Setup ALT S Access the Set up menu using this icon located at the bottom of the screen From this menu select Patient Note This is password protected and should be set up by your representative during installation Please contact your representative for further information Patient On the Patient dialogue box click the Additional Patient Ae SAAT Pien Las oOx Data checkbox i Ethnic Group Select Cancel Attention Once the required selections have been made the ZAN software must be restarted for the desired changes to take effect aa aero ie ANE oora For the changes ta take effect Once the additional patient data has been activated it will be available within the patient data screen By clicking on the Extended button YiSpire INSPIRING RESPIRATORY HEALTH the Extended Patient data screen is then opened and can be completed in the same way as the Standard Patient data screen Additional Patient Data Microsoft Internet Explorer File Edit View Favorites Tools Help e Bach x a A JO search Je Favorites B s 3 Address 2 C ZAN GPI200 SITE EXTPAT HTM
67. e is recorded and compared to the pressure which is measured in the second half of the nose We differentiate between the anterior and the posterior measurement 4 6 1 1 Anterior Measurement The anterior measurement records the pressure of both nasal tubes The pressure measurement is done while one side is blocked with a nasal tip or a foamed plastic The nasal tip or adapter is connected to the sensor by a flexible tube The patient breathes through the open half of the nose while the flow is measured with the sensor The blocking nasal tip or adapter is connected through a tube to the sensor on the rear side of the Flowhandy ZAN 100 USB Now the patient breathes with a closed mouth through the open part of the nose while the flow is measured This measurement can also be performed using a mask s b 4 6 1 1 1 Using Nasal Tips Connect the olive holder with the flow sensor on rear side of the Flowhandy Place two clean disinfected nasal tips on the olive holder Put the olives in the nostril Now one of the olives is connected with a flow meter and one with a pressure meter The patient starts breathing through his nose The data of the nasal tip connected with the flow meter will be recorded After the first measurement the equipment is turned around to measure the other side of the nose INSPIRING RESPIRATORY HEALTH Druckmessung Set up for the use with nasal tips 4 6 1 1 2 Using A Mask Even with a mask
68. e not protected from liquids that could get inside the unit Before cleaning the surface please unplug the device T Disinfection Mainten INSPIRING RESPIRATORY HEALTH The ZAN modules can be cleaned with a piece of cloth that has been moistened in soapy water Make sure that no moisture will get inside or on the contacts of the device because this could lead to short circuits or shock hazards and the contacts might oxidise Permanent electrodes must be cleaned in regular intervals This is important to ensure good signal quality Please refer to the manuals of the manufacturer for detailed information about cleaning and maintenance of the suction device 5 9 Disinfecting and Cleaning Medical Products of Other Manufacturers To disinfect medical products which have not been manufactured by ZAN Messgerate GmbH e g bicycle ergometer treadmills and pulse oxymeter read the documents accompanying these products 5 10 Cleaning and Disinfection of Parts in the Environment of the Patient For all surfaces in the environment of the patients a regular cleaning and disinfection with wipe disinfection is recommended This should be performed according to the common rules of hygiene after visible dirt has been removed To avoid any risk protective clothing during cleaning recommended especially when the patient is thought to be infectious 5 11 Cleaning The Computer Equipment Computer and peripherals are usually not built for the
69. e selection of system components The Set up screen has three active sections Test D Set up General Settings and Hardware Set up rn Eee F Record mode Results Configure General Automatic Configure Auto mode Configure Online comparison Configure Instructions English v Font size 18 D M print ATS criteria Hardware Adjust zero Test shutter Device configuration Cancel Test Set up allows you to select the results shown after the test and to set up automatic saving of the results When you click on the configure keys you get the following screen graphics i i x This screen allows you B a tocol op the urbe ot XTi gt lt NE baseline breaths before Automatic d performing the test Procedure Statt after breath Eo M Autosave 10 0 ss mpe ge pi k 1 Manoeuvre Ex tn l C Ja Es 15 i gt hal i pis SVC Measut INSPIRING RESPIRATORY HEALTH lt allows the choice of an inspired or expired breath as the first breath of the test and offers you the opportunity to enter the elapse time after which the test is automatically stored The General mode allows you to set up an automatic sequence for example the sequence shown below allows you to set up 3 consecutive FVC tests Cancel The general setting gives online comparison settings language Setup onling EE nn x settings and au
70. e to be checked regularly The O rings consist of silicone and must only be replaced by ZAN replacement O rings PolyOxyMethylen POM Ultraform H2320 by BASF is exclusively used as the basic material for all white plastic parts In addition to the information provided in this section you should refer to your local hygiene or infection control board for their guidelines on cleaning the medical equipment and or accessories described in this manual Other sources of information on cleaning are the American Association of Respiratory Care AARC and ATS clinical practice guidelines 5 2 General Recommendations For Surface Disinfection All personal should wear protective clothing when handling contaminated or polluted parts Inhalation or direct contamination of the skin with the disinfectants can be dangerous to the health of the personal Always consider the recommendations from the disinfectant manufacturers concerning concentration purpose and reaction time Cleaning tissues should only be slightly moistened with the Disinfectant Warning The ZAN Electronic modules are not protected from liquids that could get inside the unit Before cleaning the surface please unplug the device Important Make sure that no moisture will get inside the device because this could lead to short circuits or shock hazards and the contacts might oxidise 5 3 Using Filters Bacterial filters do not only retain saliva but also micro organisms like
71. e to the patient no network connections may be installed without a 4kV proof disconnection indirect coupling Caution Mains operated devices which comply to DIN EN 60950 cannot be compared to devices complying to DIN EN 60601 1 for medical devices For this reason medical devices are equipped with galvanic disconnectors indirect coupling which disconnect the medical device from the PC System according to well defined rules But a minimum AN distance of 1 5 m from the device to the patient is necessary to keep the effectiveness of the disconnectors If this is not possible nSpire Health GmbH strongly recommends the use of the nSpire system cart which is able to completely disconnect the PC from the mains spire Cie Safety Maintenance Se INSPIRING RESPIRATORY HEALTH 9 4 Connecting Devices Power cables and data connections should be fastened in a way that they cannot disconnect accidentally Always check if the device is built in accordance with the regulations in the corresponding law E g In Germany a maximum overall discharge defined in DIN EN 60601 1 must not be exceeded when additional devices are connected 9 5 Special Precautions With Treadmills Treadmills use very powerful engines Only treadmills designed according to the regulations for medical products should be used Always position the treadmill so that if the patient falls accidentally he she does not encounter injuries If the patient falls he
72. eceseceeeceeseceeseecseueseueseeeceescseseseeceuscseesenesees 29 THE CALIBRATION TREND REPORTS ccccccscccseceeecccsecccccesccuseseecesceusecueceueceescceeceeeceuseseeceeecseseseseceeeceuesenes 31 MEASURING PROCEDURES ecrini anirai Aaaa aai 33 4 1 SVC MEA U EMI Tea nance tina A EAE EE EE E 33 4 2 FLOW VOLUME MEASUREMENT ccccccsecccescccessccesscceecsecsccceueceescseecseeecsseueceuuscsuecsseussseseseeecsueecseuass 50 4 3 COMBINED SVC AND E V MEASUREMENT nurensiiiernrenn niea a E 60 4 4 MEASUREMENT OF THE MAXIMUM VOLUNTARY VENTILATION MVV cccccccsescesssesesesseessseseseeesees 63 4 5 POL WoO yA PIV ANI NAG sa ctenva picncncesvairaerttsn iadnors anc naia ienien 67 4 6 RHINOMANOME TRY cccsssccssscccsscccssversvsceavscensscensvsensvscenssvensevensesensvscenvsvensevenscsceavscenssvensevenacsseavsvensss 76 4 7 MEASUREMENT OF CO DIFFUSION AND RESIDUAL VOLUME cccccsecceecccecceeceeeceescceseseeseesceeseseesees 84 4 8 CLO NO VOLUME era E rte ne ner a Rt ne ea en Ser Tee ene eer oe 100 DISINFECTION AND MAINTENANCE eesseesseesseessecssecssecosecosecssosososssesososssosososssosssosseosseesseosseesseosse 109 5 1 GENERAL DISINFECTION AND MAINTENANCE RECOMMENDATION G cccescceeeceeeceeeccessceceseeeseeseseesees 109 5 2 GENERAL RECOMMENDATIONS FOR SURFACE DISINFECTION c00cccsecceeccescceecececcessceeseeesseseseeesees 110 5 3 MTR TU oR Sse isp sctceccse diene sce E 110 5 4 DISINFECTION OF PARTICULAR COM
73. ection see Chapter Flow volume measurement Gas bottle closed Enter operator Enter comments Increase scale more details Decrease scale less details Start measurement lt 7 e G hapte 7 MP jai Closing Vol INSPIRING RESPIRATORY HEALTH 4 8 4 Performing the CV measurement 1 The patient should sit in an upright but comfortable position the height of the seat and stand should be adjusted accordingly Select the CV program before connecting the patient to the flow sensor Once the program has been selected the flow sensor must find its zero point The warning screen below reminds the user to ensure there is no flow through the sensor at this time Attention Zero Adjust Please don t breath into flow sensor 4 Connect the patient to the mouthpiece attach a noseclip and ask them to breathe normally 5 Press Enter to start the measurement The following screen will be displayed Closing Yolume Single Breath N2 Wash Out Method S der Thomas ee x D zd io i xr Breath normally Ec FS SN FA Se e Space Enter Spirometry for CV test Gas concentration over voli 0 C 50 H A i S der Thomas SYC ref 5 581 Gas bottle closed Meaning of the icons Test shutter k Delete graph and restart FAL o Set flow zero no flow a Release gas manually hrough flow sensor M2 t Space ie Start manual evaluation Enter 6 On the left of the sc
74. ective agents and a permanent change of humidity and temperature That makes it impossible to guarantee a minimum lifetime The typical lifetime of a flowsensor is about 5 years according to customer reports Calibration Calibration is recommended after every disinfection or after exchange of the Flow Sensor Calibration can be performed by the customer using the 1L calibration syringe The syringe is available from nSpire Health GmbH The necessary software is already included in the standard software package If the customer does not want to calibrate Flow Sensors they can send them to nSpire for calibration If the calibration results in unacceptable deviations from the reference values the Flow Sensor should either be replaced or re encoded by nSpire Check There are two criteria to determine if a Flow Sensor produces correct results 1 Raw inspection of the membranes If membranes are mechanically damaged the Sensor is unusable 2 Precise Calibration Deviation in ex gt 6 or deviation 1 00 lt gt 10 The Calibration Software provides automatic detection of deviation and gives a warning message Additionally correction coefficients cannot be saved 2 Yispire safety Maintenance Se INSPIRING RESPIRATORY HEALTH ZAN600 USB Lifetime The lifetime of the ZAN600 USB system depends strongly on usage strain and maintenance One of the main factors is the lifetime of the analysers A lifetime of at least
75. elect this icon or press the F8 key to print out one or multiple templates Select this icon or press the F12 key to Check the results meet ERS ATS 2005 Standards Select this icon or press the Enter key to save the measurement and exit module INSPIRING RESPIRATORY HEALTH Selecting this icon or the F1 key opens the comments dialogue box Comments can be typed into the dialogue window and saved by pressing OK By pressing the Predefined button predefined comments can be inserted by using the second shown dialogue box This dialogue box allows the user to create modify and delete predefined comments Each predefined comment consists of a full text and a short description which is shown in the list box Multiple predefined comments can be selected by pressing CTRL during selection E Cancel Predefined Predefined Comments ES Use the CTAL key to select multiple lines Hew Modify Delete Cancel 4 1 2 2 1 Define User INSPIRING RESPIRATORY HEALTH Selecting this icon or the F2 key enters the test operators name This is saved with the al patient record The user entered is applied to all tests that are carried out on the active F patient The user has to be defined for every new patient User name field Pre entered user name selection box Display dialogue automatically at the end of the test Show always after test Clear User name field and insert new user name
76. ents Reinstall is only able to repair existing install updates or perform a new installation Select Delete to delete the ZAN programme and all related data ef Yispire System Software Inst INSPIRING RESPIRATORY HEALTH InstallShield Wizard Demo Mode Only Select Components Choose the components Setup will install Select the components you want to install and clear the components you do not want to If you chose Modify the Programme you will see ae this window Now you can install additional il p0 1 Measurement options This programme behaves just like the ponhi normal installation programme Just follow the prompts Description g Space Required on C 18588 K Space Available on C 49894980 K stashed SS InstallShield Wizard Please enter the license number of the software x License number If you choose Reinstall you have to enter S your new or existing license number After confirming the rest of the process works automatically Itis similar to an installation and does not need major changes InstallShield lt Back Cancel Note You should use the reinstall option only to repair update or reinstall InstallShield Wizard Setup Type Choose the setup type that best suits your needs Please choose a function s Add tion to th If you select Delete you are prompted to Cae eia Reinstal
77. er INSPIRING RESPIRATORY HEALTH Warning During the test a physician must be present and a defibrillator must be available The load test must be stopped immediately when the heart frequency of the patient reaches the upper threshold or if the ECG shows abnormalities Defibrillator Protection The ZAN800 ECG has a built in defibrillation protector but every cable from the patient to the device must be protected with a 4700 Ohm resister 9 3 Using customer supplied equipment The devices built by nSpire Health GmbH and the nSpire system cart together form a unit which is fully compliant to German MPG These sets are manufactured in a way that allows connection to a PC which is not protected by the security system built into the nSpire system cart If the nSpire devices are to be connected with the PC of a different provider consider the following instructions 1 The PC has to meet the minimum requirements defined in the technical description of the software manual 2 The PC has to meet the DIN EN 60950 norm and have a valid CE certification If not the patient could possibly get an electric shock when touching the device because of unequalised ground potential differences between the PC frame and the ZAN device The distance between the patient and the PC during operation must be more than 1 5 m Within a distance of less than 1 5 m no nonmedical device may be associated with a medical device 5 Within 1 5 m distanc
78. er Text for Report Headlines Font Strong AN Messger te GmbH aa e SaaS ja 1 D 97723 Oberthulba ja r coe Note Since there is only one global header definition file in the system this will change ALL headers on ALL printouts 8 1 5 6 Switching the Volumes Bar The Volumes Bar is the leftmost graphic element in the graphics area By clicking on it it can become activated or deactivated which means that it will or will not be printed on this report If the Volumes Bar is deactivated the red symbol is displayed over the graphic like shown below Otherwise the element is active Dialog x ZAN Mebgerite GmbH D 97723 Oberthulba Schlimpfhoferstr 14 Tel 09736 8181 0 Fax 09736 8181 20 Z ErgoSpwre Karl Z TV 050342 170 cm 74 ka sale 25 01 142 58Y 20007 11 11h Volumes Bar Deactivation Symbol Preview Volumes Bar deactivated ef Yispire INSPIRING RESPIRATORY HEALTH 8 1 5 7 Selecting a Measurements Graphic Type Clicking on the mid part of the graphics area opens the corresponding list of available graphic types Bitte Wahlen x 3 Sa C O amp Available graphic types In some cases not all possible graphic types are valid for the selected report Those graphic types can not be selected and the corresponding radio button fields are disabled greyed Only one graphic type can be selected Press OK to activate the selection or Cancel to abandon the selection
79. er and flow sensor must be cleaned and disinfected according to the disinfection instructions Do not reuse N disposable parts like foamed plastic etc 4 6 1 3 Important Parameters of Rhinomanometry Flow 50 Flow at 50 Pa Flow speed at 50 Pa Tidal breathe through one pressure difference nostril Flow 150 Flow at 150 Pa Flow speed at 150 Pa S pressure difference S Res 150 resistance at Nasal breath resistance s a 150 Pa at150 Pa pressure difference a Res 50 resistance at 50 Nasal breath resistance at a Pa 50 Pa pressure difference Res 300 resistance at Nasal breathresistance at s a 300 Pa 300 Pa pressure difference because the flow inside of the nose is always turbulent the pressure difference shows a square function of the flow like P f F The result shows a curve similar to this example INSPIRING RESPIRATORY HEALTH Flow ls Druck Pa Because of the non linear relation between pressure and flow the flow resistance is not constant and also depends on the pressure 3 pressure values define this curve 50 Pa 150 Pa and 300 Pa s a 4 6 2 Assembly And Connection Of The Parts 4 6 2 1 Using Olives Flowhandy ZAN 100 USB Tubing connect to Olive holder 3 and Flowhandy ZAN 100 USB 1 Put Olive holder on the adapter 5 and the Flowhandy ZAN 100 USB 1 Put the 2 Olives 4 on the Olive holder 3 nee a Of R77 Dart Alin RBRAALAAOCNIC A a NIC i If rat lt s rm It 3 A FANI
80. eration of the patient lt is important that the patient inhales and exhales the complete volume of his or her lungs with maximum flow speed You have to distinguish between an inspiratory and an expiratory F V curve To measure the inspiratory curve the patient has to slowly exhale the complete volume of his or her lungs in order to inhale as fast and as deeply as possible afterwards In order to measure the expiratory flow the patient has to exhale as fast and as deeply as possible after maximum inhalation To guarantee a complete exhalation it is recommended to exhale for at least 6 seconds During the measurement a time bar will be displayed in the upper right of the screen It starts to increase with each exhalation and changes colour from red to green after 6 seconds When this occurs the patient should inhale again Also in the right hand side of the screen is the plateau graphic which is an indication of flow nearing zero This gives information to the technician on the quality of the manoeuvre performed by the patient Exhalation time S Plateau es 4 2 8 Co operation To judge the patient s co operation the maximum exhalation should be repeated 3 times It is important that the patient exhales as fast and as deeply as possible With optimum co operation all curves will be positioned closely on top of each other and have a nearly identical form The curve s form will be pointed if the patient s co operation was at an optimu
81. err Measurement MVV ia P01 Rhinomanometry a Sniff Spiro Spiro F Modify New report Cancel Report organiser and selection dialogue Selecting a report requires three steps 1 Select the desired measurement method in the leftmost listbox The list of available reports is displayed 2 Select the desired report from the Selected reports listbox 3 Press the Modify button to enter the Report Designer BEE Measurement Selected reports Ignored reports spiro Yalue Table ErgoSpiro Anaerobe Threshold Report ErgoSpira Value Table 10s ErgoSpira Value Table 30s Stress ECG 12 Strips 6s Step Stress ECG 12 Strips 3s Step Stress ECG 12 Complexes FY6 Step Stress ECG 6 Complexes Strips Hll 2 V5 V6 Stress ECG 6 Complexes HIll 2 5 V6 Stress ECG ST Trend 12 Leads Stress ECG Short Report i ErgoSpiro 9 Wasserman Graphs SpiroErgo Index Report SpiroErgo Dyspnea Report SpiroErgo Cardiac Output SpiroErgo Training Recommendation SpiroErgo Training Description SpiroErgo Indirect Calorimetry eh Rhinomanometry SpiroErgo Nutritional Assessment Stress ECG Graph Table i Sniff SpiroErgo Recovery Capability Spiro ErgoSpiro BR and HRR Spira FY ErgoSpiro Report amp Diagnosis Sport Test Training Recommendation Sport Test Net Graph Metabolic calibration Modify New report Cancel 6 ire P Setup Customizing T INSPIRING RESPIRATORY HEALT
82. ethysmograph or when using the i environmental unit these data are automatically detected and e one Canoa transferred Ambient press 1013 mbar Humidity 30 l Use BTPS from Environment Module Caution Correct temperature adjustment is very important A mistake of 2 degrees will cause a drift in breathing of about 1 percent The absolute barometric pressure must also be entered into the system Meteorological barometers indicate a pressure which can be converted according to the sea level Note For each 100 meters of altitude the pressure will lower by 12 mbar For Example The meteorological barometer indicates 1000 mbar at 680 meters above sea level 1000mbar 6 x 12mbar 1000 72 928 mbar INSPIRING RESPIRATORY HEALTH 2 3 Check Device jonah Pressing the D key or clicking the Check Device button opens the check device options box This displays a list of the current hardware systems that are running on the current PC see the following example It is generally used for troubleshooting purposes if there is a communication problem with the existing system ZAN Device Control i x Installed Devices E System Running H ZANBTPS Running l ZAN100 AN1 310407022 Running ZAN020 Switched OF The most important entry in this list is the line ZAN 100 ZAN1310407022 Running This line makes sure that the Flowhandy is connected to the USB port and acti
83. everal device interfaces and other important settings like printer type report headlines database settings etc You can change all settings at any time using the S option from the main window The active device is displayed in the upper left corner All settings relate to this device only and may vary from device to device InstallShield Wizard InstallShield Wizard Complete The InstallShield Wizard has successfully installed ZAN Click Finish to exit the wizard The installation is complete Click on Finish in Ry ey Y Devou wentte start AN now order to close the Install Shield Wizard The installation is complete and the software is ready for operation Bz select a Neasuremen T System Software Ir INSPIRING RESPIRATORY HEALTH Start the ZAN programme by double clicking on the ZAN icon Before the first measurement and after the replacement of a flow sensor it is recommended to perform a calibration 7 3 Modifying Reinstalling or Deleting the Software Setup Type Choose the setup type that best suits your needs To modify update or delete the programme insert the installation CD The screen to add options to the programme or to completely Add an option to the program delete the program is displayed Reinstall the program Delete the program Please choose a function InstallShield lt Back Cancel Note Select Modify the Programme to add new compon
84. every stroke the syringe s piston has to be pushed in and pulled out as far as possible NAAN apinlel HIT IE E The recording of the volume time curve is displayed After about 5 to 10 pump strokes select Enter to end the calibration and begin the analysis Results of the analysis are displayed in the following window The calibration factors for each flow direction are stated Important The condition for a valid calibration is an absolutely precise calibration syringe nSpire Health is able to provide appropriate devices If the flow sensor works properly a green field will be displayed in the calibration window H Select Enter to complete the calibration and save the calibration parameters Calibration succeeded If the difference between Corr In and Corr Ex exceeds 6 or if either calibration factor deviates from 1 00 by more than 10 the flow sensor should not be used A note to replace the flow sensor will be displayed in a window After replacement of the flow sensor the calibration process must be repeated Note The flow sensor that failed calibration should be carefully cleaned and the holes of the flow sensor should be checked to verify they are not blocked After drying the flow sensor perform Temperature 2 Cancel a new calibration If the calibration fails a second time the flow aa 1013 nba sensor should not be used 7 Humidity 3
85. g Procedures 4 1 SVC Measurement SVC Slow Vital Capacity is a physiological test that measures how an individual inhales or exhales volumes of air as a function of time The manoeuvres to measure the individual parameters are unforced except at the point of reaching end expiration or end inspiration where extra effort is required The volumes that can be measured in spirometry consist of the following TV Tidal Volume The volume of air inhaled or exhaled during the respiratory cycle ERV Expiratory Reserve Volume The volume of air that can be maximally exhaled from a position of passive end tidal expiration IRV Inspiratory Reserve Volume The volume of air inhaled from a position of passive end tidal inspiration IC Inspiratory Capacity The volume of air inhaled from a position of passive end tidal expiration VC Inspiratory Vital Capacity The maximal volume of air inhaled from the point of maximal exhalation VCex Vital Capacity expiratory The maximal volume of air exhaled from the point of maximal inhalation 4 1 1 Measuring Separate Partial Volumes The most important reference point of respiration is the Tidal Volume Vt At the end of tidal expiration the retraction power of the thorax and the contraction power of the lungs are balanced ERV is measured by having the patient exhale steadily and as deeply as possible Some patients may take a small breath in before they exhale This does not affect the results Once
86. he measurement of patients the user has to receive comprehensive introduction to the handling of the device and be able to prove this towards the responsible authorities and test centres The manufacturer or the authorised specialist dealer supplies this device together with comprehensive introduction only To this effect this user manual is always used as a training document The operator is responsible for seeing that each user receives a corresponding introduction and thoroughly studies the manual Furthermore the user should be ale to prove corresponding specialised medical training The operator is responsible for the professional and appropriate handling of this device The software running under MS Windows is delivered together with the measuring device From simple spirometry pre post comparison trend analysis as well as CO diffusion measurement the measurement program includes all common requirements by default Moreover a large number of options such as for example hyperreactivity evaluation or PO 1 measurement are offered An easily understandable user interface ensures a short training period The programme structure offers ease of use The standard value equations of various authors of reference values are pre set additionally other standard values can be added in the form of equations Drug lists can be predefined and completed at any time Archiving of patient data and measurements is integrated The system is network co
87. he single efforts that are taken into account for the creation of the Best are plotted in bold The value that is reported is either from the selected effort the maximum of all accepted efforts the mean of all accepted efforts or recalculated The standard methods are according to ATS 4 i Chapt vp re SVC Meast urel INSPIRING RESPIRATORY HEALTH 4 1 5 SVC Guidelines In many cases the patient is nervous before the measurement resulting in erratic tidal breathing The patient s respiration should be corrected by verbal encouragement to give a more stable baseline for the rest of the measurement To ensure accurate results the patient should be encouraged to exhale and inhale completely This is demonstrated by a plateau at the end of each part of the manoeuvre lf there is an air leak from the patient at the mouthpiece or the patient comes off the mouthpiece the measurement should be repeated to achieve correct calculations of the partial volumes 4 1 6 Co operation To ensure accurate and reproducible results the patient should be encouraged throughout the measurement It is recommended that the test be repeated until three acceptable manoeuvres have been obtained Optimum co operation will result in reproducible results 4 1 6 1 Adjusting Lung Volume Sub Divisions Manually The position of the lung volume sub divisions can be changed and the values re calculated by selecting one of the lines with the mouse and hol
88. hes too deeply or too fast If so the patient s tidal respiration has to be corrected by demonstrating the appropriate breathing pattern Important P0 1 measurement is carried out during absolute tidal respiration The time of interruption during PO 1 measurement is limited to 120 ms because the patient must not change his or her breathing pattern If possible the interruption should be started unobserved by the patient Note lt is recommended to carry out the P0 1 measurement before the Plmax measurement because after maximum effort tidal respiration will not be regular 4 5 8 Completing the P0 1 Measurement and Analysis By re selecting the Enter symbol the measurement will be completed and the results will be calculated and inserted INSPIRING RESPIRATORY HEALTH 2 51 x a min POL POI max 5 3 172 EE z Normal Juergen PO1 Plmax 3 2 74 els Sie F With this Button you can toggle the results table on and off 4 5 8 1 Parameter Selection With a double click on the results window you can open the parameter selection window Select the relevant parameters from the parameter list They will be shown in the results window from now on Refer to the parameter selection paragraph in the SVC Measurement chapter for more details 4 5 9 Editing a P0 1 Measurement By clicking on one of the three measurement screens a small window for editing a measurement is displayed These windows will d
89. hey were performed The question mark indicates that on this day the patient folder has been opened but the measurement has not been performed Select a date with the mouse and close the archive by pressing the key A list of all measurements on this day labelled with their time shows up Archiv sssssss 14 30 15 04 15 05 15 12 15 17 15 20 8 9 N DER TINC UNTERSU N V 2401 2001 ul B B P K Mebger t pr fen D Select the measurement you would like to see Then click on to select the desired report type and press ENTER to print the report Spire INSPIRING RESPIRATORY HEALTH 2 5 5 Comparing Measurements of Several Days From the Archive menu it is also possible to compare measurements that were made on different days This is achieved by double clicking on the Days to Compare Button This opens an options box Lom ee ee _ _ _ _ ___ _ This options box enables the user to select tests from a specific day and time to be included in the comparison Tests can be moved into the Selection Window using gt or removed with lt The type of test for comparison may be modified by using the drop down menu in the bottom left corner When the desired tests have been selected the print key will print these results to the local printer The print preview option opens the report in Microsoft Internet Explorer for viewing on sc
90. htly enough The flow sensor is defective or must be calibrated Troubleshoot INSPIRING RESPIRATORY HEALTH Solution 3 Plug ZAN device into the serial interface 4 Select port or measurement device in the set up programme 5 Disconnect the device from the USB port wait at least 30 sec reconnect the device restart the programme 7 With F12 key or selecting o m2 set the zero point again 8 The patient must not breathe on the device while the zero point is set e Change flow sensor and carry out new calibration 12 Put the flow sensor correctly onto the case there must be no gap 13 Deactivate the Power Down Mode of your PC 14 Replace the O rings Clean the holes of the flow sensor or the holes of the flowhandy Take off the flow sensor and put it into the handy from the right side 18 Activate the BTPS entry module with lt B gt and correct the temperature 19 Use a nose clip 20 The patient must tightly enclose the mouthpiece or use a different mouthpiece e Calibrate flow sensor or exchange it 6 2 Body thc Ea problems The door cannot be closed The resistance curves are wide open The resistance curves run vertically The resistance curves run horizontally The TGV curves run vertically Door magnets have not been activated yet The door has been deactivated by pressing the security switch The door is not completely closed The temperature
91. hygiene has to be ensured when handling contaminable components INSPIRING RESPIRATORY HEALTH All contaminable components can easily be taken apart and disinfected Instructions on how to do that and suitable methods and means can be found in the chapter Disinfection 1 8 Special actions before daily starting up As a general rule the gas analysers have to warm up for at least 30 minutes before a calibration or measurement can be started The overall system should be calibrated at least before the first measurement of each day The calibration procedure is described in the corresponding chapter YiSpire INSPIRING RESPIRATORY HEALTH 2 User interface The ZAN GPI 3 xx software interface is designed for ease of use The list of patients and the measurement results are shown in the form of an index card tabular form on the screen There are 4 programme modes Patient Mode Measure Mode View Mode Archive Mode The visible index card lets you handle the data sets of up to 5 different patients simultaneously You can switch to single patient mode using the set up alt S The number of patients in the archive is only limited by the capacity of your hard drive Software navigation is simplified by using the buttons on the right hand side of the screen allowing quick access to entering patient biographical data for performing tests with the measure button to view results of tests performed today or in the past a
92. iew shows the Best effort of each stage This viewing mode allows Pre Post comparisons as well as trending for provocation tests If in the Effort View screen the name Effort View will be shown in the grey header of the result window To move to the Slot View left click within the result window To change from Slot View see picture below to Effort View left click within the result window on the column of the stage you want to see the efforts from While in Effort View the coloured dots are used to select the best curve set the acceptance of an effort or highlight multiple curves for better visual comparison eal 2 2 i Aal Ag DEMO m ee Oy Parameter Unit Ref m lt lt 2 7 O INSPIRING RESPIRATORY HEALTH 4 1 8 1 Comparison to references Test Pre test if it was performed on a previous visit Click the L icon and the reference list will come up Select the date and type of test and click ok You will then see the comparison of current data to the reference selected Pre test Parameter Unit Flow Volume Measurem INSPIRING RESPIRATORY HEALTH 4 2 Flow Volume Measurement 4 2 1 Definition Of A Flow Volume Measurement The Flow Volume loop is the recording of the flow rate plotted against the volume The flow volume loop shows the lung s reaction during maximum flow speed According to the constitution of the lung tissue the expiratory flow is more or less s
93. iffer a little from each other Click on the appropriate symbol to perform the desired function INSPIRING RESPIRATORY HEALTH Increases the scale of the graphic Decreases the scale of the graphic T If more than one manoeuvre has been performed use this icon to scroll up to the previous manoeuvre If more than one manoeuvre has been performed use this icon to scroll down to the next manoeuvre Use this icon to move left to position where the measurement should be analysed manually overriding the computer selection gt Use this icon to move right to reposition where the measurement should be analysed manually overriding the computer selection K Deletes the selected PO 1curve ey YiSpire INSPIRING RESPIRATORY HEALTH 4 5 10 Co operation The P0 1 measurement does not require the patient to perform any controlled manoeuvres however for PO 1max PEmax and Plmax measurements the patient needs to perform breathing manoeuvres for the test to be measured correctly Important After deep exhalation the patient must try to inhale with maximum effort AN To obtain valid results the interruption should be started unobserved by the patient so the patient does not recognise or react awaiting the interruption 2 Yispire INSPIRING RESPIRATORY HEALTH 4 6 Rhinomanometry 4 6 1 Principles Rhinomanometry measures the flow resistance of the nose The flow in one half of the nos
94. in check the voltage supply of the analysers Set zero point meanwhile the patient must not breathe on the system Check valve system or exchange it Ask the patient to hold his her breath and not to breathe against the valve Tighten the connector on the shutter but not too tight we Spire 6 4 Ergometer Problems Ergometer or treadmill does not work Treadmill does not react Devices are not activated or activated after the programme has been started Wrong mode protocol selected Note Bicycle and treadmill are controlled separately Maybe another user changed the particular ergometer setting on the ZAN PC Caution The patient must leave the treadmill immediately to avoid accidents Emergency Stop Function is activated INSPIRING RESPIRATORY HEALTH Activate device and restart programme Select the correct mode protocol and restart the ergometry programme Set the settings back to the correct values Note there are example settings for Ergoline and Elmed in the addendum For other types refer to the appropriate manuals in the PC control section Reset emergency Stop function Restart the treadmill If necessary disconnect the device from the PC restart the system and reconnect the Ergometer 2 Yispire INSPIRING RESPIRATORY HEALTH 6 5 Spiro Ergometry Problems No volume signal appears 1 ZAN600 control light is off 1 Check power cable and brea
95. inter type Note ZAN always uses the Windows default printer 8 1 8 Screen resolution This dialogue defines the resolution of the computer monitor Please select the appropriate setting This setting will not change the basic Windows setting but is used to calculate the graphics and print outs internally Raster size for ECG display for instance is also defined in this dialog The system detects correct values for this parameter automatically and should not be changed 8 1 9 ZanGate Optional ZANGATE When using the ZAN software in connection with a C Undefined CPRS you can define basic communication parameters 4 in this dialogue box BDT and GDT are data formats used in Germany to perform standardised data Printer x Use Color Printer Use Black White Printer a Screen E xj Screen Resolution 1500 x 1200 Cancel Raster Korr i 19 f 1600 x 1200 f 1280 1024 1024 769 C S00 x 600 Import Files Patient Data exchange with remote systems ii ngelen Browse File Mask bdt Options Export Files Test Reults Path Agatesout Browse File Name Jexport bat Exit Zangate after every export 4 pire Setup Customizing T INSPIRING RESPIRATORY HEALTH 8 1 10 HL 7 Optional This dialogue box is used to activate and configure HL7 communication with external hospital information systems Enable HL in ZAN applications
96. ion process you simply right click on the related coloured dot The fulfilment of ATS criteria is also visualised by the result table Green iF dan and red dots show for each parameter that is defined by ATS and whether 008 the criteria were met or not This includes the criteria for acceptance as well as those for reproducibility only shown when more than one effort performed The result window has a column called Best This column shows the results that are reported for this stage The results of the single efforts that are taken into account for the creation of the Best are plotted in bold The value that is reported is either from the selected effort the maximum of all accepted efforts the mean of all accepted efforts or recalculated The Best efforts are determined using ATS ERS standards _ 4 2 10 Different views of graphics You can view the flow volume loops in the conventional 2 dimensional view or the newly available 3 dimensional view The 3D view gives the added value of depth when looking at a number of loops a 68 3D a together To change the view click on the 3D icon You will get the following display for flow volume loops INSPIRING RESPIRATORY HEALTH To return to the conventional view click the 2D iconL L in the top right hand side of the screen 4 2 11 Quality guidelines a ATS ERS Criteria Select this icon or press the F12 key to oT ae
97. ional If you use the waiting room option data is stored in an intermediate storage place As long as there is data in the intermediate storage a waiting room symbol will remind you that it is being stored there To empty the intermediate storage select an empty index card select the waiting room icon and recall one of the listed patients Once all patients are removed from the waiting room the waiting room icon disappears 2 6 3 Paper Basket Delete Data If a Patient folder has to be purged select the paper basket The paper basket option completely deletes the current patient file A N Caution If confirmed this action is not reversible ef YiSpire INSPIRING RESPIRATORY HEALTH 2 Additional Functions This menu is located below the index card and can be used to alter some of the system settings and other important functions 2 7 1 Change Date and Time ee DATE 7 TIME Pressing the T key or clicking on the Date Time box with 06 22 2006 the mouse enables the user to change the date and time if disci necessary ROTETA Ensure that seconds are entered when changing time values Caution Ensure the date is adjusted correctly This could affect a patient s age and the appropriate reference values 2 7 2 Entry of Ambient Conditions BTPS B Pressing the B key or clicking on the BTPS box with the mouse enables the user to change the values for ambient condition Only in the Bodypl
98. l Z4N100 Z4N300 Ergo Spirometry r Description y Space Required on C 18588 K Space Available on C 49894980 K lt Back Cancel ef Yispire System Software In INSPIRING RESPIRATORY HEALTH InstallShield Wizard Select Components Choose the components Setup will install Select the components you want to install and clear the components you do not want to c install Only in DEMO MODE Eg ZANtoo Description via p0 1 Measurement 0 Rhino i 0 Compliance If you are installing the DEMO software select the LEDS symbol in front of the option The check mark AZAN500 indicates your choice If you have selected all Lanes measuring devices and options you have purchased a 1ZAN700 M Space Required on C 18588 K click on Next Space Available on C 49894980 K InstallShiela lt Back Cancel InstallShield Wizard Start Copying Files Review settings before copying files Check the set ups before installation and click on chatgesrysetngs ce ask youe sheath be setings ik New beg Next If necessary click on Back and change the copying fie set u ps Current Settings The following options are installed MW Cardiac Output ZAN600 lt Back Cancel InstallShield Wizard Setup Status ZAN Setup is performing the requested operations The ZAN programme will be installed automatically C ZAN GPI200 lodeT read
99. l the program confirm that you are really sure that you want pepe to delete all programmes and data from your Seesmpasm computer InstallShield System Software Ins INSPIRING RESPIRATORY HEALTH Confirm Uninstall x Do you want to completely remove the selected application and all of its components If you want to do so click on OK if you are not sure click on Cancel CT backup before deleting We strongly recommend creating Do you want to save the old ZAN program If you clicked on OK you are prompted to create a the backup NO WILL DESTROY IRREVOCABLY If you choose No all data related to the ZAN programme No including your settings and the existing patient archive will be deleted This action is irreversible The Deinstall is finished now we Yispire INSPIRING RESPIRATORY HEALTH 8 Set up Customising The Set up 8 1 System Set up Setup ALT S The Set up Option can be accessed by selecting the icon on the lower portion of the screen The Set up Option enables you to set and change some of the programme settings including the following a JAN Settings Device Exit Licence DEE ZAN Settings Language System MISY Exit Database Default Patent ZAN 100 Headline ZAN 300 Reports b ZAN 400 Pred Formulas ZAN 500 Frinter ZAN 600 screen ZAN 700 HL ECG Demo mode External Some parameters are protected with a p
100. ld use this kind of running start to ensure optimum results The patient has to breathe maximally for 12 seconds If the patient is unable to continue for the whole 12 seconds it is possible to stop the measurement by he selecting this icon Enter at any time and calculate their results from the data that has been recorded up to that point The maximum minute volume will be defined by extrapolation of the volume during the real measured time After 12 seconds the measurement will finish automatically Select this icon Enter or press the Enter key to save the measurement and exit Maximale Yentilation Z Normal Juergen ERGEBNISSE M 188 5 l min BF mvv 107 3 jmn FEV1 35 137 2 0 0 l min ZNormalJuergen ti D p fC INSPIRING RESPIRATORY HEALTH 4 4 3 MVV Measurement Guidelines gt The measurement should use running start to ensure best results 2 In order to inhale the absolute maximum volume the breathing frequency should not be too fast gt According to known clinical practice the optimum is about 30 cycles per minute gt lt is important that the patient uses a nose clip forms a tight seal around the mouthpiece with his or her lips and breathes maximally throughout the recording phase 4 4 4 End Of Measurement And Evaluation Selection of the Enter Icon or pressing the Enter key ends the measurement and displays the computed results 4 4 5 MVV Window After Measurement POTAE 030 J 60
101. m See picture below To exhale the whole volume the patient must exhale for at least 6 seconds The measurement curve must slowly merge into the base line To finish the measurement and display the results press the icon Chapt Flow Volume Meas ef pire INSPIRING RESPIRATORY HEALTH 4 2 9 Flow Volume Screen after Measurement and result edit 30 2 x Pre test Parameter Unit Ref Best Effort 1 Effort 2 Effort 3 Effort 4 et Ret Ret Ref Ref 109 3 AR 13x 400 103 ns 4 79 104 w 9 90 107 75 77 5 05 tega 119 mazzzzu0uNT lt Z2mmmmo s 7 annnnno lt Mh sh z 422 om The four efforts are colour coded and the computer selects the best result it In this example effort 3 is highlighted You can mix and match the flow _ volume inspired and expired according to the ERS ATS 2005 guidelines Simply click on the coloured circle you wish to see for the final report for both the top and bottom of the graphic This example shows effort 3 for the if expired loop combined with effort 4 for the inspired loop According to ATS there are criteria for the acceptance of the test The computer will automatically determine whether the criteria for acceptance W are met If an effort is not acceptable this is shown by a red cross over the of 3p corresponding coloured dot In order to remove a loop from the select
102. me 4 7 2 2 1 The Master Screen After starting the programme the master screen is displayed A timer and additional menu options appear in the measurement screen 4 7 2 2 1 1 Structure main menu volume time window gas concentration window 0CO Dithusion Single Breath Mustermann Melanie SBelSie elsiepeimiesey bittasion Spircesetr ye x Il oe 4 7 2 2 1 2 Menus The main menu provides access to common functions of the CO diffusion measurement The contents of the menu are different before and after the measurement Only valid functions are displayed Menu before Measurement stop g 0 ESC OF F2 Menu after Measurement we Yispire Symbol definitions hib i on m Select this icon or press the ESC key to stop the measurement and exit the program Select this icon or press the F9 key to input the actual Hb and HbCO concentration Select this icon or press the F11 key to trigger the shutter Select this icon or press the F12 key to reset the zero offset Patient must not breathe on the mouthpiece Select this icon or press the key to increase scale Select this icon or press the F1 key to enter comments Select this icon or press the F5 key to start CO edit mode Fast Space Select this icon or press the F8 to start residual volume edit mode Select this icon or press the F8 key to start report printing
103. me can be calculated The transfer factor and residual volume are also calculated using the Fast Space balancing method This method takes the total expiratory gas flux into account and is based on the principle that inhaled inert gas volume must equal exhaled inert gas volume plus residual inert gas volume The fast response of the multi gas analyser is utilised and the exhaled methane concentration is plotted against lung volume Distribution disease is clearly indicated by the shape of this graph Literature H J Brandt J Bender R Lodenkampfer and E Wies Balancing of a fast space by means of an alveolar mixing index Diseases of the Respiratory Tract and Lung Volume 4 No 3 1978 p160 168 YiSpir CO Diffusion and Resic INSPIRING RESPIRATORY HEALTH 4 7 2 Performing the Measurement 4 7 2 1 Assembly of the Device ZAN 100 USB Flow Handy stand lever shutter head with diffusion sample tube and stand connector shutter engine diffusion sample tube test gas supply USB cable CO diffusion demand valve the de air button on the demand valve On the back side of the demand valve is a button integrated into the black cover It is used to flush the system after changing the gas cylinder or in case the valve has to be disassembled for disinfection ZAN300 CO Diffusion 85 167 Part No 5001003ENG A 5 ire Ch at te INSPIRING RESPIRATORY HEALTH 4 7 2 2 Structure of the Measurement Program
104. me of the FRC Helium option is limited by the lifetime of the He analyser Depending on how often the analyser is switched on and off a lifetime between 3 6 years is usual Another wearing part is the suction pump The manufacturer guarantees a minimum 3000 working hours Since the pump is only working when the measurement is running which lasts about 1 minute the pump will last about 120 000 measurements Calibration Calibration is not necessary Regular maintenance ensures proper functioning of the option Leak Tests Leak free equipment is fundamental to obtain valid results The procedure of the leak test is described in the corresponding manual The test should be performed at least once per week and it must be performed when the absorber granules have been changed Absorber The absorber granules remove the carbon dioxide from the exhaled air The capacity is limited and it needs regular replacement nSpire recommends replacing the granules every 90 minutes of breathing Please refer to the option manual for more details Maintenance nSpire Health GmbH strongly recommends a Service of the ZAN310 FRC Helium option by nSpire once per year The customer will receive a written test report with all results of the service from nSpire Health GmbH V2 o har Yispire K Safety Maintenance Se INSPIRING RESPIRATORY HEALTH 9 7 7 Ergo Flow Sensor Lifetime The Flow Sensor is directly exposed to the patients breath disinf
105. mmended after every disinfection or after exchange of the Flow Sensor Calibration can be performed by the customer using the 1L calibration syringe The syringe is available from nSpire Health GmbH The necessary software is already included in the standard software package If the customer does not want to calibrate the Flow Sensors they can send them to nSpire for calibration If the calibration results show significant deviations from the reference values the Flow Sensor should either be replaced or re encoded by nSpire Check There are two criteria to determine if a Flow Sensor produces correct results 1 Raw Inspection of the membranes If the membranes are mechanically damaged the Flow Sensor should not be used 2 Precise Calibration Deviation in ex gt 6 or Deviation 1 00 lt gt 10 The Calibration Software provides automatic detection of deviation and will give a warning message Additionally the correction coefficients cannot be saved YISp I re Cre Safety Maintenance Se INSPIRING RESPIRATORY HEALTH 9 7 3 Flowhandy ZAN 100 USB Lifetime The lifetime of a Flowhandy ZAN100 USB depends strongly on usage and mechanical strain When used carefully lifetime is only limited by the lifetime of the sensors and the electronic parts inside The manufacturer of the Pressure Sensor guaranteed a maximum error of less then 0 2 over 1 million maximum pressure changes Under normal conditions the maximum ra
106. mpatible Data transfer to practice computer systems is achieved via the formats BDT GDT and HL 7 All measuring results and graphical data can be viewed on the screen Log output to the printer is carried out through the log interface of MS Internet Explorer Nearly any curve can be measured manually through tangents adaptation both directly after the measurement and after archiving Attention The option ZAN300 CO diffusion must only be operated in conjunction with a ZAN 252 or ZAN 260 system trolley otherwise the safety of ZAN300 CO diffusion may put at risk Plug connections must only be used for the components of nSpire Health described in this user manual ey YiSpire INSPIRING RESPIRATORY HEALTH 1 1 The software The supplied software GPI3 00 includes patient data management measuring and calibration programmes and a database for the measured values The archived data and measurements can be called up and printed at any time 1 1 1 PC System Requirements Minimum Requirements Operatingsystem WIN 2000 WIN XP CPU Pentium IV 1 89 GHz or better RAM Size 500MB Hard disc 40GB Installationdrive CD ROM Device interface USB 2 0 Monitor 19 Colour monitor Screen resolution 1280x1024 Pixel or better Printer colour i al System Desc INSPIRING RESPIRATORY HEALTH 1 2 Overview stand monitor measuring head with FlowHandy shutter breathing apparatus filter amp wna mouthpiece inter
107. n of CH but as soon as the alveoli of the CV close they will retain this high concentration of CH while the gas in the remaining alveoli will be diluted by the room air So at the end of the inspiration as in the N washout method there is a relatively low concentration of CH in normal alveoli and a relatively high concentration of CH in the alveoli of the CV Finally the patient expires to RV At first the air from the normal areas of the lungs which have a low CH concentration is exhaled Then at the CV the alveoli of the CV open and the CH concentration increases relatively abruptly this corresponds to an upwards bend in the inert gas CH4 concentration curve 4 8 1 2 Residual Volume N2 washout only A second interesting parameter that can be determined with the CV measurement is the residual volume RV With the calculated RV it is possible to determine further parameters such as Closing Capacity CC FRC and TLC Closing Vo INSPIRING RESPIRATORY HEALTH 4 8 1 2 1 RV measurement RV is determined during the CV measurement so no additional manoeuvre is required During the maximal inspiration no N2 is absorbed or transferred to the blood the concentration of N2 is only diluted by the RV It is therefore possible to calculate the volume in the lungs at the beginning of inspiration i e the RV using the final and the initial concentrations of N of this maximal inspiration The initial concentration of No is appr
108. nd to archive the results to the database Note To click on or select means to move the cursor over the desired button and then press shortly the left mouse button You can also select an option with the keyboard Use the yellow coloured characters to activate the desired option 2 1 Activating the Programme After successful installation clicking on the ZAN icon on your desktop activates the programme You see the index card gt AL DATA AR D INSPIRING RESPIRATORY HEALTH 2 2 Patient Data Entry Select a blank tab form either with the mouse or the keyboard and enter the surname just the surname without any add ons Press the enter key The system will now check the database to see if this name has been stored before If so you will see a list of all patients with this name Additionally this list contains an entry NEW PATIENT Using the mouse or the arrow keys you can select a patient or the NEW PATIENT Option to enter a new one Press the Enter key to confirm the selection If you select NEW PATIENT an input form appears Each field should be completed with the relevant data and confirmed with Enter The cursor will automatically jump to the next field Accurate patient biographical data is crucial for the calculation of reference values lt is important to ensure the correct format is used for each field If the wrong format is used in the date of birth field correct format
109. nect all power cables and report to nSpire Health GmbH service or your local medical device technical department Make sure that all networking connections are equipped with indirect coupling Observe carefully the instructions in the Disinfection chapter The user is responsible for the correct use of disinfection and proper set up of the equipment Electromagnetic Interference Medical devices require special care concerning electromagnetic interference All devices have to be installed and operated in accordance with the instructions and regulations provided with the equipment Strong transmitters must not operate near the equipment Portable HF devices such as Mobiles for example can possibly influence the functionality of devices Avoid using such devices near nSpire equipment The devices are tested up to a level of 3mV m and should not be exposed to electromagnetic fields of a higher level Safety Maintenance Ser INSPIRING RESPIRATORY HEALTH Do not operate the device near heavy current powerlines or devices 9 2 Device specific Security Information 9 2 1 Flowhandy ZAN100 USB The Flowhandy Caution A ZAN100 USB is part of all following devices The Flowhandy ZAN100 USB may only be operated in connection with peripherals which fulfil the DIN EN 60950 or DIN EN 60601 1 for medical equipment and have a valid CE certification PC devices must comply with the minimum configuration standards explained in the te
110. nfigure dose Medication Concentration mg ml Factor Calculation of medication by Vent oper Vent closed Dose 26 67 mgm f Wo of breath Mo of breath Delete Cancel Since the ATS 5 breath protocol requires 5 nebulizations an additional way to define the protocol exists calculating the dose by the number of breath s Simply check the No Of breath radio button and enter the desired count of breath to calculate the doses To enter a new concentration use the dialogue box shown below The description is the text that is shown in the list box and allows the physician to determine the correct dose concentration The concentration is entered in mg ml To enter a new concentration use the dialogue box shown below The description is the text that is shown in the list box and allows the physician to determine the correct dose concentration The concentration is entered in mg ml Enter concentration d x Description Concentration mg ml C Cancel To enter the factor of the nebuliser use the dialogue box below The dialogue box allows the entry of a description for instance the name of the nebuliser as well as the volume in ul that is nebulised per nebulisation x INSPIRING RESPIRATORY HEALTH Description Factor ul Nebulisation Cancel 4 1 2 3 System Set up Selecting this icon or the F9 key enables the configuration of the spirometry programme and th
111. ng test gas inhalation the air supply is blocked the patient cannot inhale During test gas inhalation the air supply is blocked the patient cannot inhale The black inert gas line reacts during the tidal breathing During test gas inhalation the black and red gas signal curves do not increase Volume CH4 and CO gas lines do not start at the same height The gas concentration lines heavily decrease while the patient holds his her breath The pressure regulator of the test gas cylinder is not open and or the pressure connection is not engaged properly to the test gas cylinder Check gas tube check if the pump runs check gas analysers The patient has consumed alcohol before the measurement or there is some gas left in his lungs from a previous measurement Check gas tube check if the pump runs check gas analysers When the zero point was set there was some gas left in the tube system The valve system is not tight The patient breathes heavily against the valve The connector on the shutter is loose INSPIRING RESPIRATORY HEALTH Open the valve of the pressure regulator The pressure connection of the breathing valve has to be put in order to make it engage for a second time This requires much physical effort Connect the tube start the programme again check the voltage supply of the analysers Re schedule measurement Connect the tube start the programme aga
112. nge will never be reached A typical flow measurement produces about 20 changes in pressure If a physician uses this device frequently and about 50 patients per day are tested this would approximately define a minimum lifetime of 5 years for the Pressure Sensor Calibration Calibrating the Flow Sensor simultaneously performs a calibration of the Flowhandy Maintenance nSpire recommends a technical check up after ca 1000 measurements or after 12 months of use which ever happens first The service is done at nSpire Health GmbH and includes tests of the following parameters e Tightness e Mechanical condition e Measurement precision e Data communication e Linearity The customer will receive a written test report with all results of the service from nSpire Health GmbH The customer can also check mechanical conditions as well as calibrate the system with the 1L Calibration Syringe which is available from nSpire Health GmbH 2 Chapt Yispire Safety Maintenance Service INSPIRING RESPIRATORY HEALTH 9 7 4 ZAN500 Body Box Lifetime The lifetime of the ZAN500 Body Box depends on how the device is used and how much mechanical strain the device has had to endure When used carefully lifetime is only limited by the lifetime of the sensors and the electronic parts inside Under normal conditions a lifetime of 8 years or more is usual Calibration Calibration of the bodyplethysmograph includes volume calibr
113. nt screen contains the necessary controls to perform the measurement S ilte E aa Select this icon or press ESC to ame erase the beginning of the test lit Select this icon or Dress the F1 1 key to a trigger the shutter ja Leh L Select this icon or press the F12 0 key to reset the zero offset Patient FH must not breathe on the aa mouthpiece Symbol definitions Select this icon or press Space to open the demand valve and deliver the test gas Select this icon or press the Enter key to start the measurement lt m Chapte CO Diffusion and Residual Vo INSPIRING RESPIRATORY HEALTH 4 7 2 2 4 The Result Window After the measurement the results in the form of a volume concentration graph are displayed in the right half of the master window sample volume traditional calcrlatinn TLCO aie JL predicted zol Sola TLCO actual IVC TLco Hb residual volume traditional additional residual volume using Fast Space E CO concentration KCO actual KCO curve expiratory predicted inert gas CH4 concentration curve expiratory vispire CO Diffusion and Res INSPIRING RESPIRATORY HEALTH 4 7 2 3 Performing the Measurement Caution Patients who have consumed alcohol may produce erroneous results due to the fact that the gas analyser also responds to alcohol 4 7 2 3 1 Start After selecting a patient in the Main Screen select the measure mod
114. nting button leads to the date range dialogue B Printing Cancel E Calibration Trend Report Please selectthe date range In the date range dialogue select the period of time to be examined Click on the desired date to select it Select multiple dates by holding the control key down during selection of dates There is a list of shorthand buttons on the left Eo o side of the dialog for quickly select frequently en used ranges year month and week select Eo n the current year month or week None clears o 14 08 2007 13 08 2007 all selections 0708 2007 i 03 08 2007 OK starts the print out 02 08 2007 01 08 2007 o 31 07 2007 2 ele 20 07 2007 Ose a a emer Cancel After a few seconds the print starts on your printer or when preview was selected the report is displayed on the screen INSPIRING RESPIRATORY HEALTH Page 1 of 1 a nSpire Health GmbH Spir echlimpthoter Str 14 o7723 Oberthulba ZAIN kieser Tal MS 499736 8181 0 Fax 49 9796 8191 20 Calibration Trend iif 1 oo oon oan Oo iN 050 Oi dd 4 6 6 F 8 g Wide 13 igis iaiT ik 10 9091 29 23 24 25 6 27 ee eo 16 01 19 00 Date Corr In Limits Ood 1 10 16 01 2008 0 960 13 08 2008 0 950 2009 napire Health GmbH Germany Teki M 99 9756 8181 0 di On closing this display the programme returns to the main menu Ep INSPIRING RESPIRATORY HEALTH 4 Measurin
115. o disinfect the flow sensor the sensor must be removed from the Flowhandy ZAN100 USB body and put into a disinfecting bath It is advisable to remove visible dirt before the actual disinfection An ultrasound cleaning of the flow sensors should only be carried out when it is necessary because the mechanical quality of the membrane could be influenced Caution To avoid infections in connection with the flow sensor it must be disinfected after each patient A N Always consider the recommendations from the disinfectant manufacturers concerning concentration purpose and reaction time gt The inside of the flow sensor must neither be rinsed with a direct jet of water out of the pipe nor must it be cleaned or touched by mechanical tools This could damage the sensitive plastic orifice and disturb the correct measuring function gt The flow sensor must be carefully dried after disinfection Before use you have to make sure that there is no more water in the holes gt If necessary blow out the holes with compressed air Hint Compressed air in sprayers for medical purposes is available from your dealer 9 1 1 Disinfection Of The Flowhandy The Flowhandy ZAN100 USB contains electronic components and may never be plunged into liquids It is possible to use surface disinfection using pieces of cloth etc If carefully applied a spray disinfection is possible The white pressure sensor on the rear side of the device must NOT be s
116. of the measurement precision nSpire Health GmbH recommends supervision by either nSpire Health GmbH or another authorised institution once a year In addition the user is also advised to follow the regulations concerning correct usage and proper handling 9 8 Service Contracts nSpire Health GmbH offers Service Contracts individually customised to meet the particular needs of our customers This assists our customers correct maintenance of their nSpire products which in turn provides optimum use and reliable results Please contact our Sales Representatives or nSpire Health GmbH directly for more information 9 9 Customer Service nSpire Health GmbH co operates very closely with our associated dealers Together we endeavour to provide an optimum service for our customers Usually your dealer has good knowledge of your particular needs concerning hard and software of your nSpire products This makes them the best point of contact to ask for assistance They will be able to give competent answers and quick support Our Service Department can also be contacted directly at nSpire Health GmbH Schlimpfhofer Str 14 D 97723 Oberthulba Phones Central 49 0 9736 81 81 0 Customer Service 49 0 9736 81 81 17 or 27 Sales Germany 49 0 9736 81 81 30 Sales International 49 0 9736 81 81 14 Fax 49 0 9736 81 81 20 Yispire Chi Safety Maintenance Se INSPIRING RESPIRATORY HEALTH 9 10 Warranty
117. oncentrations of chloride ions and that the material characteristics of the parts to be disinfected will not be influenced ZAN has tested the following disinfection fluids for their compatibility with the used materials Korsolex extra Bode Chemie Korsolex plus Aldehydfree Bode Chemie InstruPlus Dr Deppe EndoStar Aldehydfree Dr Deppe for surface disinfection Caution A Note Antifect FD10 Sch lke amp Meier ST Tissues Bode Chemie Sprayln Aldehydfree Dr Deppe Caution inflammable at low temperature 25 C Always consider the recommendations from the disinfectant manufacturers concerning concentration purpose and reaction time Visible dirt must be removed before actual disinfection Daily use and disinfection of the parts and the flow sensors will influence their mechanical quality We strongly advise you to calibrate and maintain the device according to the given recommendations Some components of the device are connected with tubes The tubes must not be put into disinfectants Water droplets have to be removed from the tube connections before putting the device into operation The complete ZAN system has gaskets O rings for connection The O rings should be covered with a thin layer of Vaseline accessories to make them slide easily Es Chapt gt gt Disinfection Maintenat INSPIRING RESPIRATORY HEALTH The tightness of the connected parts is very important so the O rings hav
118. ons When using the mask make sure that the mask is tightly connected to the patients face When using olives make sure that they are pressed from below into the nostrils and form a tight seal They should not deform the nostrils Different sizes of olives are available so find matching pairs Two vertical lines mark the 150 Pa pressure on the screen The patient should breathe in a relaxed manner but the dotted lines need to be reached or passed If the S curves do not reach these marks the patient has to be asked to breathe deeper INSPIRING RESPIRATORY HEALTH 4 7 Measurement of CO Diffusion and Residual Volume 4 7 1 Basic Principles The primary function of the respiratory system is gas exchange Oxygen is transported from the environment through the lungs into the blood while simultaneously carbon dioxide is released The inhaled air should distribute evenly throughout the lungs and oxygen once in the alveoli must diffuse through the alveolar capillary membrane into the blood The effectiveness of gas exchange is mainly influenced by three factors 1 distribution of air in the lungs 2 perfusion of the lungs 3 condition of the alveolar membranes There is a volume of air that remains in the lung even after a maximal expiration Several diseases increase this residual volume and create an imbalance of actively exchanged air and the total volume of the lung This will reduce the effectiveness of breathing Measuremen
119. opment In order to improve the lifetime of this product only materials of extremely high quality are used All materials are environmentally safe and can be recycled The manual provides instructions for operating the ZAN300 CO Diffusion system The instructions in this manual assume the user Is familiar with the intended use and application of pulmonary laboratory systems To avoid damage to the devices or incorrect measurement it is strongly recommended to follow the instructions in the manual and the technical description Your nSpire Health Team Schlimpfhofer Str 14 97723 Oberthulba Germany Tel 49 9736 8181 0 174 e u i Fax 49 9736 8181 20 yispire E Mail info nspirehealth com Web www nspirehealth com nSpire Health GmbH 134 oy a a i F EG a a L rae 1 Fl Le i T Yiopire INSPIRING RESPIRATORY HEALTH Documentation Conventions The following format conventions are used in this document to identify special information Warning statements identify conditions or practices that could result in personal injury Caution statements identify conditions or practices that could result in damage to equipment or loss of data Note The graphical illustrations in this document are for example purposes only and the hardware illustrated may differ from your hardware Safety Precautions The ZAN hardware has been tested and certified to be compliant to UL 2601 1 and CAN CSA C22 2 NO 601 1 Type
120. oximately 77 IMPORTANT The determination of the RV and the parameters CC FRC and TLC derived from it is only reliable when using the No wash out method In the case of the CH bolus method a complete and exact synchronisation between volume and gas signals is required but is almost unachievable in practice 4 8 2 Important measurement parameters of CV measurement Short description Meaning Closing Volume The volume in the lungs above which some alveoli close during an inspiration Residual Volume The volume remaining after a maximal expiration e Closing Capacity CC CV RV Functional The volume of air remaining in the lung at the end of a normal Residual breath Capacity TLC Total Lung The volume in the lung after a maximal inspiration Capacity Closing Volume INSPIRING RESPIRATORY HEALTH 4 8 3 The CV program prior to the measurement This window opens in the measurement mode after selecting the icon rf Closing Yolume Single Breath N2 Wash Out Method S der Thomas Spirometry for CV test 0 0 1 2 3 4 5 6 7 8 S der Thomas The keyboard can be used to activate these icons at any time by pressing the key highlighted in yellow A short explanation of the function of each icon will appear when hovering the mouse over the icon SWC ref 5 58 Cancel measurement Test shutter Set flow zero no flow through flow sensor Chose medication Filter sel
121. patient breathes normally gt By request the patient exhales maximally gt During exhalation click on the corresponding symbol to start the measurement gt The patient is requested to inhale as powerfully as possible gt When the next inhalation starts the respiratory flow is interrupted for 1 2 seconds The pressure is registered 100 ms after inhalation starts This pressure represents the maximum effort which the patient can make ef Y Spire INSPIRING RESPIRATORY HEALTH 4 5 4 Measuring Plmax gt The patient breathes normally gt By request the patient exhales maximally gt During exhalation click on the corresponding symbol to start the measurement gt The patient is asked to inhale as deeply as possible gt When the next inhalation starts the respiratory flow is interrupted for 1 2 seconds The maximum pressure after interrupting the respiratory flow is registered PO1max and Plmax require an identical breathing manoeuvre and will be measured simultaneously 4 5 5 Measuring PEmax gt The patient breathes normally gt By request the patient inhales maximally gt During inhalation click on the corresponding symbol to start the measurement gt The patient is asked to exhale as deeply as possible gt When the next inhalation starts the respiratory flow is interrupted for 1 2 seconds The maximum pressure after interrupting the respiratory flow is registered wef pire
122. pel Typell Flowsensor C Type ll Type lla llb CO Diffusion Breath Holding Time fi2 I Stand alone JV Integrated into Body Cancel eee a oe oe ZAN500 s ZAN 500 Port Flow 2 C Typel USB c Type ll c Flowsensor C C Type ll s Type lla llb C C eo e Cabin Volume Child Body Body Il Handicapped 4980 Liter Ulmer C Matthys O5l s Reff External Devices Ergometer Type Port v Port Configuretior RAM 70CE Port OFF Port Configuration Treadmill Type IV Confirm start of belt Jin Ergometer OFF 7 Fort Configuration BP Monitor Ergometer Port none z y Pot Configuratior BP Monitor Treadmill Port OFF Pulseoxymeter none ba Port OFF Y J Use ZAN Analog Box Configure Cancel Flow 7 Yolume Horizontal C Vertical Resistance MicroGA fa COM 1 COM 2 COM 3 COM 4 COM 5 COM 6 OFF x ZAN310 a ZAM 310 FRC Chapter 7 System Software Installation INSPIRING RESPIRATORY HEALTH Stand alone M Integrated into Body ZAN600 a ZAN 600 C Type Il Type Ill l HR analog l Polar USB Set the default device Default Device Default Device C None ZAN 100 C ZAN 300 C ZAN 400 C ZAN 700 ZAN 800 Cancel Cancel FEV gt MVV
123. prayed directly Disinfection INSPIRING RESPIRATORY HEALTH 5 4 3 Assembly Of Handy And Flowsensor Before the Flow sensor is inserted into the Handy again the O rings should be covered with a thin layer of Vaseline accessories to make them slide easily Caution Do not block the holes on the top side of the flowsensor Insert the flow sensor in a way that the holes and the yellow mark on the front rim are in top position This will prevent liquid getting inside the device 5 4 4 Disinfection Of The Shutter The Shutter can be dismantled in three parts 1 Shutter engine 2 Shuttervalve 3 Shutterhead The Shutter Valve and Shutter Head can be plunged into disinfectant liquid Spray can also be used Important Do NOT put the shutter engine in any liquid Caution The shutter head AND the shutter valve must be disinfected after each patient Always consider the recommendations from the disinfectant manufacturers concerning N concentration purpose and reaction time ZAN300 CO Diffusion 114 167 Part No 5001003ENG A ew a pire Chapt Disinfection Mainten INSPIRING RESPIRATORY HEALTH 5 5 Disinfection Of The One Way Valve CO Diffusion Option Only Caution Do not plunge the One Way Valve into any liquid Do not dismantle the One Way Valve The One Way Valve can be disinfected using tissues Spray may also be used For disinfection separate the valve from the unit and spray it carefull
124. r It has to be used for venting the system when changing the gas cylinder or for removing the breathing apparatus for disinfection INSPIRING RESPIRATORY HEALTH mre air acing outle connection Accuswitch cable to PC cable to service amp test shutter aden connector USB cable to PC gas suction tube from measuring head Rear side of ZAN300 measuring device without cover The rear cover normally does not have to be removed There are no parts or switches to be operated by the user INSPIRING RESPIRATORY HEALTH Flowsensor USB cable mouth pressure sensor Flowhandy ZAN 100 USB 1 3 1 Functional diagram of Flowhandy ZAN 100 rubber seals plastic diaphragm A pressure difference is created here through the respiratory flow conversion of py p pressure to elect signals monitor ZAN300 CO Diffusion 9 167 Part No 5001003ENG A INSPIRING RESPIRATORY HEALTH 1 3 2 The Flowsensor The sensor works on the principle of turbulent flow measurement based on pressure difference To this effect a plastic diaphragm with variable orifice is used as flow resistance The sensor works silently and is absolutely insensitive to the humidity of expired air The resistance of the diaphragm is very low so that no additional breathing load is created The patient will feel the result of these details Even patients with breathing difficulties can breathe on the system e
125. r from the optimum result and the user may want to reposition them Every line can be moved manually Selecting a button or pressing the F9 key saves the edited values 4 7 2 4 3 1 Editing the inert gas line to evaluate RV CH4 Selecting the button or pressing the F4 key loads the inert gas line CH4 Methane in edit mode The line is visible as a thicker green line The green regression line can be adjusted by clicking on the end of the line with the left mouse button If you press and hold the mouse button you can move the line along the exhalation curve If the inclination or the position of the tangent has been changed the gradient must be faded out again 4 CH4 By clicking the icon again the results will be re calculated 4 7 2 4 3 2 Editing The CO Diffusion Line _ co The CO line is edited by selecting the s button or pressing the F5 key The corresponding line can be moved with the mouse using the same method as the CH4 line above 4 7 2 4 3 3 Editing The Closing Volume Line Optional Selecting the im Icon emphasises the CV line which can then be moved with the mouse This button is only visible when the Closing Volume option is installed on the system 4 7 2 4 3 4 Considering blood data Hb Selecting the te icon or pressing the F9 key opens the blood data entry dialogue HB concentration a Enter HB 14 6 g dl S HbCO 6 z In addition to the hemoglobin value now the H
126. ransfer Factor test gas between is inhaled and after a defined the alveoli and period of time exhaled erythrocytes in the alveolar capillaries Transfer TLCO VA As above Coefficient Uptake of gas per litre of ventilated lung Functional Lung volume at Dilution of inert test gas Residual Capacity end tidal respiration Residual Volume Lung volume which As above can not be exhaled Total Lung Maximum Volume Capacity of the Lung Diffusion Time 1 3 of inspiration up to 50 collected volume Jones Mead Alveolar Volume Volume TLC anatomical dead space participating in gas exchange ToO Closing Volt INSPIRING RESPIRATORY HEALTH 4 8 Closing Volume Despite the presence of lung surfactant at low lung volumes alveoli have a tendency to close Alveoli in the lower parts of the lung have a greater tendency to collapse due mainly to the weight of and pressure caused by overlying tissue The lung volume at which alveoli collapse is called the Closing Volume CV In young people the CV is much less than the FRC With age the CV increases and the associated airway closure becomes significant as does the reduced ventilation of the lower lung 4 8 1 What can be measured during the test 4 8 1 1 CV The CV is measured by the dilution of an inert gas There are two different but similar methods and both can be measured by ZAN 1 Nitrogen wash out method and 2 Bolus or inert gas wash in method
127. raphics into a 2D view The button F V switches graphics to the Flow Volume graph button only available if not F V and V t on the screen at the same time ef YiSpire INSPIRING RESPIRATORY HEALTH 4 2 5 Performing a Flow Volume Measurement On the screen the recording of the volume time curve displays in the left part of the window The flow volume loop on the right displays when respiration starts Caution lt is important that the patient uses a nose clip and forms a tight seal around the mouthpiece The patient should perform several tidal breath s before executing a the FVC manoeuvre Using the delete key F3 the recording can be re started and the screen can be cleared z gt 9 Please inspire maximal 4 2 6 Symbol Definitions Select this icon or press the ESC key to stop the recording without saving any data Select this icon or press the Enter key to stop recording the measurement t p Select this icon or press the F3 key to delete NET Select this icon or press the m previous recordings g 2 space key to save and perform a another effort ef pire INSPIRING RESPIRATORY HEALTH Ge Select this icon or press the F8 key to switch on incentive graphics Every click on this icon will change the screen to a new incentive graph 4 2 7 FV Measurement Guidelines A flow volume measurement with meaningful results demands the optimum co op
128. reen and this will also enable changes to the printer set up Anderson James 12 06 1966 Selection 05 01 2006 15 33 06 01 2006 14 44 08 01 2006 12 34 Type of Test Spirometry a Spi re 2 5 6 Trend Graphs From the Archive menu it is possible to create a Trend graph for either restrictive analysis or obstructive analysis using one of the Trend buttons After clicking on the Trend button a window is displayed that enables the selection of multiple tests for trending analysis Once the desired tests have been selected it is possible to view the trend graph by clicking the Trend button or pressing Enter See Trend graph screen on next page Trend restrict creates a trend of Static Lung Volume values VC TLC RV and RV TLC Trend obstruct creates a trend of spirometry values FEV PEF FEV FVC and ROCC INSPIRING RESPIRATORY HEALTH cece a we ispire INSPIRING RESPIRATORY HEALTH 2 6 Archive or Delete Files From this menu the user is able to perform the following functions on the entire patient file Archive Automatically archives the entire patient file to the database Paper basket Completely deletes the current patient file Caution If confirmed this action is not reversible Export Exports the complete ZAN patient files to a specified location for import 2 6 1 Archive Use the Archive option to write your Patient Data to disc 2 6 2 Waiting Room opt
129. reen shown below are the volume and gas concentrations plotted against time In case of the N wash out method the gases are O and COs for the bolus method it is CHg 2 Yispire INSPIRING RESPIRATORY HEALTH 7 In the top right corner of the window are instructions on how the patient should perform the test Initially the patient should breathe normally 8 Next the patient should expire to RV The system will automatically detect that the patient is empty and the gas will be released for the patient to inspire to TLC The test gas will either be 100 O2 N2 wash out or 0 3 CH4 bolus Execution instruction Closing Yolume Single Breath N2 Wash Out Method S der Thomas Spirometry for CV test Inert gas ellen Sone A lotted against plotted against i time time Sader Thomas SYC ref 5 58 Gas bottle opened 9 Finally the patient is asked to expire to RV No breath hold is required During this final part of the manoeuvre it is important that the air is expired at a flow rate of no more than 0 5l s A coloured bar and pointer are located in the centre of the screen to guide the patient When the pointer is in the green region the speed is below the limit of 0 5l s and is acceptable In the yellow region the speed is slightly elevated and when the pointer is in the red region the speed is significantly too fast and the patient should be asked to expire more slowly
130. s Date Month Day Year Speed C kmh mph Temperature C Deg Celsius Deg Fahrenheit I x Id Nr Create Patient Id Nr automatically Create Patient Id Nr incrementally 001 002 003 F Database Folder ARCHIV Browse Waiting Room 7 Enable AWARTEN Browse Search Results Number of persons displayed in the Select Patient list 30 Cancel pire Setup Customizing The INSPIRING RESPIRATORY HEALTH 8 1 3 Patient Patient OF IY Use 5 patient tabs This turns on multiple tabs in the main window and activates entry of M Additional patient data Cancel additional patient data and ethnic group cl Stites areraceest 8 1 4 Headlines Report Header lt lt x Enter text for report headlines Font Bold Iv This dialogue box will change the headlines on the printout of the repo rts Schlimpfhofer Str 14 D 97723 Oberthulba Tel 09736 8181 0 Fax 09736 8181 20 Cancel FE r P Setup Customizing The S INSPIRING RESPIRATORY HEALTH 8 1 5 Report Designer The ZAN GPI software provides many preconfigured printout forms which match the most common formats But in some situations there might be a need to adapt the existing templates to particular demands In order to give the customer some control over the printed output of the program nSpire Health provides a simple but sophisticated tool to revi
131. sa cssssssusoemnccsnansacmaanoaseassaansanesenndoazedunednscoobaseueseondesaneascaceaoudledsinbasmetdanedessanmasonans 158 9 7 MAINTENANCE INFORMATION ccccccssccssccescccssccsccesccescccusceusccesceusceuscseseseesseusccesceesseusceecseueceusceuens 159 9 8 Re ONT I oaa E E E osnnsstaucdesiseneacsneceantesianasenbsaenasens 165 9 9 CUSTOMER SERV C crete s oecis E E E Ea 165 DIO WARRANTY oeni E EE AEE ERE 166 10 WASTE MANAGEMENT RECYCLING sssesecssssseccssececcosseccossseccosececosseeccossseccoseeeccosececosescecssseeessosee 167 101 FIECIRONICCOMPONENTS sricirrririisores ieis ianei s KnT NEAS ETETE AETA EAEE 167 102 MECHANICAL COMPONENTS siewienssssnswcasdavbensitousnaandendeniaceraneasiendaesatowannae EA EE EAEE RANES 167 10 3 CO ABSORBING SUBSTANCES cccccecccssccsccescccsccesccuscccssceusccenceucceueseusccuusseusseusceucceusceusceuseseusseusess 167 m L System Descrip Yiopire INSPIRING RESPIRATORY HEALTH 1 General Information on ZAN300 CO Diffusion The ZAN300 CO diffusion medical product is a PC based measuring system for the determination of the diffusion capacity of the lungs The PC and the CO diffusion electronic system are connected via a USB interface The main field of application of ZAN300 CO diffusion is in the clinical area of pulmonary function testing and pulmonary specialists All possible measurements can be seen in the table of contents of this manual Important For using this device for t
132. se insert pressure olive into the right nostril When measuring the left part of the nose the pressure olive or the foamed plastic of the nasal adapter has to be positioned in the right nostril The pressure olive is the one which is connected to the part of the olive holder where the tubing is connected To measure the right side of the nose place the pressure olive into the left nostril gt The patient starts breathing through his her nose J lt is advisable to delete the first breaths from the display selecting the F3 icon or by pressing the F3 key when the curves show wide variation he gt Selecting the Enter icon or pressing the Enter key after 5 breaths stops the measurement and displays the results Spire INSPIRING RESPIRATORY HEALTH a amp gt Re selecting one of the icons repeats the test or initiates measurement of the other part of the nose Lt gt Selecting this icon Enter or pressing the Enter key when the result window is up saves the results and ends the test 4 6 5 The Ania omanomerry Window After micastrement hinomanometrie ejaj elele z Mormal Juergen ff Symbol Definitions FR LI Save data Enter 4 6 5 1 Parameter Selection With a double click on the result window you can open the parameter selection window Select the relevant parameters from the parameter list They will be shown in the result window from now on 4 6 6 Special Recommendati
133. se the layout of the print templates 8 1 5 1 Overview Every report is derived from the same basic template This template can be looked at as one side of a printer page The page is divided into areas Every area represents a particular element and provides specific editing features For example there are text areas which can be edited other areas contain graphics in which styles can be selected from a menu x Header ZAN MeBgeriite GmbH i edit l D 97723 Oberthulba Schlimpthoferstr 14 Tel 09736 8181 0 Fax 9736 8181 20 l Patient ID automatic Volumes toggle graphics area Graphics selected Graphics selected l l l E ye Ls I a i 7 i Table caption in am no edit i i 1 P5 ta i i l FEY ipe 1 B5 i5 I I FEF Is 10 11 81 1H I l MEF25 l ad 112 I MEF Us w s 12 i 4 s 1 iid l MEF25 75 lis 497 417 124 Table values ee eee i T selected s lt lt I I i 7 cas KA Wiot kPa 130 eS Pats 65 cl Preview button Some areas can be switched off or on toggled while others are automatically filled with corresponding data etc To activate the editing functionality of an area move the mouse cursor over the desired region until the cursor shape changes to the hand symbol and press the left mouse button The editor recognises the area the cursor is in and opens the corresponding dialogue editor or menu Setu p Custom izin g 7 INSPIRING RESPIRATO
134. sensor is defective The patient s mouth or nose is not completely closed The cabin pressure is not registered The respiratory flow is not registered The cabin pressure is not registered INSPIRING RESPIRATORY HEALTH Activate door magnets by selecting the door symbol Press the security switch again Check door lock both magnets have to close audibly Call service Patient must use nose clip and tightly enclose the mouthpiece Check cabin door Pressure transducer is defective Repeat cabin calibration The flow sensor or the holes of the handy are blocked The flow sensor has not been put far enough into the handy The handy is defective Check cabin door Pressure transducer is defective The TGV curves run horizontally The mouth pressure is not registered The pressure transducer for the determination of the mouth pressure is defective The TGV curves have an oval form Only very small TGV curves appear but the resistance curves are normal The cabin is not completely air tight The interruption valve is not sufficiently tight The mouth does not sufficiently enclose the mouthpiece Poor co operation Check tightness of the cabin door Check tightness of the interruption valve The patient must use a nose clip and tightly enclose the mouthpiece The patient must breathe more heavily against the shutter 6 3 Diffusion Problems Duri
135. starts the sampling After 5 8 tidal breaths the system begins with the test gas application 4 7 2 3 3 Test Gas Application First the patient is asked to breathe steadily all the way out Important Inhalation and exhalation from the test gas must be performed steadily and without i interruption The system displays the following messages After expiration the patient is asked to maximally inhale the diffusion test gas Inhale to the maximum Inhale to the maximum If an SVC has been saved a green bar appears to indicate this patients expected inspiratory flow rate and volume This may also encourage the patient to achieve an adequate inspired volume After inhalation the patient must hold their breath for a pre set time F5 to allow the CO to diffuse X re Chapt P ate CO Diffusion and Residual Vc INSPIRING RESPIRATORY HEALTH A countdown timer is displayed on the top bar of the window CO Diffusion Single Breath Mustermann Melanie Ed Fil 0 a ae TO00E0TENOEE 6s co Diffusion Spirometrie Note If the patient is unable to maintain breath hold click on Ei or press the space bar to immediately reduce the breath hold time to zero and to open the shutter At the end of the breath hold time the patient is again asked to steadily exhale until empty Exhale To complete the manoeuvre for the Fast Space calculation the patient should return to normal ti
136. ste Management Recycling 10 1 Electronic Components ae Some products contain electronic components To avoid environmental risks or hazard waste management of these components underlies particular regulations depending on local laws These regulations may vary widely from state to state 10 2 Mechanical Components Inside the mechanical units and accessories of nSpire devices are as far as possible only materials used which can be recycled Most used materials are coated aluminium and POM Polyoxymethylen Ultraform H2320 from BASF Refer to the waste management regulations of your state or county concerning these products There is no need to send these products back to nSpire they can be disposed of by the customer nSpire Health GmbH avoids single use components where ever possible Only parts which can be separated and disinfected easily when contaminated are used In principal only unbleached paper and cardboard is used for packing Packing material can be disposed of like ordinary waste 10 3CO Absorbing substances The absorber granules absorbence must be handled according to the local regulations If in doubt ask the waste management department of your county administration for correct information
137. sted Bronchodilators can be created or deleted ey YiSpire Choose medication l x Use as Dose next stage Histamine 44 0 pg Histamine 184 3 pg Histamine 744 6 pg Histamine 1 49 mg correction of current stage Medication Shosenceine Provocation protocol Metacholine short Hew Edit Delete Hie Delete Eronchodilator Delete Cancel With the dialogue box shown below new provocation protocols can be created The protocol needs to be given a unique name The medication that is used in the protocol needs to be chosen from the list Medications can be deleted as long as they are not being used by other protocols New medications can also be created Create new protocol q x Name of protocol Medication Histamine Metacholine Cancel When creating a new medication the dialogue box below appears It allows the user to enter the name of the medication as well as if the medication is cumulative of L Yispire SVC Meas ure INSPIRING RESPIRATORY HEALTH E me Mame M Cumulative Cancel The dialogue box shown allows the user to create or edit a dose It has an entry field for the dose read only when editing an existing dose as well as a list box for the concentration and the factor to be used Again elements can be added to or deleted from the list boxes as long as they are not being used by another protocol Co
138. sults If the valve does not close with the next exhalation after pressing the space bar the patient was probably breathing too slowly Either the breathing depth or the breathing rate must then be slightly increased 4 3 3 Spirometry Flow Volume Screen after Measurement Spi 2 Normal I Juergen 7 Ioj xj Ge cee See Secs Se ee ee sae st ess Ergebnisse Spirometrie Fluss Yolumen K ire Chap P Combined SVC F V Measurement amp INSPIRING RESPIRATORY HEALTH 4 3 3 1 Symbol Definitions me toggles the results table on sand off FB ie saves the measurement 4 3 3 2 Parameter Selection By double clicking on the results table a dialogue window is displayed with a selection of parameters From the list of parameters you can select the parameters you want to view in the results table These parameters will then always be shown in the results table Look in the paragraph Parameter Selection in chapter SVC for detailed instructions The results and the measurement will be saved after pressing the H key Aspire 4 4 Measurement of the Maximum Voluntary Ventilation MVV INSPIRING RESPIRATORY HEALTH Maximum Voluntary Ventilation MVV is the maximum volume of air a subject can breathe over a specified period of time 12 seconds for normal subjects This value is normally corrected to 1 minute and is expressed in l min MVV may be useful in those conditions where ventilatory capa
139. sure change to the transducer see the following dialog box By selecting F6 different calibration values can be entered or used EJ Calibration Setup Calibration Pressure sas 10 00 mbar Cancel 1 4 Set pressure 0 0 mbar Start ENTER Follow the instructions on the screen First attach the pressure manometer tube to the mouth pressure connection located next to the connection cable on the backside of the flow sensor Next select Enter and the following dialogue will be displayed J Munddruck Kalibration Jive 2 4 Set pressure 10 0 mbar Start ENTER Use a 5ml syringe and the manometer to produce the reference pressure 2 4 Setzen Sie Druck 10 0 mbar Start ENTER 2 3 4 Set pressure 0 0 mbar Start ENTE R 4 4 Set pressure 10 0 mbar Start ENTER Results Parameter Corr Pos 0 95 The results are displayed H Select Enter to save the calculated correction factors Corr Neg 0 96 we Yispire 3 3 The Calibration Trend Reports In order to control the quality of the calibrations trend reports turned out to be very useful To create a calibration trend report press the button in the calibration menu BY select report iB eO x Select reporto print Quantity Use the CTRL key to select multiple lines E 02 CO2 Gas i Vol Select a particular report type from the list D Selecting the preview button or the pri
140. t of the diffusion capacity and the residual volume therefore give an estimation of the effectiveness of respiration 4 7 1 1 Purpose of CO Diffusion Measurement Carbon monoxide diffuses across the lung membrane in a similar way to oxygen It resembles oxygen in solubility and molecular weight and it binds to the same site on the haemoglobin molecule as oxygen but with a much greater binding affinity Baseline levels of carbon monoxide in normal non smokers are very low This allows us to easily measure the amount of inspired and after a breath hold expired carbon monoxide making possible the calculation of the diffusion capacity or transfer factor 4 7 1 2 5 2 1 2 Purpose of the RV Measurement The residual volume is the volume in the lung which can not be expired Up to a particular level this is physiological This volume will increase in some diseases Measuring the residual volume is a good way to estimate the severity and progress of the disease 4 7 1 3 Measurement Principle A test gas consisting of known concentrations of carbon monoxide CO and methane CH3 is inhaled by the patient Methane is an inert gas and is only diluted by the residual volume Both methane and carbon monoxide are equally diluted by the residual volume A further decrease in the expired concentration of carbon monoxide is due to its diffusion across the lung membrane From the concentration of inspired and expired gases the transfer factor and residual volu
141. the patient has exhaled as deeply as possible they should be encouraged to inhale maximally or as deeply as possible This manoeuvre enables the calculation of the other spirometric parameters lt is also possible to perform this measurement by getting the patient to inhale maximally from tidal breathing before exhaling as deeply as possible ef YiSpire INSPIRING RESPIRATORY HEALTH 4 1 2 SVC Window This window is displayed in the MEASURE mode after clicking on the spirometry symbol After selecting the measurement the following window is displayed Attention Zero Adjust Please don t breath into flow sensor Caution During this measurement the flow sensor will be zeroed so it is important that there is no flow through the sensor This process takes approximately 5 seconds 4 1 2 1 Symbol Definitions Select this icon or press the ESC key to aiei stop the measurement and exit the ESC programme Select this icon or press the F1 key to display a dialogue box in which you can enter comments Li REF a reference value from another test for key to define the user ET 4 ERIE Select this icon or press the L key to select A Select this icon or press the F2 comparison TE Select this icon or press the F9 key to enter the test set up Select this icon or press the F3 key to select the medication Select this icon or press the F7 key to print a single test result S
142. thing connected the switch on the backside Check connection tubes No O2 CO2 gas signal Analysers are not yet Wait until the analysers are ready ready Note The analysers Check all tubing s need at least 20 minutes to heat up Heating time starts with the start up of the measurement devices Gas suction tube is not connected to the flow sensor or is interrupted Wrong gas calibration or calibration gas cylinder is empty calibrate correctly with a refilled calibration gas cylinder Note To ensure valid measurements take always care for the following facts e Always keep volume and gas sensors calibrated to the optimum e Take care of cleanliness and correct assembly of the sensors e Watch for tight fit of mask and mouthpiece yi 4 P ie System Software Insta INSPIRING RESPIRATORY HEALTH 7 Software Installation 7 1 Installation When the system is set up for the first time install the software and drivers prior to connecting the hardware to the system When the software is ready installed connect the USB plug of your device to a free USB port of your PC system The device will be recognised by your PC automatically and the appropriate driver will be installed Note If the PC fails to recognise the device remove the USB plug from the USB port of the PC and wait 30 seconds then connect again If necessary reboot your PC and connect the cable after the reboot After that install the ZAN software GP3
143. to mode settings C Best The online comparison settings allow you to compare to best test C Rubrenne to reference or to nothing This corresponds to the test that is Best Reterence Best dominant shown in red when performing a test F Reference Best Reference dominant E Cancel Instructions The current language options include English German French and Spanish This language setting only affects the instruction texts during measurement This feature allows test instructions to be seen in alternative languages for patients who need instructions in a different language The Hardware Set up allows you to reset the shutter zero the flow sensor and set up the component for the test as seen below Your system components Curent measuring system ey YiSpire INSPIRING RESPIRATORY HEALTH Symbol Definitions By double clicking with the left mouse button it is possible to enter one of the option menus and select the appropriate component Select from mouthpiece options Select from filter options Select from Flow sensor options Select from shutter options 4 To view the current configuration hold the cursor over the appropriate option field Default mouthpiece options Default filter options Select a component Select a component D D Without Bact viral filter KoKoMoe filter x SpiroBac filter Paper mouthpiece la Bite mouthpiece Bite mouthpiece with ad
144. trongly limited Typical loops will occur according to specific lung constitutions expirate pirate pirate Flow Rate l s Flow Rate l s Vol 1 Flow Rate lie inspirate The Normal Flow Volume Loop Early Small Airways Obstruction Restrictive Disease Fixed Upper Airway Obstruction PEF Peak expiratory flaw rate l s FEV Forced expired volume at lsec l ore ae chuca PEF reduced Bey rs FVC Forced vital capacity I fr 1 FEV FVC normal VE normal norma VC reduced MIF Mid inspiratory fl te l s s n a a A Insp Irena TOW Pree CL Plateau in expirate and sometimes inspirate MEF Mid expiratory flow pate l r 4 2 2 Important Measurement Parameters Forced vital capacity Maximum expiratory volume with maximum flow speed Forced expiratory volume Volume that can be forcefully exhaled within the first within the 1st second of second exhalation PEF Peak expiratory flow Maximum flow speed during exhalation MEF 75 Flow at 75 of expiratory Flow speed after 25 of exhalation volume MEF 50 Flow at 50 of expiratory Flow speed after 50 of exhalation volume MEF 25 Flow at 25 of expiratory flow Flow speed after 75 of exhalation FEV1 FVC Ratio between FEV1 and Obstruction parameter FVC AEX Area underneath the Equivalent to FEV1 expiratory curve Peak inspiratory flow Peak flow during inhalation MI F5 O Flow at 50 of inspiratory Flow speed after 50 of inhalation volume 4 2 3 Flo
145. two options in a pop up menu 1 Schriftgr e means font size to select a different font size for the table contents Setup Customizing The INSPIRING RESPIRATORY HEALTH 2 Werte means parameters to select a subset of parameters from a menu of available parameters to be displayed Report Configuration x Report Configuration Files Available Parameters Used Parameters Selection of values to be displayed in the table Use the arrow keys to move a particular item from the Available to the Used list and vice versa Use the arrow keys on the right most side to move an item to the desired vertical order Pressing the sms button inserts a separator at the cursor position to improve readability of the table Like the parameters the separator can be selected and moved vertically To remove a separator simply select it with the cursor and use the left arrow button Ca After all changes have been applied use the OK button to activate the changes Pressing the Cancel button will discard all changes The dialogue will be closed and the user returns to the overview window 8 1 5 10 Saving the Changes Whenever changes have been made to a template a verification dialogue pops up when the user attempts to close the overview window x G Save changes If you want to save the changes press the Yes button else the changes will be abandoned and the old design of the report is restored again
146. ume will be set to zero To manually set the CV to zero adjust the cursors so that the gradient of phase IV is lower than that of phase Ill The bar graph in the middle shows clearly the individual lung volumes IVC TV ERV and RV as well as CC The scale corresponds with the one of the spirometry diagram Important Please note that the calculated value for RV only is reliable if you perform the Nz wash out method not to the bolus method 4 8 6 The CV program in the display mode single measurement When displaying an individual measurement the program is similar to the analysis phase of the measurement mode but has the following minor differences wane wy The medication icon Fa is not shown The save icon Enter is not shown The cancel program icon ese must always be used to exit the program If changes have been made you will be asked whether you want to save these changes or reject them E When the operator icon rF is selected the name of the person who performed the test is displayed but changes cannot be made After choosing the printing icon rz the program will not automatically end Closing Yolume Single Breath N2 Wash Out Method from 24 01 2006 12 31 S der Thomas 8 15 x ee Spirometry for CV test Chapt Closing Vc INSPIRING RESPIRATORY HEALTH However all other aspects remain unchanged in particular you can continue to determine
147. use in an aseptic environment We recommend covering the keyboard with an appropriate coverage and cleaning it regularly with wipe disinfection There are similar covers available for the computer mouse The advice for cleaning the cases tubes and cables are the same as for ZAN electronic modules 6p 6 Troubleshooting 6 1 General Problems Problem After starting the measurement no volume line appears After starting the volume line does not run horizontally even though the patient is not breathing After starting the horizontal line runs but breathing is not shown The volume line is recorded downward with inhalation and recorded upward with exhalation The volume time curve drifts upward or downward during respiration Possible Causes 1 Measurement device is not connected to your PC 2 A wrong port was selected A wrong measurement device was selected 6 The zero point was not set correctly Condensation or Vaseline is blocking the holes of the flow sensors 9 The flow sensor has not correctly been put into the case 10 The interface of your PC is in the Power Down Mode 11 The O rings are defective The holes of the flow sensors are blocked with water or Vaseline Flow sensor has been put into the handy from the wrong side 15 The entered ambient temperature is not right 16 The patientis not wearing a nose clip 17 The patient does not seal the mouthpiece tig
148. ve The numbers may vary and depend on the particular device However the word Running has to be found Retesh at the end of this line Lag File Enabled Clear Close 2 7 4 Calibration Pressing the K key in the menu displays the calibration window See also chapter 3 Kalibration K EB Calibration Bs xX Select the desired programme with the mouse or the arrow keys and start it by pressing the ENTER Key INSPIRING RESPIRATORY HEALTH 2 5 Modify set up fe ALT S Pressing alt S or selecting the Set up button on the base level menu activates the Set up window ZAN Settings i E lolxi System Messger t Beenden Lizenz Sprache Datenbank Patient Kopfzeile Reports Sollwerte Drucker Service Bildschirm HL Demo mode This Set up window looks like this The Set up Option enables you to set and change some of the programme settings including the following ZAN Settings icine Device Exit ZAN Settings system Gites Exit A detailed description of these settings can be found in the chapter Set up A5 of this manual S pire 3 Calibration Calibration K Pressing the K key or selecting the button in the menu displays the calibration window Depending on your license and the included options the window may have more or less symbols Only active options are displayed Select the desired programme with the mouse
149. w Volume Screen before Measurement This window is displayed in the MEASURE mode after clicking on the Flow Volume symbol Flow Volume Measure INSPIRING RESPIRATORY HEALTH alo x jx PA Pre test Parameter Unit Ref E MEF25 EF50 MEF75 MEF25 75 avae 4 2 4 Symbol Definitions Select this icon or press the ESC key to CANCEL EAE stop the measurement and exit the programme REF Select this icon or press the L key to select a reference value from another test for comparison w The button V t switches graphics to the t Volume Time graph button only available if not F V and V t on the screen at the same Select this icon or press the F9 key to enter the test set up Select this icon or press the F7 key to print a single test result Select this icon or press the F12 key to check that results meet ERS ATS 2005 Standards Click the go icon to start the test time Select this icon or press the F1 key to display a dialogue box to enter comments Select this icon or press the F2 key to define the user Select this icon or press the F3 key to select the medication Select this icon or press the F8 key to print out one or more templates Select this icon or press the Enter key to save the measurement and exit module The 3D icon switches to view graphic in 3D the magnifying glass icons zoom in and out The 2D icon switches g
150. without noticeable CO2 rebreathing e without noticeable resistance 1 3 3 List of parameters for spirometry and F V measurement ERV IRV FEV1 MEF50 FVCex FEV1 IVC FIV1 MEF25 MEF50 MEF75 MEF75 FVCex FEV1 30 ex MIF25 MIF50 MIF75 MIF75 PEF FVCex MEF75 85 1 4 The ZAN 260 system trolley The two boxes ZAN310 and ZAN610 and the peripheral units are accommodated on this system trolley The trolley offers space for a PC a printer and a flat screen as well as for gas cylinders stands and small accessory System D 2SCI INSPIRING RESPIRATORY HEALTH main switch 1 5 Special instructions for use Note Please pay attention to the notes on safety in the chapter Safety as well as the notes on cleaning and disinfection in the chapter Disinfection Important Only use bacterial filters such as KoKo Moe filters or filters approved by nSpire Health A 1 6 Initial commissioning Before commissioning the software has to be installed on the PC The description as well as a system check are included in the annexe If something does not work straightaway you can find important tips in the chapter What to do when Note For obtaining accurate measurements the user has to be familiar with the handling of the measuring device Furthermore he she must have studied the user manual and therefore know all about the safety and measurement procedures 1 7 Hygiene As a general rule an appropriate level of
151. xx as explained below 7 2 Installation of the ZAN GPI 3 xx Software Insert the ZAN CD into your CD ROM drive and the programme starts automatically Follow the prompts to install the software If the installation does not start use Windows Explorer to locate the set up file setup exe on your CD ROM and start it manually Choose Setup Language Select the language for this installation from A window pops up Select the language of the installation grease cai and the ZAN Software and confirm by pressing OK Available languages are English German French and Enact Spanish InstallShield Wizard The Install Shield Wizard will be prepared p Welcome to the InstallShield Wizard for ZAN The InstallShield Wizard will install ZAN on your computer To continue click Next and opened Click Continue Cancel we Yispire System Software Install lf you agree with the license agreement click OK Enter the license number that came with your system and click on Continue lf you have the measuring device for demonstration only you can use the programme in the DEMO mode for 30 days To use the DEMO mode enter the license number 1 1 1 The standard installation directory is CAZAN Caution Do not change the destination folder This may cause problems with the software Contact nSpire Health or your local dealer if you have any questions If you change the destination folder nSpire
152. y Spray the orifice from the patients side Dry carefully and completely in a well ventilated area During reassembly the O rings gaskets should be covered with a thin layer of Vaseline accessories to make them slide easily Caution In order to exclude any danger in relation with the shutter the shutternead AND the shutter valve must be disinfected after each patient AN Use of filters is strongly recommended Always consider the recommendations from the disinfectant manufacturers concerning concentration purpose and reaction time 5 6 Disinfection of the Ergo Flow Sensor ZAN 600 680 only Assembled Ergo Flow Sensor with adapter and mouthpiece Mih p ire Disinfection Mainte INSPIRING RESPIRATORY HEALTH To disinfect the flow sensor the pressure ring must be removed It can be pulled off to the back seen from the patient s point of view When you put the pressure ring on the flow sensor again please consider that the blue connection points towards the flow sensor gt Remove p lt Pressure Ring blue yellow i Mask Adaptor Ergo Flow sensor Caution The blue connecting piece on the pressure ring must point towards the patient N The opening of the water trap must be closed again with a new cotton plug It is recommendable to remove visible dirt before the actual disinfection An ultrasound cleaning of the flow sensors should only be carried out when it is necess

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